Blogfinger

Do this and look like them. Exercise for health.

USA Today (2/9, Hellmich) reports that just “one in three people in the USA say their doctor advised them to start exercising or continue doing so during an office visit over the course of a year, a new government study shows.” These “findings are based on interviews with more than 60,000 people as part of the CDC’s National Health Interview Survey.” The survey indicated, “In 2010, 56% of adults with diabetes were advised to exercise; 44% of patients with high blood pressure; 41% with heart disease; 36% with cancer.”

Blogfinger Medical Commentary by Paul Goldfinger, MD, FACC.

It’s funny, but just about everybody, not only doctors, knows that exercise is good for one’s health. The medical literature is replete with studies that show benefits for heart disease, diabetes, lung disorders, obesity and other issues. But probably the most widespread potential usefulness is in the area of preventive medicine for apparently healthy individuals, including children.

So, despite the ready availability of this important, safe, beneficial and low cost modality, doctors do not usually discuss exercise with their patients. My cardiologist always asks me about it, but my other doctors do not. What is the reason? It’s complicated.

This failure on the part of doctors is inexcusable, but it is no different from the failure to deal with other prevention issues such as nutrition, smoking, psychological factors and weight. A number of clinical studies have shown that even cardiologists may not achieve target blood cholesterol goals with heart patients. The reasons for these failures in the area of prevention are multifactorial and deserve more study.

I think that many physicians, including some cardiologists, don’t know much about exercise physiology and they do not know how to write an exercise prescription. I saw a talking-head doctor on TV last week who was asked why physicians order too many exercise stress tests. He was quick to answer, but his answer was nonsense. He said that physicians did too many stress tests on “normal” people, implying that the test was useless unless the patient had heart disease.

Exercise testing is a complicated subject, and he shouldn’t have attacked the profession on this issue. I was afraid that he, single handedly, might cause the death of someone who saw the show and then tore up a doctor’s script for an ET (exercise test).

For a person who wants to embark on an exercise program, especially if they have been sedentary and/or are in certain high risk groups, a doctor should order a stress test in order to get a baseline as to physical conditioning, to look for issues such as breathing difficulty or leg cramps and to see if there are any worrisome cardiovascular indicators involving blood pressure, heart rhythm , symptoms like chest pain or ECG changes. The test is not 100%, and yes, someone can have a heart attack after “passing” a stress test, but the test is, nevertheless, important in the hands of a doctor who knows how to interpret the results.

Patients need to get involved in their own care. If their doctor fails to mention exercise, then the patient must bring it up.  Exercise can be dangerous for some individuals, and the physician should provide guidance.