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Exercise Prescription Coming Your Way?

When Doctors Prescribe Exercise, Patients Get Moving

By Miranda Hitti
WebMD Health News

Reviewed By Louise Chang, MD

April 17, 2009 -- The next time you see your doctor, he or she might do more than just tell you to get some exercise -- they could pick up their prescription pad and prescribe exercise.

Exercise prescriptions get inactive adults moving, a new study shows.

The study, published in this week's Archives of Internal Medicine, is a "milestone" because it proves that exercise prescriptions work, says Pamela Peeke, MD, MPH, FACP.

Peeke, who is the spokeswoman for the American College of Sports Medicine's "Exercise is Medicine" campaign, says it's "quite rare" for U.S. doctors to prescribe exercise, but that's changing.

"It's just in its embryonic phase," Peeke tells WebMD. Here's a look at the new study and the fledgling trend in exercise prescriptions.

Exercise Prescription Study

The new study comes from Spain, where researchers trained family physicians in how to deliver custom-made exercise prescriptions for inactive adults during a 15-minute doctor visit.

Those doctors gave more than 2,200 inactive adults exercise prescriptions that were tailored for each patient. For comparison, they didn't give exercise prescriptions to nearly 2,070 other sedentary adults.

Six months later, the patients who had gotten the exercise prescriptions reported more physical activity than those who hadn't received exercise prescriptions.

The effects were "clinically relevant," write the researchers, who included Gonzalo Grandes, MD, MS, of Spain's Basque Health Service-Osakidetza.

Specific Prescriptions

Just giving vague advice to get some exercise didn't cut it. For the patients to benefit in the Spanish study, they needed a specific exercise prescription written just for them.

That rings true to Ann Yelmokas McDermott, PhD, MS, LDN, who directs the Center for Obesity Prevention and Education and is an associate professor in the kinesiology department at California Polytechnic State University in San Luis Obispo, Calif.

"Advice alone does not do it," McDermott says. "It must be a customized and personalized prescription in order to get the best benefit."

McDermott says exercise needs to be prescribed as thoroughly as a pill.

Doctors "would never say [to a patient], 'This medication is good, end of story.' You have to give the details for it to be valued. Why is it good? What's it going to do? How do I take it?" McDermott says.

Doctor's Experience

Peeke wrote her first exercise prescription 15 years ago for an executive who was obese and who was resisting Peeke's advice to make exercise a priority.

Frustrated with her patient, Peeke -- who is an athlete and who has sports medicine training -- recalls picking up her prescription pad and filling in the patient's name and exactly what she should do for physical activity. Peeke even put the infinity symbol in the "refill" column of the pad.

"I signed the thing, ripped it out, and handed it to her and she smiled widely and left," Peeke says. Three weeks later, the patient was back in her office, having already lost eight pounds.

Peeke was shocked. "I said, 'Lord above, how did you do this?' And she said, 'Dr. Peeke, you wrote a prescription.' I thought, "I'll be damned!" Peeke says. "This is powerful! It's the power of my prescription pad.'"

That patient, Peeke says, still has her original exercise prescription on her bulletin board and has met and maintained her health goals over the years.

Still, Peeke says it's "quite rare" for U.S. doctors to prescribe exercise. McDermott agrees.

"Many physicians have had no medical training on physical activity or nutrition in the practice or how to set guidelines or how to customize [exercise programs]," McDermott says.

But that may be starting to change.

Peeke says that Kaiser Permanente in Los Angeles is testing an exercise prescription program, and that the ACSM's Exercise is Medicine web site has guidance for doctors who want to start writing exercise prescriptions.

SOURCES: Grandes, G. Archives of Internal Medicine, April 13, 2009; vol 169: pp 694-701. Pamela Peeke, MD, MPH, FACP, spokeswoman, American College of Sports Medicine "Exercise is Medicine" National Campaign. Ann Yelmokas McDermott, PhD, MS, LDN, director, Center for Obesity Prevention and Education; associate professor, kinesiology department, California Polytechnic State University, San Luis Obispo, Calif.

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