ENCOURAGING EXERCISE

It is all very well knowing that exercise is good for you but, like knowing that eating too much makes you fat, does not necessarily lead to a change in behaviour. Telling someone that they should get more active is a rather ineffective intervention.

One of my hopes for this blog is that telling people just how effective exercise is might have some small effect – but it will take a shift in many aspects of life to make a real difference.

Referral networks that increase opportunities for physical activity

The American College of Sports Medicine (ACSM) has published an article on “Strategies for partnering with health care settings to increase physical activity promotion”¹ which gives some good pointers.

Granted that this comes from across the pond, but most of their excellent suggestions are applicable in the UK. They start by quoting that only 26% of men and 19% of women meet the minimal recommended levels of physical activity (which are the same in the US and the UK). Those of you who have read my Blog “Exercise, Obesity and Self-Deception” will realise that these figures for exercise-taking are likely to be gross exaggerations.

The authors identify nine sectors of society which have the potential to promote increased physical activity: business and industry; community recreation; fitness and parks; education; faith-based settings; health care; mass media; public health; sport; transport, land use and community design. Each of these settings could keep me in Blog material for yonks but this ACSM article is written with healthcare in mind.

The authors emphasise that training of medical students and doctors is sadly lacking for this topic. Moreover, although doctors can have a small effect on the physical activity of their patients, only a minority raise the possibility during consultations – their figure for the US is that physical activity counselling is given in 32% of consultations. I suspect that it is much lower in the UK where the “prescription” of exercise is not part of the thinking of most GPs.

The authors suggest that one way of tackling this problem would be to “partner with providers of community physical services to form referral networks that increase opportunities for physical activity and ensure equal access of their patients to community resources, including patients living in rural areas”.

The UK programme which provides exercise for older people

I run a programme which provides exercise for older people particularly those at increased risk of cardiovascular disease (mainly heart attacks and strokes).

This was slow to take off but I am pleased to say that referrals from GPs has been gradually increasing. We have increased the numbers by persuading local GPs to send information about our programme to patients on their lists who have relevant risk factors such as high blood pressure, obesity, type 2 diabetes etc. Even so the commonest reason for admission to our “Staywell” programme is that the patient, having heard about it, has requested referral.

“Prescription for exercise” is available widely in the UK, usually involving local sports centres. Many, particularly older, people are not that keen on sports centre based activities which they view as being for lycra clad youngsters. They need to know what else is available (walking for health, badminton, games and sports of one sort or another).

We are building up a database of all the exercise opportunities in our area and will make that available to GPs. It is my hope that handing a patient such information at the end of a consultation will become more common than giving a drug prescription. Any chance?

1. Doi: 10.1249/FIT.0000000000000486