Family Physicians’ Role in Increasing Levels of Physical Activity and Exercise
It is well documented that participating in physical activity or exercise is associated with health and fitness benefits that may be physiological, metabolic, or psychological and furthermore prevents the development of chronic diseases and mature mortality (ACSM, 2006). Prior to 1992, 40 studies had been published of blood pressure effects of endurance training by essential hypertension patients. In that research, for up to 72% of the study samples, training was shown to lower systolic blood pressure at 11 mm Hg from the initial 153 mm Hg, while diastolic blood pressure was reduced at 9 mm Hg from initial 99 mm Hg. These reductions, again, were a result of hypertensive participants taking part in endurance exercise training (ACSM, 1993). Findings from these hypertension studies suggest that endurance exercise training that was measured in a laboratory or clinical setting can lower blood pressure in patients who experience mild blood pressure elevation. However, moderate intensity endurance activities (those at 40–60% of maximum work capacity) appear to be more effective for lowering blood pressure than is exercise training at higher intensity (ACSM, 1993).
Investigation of exercise training with cancer patients has also produced positive outcomes. In a review article exploring cancer survivors’ involvement in exercise, for example, it was concluded that exercise participation can be an effective intervention improving quality of life during and after cancer treatment (Courneya, 2003). Likewise, exercise training has been shown to have acute and chronic influences with diabetic patients. Rapid change in glucose concentration, for instance, is known to occur as the result of exercise (Borghouts & Keizer, 2000). Exercise training thus is a justifiable measure to apply in a non-pharmacological scheme to reduce incidence of chronic disease in at-risk individuals.
Given that scientific research consistently shows that physical activity including regular exercise significantly enhances overall health, government, health care, and other agencies in the U.S. and Canada advocate exercise and other physical activity for the population. They have drafted recommended guidelines, begun mass media campaigns, and organized exercise-promotion initiatives. To encourage physical activity and exercise among Americans and reduce the risk of chronic disease, the U.S. Surgeon General and the American College of Sport Medicine (ACSM) published and endorsed physical activity guidelines. One well-known exercise program endorsed by the ACSM is the FITT Principle (Pescatello et al., 2004), a recommended fitness regimen that can be based on cardiovascular fitness or on strength training principles. The FITT Principle is regularly applied by exercise physiologists and fitness professionals to prescribe exercise training to various clients. The acronym stands for frequency, intensity, time, and type.
To urge Canadians to be more physically active, the Public Health Agency of Canada collaborated with the Canadian Society of Exercise Physiology in sanctioning the Canadian Physical Activity Guides. This series of publications was specifically designed to help Canadians make better choices concerning physical activity and is available for children, youth, adults, and older adults. A family physical activity guide for children and youth as well as a teacher’s guide for children and youth are also available. Each guide is presented as a one-page summary sheet or in a handbook format that discusses ways to incorporate physical activity in everyday life. Each physical activity guide is also available online on the webpage of the Government of Canada Public Health Agency, under the heading “Healthy Living Unit” (http://www.phac-aspc.gc.ca/pau-uap/paguide/index.htm) (Health Canada, 2007).
Despite the many benefits of exercise and physical activity (e.g., prevention of cardiovascular disease) and despite ready access to various published exercise guidelines, the literature makes clear that too many Canadians continue in a sedentary lifestyle (Katzmarzyk, Gledhill, & Shephard, 2000). Lack of physical activity or exercise is more prevalent among women than men and among minority populations (Nieman, 2006). Bryan and colleagues reviewed investigations of the level of physical activity among Canada’s minority groups, finding that (with odd ratios adjusted) black and South Asian women were 50% less likely to be moderately physically active than were white women (Bryan, Tremblay, Perez, Arden, & Katzmarzyk, 2006). Physical inactivity has been reported more prevalent in older adults as compared to younger adults and more prevalent in lower socioeconomic groups than in higher (Nieman, 2006).
