Doctors fight fat with prescriptions ordering specific workouts

CONCORD, N.H. (AP) _ Take two hikes and call me in the morning. <br/><br/>It may sound like an unusual prescription, but it's an increasingly common one at a hospital where physical fitness is part

Monday, February 7th 2005, 1:54 pm

By: News On 6

CONCORD, N.H. (AP) _ Take two hikes and call me in the morning.

It may sound like an unusual prescription, but it's an increasingly common one at a hospital where physical fitness is part of doctor's orders for patients battling obesity.

The effort is the result of an unusual partnership between physicians and hiking enthusiasts. Just a few months old and already earning praise, the program involves several dozen doctors writing detailed, albeit symbolic, prescriptions for getting fit and then giving patients trail maps to accomplish it.

``The idea is to make a more specific explanation,'' said Dr. Charles Brackett, director of the program at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

``You can say, 'Walk this trail near your house twice a day,' as opposed to, 'You're supposed to exercise more.'''

That personalization is key. In weight-obsessed America _ where two-thirds of adults are overweight or obese _ follow-through on fitness and nutrition can be as much a problem as ignorance.

Studies show that the more concrete a doctor's advice, the more likely a patient is to heed it. While Dartmouth-Hitchcock's prescriptions aren't technically real, the hope is that the format makes the advice hard to ignore.

It made the difference for Gloria Beattie, a 72-year-old woman for whom Brackett prescribed fitness in December. Winter weather so far has kept her off the hiking trails, but the prescription motivated her to get on her treadmill.

Before that, the overweight woman got little exercise, adding to her existing health problems. She already has lost 12 pounds and is eager for spring so she can head outdoors.

``It had a big effect,'' she said of the prescription. ``If no one says anything, you just keep letting it go. But if they talk to you and explain why you need it ... you finally come to the realization that exercise is really the thing that you need.''

Using the power of the prescription pad to encourage physical fitness isn't new, but in general medicine it is rare.

Though so-called exercise prescriptions are widely used by doctors at obesity clinics, the practice hasn't caught on with general practitioners.

In fact, few primary care doctors talk about fitness and weight loss at all with patients, even obese ones, said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital in Boston.

That's because the medical community has been slow to address lifestyle as a means of disease prevention, said Manson, co-author of a report urging doctors to counsel patients on exercise and weight control.

``A prescription for exercise may be the most important prescription a physician writes all day,'' she said.

``If a prescription for medication could reduce the risk of heart disease, stroke, Type 2 diabetes and osteoporosis by 40 percent, everyone would be clamoring for it. Well, a prescription for brisk walking has the potential to do just that.''

Yet more than half of American adults aren't active enough, and a quarter do no physical activity at all, according to the Centers for Disease Control and Prevention.

Few doctors have embraced this approach for the same reason so many of their patients aren't out doing laps: lack of time.

The pressures of a busy practice leave many doctors little time to chat about fitness. But Manson says it's either find a way now, or spend much more time with the patient later dealing with the health consequences of obesity.

Brackett thinks he has found a way.

At Dartmouth-Hitchcock, exams of overweight and sedentary patients end with the doctor writing fitness advice on a prescription-like form, then offering a booklet of trail maps and a pep talk about physical activity and good health.

Total time: two to three minutes.

Doctors also can ask patients to buy pedometers ($4 from the receptionist) and check a box on their charts to arrange for a student from Dartmouth Medical School, with which the hospital is affiliated, to make a follow-up call in a month.

Eventually, the hospital hopes to offer maps of more advanced trails so patients can progress to more challenging walks. The first map focuses on easy, level, sometimes even paved, hikes and paths.

The goal isn't to tell people to work out, but to work in physical activity, said Wally Elton, executive director of Upper Valley Trails Alliance in White River Junction, Vt., the hospital's partner in the program.

So far, the program has cost only about $14,000, including printing costs and Brackett's time. Much of that has been covered with a grant by Upper Valley Trails, with help from the National Parks Service.

Dr. Cedric Bryant, chief exercise physiologist for the American Council on Exercise, said programs like this are badly needed because efforts to get Americans to treat exercise as recreation rather than a lifestyle generally have failed.

But he says a doctor's intervention could make a tremendous difference.

It's too soon to tell how much of a difference Dartmouth's program will make. The clinic's doctors are still getting used to giving the advice, and the medical students have only begun follow-up calls.

But Dr. Mike Jensen, a board member of the North American Association for the Study of Obesity, said no matter how small the effect, the effort will be worth it.

``The cost of what they're doing is practically nothing,'' he said. ``So even if it only works in 5 percent of the people, that's a huge benefit because the cost is nothing.''