Health Matters

Prescription for health has new paradigm

Conway McLean, DPM, Journal columnist

A typical scenario plays out as follows. Chest pain is experienced, perhaps someone has abdominal pain, or a joint hurts, and so they go to their primary care provider’s office or maybe an urgent care clinic. There are a thousand and one reasons an American presents for medical care. The result of this encounter quite commonly is a prescription for some medication to treat the patient’s symptoms.

Not only is this the norm, people often feel disappointed when not provided with some miraculous medication. Indeed, the advances in pharmacology have been astounding, but some would posit our medical system has become reliant on pharmaceutical therapies.

We have a drug for the symptom you came in with, and then a drug for the side effects of the first drug. Hence the large number of Americans who have become ensnared in polypharmacy, whereby they are taking numerous medications throughout the day, with little to no idea what most of them do or why they take them.

Let’s direct our attention to the previously mentioned chest pain, the prototypical sign of a myocardial infarction, a heart attack. Prior to industrialized, modern culture, a heart attack was a medical oddity, a rarity.

This should lead one to question what has changed so greatly that now it is the number one killer. A strong argument can be made for the dietary changes as the leading culprit, but this is too complex a subject to simplify so easily.

Detailed studies aren’t necessary to see the changes in activity levels of the average individual in pre-industrial society. We worked hard with our hands performing physical, demanding tasks. The reduction in physical activity, and fitness, has been profound. Most of the diseases that plague modern man are those of lifestyle. If we didn’t eat so much, didn’t consume so much junk, and moved a lot more, there would be fewer heart attacks, strokes, and many cancers.

Although primarily given only lip-service to this point in time, the concept of the exercise prescription has raised some hopes and raised some eyebrows. Many traditionalists when it comes to health and well-being continue to rely on the concept of drugs first, then maybe lifestyle changes.

Unfortunately, modern healthcare gives little weight and minimal attention to the idea that getting someone fitter may help their heart become stronger and so need less medication.

The evidence is particularly strong and gets more so every day. New benefits are discovered regularly.

Multiple studies demonstrate the cardiovascular consequences, including stronger heart muscle, clearer arteries, even better thinking (from enhanced blood flow to the brain). Blood pressure is stabilized, although there are many mechanisms at play here.

Cholesterol levels are improved with exercise, while also helping to maintain a healthy body weight. For the diabetic, our cells become more sensitive to insulin, while also aiding in glycemic control. As mentioned, cancer rates are significantly lower in those who exercise. And targeted exercise, directed so as to improve some bodily process, has been gaining momentum as an effective treatment for various ailments, but too slowly in the opinion of many well informed on the subject.

This is considered a radical change; prescribe improved fitness before giving one for a drug, with their side effects and complications. And they all have them, although the same can’t be said for being more physically fit. And there is almost always some form of activity available, for every level of fitness, for nearly every handicap and disability. Of course there are exceptions, but they are few and far between. In contrast, the excuses are plentiful.

Doctors know, intellectually, of the benefits. After all, they spend the majority of their time engaged in managing the diseases so closely associated with inactivity. These are the ones already mentioned, the plagues of modern culture, the diabetes, heart disease, hypertension, the diseases tied to “Western culture” with its fast food and computer addictions.

But it’s clear our physicians aren’t having this conversation with their patients. Although improving, most healthcare professionals have had no training in this approach, how to actually prescribe it, what specific recommendations to make. Despite recent efforts, medical students polled recently still feel unprepared to prescribe physical activity to their patients.

Prescribing improved fitness is good medicine, and the studies bear this out. Exercise, properly manifested, is a highly effective prescription for a variety of ailments, with clear indications for over forty common problems. Primary care providers should be well versed in this type of prescription, not just one for a pharmaceutical. A beneficial option is a referral to a certified health fitness professional or physical therapist. But for many Americans, it’s simply having a professional give some guidance, some impetus, and written guidelines for how to go about this safely but effectively.

Such a recommendation should include some specifics as to the type of activities, the duration, as well as the intensity. For most homo sapiens, a combination of aerobic and resistance training is going to provide for optimal fitness and health. The latter is vital for bone and muscle health while the former is especially positive in its effects on blood vessels and heart health. Some common recommendations include starting these kinds of changes gradually, especially a fitness program in someone who has been inactive.

Impediments to activity should be addressed. Since walking is the most common and successful form, seeing a podiatrist can aid in achieving your fitness and health goals. But be assured, there’s some type of exercise for everyone. We simply need to make it mainstream, the norm, from our youth to later years.

At all levels of health care, physical activity should be integrated into routine practice. The ultimate goal is to make fitness a foundational component of preventative medicine. Many debilitating conditions are made less likely by eating healthy, getting physically fit, and vaccinated for the diseases that are part of our world. Prevention: the concept that many limitations of health and longevity can be prevented. It’s a shame we haven’t been able to put it into practice.

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.


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