How to be a healthy doctor—without trying too hardBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7465.s96 (Published 04 September 2004) Cite this as: BMJ 2004;329:s96
Doctors spend a lot of their time advising patients to eat healthily and take regular exercise. But how many of us actually practise what we preach? Karen Hebert gets some tips on how doctors can combine their busy working life with staying healthy
It seems that every day another news story is published about the obesity epidemic and the rising incidence of diabetes. We all know what we need to do—eat more healthily and do more exercise. We are quite happy to extol the virtues of exercise—after all, who would argue with the benefits of lowered blood pressure, decreased stress levels, and lower morbidity and mortality from heart attack and stroke?12 But somehow it isn't always that easy to do it ourselves. We're busy, stressed, and don't have time to go to the gym or run round the park every day. So how can doctors make their working day more healthy—without spending hours in the gym or following the latest fad diet?
You are what you eat
From hospital canteen fry-ups to the handy petrol station snack, a doctor's diet can easily become haphazard and unhealthy. But Anne Nugent, a nutrition scientist at the British Nutrition Foundation, emphasises how important it is for doctors to eat well (box 1): “Good nutrition is essential for busy doctors. Not only do they need energy to keep them going during busy clinics, surgeries and shifts, but it is also important to get lots of vitamins, minerals, and antioxidants to ensure optimal nutrition status and help protect against cardiovascular disease and cancer. They also need to cut down saturated fat (fried food) and eat more monounsaturates and polyunsaturates, particularly those in oily fish.”
Physical activity without joining a gym
When it comes to physical exercise, some doctors' jobs naturally involve more exercise than others. A busy junior doctor in a hospital, for example, might walk several miles a day (and night)—whereas some general practitioners could be sitting at their desk or in their car for most of the day. So how can sedentary doctors factor more exercise into their daily routine?⇓
There are many ways to become more physically active without joining a gym, the simplest being walking and cycling.3 Research shows that building walking and cycling into your routine is much more likely to be sustainable in the long term than gym based prescription schemes.4
Box 1: Nutrition scientist's tips on healthy eating for doctors
Have a store of healthy snacks on hand (fruits, nuts, or dried fruit)
Buy lunch on your way to work—this will ensure you eat healthily no matter how rushed you are
Drink plenty of water
Eat breakfast—this will avoid the mid-morning sugar cravings and boost your fibre intake
Leave long gaps between meals—this makes you hungrier and more likely to overeat
Eat late at night if you have indigestion
The cycling doctor
John Green is a general practitioner (GP) who cycles to and from work, as well as on visits to patients.5 Although he's far from obsessive about his health, he's passionate about the benefits of cycling: “I personally don't want to worry about my fitness. Like most people I've got enough going on in my life without worrying about something frankly as boring as my health. By cycling everywhere I don't have to think about physical fitness, and I certainly don't have to make time for activities scheduled solely to keep my body functioning effectively.”⇓
John explains that by making cycling his primary mode of transport, he has far less opportunity to skip exercising. “I have to go to work, I have to go on visits, I have to go to the cooperative, I have to go to the school open day, I have to live, and I can't say I don't feel like it today or I haven't washed my gym gear.”
He points out that it is not hard to fit cycling into your day. “I live 10 minutes away from the surgery by bike. All the drivers take as long, or longer—sometimes much longer.” He's heard all the usual excuses for avoiding cycling, including the problems of carrying lots of cycling kit. But he's not impressed by the excuses: “All you need is a bike, pannier, pump, lights, cycle repair kit and bicycle clips, and a nice breathable waterproof, all of which can be bought from any good bike shop.” Box 2 shows more tips.
The walking doctor
Cycling does not suit everyone, however. It may be impractical if you live a long way from work or if the route is not suitable for bikes. However, walking is an easy, inexpensive, practical alternative to increase your activity levels.
Mark Tully, a GP from Belfast, wrote to the BMJ promoting the benefits for the “walking doctor.”6 “Cycling is a beneficial and enjoyable exercise, but one that is not applicable to everyone. Walking does not require the equipment or training that cycling does. For the sedentary individual, walking is a more acceptable and sustainable form of exercise. Walking may not be a feasible form of travel for house calls, but certainly could easily be incorporated into the working day of even the busiest health professional.”
