Many Doctors Overlook a Key Prescription: Dose of Exercise

“If exercise is so important to my health, why has no doctor ever discussed it with me?”

That question has been bothering Burling Lowrey, a 70-year-old Washington freelance writer.

“Over the past 20 years, I have been to a variety of internists and specialists for a variety of ailments,” he said, “and not one . . . ever mentioned exercise and / or diet as a procedure for me to follow.”

A regular exerciser, Lowrey occasionally tells his doctors that he walks on a treadmill and lifts weights, but “they don’t even respond,” he said. “I’m puzzled by a near-obsession about these healthy behaviors in the media and the apparent total lack of interest in them from doctors.”

Lowrey’s experience is all too common, public health experts say.

“Many providers do not believe that physical activity is an important topic to discuss with their patients, and many lack effective counseling skills,” concluded last year’s U.S. Surgeon General’s Report on Physical Activity and Health.

Despite the demonstrated health benefits of even moderate exercise, “only an estimated 30% of doctors effectively counsel patients about regular physical activity,” said Michael Pratt of the U.S. Centers for Disease Control and Prevention.

Increasing that proportion to at least 50% is one of the federal government’s health objectives for 2000, Pratt said, pointing to a new CDC-funded project called PACE, Physician-based Assessment and Counseling for Exercise.

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A nonprofit program developed at San Diego State University, PACE provides a comprehensive kit of materials to help doctors get their patients moving.

“One of the main reasons most doctors don’t counsel patients about exercise is lack of training in physical activity,” said project co-director James Sallis, professor of psychology at San Diego State.

“In most medical schools it’s not even on the syllabus, so many doctors aren’t confident in their knowledge.”

PACE provides educational materials to help doctors write safe, effective exercise prescriptions that are tailored to each patient’s needs.

Time pressure is another reason cited by doctors who don’t counsel patients on fitness, and PACE addresses that concern by incorporating waiting room “downtime” in the process.

When patients arrive for a regular appointment, the office staff give them a brief questionnaire about their current level of physical activity and health status. Based on this information, which identifies their readiness to make a behavior change, they get one of three PACE counseling packets:

* Couch potatoes (not active, not interested in exercise) receive materials designed to encourage them to simply consider ways to get moving.

* Contemplators (infrequent exercisers who would like to do more) get information on making a specific plan to start an exercise program.

* Actives (regular exercisers) receive information about continuing their activity.

Patients are encouraged to read these materials and answer questions about their goals and barriers to exercise while waiting to see the doctor. Then, during their exam, the physician uses their answers to make activity recommendations.

The process is followed up with a postcard or phone call from the office staff about two weeks after the appointment to check on the patient’s progress.

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Studies of PACE’s effectiveness, reported in the journal Preventive Medicine, showed that physicians were able to counsel patients in three to five minutes. Patients who received counseling reported increasing their walking by about 40 minutes a week.

PACE is now being used in hundreds of physicians’ offices around the country, and material is being revised to include nutrition information.

Although PACE is just one of a growing number of public health programs designed to jump-start sedentary Americans, it has the potential of being the most effective.

The well-documented “power of the white coat” suggests that people take a doctor’s advice extremely seriously, said PACE co-director Kevin Patrick, a family and preventive-medicine physician at San Diego State.

“Those few minutes a doctor takes to put his or her hand on a patient’s shoulder and say, ‘I’m concerned that your inactivity is harming your health,’ could be exactly the stimulus a sedentary person needs to finally get moving.”

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For more information on PACE, call (619) 594-5949, e-mail Project.pace@sdsu.edu or visit the World Wide Web site at https://shs.sdsu.edu/pace/.