Promoting Physical Activity and Exercise
There is no question that non-communicable diseases are the leading cause of death in the world. These are mostly preventable problems such as hypertension, smoking, diabetes, physical inactivity and obesity. Strikingly, physical inactivity accounts for a significant proportion of premature deaths worldwide. Physical inactivity and low cardiorespiratory fitness are major public health problems and as health care providers we must be on the forefront to promote improving physical activity in our patients.
Primary care physicians are especially important in this fight. We should promote this for several reasons. One, we have an ethical obligation to do this. Second, promoting physical activity for prevention and treatment of chronic disease has impacts from the individual patient to our entire medical system. Third, it is at the personal level for each patient that intervention could be the most effective. In the Activity Counseling Trial, simple physician advice and written educational advice translated to increasing physical activity by 600ckal/week six months later. When we plug that into the Harvard Alumni Study, this produces significant decrease in mortality. The point is that a simple intervention translated to significant benefit.
Joy et al proposed three principle actions to promote physical activity in the exercise medicine community.
Action 1: Give physicians methods and support to counsel patients and be reimbursed for that rather than reacting to disease. One example is using physical activity as a vital sign. How much do you exercise each week?
Action 2: Develop programs to educate physicians, especially in medical school, residency, fellowship and I would add practicing physician Continuing Medical Education.
Action 3: Encourage medical students and physicians to be active.
There are several keys for us: we should by positive role models for our patients; commit to promoting physical activity in our practices and medical systems; promote physical activity in our CME for physicians.
Writing Group for the Activity Counseling Trial Research Group. Effects of physical activity counseling in primary care. J Am Med Assoc 2001; 286:677-87
Joy E, Blair SN, McBride P, Sallis R. Physical activity counseling in sports medicine: a call to action. Br J Sports Med 2013; 47:49-53.
Exercise is Medicine