Prescription of physical activity

Abstract

I agree with Pedro Hallal and I-Min Lee (Feb 2, p 356)1Hallal PC Lee I-M Prescription of physical activity: an undervalued intervention.Lancet. 2013; 381: 356-357Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar that “prescription of physical activity should be placed on a par with drug prescription”. However, this statement implies that doctors know how to prescribe, monitor, and evaluate the effectiveness of the exercise prescribed (eg, adapting exercise type, intensity, frequency, and duration according to individuals' characteristics, such as age and chronic conditions). Scientific reports2Eden KB Orleans CT Mulrow CD Pender NJ Teutsch SM Does counseling by clinicians improve physical activity? A summary of the evidence for the U.S. Preventive Services Task Force.Ann Intern Med. 2002; 137: 208-215Crossref PubMed Scopus (223) Google Scholar, 3McPhail S Schippers M An evolving perspective on physical activity counselling by medical professionals.BMC Fam Pract. 2012; 13: 31Crossref PubMed Scopus (51) Google Scholar and my experience in a public health programme for the promotion of daily exercise in Brazil suggest that this is not the case. Physicians are not specific enough in their instructions to patients,4Katz MH Writing more specific exercise prescriptions.Arch Intern Med. 2012; 172: 1283-1284Crossref PubMed Scopus (4) Google Scholar these instructions do not provide enough information to empower people to exercise, especially if the patient has a comorbid condition, such as osteoarthritis.Although promotion of physical activity should be part of routine clinical consultations, promotion of an active lifestyle at the individual level, as well as at the population level, needs a multidisciplinary approach involving doctors and other health professionals, including instructors with deep knowledge of sports science.I declare that I have no conflicts of interest. I agree with Pedro Hallal and I-Min Lee (Feb 2, p 356)1Hallal PC Lee I-M Prescription of physical activity: an undervalued intervention.Lancet. 2013; 381: 356-357Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar that “prescription of physical activity should be placed on a par with drug prescription”. However, this statement implies that doctors know how to prescribe, monitor, and evaluate the effectiveness of the exercise prescribed (eg, adapting exercise type, intensity, frequency, and duration according to individuals' characteristics, such as age and chronic conditions). Scientific reports2Eden KB Orleans CT Mulrow CD Pender NJ Teutsch SM Does counseling by clinicians improve physical activity? A summary of the evidence for the U.S. Preventive Services Task Force.Ann Intern Med. 2002; 137: 208-215Crossref PubMed Scopus (223) Google Scholar, 3McPhail S Schippers M An evolving perspective on physical activity counselling by medical professionals.BMC Fam Pract. 2012; 13: 31Crossref PubMed Scopus (51) Google Scholar and my experience in a public health programme for the promotion of daily exercise in Brazil suggest that this is not the case. Physicians are not specific enough in their instructions to patients,4Katz MH Writing more specific exercise prescriptions.Arch Intern Med. 2012; 172: 1283-1284Crossref PubMed Scopus (4) Google Scholar these instructions do not provide enough information to empower people to exercise, especially if the patient has a comorbid condition, such as osteoarthritis. Although promotion of physical activity should be part of routine clinical consultations, promotion of an active lifestyle at the individual level, as well as at the population level, needs a multidisciplinary approach involving doctors and other health professionals, including instructors with deep knowledge of sports science. I declare that I have no conflicts of interest. Prescription of physical activity: an undervalued interventionIn The Lancet, Peter Kokkinos and colleagues1 add to the large body of work on the benefits of physical activity or fitness for health, by showing an inverse association between fitness and all-cause mortality in 10 043 individuals with dyslipidaemia. Irrespective of whether patients were prescribed statins, the physically fittest participants had a 60–70% reduction in all-cause mortality rates during follow-up, compared with the least fit participants (HR for patients taking statins 0·32, 95% CI 0·23–0·45; HR for patients not taking statins 0·37, 0·31–0·44). Full-Text PDF Prescription of physical activity – Author's replyPhilipe de Souto Barreto raises an important issue in response to our Comment1 on the need for more prescription of physical activity by physicians. How prepared are doctors to do so? A survey of 31 medical schools in the UK reported that physical activity education in the undergraduate curriculum is virtually non-existent.2 The situation is not much better in the USA, where only 13% of medical schools feature physical activity education within their curriculum.3 Although we were unable to find statistics, this situation is likely to be more dire in medical schools in low-income and middle-income countries. 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