08/07/2013 02:55 pm ET Updated Oct 07, 2013

Unfit Doctors Withhold Lifesaving Intervention

What if you were to discover that your physician was withholding something that could significantly reduce your risk of cancer, Alzheimer's disease, heart disease, high blood pressure, stroke, Type 2 diabetes, osteoporosis and depression?

"It would be outrageous," you say, "but there's no such treatment."

Outrageous? True. No such thing? False.

This miracle cure is physical activity.

I intentionally use the term "physical activity" and not exercise. Recent research has shown that the amount of time we spend sitting correlates with reduced metabolic function, increased triglycerides and decreased HDL-cholesterol (the good one), decreased insulin sensitivity and impaired carbohydrate metabolism. These are the usual suspects in any discussion of cardiovascular disease, diabetes or obesity.

Unfortunately the negative effects of prolonged sitting are not significantly reversed by exercise. It appears that physical activity and sedentary behavior act independently through different mechanisms. This would explain why the damage of prolonged sitting (>10 hours per day) is not mitigated by 30 minutes of daily exercise.

A sedentary lifestyle is a controllable cardiac risk factor with a prevalence of at least twice that of smoking, high blood pressure, and elevated cholesterol. Given this well documented connection between physical activity and health, isn't there an ethical obligation for physicians to prescribe this intervention? Unfortunately, most physicians do not prescribe it much less ask about the form it takes in their patients' lives.

Has your doctor ever asked you how many hours you sit each day? This is essential health data and differs from how much exercise you get. A 2010 survey revealed that approximately one in three patients who had seen a health professional had been advised about physical activity.

Why do so few physicians speak with patients about this?

Several barriers have been identified, including limited time and lack of reimbursement. But two factors are particularly troubling. The vast majority of doctors lack training in this arena. In 2002, only 13 percent of 102 U.S. medical schools included physical activity and health in their curricula. Educating physicians is essential because simply suggesting more exercise or activity has been shown to be ineffective. A comprehensive personalized prescription must include type of activity, specific workloads, duration and frequency, intensity guidelines and precautions. Follow up counseling during regular check-ins to help overcome obstacles and resistance or answer questions dramatically raises compliance rates and health gains.

The second barrier to doctors prescribing activity/exercise has to do with the personal lifestyle and fitness of the doctors.

Studies have repeatedly demonstrated that inactive doctors are less likely to give activity/exercise counseling. In addition, when unfit physicians do prescribe exercise the patients' compliance rates are low. Not surprisingly, a doctor who doesn't "walk the talk" is a less credible role model.

A generation ago no one paid any attention to the lifestyle, fitness or health of the doctor.
It was assumed that a cardiologist could be overweight and even smoke and still be an effective cardiologist. Those days are gone. We now know that the health of the healer directly impacts the patient.

Physician, heal thyself in order to heal others.

For more by Paul Spector, M.D., click here.

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