Posts Tagged ‘American College of Sports Medicine’

Check with your doctor before exercising? For what?

Friday, February 8th, 2008

It is the ultimate cover your a** statement placed on any piece of exercise equipment, exercise video, exercise book, exercise facility, etc. It comes in many variations, but the message is the same: You could die or get seriously hurt if you engage in this exercise related activity.

How’s that for encouraging our obese, lower back pain crippled society to exercise? I can’t think of a better way to scare off those who need exercise the most.

We’ve all seen a variation of this warning a million times. And anyone with a mild interest in exercise has probably become oblivious to it because they’ve seen it so many times.

This warning obviously is important to a very small percentage of the population. And even those in that small percentage should not be discouraged from starting a gentle exercise program (such as walking) before seeing their doctor.

But here is the biggest surprise of all: Your doctor is not going to tell you how to exercise because your doctor does not know anything about exercise prescription. As brilliant as he or she might be, the extent of their exercise knowledge is likely limited to their own personal experience (and for some, it’s not even that).

Even if the doctor is physically fit, there is little correlation between what he does to stay in shape and what his patient needs to do. Instead, what the physician should be doing is referring patients with risk factors to a degreed and certified exercise professional that has experience working with that type of client.

Too many physicians are not even recommending exercise in the first place. This begs the question, “Why not?!” Under what rock must a physician be living to not know about the countless studies that support the benefits of exercise on lifestyle related diseases and disabilities?

A survey, “Fitness American Style II” commissioned by IHRSA (International Health, Racquet and Sportsclub Association) found that 70% of Americans say they had an annual physical last year. But only 28% said their doctor suggested exercising regularly to improve their overall health, and only 41% said their doctor asked if they exercised regularly.

The American College of Sports Medicine has initiated a program in partnership with the American Medical Association that is “Calling on physicians to assess and review every patient’s physical activity program at every visit”.

It’s great to see this happening. But once the physician assesses the patient’s physical activity and finds out they are not doing enough-then what? This is where I believe the medical field over estimates the influence they have over their patients. Because most doctors believe that if they just tell their patients to exercise the patient will immediately follow that advice.

The reality is that these patients have never exercised or have not exercised for an extended period of time for their own reasons (whatever they may be). We refer to these as “barriers to exercise”. With all due respect to the doctors, they do not wield the same influence that their house-call making predecessors did. Patients now literally have to be scared to death before they see the consequences of their lifestyles.

One of the best ways to overcome barriers to exercise is for the doctor to provide the patient with clear directions for the next step. Since the doctor is not an exercise expert, those directions should involve a direct referral to a qualified exercise specialist.

Here is where the “check with your doctor part” becomes most valuable. The doctor’s referral should include what the patient should NOT do, also referred to as “contraindications”. This saves the doctor time and the potential embarrassment of not knowing what to tell the patient to do.

For example, the patient 6 months out from a hip replacement will have specific ranges of motion to avoid. This is great information for the doctor to include and for the exercise professional to be aware of.

Another example is the hypertensive patient on beta blockers who should not exceed 60% of their maximum heart rate. The exercise specialist can safely work within these parameters

That is step 1. The doctor documents this in the patients file and can follow up with them on their next visit.

Step 2 is when contact has been made with the qualified fitness specialist. Now that professional is in a position to use their expertise. Their expertise is not just about designing a safe exercise program. It also involves many of the skills necessary to help this person overcome many of the past barriers to exercise. Then it is the exercise specialist responsibility to communicate their assessment, objectives and plan to the physician.

During your next doctor’s visit, let them know your current exercise status. If they don’t ask, tell them anyway. Ask them for contraindications. And then ask them for a referral to an exercise specialist. If they look like a deer in the headlights with this question, tell them you know this group called Function First…..

Exercise specialist can find lots of great tools for working with doctors in my book, Relationships and Referrals: A Personal Trainer’s Guide to Doing Business with the Medical Community. Relationships and Referrals cover