Tuesday, March 20, 2012
Do adults need physicians to tell them to exercise?
According to a new CDC report, only 1 in 3 doctors advise their adult patients to exercise. The survey-based findings are limited, in part, because they rely on people's recollection of whether they'd visited a physician in the previous year and what they were told. Nonetheless, the study revealed some clear trends:
1. In 2010, 32.4% of adults who'd seen a health care professional were advised to begin or continue with exercise or other physical activity. That fraction's up significantly from 2000, when a slim 22.6% of patients recalled their doctors telling them to get a move on.
2. Among folks over 85 years, nearly 29% say they were told to exercise. That number's nearly doubled since 2000, when only 15.3% of elderly patients reportedly received this kind of advice.
3. Adults with diabetes were told to increase their activity more often than those with high blood pressure, cardiovascular disease and cancer. Compared with healthy weight adults, obese people were twice as likely to have been told to exercise by a physician or other health professional.
An underlying message is that doctors should be prodding their patients to exercise. From the report: "Research points to the benefits of physical activity for reducing the risk of chronic health conditions (1–4). Engaging in regular physical activity can reduce medication dependence, help maintain functional independence, and improve the quality of life for older adults (5,6). Physicians and other health professionals can be influential sources of health information, and exercise counseling by primary care physicians has been shown to increase patients' participation in physical activity (6–9)."
There was discussion about this on Twitter, stemming in part from a USA Today article on the report. And here's the essence of the short-form debate:
Some suggested that doctors don't tell patients to exercise because they, themselves, are overweight. Or it's because they don't feel comfortable recommending for others what they don't do themselves. While this might explain some physicians' behavior or discomfort with the topic, it can't explain that of the majority.
So why don't more doctors prescribe exercise for their patients?
Reasons I wonder about include a lack of time for "non-essential" communication, especially in clinics. In specialists' offices, the omission of exercise could have to do with the visit's purpose. A gastroenterologist or internist who evaluates a patient for a problem like diarrhea, say, might not think to ask about exercise. For some doctors it might be, problematically, an attitude issue--that they just don't care that much, or think it would be a waste of time to discuss the matter of exercise.
Whatever the reasons are that most doctors don't bring up the issue, one might ask this: Why do adults need doctors to tell them about the health benefits of regular exercise? After all, it's common knowledge--the kind of thing taught in elementary school, like nutrition should be--that regular exercise is good for most people. As we age, being out of condition makes every task in life, like walking a few blocks, harder.
In an ideal world, we'd have most adults exercising regularly, and doctors who'd occasionally intervene and counsel patients about what they shouldn't do because of a particular medical condition, like arthritis or heart limitation. I guess we're not there yet.
This post originally appeared at Medical Lessons, written by Elaine Schattner, ACP Member, a nonpracticing hematologist and oncologist who teaches at Weill Cornell Medical College, where she is a Clinical Associate Professor of Medicine. She shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology and as a patient who's had breast cancer.
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