...Then, consider these points:
TREATING LIFESTYLE-RELATED ILLNESSES WITH DRUGS IS ONLY MODERATELY SUCCESSFUL
Cardiovascular drugs, drugs that lower cholesterol, and drugs that control weight and diabetes are the top categories of drug expenses in the US. However, patient compliance with these medications is poor:
• Antidiabetic Drugs: A study of 6090 newly-diagnosed diabetics revealed that 37% had stopped taking their antidiabetes medication 12 months later (Clin Ther 2005;27:1064-1073.)
• Antihypertensive Drugs: An analysis of 4783 hypertensive atients revealed that almost half had discontinued their medication at the end of the first year (BMJ 2008;336:1114-1117.)
• Lipid-Lowering Drugs: Numerous studies have documented poor long-term compliance with statin drugs. In one, only 25-40% of patients took their statin drugs as prescribed during the 2 years they were monitored. (JAMA 2002;288:462-467.)
• Post-MI Drugs: 12% of post-MI patients discharged on aspirin, a beta-blocker, and a statin drug had stopped taking all 3 drugs within the first month (Arch Intern Med 2006;166:1842-1847.)
EXERCISE IS MORE EFFECTIVE THAN DRUGS FOR LIFESTYLE-RELATED HEALTH PROBLEMS
Many studies show that exercise can match and even exceed the therapeutic power of drug therapy. Here are several:
• Walking: Regular, brisk walking reduced the need for antidiabetic, antihypertensive, and lipid-lowering drug therapy by roughly half in both men and women (Med Sci Sports Exerc 2008;40:433-443.). In another study, a daily 3-mile walk was estimated to lower annual drug costs in diabetics by roughly $600/yr per person (Diabetes Care 2005;28:1295-1302.)
• Running: Twenty-four of 47 patients receiving drug therapy for hypertension were able to discontinue all drug therapy after running 2 miles per day for 3 months (Am J Med 1984;77:785-790.).
• Cycling: Thirteen of 24 chronic renal failure patients receiving hemodialysis required less intensive drug therapy for hypertension after riding a stationary bicycle for 6 months. The cost savings was estimated to be $885/patient-year (Am J Kidney Dis 2002;39:828-833.).
The health benefits that exercise offers far exceed what any drug or group of drugs can provide. While statin drugs do lower LDL-cholesterol, and, ACE inhibitors do lower blood pressure, none of these drugs improve aerobic fitness, bone density, muscle strength, weight loss, cognitive function, mood, sleep quality, balance, etc. No drug, or group of drugs even comes close!
IT'S NOT A "DISEASE," IT'S AN "EXERCISE DEFICIT"
Health problems that arise in patients who are sedentary mostly reflect an imbalance of normal physiology. In these patients, atherosclerosis is not a "disease" in the classic sense like lupus, epilepsy, cystic fibrosis, etc., but, rather, more of an "exercise deficit," if you will. Thus, it is more logical to base the treatment on a physiologic approach, not a pharmacologic one. The primary therapeutic agent should be exercise, not a complex array of drugs that only address the various manifestations of that process. Prescribing drugs in lieu of exercise is like treating the symptoms of iron-deficiency anemia without replacing iron stores, or, treating the symptoms of hypothyroidism without prescribing levothyroxine.
Professor Steven Blair has recently concluded that "physical inactivity is the biggest public health problem of the 21st century." After analyzing over 40,000 patients, he shows that "low cardiorespiratory fitness" was the biggest contributor to death than any of the other traditional risk factors that clinical medicine currently monitors....in fact, it was substantially higher than risk factors that currently get most of the attention such as obesity and high cholesterol (Br J Sports Med 2009;43:1.)
"Lifestyle"-related illnesses now represent the largest percentage of health care expenses in the US. Because of less-than-adequate results, continuing to attack this with drugs and complex (and expensive!) procedures doesn't make much sense. The way we see it, prescribing drugs for lifestyle-related disease is about as silly as a dentist prescribing a drug to prevent cavities! A lifestyle-related health problem requires a change in behavior, not drug therapy.
A NEW STRATEGY IS COMING TO HEALTH CARE
A new strategy is coming to health care. Stanford professor Walter Bortz, MD, has proposed the concept of "a new class of medical professional trained to promote health rather than treat disease” in his latest book “Next Medicine: The Science and Civics of Health.”
