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Exercise: The 5th Vital Sign?
Jon Opsahl, MD, MPH, TLC
The American College of Sports Medicine (ACSM) has been leading a global initiative called "Exercise Is Medicine" (EIM) since 2007. For over 15 years, it has been trying to get doctors and other health care professionals to address physical activity (aka: exercise) as the 5th vital sign with "every patient at every clinical encounter" as doctors do for the four traditional vital signs: 1) Body Temperature, 2) Heart Rate, 3) Respiration Rate, and 4) Blood Pressure. But for some "unknown" reason, doctors have been resistant to adopting this new clinical standard.
The traditional four vital signs are standard in most medical settings, because of their direct implications regarding potential physiological responses to an acute illness or injury. These vital signs provide critical information for a) Determining the possible cause of many life-threatening conditions, b) Implementing the appropriate treatment, and c) Tracking the patient’s response.
ACSM asserts that the demands on healthcare have changed. Over 80% of the conditions that present in a medical clinic are NOT in response to an acute process, but rather a chronic one. One that is most likely associated with a sedentary (physically inactive) lifestyle.
Indeed, they are right! Heart disease, high blood pressure, high cholesterol, type 2 diabetes, obesity, depression, and many forms of cancer can be largely attributed to a lack of exercise.
More importantly, research has clearly shown that engaging in regular exercise can prevent, and often reverse, the devastating effects of these chronic diseases. The National Guidelines recommend that everyone should get at least 150 minutes of physical activity per week. That's only 30 minutes per day, 5 days per week. It's a reasonable and very cost-effective approach for alleviating the disease burden plaguing our modern society.
So why don't doctors at least ask the questions to get the "vital" information regarding their patient's exercise patterns? And, if their patient isn't getting the recommended amount, why doesn't the doctor make it perfectly clear that exercise is powerful medicine, and that it must be part of their treatment plan, that is, if the patient wants a favorable outcome?
There are several reasons why doctors haven't adopted exercise as the 5th vital sign, and their answers might surprise you:
The first reason is because doctors prefer objective and precise information. They report that the responses to their questions about exercise are vague and unreliable. In fact, most doctors are skeptical that their patients even know the truth. "Most of my patients think they’re more active than they actually are, or they’ll often tell me what they think I want to hear in order to avoid the lecture and get their pills."
Although that may be the case for some patients, other doctors don't ask the questions simply because they think they already know the answers. "My patients are all overweight and terribly deconditioned. I know they're not exercising regularly. If they were, they would be in much better shape, and they probably wouldn't need to be on so much medication."
Beyond this, many other doctors simply assume that their patients already know they should be exercising regularly. "My patients know full well about the many benefits of regular exercise. They didn't come to see me for the obvious advice that they should get their butts off the couch once in awhile."
Then another study was done to discover the difference between the many doctors who refuse to ask about exercise from the few doctors who consistently do. Their findings were quite sobering. The doctors who didn't ask were out-of-shape themselves and didn't practice a healthy, active lifestyle. The doctors who were more lifestyle-oriented themselves had no problem asking the questions and coaching their patients in therapeutic lifestyle change.
Which patients do you think achieved better treatment outcomes?
If we truly want to fix our health care system and help patients avoid disease and enjoy a higher quality of life, we'll have to address the health of our healthcare providers, because the old adage proves true: "Physician, heal thyself!" (Luke 4:23) And, since the American way of life, along with our current medical system, has proven to be hazardous to our health, the same adage holds true for every patient, as well.
As a health/fitness professional, and/or as a patient, are YOU ready to take control of your health and life?
The traditional four vital signs are standard in most medical settings, because of their direct implications regarding potential physiological responses to an acute illness or injury. These vital signs provide critical information for a) Determining the possible cause of many life-threatening conditions, b) Implementing the appropriate treatment, and c) Tracking the patient’s response.
ACSM asserts that the demands on healthcare have changed. Over 80% of the conditions that present in a medical clinic are NOT in response to an acute process, but rather a chronic one. One that is most likely associated with a sedentary (physically inactive) lifestyle.
Indeed, they are right! Heart disease, high blood pressure, high cholesterol, type 2 diabetes, obesity, depression, and many forms of cancer can be largely attributed to a lack of exercise.
More importantly, research has clearly shown that engaging in regular exercise can prevent, and often reverse, the devastating effects of these chronic diseases. The National Guidelines recommend that everyone should get at least 150 minutes of physical activity per week. That's only 30 minutes per day, 5 days per week. It's a reasonable and very cost-effective approach for alleviating the disease burden plaguing our modern society.
So why don't doctors at least ask the questions to get the "vital" information regarding their patient's exercise patterns? And, if their patient isn't getting the recommended amount, why doesn't the doctor make it perfectly clear that exercise is powerful medicine, and that it must be part of their treatment plan, that is, if the patient wants a favorable outcome?
There are several reasons why doctors haven't adopted exercise as the 5th vital sign, and their answers might surprise you:
The first reason is because doctors prefer objective and precise information. They report that the responses to their questions about exercise are vague and unreliable. In fact, most doctors are skeptical that their patients even know the truth. "Most of my patients think they’re more active than they actually are, or they’ll often tell me what they think I want to hear in order to avoid the lecture and get their pills."
Although that may be the case for some patients, other doctors don't ask the questions simply because they think they already know the answers. "My patients are all overweight and terribly deconditioned. I know they're not exercising regularly. If they were, they would be in much better shape, and they probably wouldn't need to be on so much medication."
Beyond this, many other doctors simply assume that their patients already know they should be exercising regularly. "My patients know full well about the many benefits of regular exercise. They didn't come to see me for the obvious advice that they should get their butts off the couch once in awhile."
Then another study was done to discover the difference between the many doctors who refuse to ask about exercise from the few doctors who consistently do. Their findings were quite sobering. The doctors who didn't ask were out-of-shape themselves and didn't practice a healthy, active lifestyle. The doctors who were more lifestyle-oriented themselves had no problem asking the questions and coaching their patients in therapeutic lifestyle change.
Which patients do you think achieved better treatment outcomes?
If we truly want to fix our health care system and help patients avoid disease and enjoy a higher quality of life, we'll have to address the health of our healthcare providers, because the old adage proves true: "Physician, heal thyself!" (Luke 4:23) And, since the American way of life, along with our current medical system, has proven to be hazardous to our health, the same adage holds true for every patient, as well.
As a health/fitness professional, and/or as a patient, are YOU ready to take control of your health and life?
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