Heart Rehab

Cleveland Clinic exercise physiologist Audra DiRauso sets up an exercise bike for Anthony Rugare during a cardiac rehabilitation class Monday, Dec. 21, 2009, in Cleveland. Researchers found people who completed all 36 sessions of cardiac rehabilitation that Medicare covers were less likely to die or suffer a heart attack in the following three to four years. (Mark Duncan/Associated Press)

The Public Health Agency of Canada says three out of every five Canadians has at least one chronic condition such as heart or lung disease.  Doctors are good at prescribing pills.  An article just published in the Canadian Medical Association Journal says they should prescribe regular exercise in addition or even instead of pills.

Exercise has long been shown to benefit patients with a variety of chronic conditions. When it comes to reducing the chance of dying from a heart attack, regular workouts are just as effective as pills. The same goes for rehabilitation following a stroke, preventing diabetes, lowering blood pressure and treating heart failure. For non-life threatening conditions like back pain and osteoarthritis, exercise has substantial benefits. Despite this, many doctors seldom prescribe exercise, and instead prefer to prescribe medication or recommend surgery.

Makes you wonder why they don't. It's tempting to say doctors are in the pockets of drug companies. I'd say many of us undervalue exercise and overvalue pills.  Many doctors know little if anything about the effectiveness of regular exercise on health.  Even when they know that exercise is a good thing, they know little about what kind of exercise to recommend.  

The authors of the article – from Bond University in Australia – say medical schools don't teach budding physicians which types of exercise have the greatest benefit – much less how to help patients set up an effective workout routine.  Some of that isn't the doctor's fault. More than 60 per cent of the published studies that recommend exercise don't tell patients or their doctors how to do what they recommend. Surprisingly, nearly 60 per cent of the published routines for heart patients failed to have an adequate description of the recommended exercises.

To bridge the gap, check out the article, which I have linked.  The authors put exercise plans into boxes that are easy to read, with clear instructions on what to do, what materials or equipment are needed, and what kind of health care provider should supervise the workout – from physician or nurse practitioner to physiotherapist to exercise physiologist.

The exercise program varies with the condition.  For people with arthritis of the hips and knees, it's muscle strengthening plus range of motion exercises to relieve pain and improve function.  For low back pain, it's an eight to 12 week program supervised by a physiotherapist plus exercises done at home.  There's an exercise program to help prevent falls in frail seniors, and another for people with chronic obstructive pulmonary disease.  For each condition, the benefits of exercise are spelled out clearly.

Each set of exercises comes with appropriate precautions.  Not surprisingly, you can't start a cardiac exercise program if you have uncontrolled heart failure, unstable angina or chest pain, and if you are prone to heart rhythm disturbances.   
For people with osteoarthritis, the exercise program should be modified if the joints are inflamed.  Seniors who are starting a workout program to prevent falls are at increased risk of falling.  As well, extra precautions need to be taken if they also have heart or lung disease.  People with back pain might find that the pain is temporarily worsened in the early stages of an exercise program.  People who are starting a rehabilitation program for pulmonary disease need to be aware that some have heart disease that needs to be stabilized first. 

I think there's great potential for doctors to help patients help themselves.  But as much as I like the idea, I doubt doctors will do more than tell patients to get more exercise.  I suspect your GP will refer patients to rehabilitation programs rather than do the prescribing.  Depending on the condition, some provinces pay for exercise programs.  My hope is that group family practices and family health teams hire health coaches and other providers to run their exercise programs. Health coaches provide peer support and help motivate patients to exercise and eat better.  They're adept at turning suggestions by the doctor into achievable goals.

The bottom line is that exercise is as powerful as the most potent prescription drugs. If you know how to do it.  

Now, there's no excuse.