It’s not enough to walk the talk: Prescribe it!

James Beckerman, M.D., FACC
Cardiologist, Providence St. Vincent Heart Clinic
Providence Sports Care Center
Team cardiologist, Portland Timbers
Medical director, Play Smart Youth Heart Screenings

Published February 2013

There’s a treatment out there that your patients might not know about.
It reduces their risk of heart disease, diabetes, cognitive impairment, osteoporosis, chronic pain, depression and many cancers by 20 to 50 percent. For patients with a history of heart attack or heart surgery, it reduces mortality by 20 percent.

It has no side effects, and it’s free. Its generic name is exercise, but it also goes by walking, running, swimming, hiking and lifting weights, to name a few.


Physicians, patients train together

We’re walking (actually, running) the talk at Providence Heart and Vascular Institute.
 
Since December, phyicians have been leading a group of our patients and employees in a 5K training program called Heart to Start.

We crossed the finish line on Feb. 9! Check out the photo gallery on Facebook.
So the question is – why aren’t we recommending it for our patients? One problem might be with the prescriber. It turns out that fewer than 30 percent of physicians meet the American Heart Association’s recommendations for regular exercise, which at about 150 minutes a week is less than half an hour a day.

And physicians who don’t exercise are less likely to recommend it to their own patients.

Quick poll: Do you prescribe exercise?

A second barrier could be the misconception that exercise prescriptions are ineffective. The data suggest otherwise. Studies show that a single exercise prescription in the office setting can impact behavior for up to six months, and multiple exercise prescriptions at routine visits last even longer.

Patients who are prescribed exercise are significantly more likely to meet exercise recommendations, and many more will increase their activity by 30 minutes to an hour a week. This alone can have a positive effect on their physical and mental health, and can contribute to their overall quality of life.

So how do you do it? Get SMART:

Be Specific. Rather than just telling your patients to “exercise more,” prescribe a particular exercise with a specific number of minutes and frequency. Patients will be more likely to comply.

Make it Measurable. It helps to measure exercise by distance or (using a pedometer) number of steps. Also, tie in blood pressure checks, lipid testing or diabetes testing to help patients recognize that exercise is having a positive effect on their health.

Make the goal Attainable. Patients (and physicians!) need goals they can achieve. Even if the goal is 30 minutes of exercise every day, patients will still be successful if at the end of six months they are exercising just 10 minutes a day more than they are now. Explain that this isn’t an all-or-nothing game.

Get Realistic. This isn’t about running a marathon or losing 50 pounds. It’s about creating concrete goals that will enhance health. Help your patients see exercise as a positive activity, not as a punishment for eating unhealthy food. Share the benefits, many of which aren’t obvious on the scale.

Time it. Build in a follow-up visit or phone call to see how your patients are doing. Plan on increasing the speed, distance or timing of their exercise prescription to keep them motivated and accountable.

We’re used to giving patients a quit date. Let’s try giving them a start date by prescribing exercise at every visit.

If you have any questions about exercise prescriptions, particularly in patients with a history of congenital or acquired heart disease, call our sports cardiology clinic at Providence Sports Care Center at JELD-WEN Field, 503-216-0900.

Clinical articles by James Beckerman, M.D.