The Walking the way to Health Initiative
If the idea of going for a hearty stroll in the middle of your working day doesn't appeal, there is an approach that may help. The Walking the way to Health Initiative (WHI) is a proven practical approach that could help you and your patients to introduce walking into your everyday routine. It is also a good way to maintain the changes that you make.
The WHI, launched in 2000, is a joint initiative of the British Heart Foundation, the Countryside Agency, and the New Opportunities Fund. It is a five year project that aims to increase the health and wellbeing of disadvantaged and sedentary people (doctors included) by promoting regular and brisk walking within local communities.
Box 2: Tips from a cycling doctor
The map you have in your head of your practice area is wrong. You need a new one that avoids avoidable hills and doesn't take you around the one way system, but instead takes you through the park or down the river
Get a pannier—a rucksack will make you sweaty. It will hold any medical equipment that is necessary—barring a nebuliser. Read the patients' notes before you go
Don't cycle in the gutter. Look drivers in the eye-you have as much right to be on the road as they have
Mitch Counsell from the WHI explains, “Walking is central to the long term health, and fitness, of the nation. It is realistic, achievable, accessible, and affordable for almost all the population. 30 minutes of brisk walking five times a week confers much benefit. In addition there is growing evidence that the 30 minutes can be broken up during the day into three 10 minute chunks.”
He adds, “An increasing wealth of research and data show the physical and mental health benefits of walking for individuals, to say nothing of the community and environmental advantages. The confidence and self esteem that come from simply getting out, meeting people in pleasant surroundings, give people the motivation and drive to maintain their lifestyle change.”
The doctor's key role
The WHI may be of interest to GPs both personally to improve their own fitness, and in terms of their patients' lifestyles. As Mitch Counsell says, “GPs have a very important, dare I say, crucial role in spreading the word.” We have more than 300 local “walking for health” schemes many of which would benefit from greater GP participation.⇓
The WHI has also introduced the Step-OMeter—a pedometer that, along with critical advice and support, is a proved cost effective way of raising awareness, motivating otherwise disengaged audiences, and giving them the information and tools they need to encourage them to be more physically active in their everyday lives via walking more.
The premise is that you wear the pedometer for seven days without altering your activity levels. You can then calculate your baseline average daily step count. You would then aim to increase your daily step count by, say, 10% the next week. So, for example, if you walk a baseline average of 4000 steps a day your daily target for the following week would be 4400 steps per day.
Box 3: WHI: Tips on increasing your daily step count
Take the stairs or walk up the escalator
Walk to the next bus stop or get off one or two stops early
Enlist the support of a friend or colleague
Leave your car at home for short journeys
Take a walk at lunchtime
Walk the kids to school
This weekly increment can be continued until you reach the ideal daily 10 000 steps. Counsell advises, “Make a habit of glancing at the pedometer say, just before lunch and then again at the end of the working day. This acts as a timely reminder, depending on your step count, of how much you still have to do to reach your daily target... and still have time to do it.” He has some practical tips for boosting your daily step rate painlessly (see box 3). And here's one I made up earlier in the BMJ office: use the printer that is furthest away from your desk.
Seize life by the handlebars
Change is achievable. As John Green says, “A working lifetime exhorting patients from your comfortable swivel chair to take control of their own health and fitness, while you fail to do so, is unlikely to be satisfying. You'll only be a doctor once, so walk the way you talk, or alternatively seize life by the handlebars.”⇓
Win a free three month trial with a Step-O-Meter
Enter our competition to win a three month trial with a Step-O-Meter and a free fitness assessment courtesy of the Walking the way to Health Initiative. All you have to do to enter is describe your top tip on staying healthy without trying too hard, in 25 or fewer words. Send your entry to
We will choose 10 winners and announce them in Career Focus in a month's time. If you agree, we'd like to follow the progress of the winning doctors for a future article in Career Focus. The winner's names will also be posted on the WHI website (www.whi.org.uk) and in the WHI newsletter, which goes out to some 5000 health and leisure professionals.
The doctor who, in our view, shows the most improvement over the three months will win a WHI Step-O-Meter loan pack, complete with 10 step-o-meters for use in his or her practice.