A Prescription for Exercise

March 3, 2016 Brigham and Women's Hospital

A recent study found that only 34 percent of adults were counseled about physical activity during their last primary care visit.

Has your doctor ever given you a prescription for exercise?

Dr. JoAnn Manson, Chief of the Division of Preventive Medicine at Brigham and Women’s Hospital, recently co-authored an article that calls for physicians and other health care professionals to make exercise counseling a consistent component of their interactions with patients. Failure to do so, explains Dr. Manson, is a lost opportunity to safely and inexpensively improve the health of patients.

“There is a consensus within the medical and public health communities that increasing physical activity among our patients should be a priority,” says Dr. Manson. “No other single intervention or treatment is associated with such a diverse array of benefits.”

Among those benefits is reducing the risk for major chronic diseases, including high blood pressure, type 2 diabetes, obesity, heart disease, stroke, cognitive decline, certain cancers, and depression.

A recent study, however, found that only 34 percent of adults were counseled about physical activity during their last primary care visit. Among adults with vascular risk factors, about 40 percent received such counseling. Dr. Manson and her co-authors suggest that this lack of guidance may be due to time constraints, a lack of useful tools, or skepticism about the impact of exercise counseling.

Tools for health care providers

To help address some of these obstacles, Dr. Manson and her colleagues developed a series of strategies to help providers efficiently incorporate exercise counseling into each patient visit, including:

  • Make physical activity counseling a routine component (“vital sign”) of every patient visit.
  • Ask patients whether they exercise regularly. If they do, ask about the type, frequency, and duration of the exercise. If they don’t, ask whether they’re willing to start an exercise program.
  • Stress the association between physical activity and a reduced risk of heart disease, stroke, diabetes, and certain types of cancer.
  • Write a prescription for an agreed-upon daily exercise regimen, working toward a goal of at least 30 minutes of walking or some other type of moderate-intensity activity.
  • Encourage patients to use a pedometer (or other fitness tracking device) to keep track of their progress.
  • Recognize success and continue to encourage reluctant adopters.

Does exercise counseling work?

Recent research demonstrates that exercise counseling is impactful and doesn’t require a lot of time. In the Activity Counseling Trial, primary care physicians were trained to routinely give short exercise consultations (three to four minutes) to their patients. This led to increased levels of physical activity and a corresponding improvement in cardiopulmonary fitness among patients, and physicians reported that the counseling was an asset to their practice. Likewise, the PREMIER Trial found that brief lifestyle and physical activity consultations for adults with prehypertension or hypertension (high blood pressure) significantly reduced their risk factors for coronary heart disease.

Are health care providers and patients ready to act?

Dr. Manson says that it’s clear that routine exercise counseling is effective and can be integrated into clinical practice almost seamlessly. Making this counseling a priority will improve our patients’ health and reduce their risks of developing a wide variety of diseases. The question is whether medical professionals and patients are ready and willing to act.

Read “Making Physical Activity Counseling a Priority in Clinical Practice” to learn more about the move to make exercise counseling a priority.

– Chris P.

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