Prescribing activity

Issue: BCMJ, vol. 54 , No. 5 , June 2012 , Pages 221 Editorials

I was recently asked to give a talk on physician health with a focus on exercise, which got me thinking about obesity and inactivity. General perception is that obesity is the bigger evil but this assumption has been challenged in recent years. 

I was fascinated by a number of talks I attended on this issue at a conference by Dr Steven N. Blair from the University of South Carolina. Essentially, Dr Blair’s convincing re­search shows that inactivity is a much bigger health risk factor than obesity. 

He has shown that all-cause mortality is inversely related to activity level across a range of body mass. He has also shown that contrary to popular belief, caloric intake has remained quite stable over the years while activity levels have dropped off. Lastly he has shown that increasing activity, regardless of body mass index, lowers all-cause mortality. In summary, the “fit fat” have lower health risks than the “sedentary skinny.”

Considering the above, physicians have a real opportunity to make a difference in their patients’ lives. We often talk to our patients about healthy eating and exercise but how many of us actually ask about—and record—activity level in patient charts? Perhaps we should start thinking of exercise as a vital sign, like blood pressure, heart rate, and weight. 

The current Canadian exercise recommendation for adults aged 18 to 64 years is at least 150 minutes of moderate to vigorous intensity aerobic activity per week in bouts of 10 minutes or more.[1] I wonder how many physicians meet this guideline?

Physicians in BC have always been at the forefront in health promotion. Smoking cessation programs, advocating for bicycle helmets and car seats, and calling for an end to cellphone use while driving come to mind. Taking a leadership role in encouraging physical activity is a logical next step. 

Many of us have no problem in taking the time to prescribe a statin or an oral hypoglycemic agent but hesitate in giving our patients an exercise prescription. How many treatments do we have where the number needed to treat for patient benefit is one?

Patients are quite resilient at finding ways not to exercise and often come up with many excuses and reasons to avoid activity. Taking the time to listen to these excuses and come up with practical solutions for patients can be very rewarding. For example, sometimes all that is needed to encourage patients is to enlist the help of a spouse or close friend to walk with them. 

Having a basic knowledge of what facilities and programs are available in your community is also very useful. Many communities have a wide range of exercise classes for all ages and body types. Some communities have novel programs like mall walking, where seniors meet for regular walks in a safe, weather-controlled environment. 

There are also numerous online exercise resources and programs in which patients can become involved. The BCMA has a unique program called Walk with your Doc in which registered physicians can en­courage their patients to join them in a 30 minute or 1 km walk.

It is clear that physicians have the ability to make a huge difference in their patients’ health simply by promoting physical activity. I’m reminded of what Grandpa Richardson use to say, “Any movement is a good movement.”
—DRR


References

1.    Canadian Society for Exercise Physiology. Canadian Physical Activity Guidelines. Accessed 3 May 2012. www.csep.ca/english/view.asp?x=804.

David R. Richardson, MD. Prescribing activity . BCMJ, Vol. 54, No. 5, June, 2012, Page(s) 221 - Editorials.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply