DOCTORS AND EXERCISE

When, in the 1960s, the information about the ill effects of smoking became known, the medical profession was the first group to show any reduction in tobacco use. This was probably the result of self preservation rather than trying to set a good example. Still, it did make doctors a role model as far as smoking was concerned.

A role model?

Could the same motivations persuade doctors to take up exercise? Certainly they have never been very good at promoting exercise as a prevention or a treatment for disease. Exercise physiology and the clinical benefits of exercise are not big in medical education. Writing a prescription is easier than trying to persuade a usually reluctant patient that exercise might be a better way of tackling their problem that swallowing pills. To be fair, the patient also finds it much easier to take the pills than take up exercise. However doctors who exercise could and should stimulate their customers to do the same.

It is encouraging to read two recent publications on the medical advantages of exercise and physical activity, aimed at doctors.

A miracle cure

The British Medical Journal has published an article entitled “Promoting physical activity to patients”, written by three general practitioners ¹. They point out that inactivity contributes to as many deaths in the UK as smoking and is the fourth leading risk factor for mortality worldwide. The figures they quote for potential benefits include 30-40% lower risk for type 2 diabetes, 20% lower risk of breast cancer, 20-35% lower risk of heart disease, reduction in osteoarthritis by 22-83%, 20-30% lower risk of depression and dementia and 30% reduction in falls for older adults. An accompanying editorial points out that the Academy of Medical Sciences has called physical activity a “miracle cure”. The editorial advises that physical activity is safe and beneficial for almost everyone. It has few if any side effects and, unlike some prescription drugs, it is not generally addictive. It concludes with a call for doctors to encourage their patients by taking more exercise themselves – an unarguable conclusion.

Although this article is written for doctors, at 7 pages, including references, it makes an easy and persuasive read for anyone.

In a letter responding to the article one correspondent commented: “Sadly, many gyms require people (especially those who have been ill or have common conditions such as hypertension) to obtain a letter from a doctor to absolve the gym of liability if the gym member becomes unwell while exercising. The familiar “get a note from your doctor” situation. This puts people in the position of having to ask overworked general practitioners for a note and possibly (as it clearly isn’t NHS work or part of a GP’s contractual duties) having to pay for it, which is clearly a barrier to them accessing the benefits of exercise in the gym.”

My own view is that a doctor’s note should only be needed if you are planning not to take exercise.

The Chief Medical Officers’ Report

UK Chief Medical Officers’ Physical Activity Guidelines, at 65 pages, is a more comprehensive document ². Aimed at “professionals, practitioners and policy makers” this too is still entirely suitable reading for the layman. I can do no better than quote directly from their summary:

“We want as many people as possible to make use of these guidelines to work towards and achieve the recommended activity levels. ……….. Being active every day provides a foundation for a healthier and happier life. ………….. We therefore want to underline the importance of regular strength and balance activities. Being strong makes all movement easier and increases our ability to perform normal daily tasks.

“We want this report to be a catalyst for change in our attitudes to physical activity. Our environment can make it difficult to be healthy and our health is being damaged by inactivity. But the good news is that even small changes can make a big difference over time …………….We want as many people as possible to protect their future health and start their journey to a healthier life now.”

Setting the tone

I would encourage anyone who is interested in their future welfare to read these papers. We all need to look after ourselves as well as possible –  for our own good and long term happiness and also to reduce the burden which we could place on society if we fail to do so. Most of the diseases of later life are promoted by lack of exercise and ultimately lead to frailty and dependence. This is well demonstrated by the CMOs’ report with some helpful and persuasive graphics.

The future of health promotion should be centred on trying to get the population to take more exercise. Doctors who are couch potatoes may be pushed to get their patients to comply with such advice.

1. doi:10.1136/bmj.l5230
2. UK Chief Medical Officers’ Physical Activity Guidelines 19th Sept 2019