Yahoo Health News – February 7, 2005
http://health.yahoo.com/news/_58121
Take two hikes and call me in the morning. It may sound like an unusual prescription, but it's an increasingly common one at a hospital where physical fitness is part of doctor's orders for patients battling obesity. The effort is the result of an unusual partnership between physicians and hiking enthusiasts. Just a few months old and already earning praise, the program involves several dozen doctors writing detailed, albeit symbolic, prescriptions for getting fit and then giving patients trail maps to accomplish it.
"The idea is to make a more specific explanation," said Dr. Charles Brackett, director of the program at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. "You can say, 'Walk this trail near your house twice a day,' as opposed to, 'You're supposed to exercise more.'" That personalization is key. In weight-obsessed America — where two-thirds of adults are overweight or obese — follow-through on fitness and nutrition can be as much a problem as ignorance.
Studies show that the more concrete a doctor's advice, the more likely a patient is to heed it. While Dartmouth-Hitchcock's prescriptions aren't technically real, the hope is that the format makes the advice hard to ignore. It made the difference for Gloria Beattie, a 72-year-old woman for whom Brackett prescribed fitness in December. Winter weather so far has kept her off the hiking trails, but the prescription motivated her to get on her treadmill. Before that, the overweight woman got little exercise, adding to her existing health problems. She already has lost 12 pounds and is eager for spring so she can head outdoors. "It had a big effect," she said of the prescription. "If no one says anything, you just keep letting it go. But if they talk to you and explain why you need it ... you finally come to the realization that exercise is really the thing that you need."
Using the power of the prescription pad to encourage physical fitness isn't new, but in general medicine it is rare. Though so-called exercise prescriptions are widely used by doctors at obesity clinics, the practice hasn't caught on with general practitioners. In fact, few primary care doctors talk about fitness and weight loss at all with patients, even obese ones, said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital in Boston. That's because the medical community has been slow to address lifestyle as a means of disease prevention, said Manson, co-author of a report urging doctors to counsel patients on exercise and weight control. "A prescription for exercise may be the most important prescription a physician writes all day," she said. "If a prescription for medication could reduce the risk of heart disease, stroke, Type 2 diabetes and osteoporosis by 40 percent, everyone would be clamoring for it. Well, a prescription for brisk walking has the potential to do just that."
Yet more than half of American adults aren't active enough, and a quarter do no physical activity at all, according to the Centers for Disease Control and Prevention. Few doctors have embraced this approach for the same reason so many of their patients aren't out doing laps: lack of time. The pressures of a busy practice leave many doctors little time to chat about fitness. But Manson says it's either find a way now, or spend much more time with the patient later dealing with the health consequences of obesity. . . . . . . . .
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