The Art of Implementing Effective Exercise Prescription in the Clinical Setting
Exercise is medicine has been shown to treat and prevent over 40 diseases and has been proven to be as effective as medications, however, less than 10% of individuals exercise to meet the national guidelines for exercise. The recommendations for exercise are in the guidelines for almost all diseases, such as cancer and diabetes, however, less than 40% of physicians counsel patients on exercise. This is partly due to less than 20% of physicians educated in the United States are required to take one class in exercise/physical activity as part of their curriculum. However, educating primary care providers in sports medicine has been an effective method for helping patients be significantly more physically active/exercise and continue being compliant with appropriate exercise.
If our patients are willing to improve their physical health with an effective exercise prescription, how do physicians implement it. The first thing is to understand your patient and their views/history of exercise. Most patients are confused from misinformation that they “have to sweat” and “no pain, no gain” for exercise to be effective. Some are under the impression that just being active won’t help them. Discussing these issues and educating them in the clinical setting about the types of exercise that are most beneficial for their needs is an excellent way to motivate and improve compliance (ie., walking is effective to decrease catecholamines produced by stress). If we refer them to a gym, there is approximately 60% chance that they will stop going within 6 months. Also, the type of fitness professionals we refer our patients to is important, since most of our patients have significant medical issues that require close monitoring m. Exercise physiologists are educated specifically for this reason. Utilizing them in a clinical setting is a great way to take advantage of the skill set, especially for clinicians who do not have a strong background in exercise prescription.
Some patients are not likely to follow-up with fitness professionals, the clinician is the sole person to who will help develop an exercise prescription for these patients. Once their medical and exercise/physical activity history has been obtained, then a specific type of exercise for them can be discussed. Also, understanding their baseline fitness level can be obtained with the “walking visit”, which then can be utilized to help them understand intensity of exercise and the “talk test”.
Addressing the risk of injury or physical limitations is paramount for patients since exercise/physical activity should never be painful, since this is one of the main reasons patients stop exercising. For the patients to understand that exercise is medicine and that we must limit the side effects, such as injury. For the walkers, make sure that they don’t have any joint pain. Also, educating them on the types of surfaces and quality shoes/socks that reduce the risk of injury the most, such as walking on a track instead of at the mall due to more joint strain. The clinician’s most important focus should be to make sure that the patient never develops an injury that prohibits them from exercising. Increasing the patient’s overall activity throughout the day, such as at home and work should also be included in an exercise/physical activity prescription. This could be getting a standing desk, walking farther to the printer, going to a dance class with your friend, or any way to increase movement throughout the day. This could also be “moving to the tunes”, which is done sitting or dancing. Also, take into consideration what is available in the patient’s community, such as ParkRx or Silver Sneakers, or an exercise class at work.
Implementing the exercise prescription in a clinical setting can be time consuming to be effective and the reimbursement for exercise professionals is limited at best. The utilization of physician assistants/nurse practitioners (advanced practice practitioners-APPs) who have an interest and education is extremely cost effective since their time is billable under normal insurance coverage as an office visit.
It is important to understand the motivation of “purpose” and the people in the patient’s life. If someone has family members that are important to them, they are more likely to exercise or be physically active for their family members, as well as themselves. Tap into the important things for the patient and not just the guidelines. Our patients are at the center of each exercise prescription we write. We are just their consultants, so give them the tools with education, realistic goals that they came up with, and the positive support to make even small changes will have significant medical benefits. Also, utilizing the lab work and medical outcomes is extremely motivating. Exercise is the best medicine in the world! The art of implementing this medicine should be shared.
- Review the importance of exercise as medicine.
- Utilize exercise prescription in the clinical setting.
- Develop an effective approach to implementing exercise prescription for patients in the clinic.
CME/CNE/CE: 1.0 | CPE: 0.0