9 April 2018

GPs aren’t writing scripts for exercise – here’s why

Clinical General practice Patients

An MJA article has lamented the lack of exercise prescribing by doctors, but some GPs say they have neither the time nor the inclination to create exercise programs for patients. 

There was a high level of awareness about the broad-reaching health benefits of exercise in Australia, but most doctors did not regularly assess or prescribe physical activity, the authors said. 

The researchers from the University of Queensland recommended that doctors ask patients about exercise at every consultation and help patients set specific, written goals.

The authors (GP Anita Green, senior lecturer in human moment and nutrition Craig Engstrom, and sports and exercise physician Peter Frills) noted that doctors who did more exercise themselves were more likely to provide physical activity counselling to their patients.

Dr Joe Kosterich, a Perth-based GP and industry consultant, ripped into the MJA paper, saying that asking GPs to prescribe exercise was a “ridiculous” idea. 

And Dr Kosterich is no couch potato, himself. For the past 12 years, he has run two to three times a week. He also has a personal trainer, which he says helps put exercise in his diary. 

An exercise prescription from a GP was likely to be “off-putting” for a healthy person and might make physical activity seem like hard work, instead of a normal part of human existence, he said. The message should be “do what you can”. 

Some patients would not have the time to complete 150 minutes of exercise a week and putting a number on it might dissuade patients from doing any exercise at all. 

Exercise should only be medicalised when a patient had to avoid certain types of physical activity due to a specific medical condition, or in cases such as cardiac rehab where monitored and specific exercise was required, Dr Kosterich said.   

Responding to the MJA article, Tammy Hoffmann, a professor of clinical epidemiology at Bond University, said it was important to distinguish between exercise regimes prescribed for specific medical conditions, and general lifestyle advice for healthy individuals. 

For patients with chronic disease such as knee osteoarthritis, type 2 diabetes, COPD and back pain, or for patients recovering from cardiac surgery, “it is not sufficient to get a vague suggestion to exercise [from a GP]”, Professor Hoffmann said. 

Exercise as a treatment needed to be a detailed prescription, including what type of exercise, the intensity, and duration, she said. 

For healthy individuals, however, general advice to complete the recommended 150 minutes per week of exercise in any form that appeals to the patient was usually sufficient. 

GPs probably weren’t focused on exercise because they were under time pressure to get through their patient lists, Professor John Orchard, a sport and exercise physician at the University of Sydney, said. 

Exercise-based health professionals could provide detailed exercise advice for patients who could afford it – but this wasn’t well-funded under the MBS. 

GPs could help encourage physical activity as “Australians do trust their GP’s advice”, but GPs were not the best professionals to set up a detailed exercise program, Professor Chris Maher, a musculoskeletal researcher at the University of Sydney, said. That duty should fall to physiotherapists, exercise physiologists and sport and exercise physicians.

The MJA paper also raised a concern that exercise levels decreased during medical training and through residency. 

Alex Farrell, the president of the Australian Medical Students’ Association (AMSA), said medical training could be a high-stress period, in which study and work were prioritised above self-care. 

“[With the] long hours in university, hospital, and studying, it is easy to see how commitment to physical activity and self-care could be put on the back-burner,” she said. 

This year, AMSA launched an initiative called Activ8, which includes a month devoted to the benefits of incorporate exercise into weekly routines. 

“There also needs to be a commitment to changing the work environments and expectations that make it difficult for medical students and doctors to exercise in the first place, Ms Farrell said.

MJA 2018, 2 April