A romp through exercise prescriptions for MDs

If exercise is healthy and “laughter is the best medicine of all” then why not combine them in a cheeky blog article to lighten things up? Let’s face it, there’s no hard science behind the rule of 10,000 steps a day! It’s a marketing myth. A beautifully crafted number from Japan that could be easily adopted by smart watch users all over the globe. FYI—it worked! According to guidelines posted by the highest authority of our country, the Canadian federal government, we need 150 minutes a week of exercise to survive. A cut and paste directly from Canada.ca website: "Physical activity plays an important role in your health, well-being and quality of life. Improve your health by being active as part of a healthy lifestyle. Be active at least 2.5 hours a week to achieve health benefits. Focus on moderate to vigorous aerobic activity throughout each week, broken into sessions of 10 minutes or more. Get stronger by adding activities that target your muscles and bones at least two days per week." Another leading authority, the Mayo Clinic adds, “Reducing sitting time is important, too. The more hours you sit each day, the higher your risk of metabolic problems. Sitting too much can negatively impact your health and longevity, even if you get the recommended amount of daily physical activity. And some research has found that people who've lost weight may be more likely to keep off the lost weight by sitting less during the day”. Recent publications have pointed to lower and lower amounts of time actually needed daily to gain physical and mental health benefits. Just 15 minutes a day for breast cancer survivors is effective and even eight minutes a day works for a surprising list of medical conditions including heart disease, cancer, migraine headaches and dementia. These times sound like the time intervals of clinic visits. An interesting connection! Let’s look at exercise prescriptions the same way we approach the scheduling of clinic appointments. With my tongue planted firmly in my cheek, a scientifically proven form of resistance training for small muscle groups, here goes: One hour Are you kidding me? Who has one hour to spend with a patient? Unless you are a geriatrician or practicing concierge medicine in a private clinic, you don’t have an uninterrupted 60 minutes in a day to do anything! Even a psychiatrist’s one-hour appointments are 45 minutes with the patient, 10 minutes to chart and five minutes to gaze lovingly at their navel. So if this is impossible in your clinic, it's impossible for an exercise prescription. Don’t set yourself up for failure. Just don’t do it! The 60-minute bar a day is too high to jump over, you’ll only hurt yourself. Now I know, all the type-A exercise fanatics and retired MDs reading the Medical Post will scoff at this and continue putting in 60+ minutes, seven days a week. Go on, prove me wrong. This is advice for the masses, not us hard-core endorphin junkies. 30 minutes This is more like it, a complete medical exam. Because an annual exam is a dirty word (actually, two dirty words), let’s call this half hour a comprehensive health review that could occur every one to five years. Thirty minutes of moderate activity at least five days a week gives us the magical 150 minutes that we must achieve. That’s thirty minutes a day, Monday to Friday (weekends off). More realistically for MDs that’s cramming it in Saturday, Sunday and Tuesday, Wednesday, Thursday as Monday and Friday are just too darn busy in the clinic. Moderate aerobic activity. A brisk walk, jog, cycle, snow shoveling, dragging kids and sports equipment in and out of homes and cars and arenas. Unfortunately, EMRs have made paper charts a thing of the past so hauling piles and piles of charts from clinic to home and back is no longer the best exercise we ever got. By the way, I never, ever did this . . . 15 minutes A standard, regular clinic visit. Time enough to deal with more than one complaint, but not the dreaded “list.” This is the time interval that we know very well. We don’t even have to look at a watch or cell phone to know when this time interval is over, we hear a loud “ding” in our heads. A Pavlovian phenomenon. This is the MD super sweet (and sweat) spot. I will not use the SSS acronym here. We can all find 15 minutes a day to be active. If we do it twice a day on most days we’ve got it!! 7.5 minutes I used to spend far too much of my clinic life “double booked” during 15-minute intervals. My internal timer still goes off at seven and a half minute intervals to this day. This leads me to my most favorite exercise topic. I have written about it in the past and am fanatical about it with patients. The SEVEN-MINUTE WORKOUT. There are a multitude of variations on this HIIT (High Intensity Interval Training) routine easily found on the Internet. Google Youtube videos on this and away you go. It is absolutely brilliant—short, intense, vigorous. It's everything you need and always fits into any schedule. String a few together most days of the week and you will be healthier and happier (and addicted). Miscellaneous tips for WIN:WIN scenarios Charting burns calories (because, well, all human activity burns calories)—do it at a standing desk for better bang for the buck. Stand during clinic visits or better yet, pace around the clinic room. Patients generally worry about you more and cut their complaints down so they can get out of the room quicker. Bring your patients from reception to clinic room yourself. Extra steps for you, a personal touch for the patient and one less clinic staff needed. Demonstrate a seven-minute workout to your patients. You will get your minutes in easily and patients sometimes like to see their doctors sweat. Book walking counselling sessions with your patients. You want to talk? Then be prepared to walk. Everyone wins in the scenario. Similarly we could book appointments with our patients while we are snow shoveling or cutting the grass. We listen and help them; they help us with getting our aerobic exercise minutes in. So if you can’t find an hour to exercise, you just need a few minutes. Go for it—it’s worth the sweat!! Dr. Ted Jablonski is a singer-songwriter, emerging playwright and neophyte poet who has retired his family practice to focus on sexual medicine and transgender health in Southern Alberta. He finds himself advising medical students at the Cumming School of Medicine and still on the front-line trenches of acute primary care.

A romp through exercise prescriptions for MDs

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