Wednesday, December 3, 2014

Fitness Experts at the Doctor's Office

Continuing to talk about how to improve the healthcare system (like I did here) there is another clear place for primary care to improve - exercise and fitness advice at the doctor's office.

Too many times I have had friends complain, legitimately, that the doctor just tells them to get more exercise and says nothing more about the topic. They just hope that this is enough. Or maybe there is a pamphlet. 

Exercise is too big a topic for most people to just jump right in because their doctor said so. And those who do are quite likely to overdo it, injure themselves and then stop exercising because last time they got hurt. (Commonly this is thinking that you have to do 30 minutes of cardio as a minimum; which is too much as a starting point for most folks -  I talk more about this here.)

Furthermore, most doctor's don't know what's involved in a complete approach to physical activity for health. Doing a lot of running, without any kind of strength training can cause injury and does little for some of the common problems of aging like muscle loss and osteoporosis. As I've said before, I don't fault the doctor's for not knowing everything. But it is a reason for primary care to have some fitness and/or PT component attached.

What people need is someone who can guide them through getting started with an exercise program. Doctors' offices are already incorporating dietitian's to provide nutrition advice, so let's add the other half of healthy living: physical activity. 

The emphasis of such a program should be on behavior change. A topic well-covered in my undergrad program. Basic exercise advice is easy. Helping a person make long-term changes to their life is different. It requires a different skill set. It takes a lot more than just a personal trainer certification.

UMass Boston's major in Exercise & Health Sciences has a mandatory track of classes in behavior change. Graduates from this program would be the ideal kind of person to add to the staff at a doctor's office. Because this person doesn't get paid like an MD they can spend more time with each patient. They would be dedicated to just one topic when they meet with the patient, unlike an MD doing a physical which has to cover every organ system of the body.

I'm going to see what I can do about just this as part of my time at the Institute of Health Professions. Health promotion and community outreach is a part of our the program at IHP. Perhaps I'll get to run a small pilot program. I don't know. 

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