Imagine you are lying in bed two days after having open-heart surgery in which three of your coronary arteries were replaced -- a procedure commonly referred to as a "coronary artery bypass graft," or CABG. This was preceded by a trip to the emergency room three days earlier after experiencing a progressive squeezing in your chest similar to being hugged by the largest bear at the zoo. Just before surgery, the surgeon tells you that with the extent of your coronary blockage you are very lucky to be alive. Pretty scary.
So, you have had your surgery two days ago, and the surgeon walks into your room while making rounds. After he does a quick review of your vitals and asks you how you are feeling, you ask the doctor, "How do I keep this from happening to me again?"
The doctor replies, "You got to get out of that recliner at home and start being more active."
"What should I be doing?" you ask, expecting something detailed -- after all, you are lucky to be alive. You had three mostly-blocked arteries.
"Just walk, " he says.
"How fast?" you ask, expecting a bit more.
"Just start slow and build up," the doctor responds very casually. After all, he is not the one that suffered a major heart attack several days ago. The doctor appears to be finished talking about it as he makes his way toward the door.
Where is this story going you ask? Is there a point to imagining this happened to you? Most definitely, that is, if you are at all like me. And here it is. If I had just had a serious health scare such as the one just described, I would want far more detailed exercise advice than just being told to be more active or just walk.
Being told to "be more active" or "just walk" would simply not be good enough. I wouldn't know how far to walk or how long, how fast to go or how often. How much is enough? How much is too much? If I do too much am I likely to have another heart attack?
Doctors need to take the time to be a bit more detailed when giving instructions to their patients regarding not only the need for exercise, but how to do it. That is, doctors need to know the current guidelines for prescribing exercise so that they feel comfortable doing so. Ideally, patients need to leave the doctor's office with an exercise prescription in hand, complete with frequency, intensity and duration guidelines.
I believe providing patients with written prescriptions for exercise that contains all of the pertinent details as to how to do it, would increase the total number of people that exercise. The American College of Sports Medicine, in conjunction with the American Diabetes Association, has published a position paper on exercise prescription guidelines that explains in detail their current recommendations.
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