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Pilates, not pills: Doctors are writing exercise prescriptions

  • September 13, 2019

Family doctors are acknowledging that there’s only so much medicine can do, and sometimes a walk in the park is just what a person needs.

If your family doctor said you had to exercise for a set amount of time each day and wrote exactly what you had to do on a prescription pad, would you be more likely to follow those directions than if he or she simply said, “Lose weight”? This ‘prescription approach’ is gaining traction in the United States, where family physicians are finding that explicitly stating exercise goals for overweight and unhealthy patients is helping them to follow through.

In an article for the Washington Post, professor of family medicine Ranit Mishori describes a sample prescription that she might write for a patient with diabetes:

– Frequency: At least 3-4 days a week.
– Intensity: Exercise at a moderate level.
– Time: Exercise 30-60 minutes per day (all at once, or break it up into a few sessions of at least 10 minutes each).
– Type: Aerobic or rhythmic exercises using the large muscle groups (walking, cycling, swimming). Weights 2x week.

Mishori explains:

“We physicians often don’t have time during a typical office visit of 15 or 20 minutes to discuss ­lifestyle-related recommendations for improving health. Many of us tell patients, ‘You need to lose weight’ or ‘stop smoking’ or ‘exercise more’ — but in practice we tend to skimp on the details. The exercise-prescription idea was supposed to help eliminate this vagueness by giving patients more-specific information to act on.”

Mishori is not the only doctor doing this. She references doctors in Vermont prescribing hiking and time spent in nature; the American Academy of Pediatrics showing patients where the nearest parks are; a program in Chicago called Food Rx that gives patients food coupons and connects them to food-related resources. There is also a broader, official initiative among the medical community called Exercise is Medicine, the goal of which is to make physical activity a standard in clinical care.

Sometimes the prescriptions go beyond exercise and diet in order to address differences in what are known as the social determinants of health — how social factors, such as where one lives, what one eats, how much one earns, accessibility of health care, etc., affect health. This is what Britain has done, with its recent appointment of a minister for loneliness, in an effort to help the thousands of people for whom loneliness is undermining physical and mental health.

Moshari admits that exercise prescriptions are not backed by science; no studies have proven yet that it works. But she argues that it initiates valuable conversations about exercise and diet that many family doctors do not have time to engage in, and it gives patients some concrete instructions with which to work.

“From a purely anecdotal standpoint, I will admit to mixed results so far. Some patients have reported back that they had taken my recommendations to heart and begun to change their lifestyles. Others shoved my prescription in their bag and probably never looked at it again.”

But for those who did follow through, it has probably changed their lives. The more people who can be encouraged to improve their health through exercise and diet, without relying on expensive pharmaceuticals, the better off they’ll be. Until all doctors are given more training in exercise and diet recommendations — and prioritize the time in which to educate their patients — relying on exercise prescriptions may be the best option.

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