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EDITORIALS: Steve Iliffe, Tahir Masud, Dawn Skelton, and Denise Kendrick Promotion of exercise in primary care BMJ 2008; 337: a2430 [Full text]

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Promotion of exercise in primary care

Robert Bunney   (11 January 2009)

Promotion of exercise in primary care.

Timothy Whelan   (20 January 2009)

Promotion of exercise in primary care 11 January 2009
Robert Bunney, GP Barnstaple EX328GP Send response to journal: Re: Promotion of exercise in primary care	So after 7-13 minutes with a practice nurse and 5 phone calls of 15 minutes each those that come for another 30 minute appointment with the nurse tell her they are exercising more but all firm data such as BP, weight, waist circumference, lipid measurements and current medication are unchanged. People are generally keen to please and it would seem ungrateful to report to the nurse little has changed I don't yet share the conclusion that "Lawton and colleagues’ study shows that exercise promotion through general practice can change behaviour if it is embedded in routine care, based on continuing contact and dialogue, and tailored to individual needs" I do feel increasing exercise is very important for all age groups, particularly the elderly but in the absence of stronger evidence cannot so far back adding this huge burden to our practice clinic system. I agree we should encourage activity but when one of my elderly patients requested if any light exercise group such as Tai Chi existed locally for elderly patients none of our local myriad of overlapping, opaquely titled acute intervention or chronic rehabilitation services seemed sure and I remain unaware of any except for the local "Water Mobility Association" set up and run on non profit making basis by an enthusiastic local swimmer and diver over 20 years ago which has helped many and I hope survives his recent death in his late 80s. Bob Bunney GP principal Competing interests: None declared
Promotion of exercise in primary care. 20 January 2009
Timothy Whelan, GP The Dower House, Newport, Isle of Wight, PO30 1JW, UK Send response to journal: Re: Promotion of exercise in primary care.	I am concerned that my GP colleagues may infer undue optimism from the tone of this Editorial. In the linked paper, Lawton et al show that, after two years, out of 1089 participants, only 214 (39%) in the intervention group reached the target of activity (150 minutes per week of exercise such as brisk walking), compared with 179 (33%) in the control group without any intervention at all. How then can the Editorial trumpet a positive result without the qualification "in a highly selected group of New Zealand women (including Maoris), previously enrolled in research on exercise programmes, aged 40 - 74 years"? Please consider that there were no men, and whether your population is comparable with New Zealand (just pause to think of rugby, sailing, or the first ascent of Mount Everest). Most adults, working full-time and raising a family, find even 150 minutes per week of exercise unrealistic, and may become demoralised by this level of expectation. Finally, has anyone done a study to determine whether this amount of walking (over 20 years, say) causes more osteoarthritis in backs, hips, and knees? Competing interests: As a GP, I occasionally refer patients to an exercise programme.