By Ann Gates (@exerciseworks)
It is unacceptable in 21st century medicine for 36 million people to die from preventable and treatable diseases!
A recent BJSM paper reviewed the barriers to health professionals in giving exercise advice and support to patients within the context of a primary care consultation.
This review identified three key barriers to successful brief interventions within a consultation:
- lack of time;
- lack of knowledge/training in physical activity counselling, and;
- lack of success with changing patient behaviour.
So let’s discuss overcoming these specific barriers:
Lack of time
This is difficult as most health care professionals diagnose, treat, counsel, refer, support and discuss health problems with their patients in 7-10 minute consultations. To expect health professionals, especially doctors, to give exercise advice to every patient may be pressurising the ‘consultation process’. However, giving medication advice within that consultation is routine.
One strategy may be to add 45 seconds of advice: ‘I want you to start an exercise plan in the treatment of [insert disease condition]. When I see you for review of your health problems and medication, I will also be reviewing the effectiveness of regular exercise in helping you to manage your disease/condition.’
A recent article from the USA showed that including exercise inquiry and advice within consultations is now considered a routine ‘vital sign.’ If the USA health care systems can afford the time to manage patients with exercise advice and support, then why would it not work in other countries to help manage the epidemic of non communicable diseases?
Lack of knowledge/training in physical activity counselling
We know that brief intervention works within primary care models so why do so many health professionals still struggle with advising patients to exercise regularly? Why is it that health professionals easily give advice and support on asthma medication, cancer referral, or the management of taking warfarin? These are still treatments or medicines just as ‘exercise is a medicine.’ Actually, the most significant fact about exercise as a medicine is that it works in a variety of disease conditions and is extremely successful in preventing many diseases such as cancer and heart disease. So even basic knowledge is easily confined to: ‘exercise for at least 150 minutes a week, or at least 30 minutes on five days a week, I will review your blood pressure or cholesterol levels regularly so we can monitor the effectiveness of your exercise plan.’
The medical knowledge for exercise as an important therapeutic intervention has been clearly demonstrated by Dr Mike Evans ‘viral’ 9 minute YouTube video 23 ½ hours. Training in physical activity counselling is identical to counselling for patients to take medicine safely and effectively.
Motivational interviewing using the most basic methods of: exploration, education, empowerment and enablement over a series of primary care consultations could make a real difference to consultations on both medication and exercise prescriptions. Current clinical training provides both primary and secondary care with the information and knowledge to support patients on taking their medicines. Why shouldn’t Sports and Exercise clinicians, health and fitness professionals and patients help ‘form’ the knowledge and learning pathway for exercise advice as part of every health care professional’s training and continuing professional development? This would ensure that health professionals are confident in giving exercise advice as a ‘vital sign.’
Lack of success with changing patient behaviour
The broader public health climate presents difficulties for clinicians to successfully change patient behaviour. The current obesity, diabetes and other non communicable diseases epidemic is in part a result of unfocussed public health policies, poverty, lack of public education on healthy diets and regular exercise, and patients’ own lack of the realisation that too many convenient ‘fast foods’ make you fat, fast!
However, our last blog clearly demonstrated that the majority of health professionals are ready to act in enabling regular exercise to become a ‘routine and integral part’ of their patient’s lives and treatment options. As one example, Scotland has taken initiative to inspire allied health professionals to be proactive in recommending physical activity advice to all patients under their care (read more here).
So my final questions for you today are:
Are lack of time, knowledge, and patient behaviour change really reasons not to take action on what is clearly one of the world’s most challenging health epidemics?
What are your ‘exercuses’ in not giving exercise advice to every patient?
What strategies can you incorporate to overcome these barriers?
Ann Gates BPharm(Hons) MRPharmS
Personal Trainer, Chronic Disease Exercise Specialist, BACPR Exercise Instructor.
Founder of Exercise Works!