Doctors encouraged to prescribe exercise to fight obesity

"Walk two miles and call me in the morning."

That’s what doctors could soon prescribe if the new leaders of two major medical groups have their way.

"We’re trying to get every physician to prescribe exercise," says Robert Sallis, a California physician who recently became president of the American College of Sports Medicine. Physicians "have a moral responsibility to inform patients of the danger of inactivity and the health benefits of being more active."

That’s also the message from the new head of the American Medical Association.

"We are in lockstep with them on that concept," says incoming AMA President Ronald M. Davis, who also is the director of the Henry Ford Health System’s Center for Health Promotion and Disease Prevention in Detroit. "We need to get doctors to prescribe exercise more and we need to get patients to follow that advice."

More than half of Americans fail to get the 30 minutes of physical activity recommended daily to provide health benefits, according to the Centers for Disease Control and Prevention. Cars, elevators, remote controls and other modern devices all help to engineer physical activity out of daily life. Extended workdays and long commutes add to the problem.

So many Americans are inactive that some experts have coined a new term for it: sedentary death syndrome. The condition helps cut short an estimated 250,000 lives annually, according to Frank Booth, professor of physiology at the University of Missouri. Research suggests that people who are sedentary spend about $1,500 more annually on medical bills than do their more active counterparts.

"There are also studies to show that they miss more work and are not as productive," Sallis says. Research shows that regular physical activity improves health by cutting the risk of heart disease, stroke, colon cancer, diabetes and high blood pressure. Even brief bouts of activity several times a day can help control weight and relieve arthritis, anxiety and depression.

"Exercise is medicine," Sallis says. "We know that it works very well. We just don’t have the proper way to administer it."

That’s where the doctors come in. Sallis is leading the charge to get doctors and other health professionals to ask every patient at every office visit about their exercise habits.

In California, the Governor’s Council on Physical Fitness and Sports has recently launched an initiative to give exercise prescription forms to doctors. The forms resemble a standard prescription pad, but instead of dispensing medication, they prescribe activity.

"Fitness is the greatest drug in the world," says Jake Steinfeld, a former personal trainer to Hollywood stars and now chair of the California fitness and sports panel. "It’s addictive. … Why wouldn’t doctors want to do this? There’s no extra work and, as a matter of fact, it’s another service that the doctor is providing for … patients. A doctor has the ability and power to help make that change."

It isn’t just activity that doctors are being asked to encourage. The Harvard Medical School and the Culinary Institute of America recently teamed together to teach physicians to cook more healthfully for their own personal consumption. The "Healthy Kitchens, Healthy Lives" conference drew about 200 health professionals to California’s Napa Valley to learn how to cook whole grains, salads as well as healthier sandwiches and desserts.

The theory is that by teaching doctors how to cook, they may be more likely to encourage their patients to do the same. Harvard also is considering establishing "teaching kitchens" in hospitals. The goal would be to take patients who have recently been diagnosed with diabetes, heart disease or other nutritionally related conditions, and show them how to make healthier meals.

"Unless doctors, nurses and other health providers live this way, it’s hard for them to get patients to make needed changes," says David Eisenberg, associate professor of medicine at Harvard and the conference organizer.

But do patients really listen when their doctor advises them to exercise, eat right and make other changes including giving up smoking?

"That’s the million-dollar question," Sallis says. "There is limited research available."

What’s available shows mixed results. For the first six months after doctors advise exercise, patients improve their activity levels but then tend to slip back into their old sedentary habits.

Enlisting physicians to coach patients to exercise and eat right "is an important ingredient" to improve behavior, says the AMA’s Davis, but it’s not the only ingredient. It’s also important to have safe and convenient places to work out, whether that’s walking or playing recreational sports. And patients have to accept the idea of listening to their physician on exercise advice, just as they do for medical advice.

It’s difficult "to get people to walk more, ride bikes and play recreational sports," Davis says. But "this goes part and parcel with healthy eating as well. It’s all connected as a way to prevent or turn around our obesity epidemic."

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