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Physical activity - the cure of all ills? |
Everybody knows that taking the dog for a walk is good for both yours and the dog’s health. But in this world of evidence-based medical practice is there the research to show just how effective physical activity (PA) is in keeping us healthy and preventing illness?
How does PA compare with pharmaceutical intervention in prevention? This is an important question as governments determine which patients should have subsidised risk reducing medications like the statins for primary and secondary prevention.
What intensity and duration of PA is needed to have benefit? What sort of exercise prescription should GPs be giving their patients?
To help answer some of these questions, Health Canada and the US Centre for Disease Control and Prevention sponsored a scientific symposium in October 2000 to determine whether there is a dose response relationship between PA and health outcomes. The invited experts reviewed and evaluated the existing literature according to an evidence-based methodology used previously by the National Institutes of Health. The report of the consensus committee is published in a recent edition of Medicine and Science in Sport and Exercise (1) and is worth reading for those who want a detailed review.
Regular exercise reduces health risks
The panel concluded that a large body of evidence shows that regular PA is associated with a reduction in all cause mortality, fatal and non-fatal total cardiovascular disease and coronary heart disease. It is also associated with a reduction in the incidence of obesity, and type 2 diabetes and an improvement in the metabolic control of individuals with established type 2 diabetes. Also PA is associated with a reduction in the incidence of colon cancer and osteoporosis. Further benefits of regular PA includes improved physical function and independent living in the elderly.
Individuals with high levels of PA are less likely than those with lower levels to develop depressive illness. In those with mild to moderate depression and anxiety, prescribed PA is associated with improved symptoms. Other benefits of PA included reduction in blood pressure, improvement in the plasma lipid profile and alterations in coagulation and haemostatic factors.
Prescribing exercise
No doubt as further research is done the list of benefits of regular PA will grow as will advice about the level of PA needed for improved health outcomes. In the meantime it may be prudent for GPs to encourage their patients to engage in regular moderate PA as a preventative health measure. Following the National Physical Activity Guidelines (see below) is a safe and effective prescription for our patients. The effectiveness of a GP’s advice is not to be underestimated in a similar way to the proven effectiveness of their advice on quitting smoking.
For those patients who need more encouragement and motivation than the GP’s recommendation, referral to an exercise specialist may be the next step. With new Enhanced Primary Care (EPC) Medicare item numbers and the prospect of more graduates from the Southern Cross University human movement course looking for a role in health care, we may be getting closer to a time where referral to exercise specialists will reach the same level as referral to dietitians.
Another option is referral to a commercial program such as the GutBuster program.
Whether it is a one to one approach from the GP or referral to an appropriate health professional or program will differ for each patient according to need, personal preference, availability, cost etc. EPCs may increase the options for GPs.
Local trial
In my practice I am currently trialing and evaluating the referral of some patients with the metabolic syndrome to senior human movement students for personal exercise coaching under close supervision and guidance from myself and the lecturers from the SCU human movement/exercise science course. There are numerous clinical and research possibilities in this approach and other GPs and physicians may want to become involved in this.
UK developing formal link with exercise professionals
UK health authorities are developing a formal process for exercise referral schemes from GPs to exercise and fitness professionals through the NHS Health Improvement Programs (see www.doh.gov.uk/exercisereferrals). This scheme has addressed the medico-legal concerns and has been endorsed by the Medical Protection Society. Australia is well positioned to follow suit. This has the potential to open up career opportunities for exercise and fitness professionals and could help our patients become more physically active and thereby enhance their health.
(1) Kesaniemi, A et al. Dose-response issues concerning physical activity and health: an evidence based symposium. Medicine & Science in Sports & Exercise 2001;33:S351-S358
Andrew Binns has a special interest in obesity issues and runs local GutBuster courses.
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