The title of an article in Mayo Clinic Proceedings from 2002 states it pretty clearly: "An Obligation for Primary Care Physicians to Prescribe Physical Activity to Sedentary Patients to Reduce the Risk of Chronic Health Conditions." (Mayo Clin Proc 2002;77:165-173.)
Virtually all major medical advisory groups now endorse exercise as a viable health strategy:
• The American College of Sports Medicine (ACSM) and the American Medical Association (AMA): ACSM and the AMA jointly launched the “Exercise Is Medicine” initiative in November 2007. This campaign calls on all physicians to “prescribe” exercise as they would for other traditional therapeutic agents.
• Dept. of Health and Human Services: The US Government issued its first set of Physical Activity Guidelines in June 2008.
• Presidential Committee on Exercise: The National Physical Activity Plan was released May 2010.
• Healthy People has been providing exercise / physical activity recommendations for decades.
We, too, have been pushing exercise as a therapeutic agent. We launched AthleteInMe.com® in 2005, and, an entire chapter in Reents' text Sport and Exercise Pharmacology is devoted to the concept of prescribing exercise to "treat" health problems. (That book was published in 2000!)
Cardiovascular disease has been the #1 cause of death in adults in the US every year since 1900! (except for 1918, when there was an influenza outbreak). After more than 100 years, is it perhaps time to try a different approach? We think so!
What would happen if we focused more attention on exercise as a therapeutic agent in health care? Answer: We might have a better impact on cardiovascular diseases!
REFERRING YOUR PATIENTS TO A QUALIFIED HEALTH / FITNESS COACH IS THE PERFECT SOLUTION TO MANAGING LIFESTYLE-INDUCED ILLNESSES
Let’s face it, you don’t have time to educate your patients how to exercise properly, even if you did have the background, training, and knowledge. Thus, it is critically important that you have a reliable fitness resource to refer your patients to.
Referring your patients to a qualified health/fitness coach is no different than referrals to other non-physician health care professionals (ex: referring a patient who needs back rehab to a physical therapist, or, referring newly-diagnosed diabetics to nurses and pharmacists who provide diabetic teaching). For some tasks, these allied health professionals perform better than physicians:
- Cholesterol counseling: Registered dietitians do a better job than physicians (Am J Med, 2000;109:549-555.)
- Medication counseling: Pharmacists routinely obtain more thorough drug histories from patients than physicians do.
HOME-BASED EXERCISE, COMBINED WITH EXPERT GUIDANCE, IS AN IDEAL STRATEGY FOR MANAGING LIFESTYLE-RELATED ILLNESSES
Many of the major health insurers (Aetna, BC/BS, Humana, etc.) offer discounted gym memberships to their clients.
This is helpful, but annual stats routinely show that only about 12-14% of adults in the US belong to a gym. And, a large percentage of those people don't even attend!
It turns out that home-based exercise -- with proper guidance -- often produces better results than hospital-based or gym-based programs in patients with health problems:
• In adolescents: A remote counseling program utilizing the Internet, telephone counseling, and printed materials improved exercise and nutrition behaviors in adolescents (Arch Pediatr Adolesc Med 2006;160:128-136.).
• Cancer Survivors: Cancer survivors who exercised at home and received guidance via telephone counseling and printed materials had a reduced rate of decline in functional status and an improvement in quality-of-life (JAMA 2009;301:1883-1891.).
• Patients with coronary artery disease: Ten patients exercised in the hospital for 1 month, then, at home for 5 months. The home-based program involved riding an exercise bike for 20 min/day (7 days per week) and 1 group exercise session per week. After 6 months, coronary endothelial function was effectively maintained by the home-exercise program, though the response had declined somewhat compared to the 1st month of hospital-based exercise (Am Heart J 2003;145:e3.)
• Obese patients: A home-based walking program achieved higher adherence and better weight loss at 12 months and 15 months compared to a group-based exercise program (J Consult Clin Psychol 1997;65:278-285.).
• Patients with CVD, or COPD, or arthritis: A Cochrane Review compared home-based exercise vs. traditional center-based exercise and found that home-based exercise was a better strategy because long-term adherence was higher (Cochrane Database Syst Rev 2005;25:CD004017.)
Hopefully, by now, you are convinced that exercise truly is the one "magic bullet" you have in your arsenal, and, that exercise counseling can be provided at home.
"But where can I find such a service?," you might be asking.... You just did!!