Sunday Tribune

A walk a day keeps the doctor away

Exercise is medicine, and doctors are starting to prescribe it, writes

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THERE is a movement afoot to get more people exercising by involving their family doctors.

In the UK, the government recently released Moving Medicine – an online resource to help doctors talk to their patients about the importance of exercise in relation to conditions as diverse as cancer and dementia. This is a welcome initiative given that physical inactivity is the fourth leading cause of death in the world, according to the WHO.

The benefits of exercise have been proven over and over again: Exercise reduces risk of depression, type 2 diabetes, heart disease, stroke and many cancers, and prevents early death.

If it were a pill, exercise would be a trillion-dollar money-maker prescribed to everyone.

Exercise as a therapy is mentioned in almost all prevention and treatment guidelines, which are written by doctors themselves. Still, most patients never hear their doctor talk about it and fewer than one in four Canadians meet current guidelines for physical activity, which recommend that people participat­e in moderate (brisk walking) and vigorous (jogging, swimming or running) activity for at least 150 minutes per week. Part of the reason is that most doctors in practice today received little, if any, training on the role of exercise in managing disease.

Free gym prescripti­ons

In recent years, Canadian medical schools – such as the Cumming School of Medicine at the University of Calgary – have revised their curricula to incorporat­e aspects of exercise in the prevention and treatment of disease.

This is one part of growing initiative­s like Exercise is Medicine that advocate for the role of exercise and encourage doctors to prescribe it.

Similarly, the Prescripti­on to Get Active programme in Alberta allows doctors to prescribe free 30-day gym membership­s to patients.

A grassroots programme called Walk with a

Doc has local doctors walking with their patients. The programme was begun by Dr David Sabgir, a cardiologi­st in Columbus, Ohio, who was frustrated with his inability to affect behaviour change in the clinical setting and invited his patients to go for a walk with him in a local park one Saturday morning. More than 100 people showed up, and there are now 400 chapters worldwide.

There have also been calls for exercise to be considered a vital sign, much like blood pressure and heart rate. Health insurance provider Kaiser Permanente requires doctors in the US to record how much physical activity a patient does.

More needs to be done, however, when only one-third of doctors talk to patients about exercise.

Reactionar­y health-care system

Not surprising­ly, doctors who exercise are more likely to counsel their patients about physical activity. Therefore, targeting doctors to be more active may provide a substantia­l population effect. At the same time, doctors say they need more and better training with respect to the benefits of exercise and how to counsel patients.

The need for this change in approachin­g health and disease comes from two key realisatio­ns. One is that there are a growing number of people with preventabl­e chronic illness, and our health-care system is not adequately prepared to deal with all these patients. Our system is reactionar­y; it is designed to wait until someone has a disease instead of preventing it. But chronic illnesses are not like diseases of old. They cannot be cured, although many can be prevented. Exercise is increasing­ly recognised as important to this change.

Exercise for cancer care

Exercise is used for cardiac rehabilita­tion after a heart attack. It works as well as drugs that lower cholestero­l and blood pressure in preventing early death and diabetics who exercise require less medication to manage their blood sugar.

With cancer, exercise can reduce the side-effects of treatment, prompting the Clinical Oncology Society of Australia to recommend exercise as part of regular cancer care. | The Conversati­on

Scott Lear, Professor of Health Sciences, Simon Fraser University.

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