Exercise should be prescribed like other medicine, doctors say

Doctors should prescribe exercise for patients who are physically inactive to help keep them disease-free, according to a recent commentary in the Journal of Physiology.

Dr. Michael Joyner, a professor of anesthesiology at Mayo Clinic, argues that if doctors "medicalized" physical inactivity, exercise could be the prescription of choice for high blood pressure, heart disease, some cancers and other health ills.

In the same August issue, Joyner addresses a study showing that three months of exercise training reversed or improved patients' excessively rapid heart rate upon standing and exercise. Other benefits include improved exercise capacity, blood volume and stroke volume, said Joyner, an expert in exercise and applied physiology.

Joyner said physical inactivity affects the obese, office workers sitting for long periods, and women on extended bed rest during pregnancy. Once they return to a sedentary lifestyle, patients' heart rate may rise excessively during exercise, bones and muscle atrophy, physical endurance wanes, and blood volume goes down.

Only about 5 percent of people meet the recommended requirements for exercise and 70 percent are either overweight or obese, according to Joyner.

"People who are sedentary have an increased risk from death from all sorts of things caused by inactivity," he said in a recent interview.

But doctors can't just tell patients to exercise more and expect results, Joyner said. They must provide specific fitness regimens that meet patients' needs. He said a supportive environment with trainers and cognitive and behavioral therapy is sometimes necessary.

"It's very easy for a doctor to write a prescription (for medication), but it's very difficult for a doctor to tell somebody they're de-conditioned, give them detailed information about it and send them some place they can get in shape," Joyner said.

Though few doctors offer detailed fitness and diet regimens for their inactive patients, a growing number of them, like Joyner, are giving greater priority to lifestyle changes.

Dr. John Principe, an internist in Palos Heights, said roughly 70 percent of his patients need more exercise and a leaner, more nutritious diet. He regularly suggests specific fitness regimens and nutritional changes to help them get back in shape.

"It's part of the prescription given in the visit," he said.

Principe started WellBeingMD Ltd. in 2009 after seeing patients for years who weren't taking care of themselves. His practice offers two Roadmap to Wellness programs, the first focusing on nutrition and cooking, physical activity and stress reduction, and the second on functional fitness and maintaining a healthy lifestyle.

Much of Principe's inspiration came from Dr. Edward Phillips, who directs the Institute of Lifestyle Medicine in Brighton, Mass., founded by the Spaulding Rehabilitation Hospital Network and Harvard Medical School.

Principe said he tries to show patients the science behind the benefits of exercise and offers fitness and nutrition suggestions tailored to patient's needs and abilities.

"You have to make a careful assessment of what they can do and tailor (exercise) to their physical ability," said Principe, adding if patients won't follow through on certain exercise suggestions, smaller goals should be set.

"If you don't set specific goals for people, they're left nebulous (vague)," he said.

Tom Cramer, of Orland Park, a patient of Principe's, who has taken exercise classes through WellBeingMD, hopes to lower his high blood pressure and shed a few pounds. Cramer tries to exercise regularly but is often too busy because he owns his own tile company.

Even though he was sore after the first exercise class, Cramer said he was inspired to do more afterward. "It gave me more enthusiasm to go out and work out more."

Copyright © 2018, The Baltimore Sun, a Baltimore Sun Media Group publication | Place an Ad