16 Nov Doctors to prescribe exercise

Exercise is the best, cheapest, and most accessible medicine available. In order to improve chronic disease mortality rates, people need to move more. But many doctors still aren’t talking to their patients about their physical activity levels.

This week is Exercise Right for Doctors week, a campaign aimed at educating doctors, nurses and healthcare professionals about the benefits of prescribing exercise as medicine. We spoke to emergency doctor, Ash Bowden (aka Dr Do More), about why he is so passionate about promoting the health benefits of exercise to his colleagues all around Australia. Here’s what he had to say…

Why is exercise such a powerful tool in medicine?

From an academic perspective, exercise has been proven to have tremendous and positive impact on every main health domain from mental health to cancer risk reduction and cancer survivorship to age-related diseases like dementia and falls. I’m constantly amazed with how such a simple intervention has such significance for health amongst so many expensive and technologically advanced treatment options.

Personally, I recognise exercise as a powerful tool because it appeals to our desire for short-term results whilst also providing impressive long-term benefits. We all want the quick fix: the miracle diet, cosmetic surgery, or the pill over the slow (but effective) lifestyle change. Exercise has been shown to give both immediate benefits as well as long-term benefits for our health. The short-term effect on mental health is something we can all recognise and appreciate. I think it’s this immediate effect that can help us utilise exercise as a fundamental treatment for a whole range of ailments.

Do you think there’s enough focus on prevention in medicine?

Definitely not. I may be biased as I work in emergency, typically a ’see and treat’ mindset, but it’s only through work on preventive medicine that gives me a positive outlook when I return to the emergency department. Without critical work on illness prevention, my workload would grow and my optimism would steadily wane as I see an increase in presentations of preventable illnesses (e.g. cardiac events, diabetic complications, falls, respiratory exacerbations…the list goes on).

I make a point of counselling every patient I see about the benefits of exercise and how they might strive to do more in hopes that this sees them attending an emergency department less frequently. If more focus was placed on prevention in medicine, especially with free tools like exercise, we could see fewer mental health presentations, fewer cardiorespiratory complications, fewer elderly falls, fewer cancers and fewer cancer-related complications (amongst so much else).

Why are you so passionate about educating other doctors about the value of lifestyle change (as opposed to just medication alone)?

My focus and enthusiasm for exercise as a treatment has grown from a number of personal and professional experiences that have demonstrated the impact on both mental and physical health. This started when I saw how protective exercise was for my own mental health and this was backed-up with studies demonstrating I wasn’t an anomaly! Exercise is an effective treatment for mild-to-moderate depression amongst other mental illnesses.

I’ve become increasingly passionate about educating doctors about the value of lifestyle change because their benefits relate to everybody. Doctors well-being has been increasingly suffering and educating one another about the utility of exercise helps not only their patients, but us as healthcare professionals too. Unlike medication, exercise should be taken by everyone, it can be ‘dosed’ and modified for anyone and it’ll help no matter the illness. I’ll focus my enthusiasm on something else when you can show me it’s better than this.

How can doctors help their patients by talking to them about their exercise levels and where should they start?

How can we get people improving their exercise levels? I used to think advice given on lifestyle modifications would have very little impact. It was comparing the number needed to treat for medications against that for smoking cessation and exercise counselling that reinforced what was previously just blind optimism. Here are my top tips for talking to your patients about exercise:

Tip number 1: Counselling patient’s on exercise matters, so spend 30seconds to a minute talking with every patient. As you do it more you’ll learn what words people related to and how much exercise the average patient is doing (spoiler: it’s not a lot).

Tip number 2: Don’t use medical jargon. Even the word exercise is poorly understood. When I ask patients about their exercise tolerance or exercise levels, I say “how active are you?” or “how much movement do you do?” These are very open questions but they remove the misplaced fear that’s associated with the word ‘exercise’. Patients are no longer just thinking about the gym or running, they’ll volunteer how often they go walking or if they do something weird and wonderful.

Tip number 3: We’re not looking to make athlete’s out of everyone. The goal is to increase the dose of physical activity patients are doing. First establish how much they move and then explore ways they can move more.

Tip number 4: Make it personal, make it fun and exude encouragement. When patients tell me they take their dog for a walk I get so happy! “How far do you go?” “Who walks who?” “Could you go further or walk a little faster?” If there’s something they’ve been wanting to try (e.g. salsa dancing, bowling, yoga, kayaking on the local river) that’s your chance to be their cheerleader.

Tip number 5: Direct them to talk to other healthcare professionals about their exercise. If you can encourage them to see an exercise specialist like an exercise physiologist that’s even better.

What would you suggest to people who want to make lifestyle change but aren’t sure where to start?

This is so common! Patient’s have often been wanting to make a change but putting it off like the last job on your to-do list that sits there for months.

“Just start and start small” is my advice. “Yep, smaller than that!”.

It’s not about getting to the end point tomorrow. It’s not about being a marathon runner or a cross-fitter right away. It’s about doing more and that can start with adding a short walk into our weekly routine. Find a beginners class, speak to a accredited exercise professional, chat with your GP, try a home workout or add a little run into your walk. If we focus on the smallest of improvements then in six months time we’ll have something remarkable to show for it.

Education for doctors

As part of Exercise Right for Doctors, we’re offering doctors and nurses FREE online education. Click here to register now. Alternatively, you can find our more information and access a range of free resources on our website.