From Back Pain to Heart Rehab, Exercise Is Underused

What if doctors could prescribe something that could relieve lower back and neck pain, very likely improve the outlook for many heart disease patients, and significantly cut the odds of developing or worsening diabetes? You'd assume that they'd write the prescriptions and patients would eagerly fill them, right?

That process might work if it were as easy as taking a pill, but it falls apart when the remedy is exercise. Just this week, researchers reported that exercise was prescribed by fewer than half of the doctors, chiropractors, and physical therapists seen by a group of patients with lower back or neck pain. That, despite the evidence that for many, stretching and strengthening exercises ease the pain.

It goes beyond that. Last year I wrote about how women were less likely than men to participate in cardiac rehabilitation, the programs for heart patients incorporating exercise, nutritional advice, counseling, and other preventive steps. It appears that is partly due to a failure of doctors to prescribe it, according to a review published last year in Critical Care Nursing Clinics of North America . The review said that only between 20 percent and 30 percent of eligible patients of both genders are actually referred, and the participation rate may be as low as 10 percent. In 2006, a study published in the Journal of Science Medicine and Sport found that physical therapy and exercise were not commonly prescribed for osteoarthritis of the hip—again, despite evidence that it can help ease symptoms.

And last year, the American Cancer Society said that fewer than half of cancer survivors were getting the recommended dose of weekly physical activity, among other healthful lifestyle steps like eating fruits and veggies and avoiding tobacco. Whether or not they were told to exercise by their doctors or other healthcare providers is unknown.

It's hard to tease out exactly why exercise isn't being used as much as it should be. On the supply side, researchers have suggested that doctors simply aren't as educated as they should be on the benefits of exercise for various ailments, particularly for the elderly. Insurance doesn't always pay for supervised exercise with a physical therapist or other healthcare worker. Patients may run into the cost issue, too, if a supervised program has been recommended, plus there are probably disease-specific and other issues. Women tend to get heart disease later than men, for example, which means they aren't likely to be as accustomed to exercise as men or younger women, or they may have other medical problems that make it tough to work out. (This despite the fact there are very few excuses for not exercising, even for people with aches, pains, and even diseases.)

And of course, folks with ailments are just like the rest of us: Exercise is not something the average American particularly enjoys. And doctors don't always encourage it for us, either; at my own recent checkup, I was asked about my use of alcohol (occasionally), cigarettes (never), and illegal drugs (never), but not once about how much, and how, I exercise.