DOCTOR’S ORDERS
Exercise is good for you, even ‘softer’ activity can prolong life, doctor says
Physicians are writing ‘social prescriptions’ to encourage patients to exercise,
About a decade ago, a colleague told me about a cool new initiative, something called “Exercise Is Medicine.” The idea made total sense to me: Rather than just tell my patients about exercising, I would hand them an actual prescription for exercise, just like the ones I give patients for high blood pressure or diabetes. The thinking behind it was that an official “doctor’s order” for exercise, in the form of a prescription-pad-style piece of paper, would be taken more seriously by patients than a mere suggestion.
I quickly started giving out these prescriptions, going so far as to find some official-looking templates online and printing them out. I wrote out “dosages” based on each patient’s age and medical condition, and relying on evidence-based recommendations.
Many doctors have now expanded the prescription approach for exercise to a whole range of behaviours and activ- ities associated with a healthy lifestyle. The assumption is that if the prescription pad can get more people exercising, then maybe it could also get patients doing other activities — dance lessons or an art class or a stroll in the park — that have been found to improve physical and mental health. Such interventions are known as “social prescribing,” in which health-care professionals are asked to identify and recommend interventions outside the exam room or hospital that might help patients adopt healthier lifestyles.
The social prescribing trend focuses not only on food, exercise and housing, but also on “softer” activities such as making art, singing, participation in social gatherings.
There is irrefutable data showing that exercise is good for you, regardless of your age, gender, physical abilities or medical conditions. And there is beginning to be more-robust evidence for benefits from spending time in nature, dancing, singing, engaging socially and keeping your brain active.
However, I realize that my use of this approach has exposed deep inequities in their access to resources. I get professional satisfaction from recommending hikes in Rock Creek Park, running along the mall or singing in a chorus. But can I really ask a patient who works two jobs and cares for her children to find 30 minutes a day to squeeze in a walk in a park? Or one who has no car to take two buses to get to an art class on the other side of town? From a purely anecdotal standpoint, I will admit to mixed results so far. Some patients have reported back that they had taken my recommendations to heart and begun changing their lifestyles. Others shoved my prescription in their bag and probably never looked at it again. I’m waiting for a big study to show me whether this trend can make a difference.
Before we start proselytizing, we need to make sure that the resources are there, that the evidence of benefits is there and that we, as physicians, are well trained in how to push a change without causing any harm.
Ranit Mishori is a professor of family medicine and the director of the Health and Media Fellowship in the Department of Family Medicine at Georgetown University School of Medicine.