Should doctors be prescribing exercise?

With the extensive health benefits of exercise as they’ve been outlined, it’s time to drill a bit deeper into the reasons as to why  many aren’t enjoying them. To get some answers, and find out what we could do about the problem, I visited Raj Amranani, sports and exercise medicine specialist at University College Hospital in London…

Raj - There are really lots of challenges, both from a personal point of view, but also from an environmental point of view, that people find difficult to overcome in order to engage with physical activity. Across studies, the top three significant barriers have often been time, energy, and motivation. There are lots of other barriers and these include things such as cost of access to exercise resources, a lack of facilities in the local area, concerns around illness and injury, and not having the confidence to take part in physical activity. There's also other areas around family and lifestyle. So, for example, unaffordability of childcare in order to be able to engage with physical activity, but also finding programmes that are near to people so they feel suitable or comfortable engaging with them. So, as we can see, a huge host of barriers towards physical activity.

James - I know there's been talk of a tool in the arsenal being doctors prescribing people with exercise. Is that something that can work? Is it effective?

Raj - It's a really good question, and I think we know that being very prescriptive and telling patients exactly how to exercise often can be really unsuccessful, actually. It's actually about having what we call active conversations with patients in order to encourage them to take part in physical activity and make it a part of their lifestyle. Despite this, however, we know that there's a huge challenge for healthcare professionals because, from a knowledge point of view, we know that physical activity often isn't taught in medical curriculums, and often we find that healthcare professionals struggle with having those skills in motivational interviewing and behavioural change counselling.

James - Especially with the health benefits as they've been outlined, and the thought that, if exercise were a pill, it'd be a trillion dollar enterprise or more, to hear you say that medical professionals often don't feel confident in having those conversations with patients is quite shocking.

Raj - No, absolutely. Another sad, unfortunate situation is that of course with the NHS and the pressures that it's going through at the moment, often appointments are very streamlined and often doctors find that they don't have the time to have those conversations with patients. And actually there's lots of resources now that are coming out to try and address that. One example is the Moving Medicine initiative that provides free to access resources for healthcare professionals on how to have those active conversations. Even if you have one minute at the end of your consultation, to start that conversation around physical activity, we know that it could be really beneficial and it can help patients start thinking about how they move towards a more physically active lifestyle.

James - And on those conversations, as you were saying, people generally don't really like being told what to do that much and, as much as they might know it could benefit their health, it's that lack of autonomy that stops people engaging with it. So tell me a bit about those strategies to overcome this and make it feel like more of a decision they've come to themselves rather than something they're being instructed on.

Raj - We normally suggest talking to them in such a way where it actually ends up them telling themselves that a more active lifestyle would be better for them is often a lot more successful. So, for example, rather than jumping in with a suggestion on how to become more active, actually spending that time going through things about what's important to them, how they might best get started, or who they might like to do an activity with can be much more likely to actually change their behaviour and incorporate that physical activity into the day-to-day lives.

James - What happens then if that fails, essentially? If, despite the best intentions of the doctor, they've failed to reach that agreement with the patient. For whatever reason, they are still having trouble with hitting those recommended targets.

Raj - We know that actually there are lots of barriers towards physical activity that we've talked about. And one of the main solutions to try and address that is actually a sense of belonging and a sense of community. So there's lots of initiatives such as Parkrun that do encourage people to come out of their bubble and actually meet their friends, meet family, and do something a bit more physically active. That sense of being part of something that's slightly bigger than them can be really helpful. Often we find that encouraging patients to take part in group exercises and group classes is beneficial.

James - And one of the things that's particularly alarming as well is that youth participation levels in sport where physical activity is traditionally higher anyway is starting to fall. Is there a risk of not establishing those habits, not establishing a relationship with exercise?

Raj - Yes, absolutely. That is hugely important. And we know that actually being physically active at a younger age does set those good habits for the future. There have been studies that children as young as 11 years old, the way they conceptualise physical activity and understand the importance of it really has a lasting association and impact as to how they then engage with it going forward as they get older. So we know that setting those examples at a really young age and getting children outside of computer games and off their phones and back into parks and back into playing sport can be a massive benefit for their future.

James - Thank you very much for speaking with me.

Raj - Thank you very much for having me James.