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Doctors should be able to prescribe exercise like a drug

BMJ 2016; 353 doi: (Published 05 May 2016) Cite this as: BMJ 2016;353:i2468

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Re: Doctors should be able to prescribe exercise like a drug

Thank you for your comment. Again and again, exercise should be promoted during medical visit but I do not think that the biggest problem is dose/risk question (i.e., WHAT) but HOW to promote physical exercise and active lifestyle.

Two major determinants of exercise promotion in care givers (GP, nurse, psychologist, oncologist…) are their physical activity habit (see Fie et al. 2013 Health Educ J) and physical activity education occurring in (medical) education (Cardinal et al 2015 JPAP, ‘If Exercise is Medicine, Where is Exercise in Medicine?’). For instance, more than one-half of the physicians trained in the US in 2013 received no formal education in physical activity and most courses focused on exercise physiology. Behavior change interventions are efficient to promote physical exercise (see meta-analysis from Gourlan et al 2016 Health Psy Rev) but these results and implementation strategies are mainly known in health psychologists, much less in medicine and exercise specialists.

In brief, providing more information about benefits/risks/dose/targeted intensity … is not enough, maybe not the priority. To prescribe a health behavior change like a drug could be a reductionist and biomedical view. Health behavior change (especially for physical activity) needs multilevel interventions (see Sallis et al., 2012 Circulation and 'Behavior Change Wheel' from Michie et al 2011 Impl Sc) (e.g., adapted goal setting, decisional balance, habit development, active travel, active break against sedentary, environmental changes…). In parallel, it is also very important to include more exercise specialists (with initial training focusing more on behavior change techniques than physiology) (e.g. Exercise Referral System in UK) in the health care system, they could be become the ‘catalyst’ for exercise promotion.

Competing interests: No competing interests

06 May 2016
Paquito Bernard
Postdoctoral researcher