Moreover, Katzmarzyk, Gledhill, & Shephard (2000) analyzed the economic cost of physical inactivity in Canada and found that Canadians’ widespread physical inactivity placed an economic strain on the health care system. It follows that increasingly widespread physical activity among Canadians should reduce health care costs related to chronic diseases. Katzmarzyk and colleagues’ further analysis of information in the 1999 Canadian Health Expenditures Database showed an estimated $2.1 billion in direct health costs to be attributable to physical inactivity, representing 2.5% of total annual health care costs (Katzmarzyk, Gledhill, & Shephard, 2000). The primary expenditures attributable to insufficient physical activity were associated with coronary arterial disease ($891 million), osteoporosis ($352 million), stroke ($345 million), and hypertension ($314 million) (Katzmarzyk, Gledhill, & Shephard, 2000).
Family physicians, with their regular contacts with a very large segment of the Canadian population, could be a potent force encouraging physical activity and exercise among their patients. In the United States, the U.S. Preventive Services Task Force recommended that primary care physicians take time during routine office visits to counsel patients about being physically active. A number of qualitative surveys, however, have looked at family practitioners and exercise counseling, and they indicate that even when doctors advise patients to exercise, they do not tend to elaborate on how patients should exercise (Glasgow, Eakin, Fisher, Bacak, & Brownson, 2001). Some physicians perhaps question their role in assisting patients, at length, to make lifestyle changes. Behavioral counseling may be necessary to motivate positive change, and not all physicians have studied behavioral therapy. It may be necessary—if physicians are to begin offering real guidance to patients concerning physical activity—to offer physicians some guidance in effective counseling techniques.
Urging all physicians to prescribe exercise to their patients, the ACSM and the American Medical Association have proposed a campaign called Exercise is Medicine. The campaign involves having physicians record physical activity as a vital sign when a patient visits the office or clinic and having physicians then advise patients to be physically active for 30 minutes (and engage in stretching and light muscle training for 10 minutes) five days a week (ACSM, 2007). This proposal is in its early stages, so any conclusions about it will have to be drawn at a point in the future. Nevertheless, the Exercise is Medicine strategy is a positive step toward family physicians’ greater involvement in motivating patients to adopt healthier lifestyles to significantly improve health and quality of life. Such a positive step is badly needed in Canada to promote a healthier way of life among Canadians.
References
American College of Sports Medicine. (n.d.). Exercise is medicine. Retrieved November 1, 2007, from http://www.exerciseismedicine.org/taskforce/index.htm
American College of Sports Medicine. (1993, October 25). Position stand: Physical activity, physical fitness and hypertension. Medicine and Science in Sports and Exercise. 10, 1–10.
American College of Sports Medicine. (2006). Benefits and risks associated with physical activity. In: ACSM’s guidelines for exercise testing and prescription (pp. 3–18). Philadelphia: Lippincott Williams & Wilkins.
Borghouts, L. B., & Keizer, H. A. (2000). Exercise and insulin sensitivity: A review. International Journal of Sports Medicine, 21, 1–12.
Bryan, S. N., Tremblay, M. S., Perez, C.E., Arden, C. I., & Katzmarzyk, P. T. (2006). Physical activity and ethnicity: Evidence from the Canadian Community Health Survey. Canadian Journal of Public Health, 97(4), 271–276.
Courneya, K. S. (2003). Exercise in cancer survivors: An overview of research. Medicine and Science in Sports and Exercise, 35(11), 1846–1852.
Glasgow, R. E., Eakin, E. G., Fisher, E. B., Bacak, S. J., & Brownson, R. C. (2001). Physician advice and support for physical activity: Results from a national survey. American Journal of Preventive Medicine, 21(3), 189–196.
Health Canada. (n.d.). Healthy living–physical activity. Retrieved September 22, 2007, from http://www.hc-sc.gc.ca/hl-vs/physactiv/index_e.html
Katzmarzyk, P. T., Gledhill, N., & Shephard, R. J. (2000, November 28). The economic burden of physical inactivity in Canada. Canadian Medical Association Journal, 163(11), 1435–1440.
Nieman, D. C. (2006) Exercise testing and prescription: A health-related approach (6th ed.). Mountain View, CA: Mayfield.
Pescatello, L. S., Franklin, B. A., Fagard, R., Farquhar, W. B., Kelley, G. A., & Ray, C. A. (2004). American College of Sports Medicine position stand: Exercise and hypertension. Medicine and Science in Sports and Exercise, 36(3), 533–553.