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primary health care

Feb 3, 2012

When doctors "prescribe" exercise, does it make any difference?

Doctors are often encouraged to "prescribe" exercise to sedentary patients, but it's not been clear whether such initiatives make any difference, to either peoples'  level of activity

Doctors are often encouraged to “prescribe” exercise to sedentary patients, but it’s not been clear whether such initiatives make any difference, to either peoples’  level of activity or their health.

In its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) highlights a recent systematic review and meta-analysis investigating the issue.

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An important question in need of an answer: how to get patients moving?

Amanda Carne, Research Associate, Primary Health Care Research & Information Service (PHC RIS), writes:

Moderate physical activity has been consistently identified as a key factor in the improvement of health and overall wellbeing.

Yet many Australians appear to ignore the recommendation to achieve at least 30 minutes of moderate intensity physical activity throughout the day, with an alarming one in four Australians classified as obese. The consequences of obesity include increased risk of chronic health conditions, increased service use and increased mortality, and represent a significant burden on the health care system.

With the recent Healthy Weight Week (22-29 January 2012) and current reality TV weight loss shows going head-to-head in evening television, it is timely to consider the question of whether prescribing exercise improves health outcomes.

English researchers recently assessed the impact of exercise referral schemes on physical activity and health outcomes.  They advocated primary care as a key setting for promoting physical activity.

Exercise referral schemes require GPs (or a member of the primary care team) to identify and refer sedentary individuals with cardiovascular risk factors to a third party service (i.e. a sports centre or leisure facility). This service then prescribes and monitors an exercise programme tailored to the individual needs of the patient.

So, how good are exercise referral schemes for getting at risk patients to exercise?

The authors conducted a systematic review on primary care-based exercise referral scheme interventions, with mixed results.

When comparing eight randomised controlled trials with usual care, no intervention, or alternative exercise referral schemes, under their strict criteria they found weak evidence of short-term increase in physical activity and reduction in depression levels. But they did not find consistent evidence that exercise referral schemes increased physical fitness, psychological wellbeing, or other health indicators.

However, despite these findings, the researchers suggest that exercise referral schemes remain a potentially valuable primary care intervention for promoting physical activity.

While this systematic review did not find conclusive evidence in favour of exercise referral schemes, the issue may be more complex – generic exercise programs may work but for some reason referrals do not – and therefore requires more focussed research with possibly longer follow-up periods.

Despite a clear need to get people “moving”, it seems that we still haven’t found a really effective model for practitioner or patient.

• Pavey TG, Taylor AH, Fox KR, Hillsdon M, Anokye N, Campbell JL, Foster C, Green C, Moxham T, Mutrie N, Searle J, Trueman P, and Taylor RS (2011). Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis. BMJ, 343

This article, which can be accessed at http://www.ncbi.nlm.nih.gov/pubmed/22058134, features in the 2 February 2012 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php.

The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php

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Previous PHC RIS posts:

• Caring for country is also good for Aboriginal people
http://blogs.crikey.com.au/croakey/2012/01/27/caring-for-country-is-also-good-for-aboriginal-people/

• The perils of surrogate markers
http://blogs.crikey.com.au/croakey/2012/01/20/what-matters-in-healthcare-surrogate-markers-or-patients/

Are Australians willing to pay more for better oral health?
http://blogs.crikey.com.au/croakey/2011/12/15/are-australians-willing-to-pay-more-for-better-oral-health/

• What helps encourage self-care for those with chronic illness?
http://blogs.crikey.com.au/croakey/2011/12/08/for-those-with-chronic-illness-what-helps-encourage-self-care/

• More effort needed to strengthen shared care for people with serious mental illness

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