WE ALL know the vital signs when doctors screen to assess our health: our pulse, body temperature, breathing rate and blood pressure.
But are doctors testing for the other vital sign that could be the most important in curbing the explosion of non-communicable diseases (NCDs) across the world - exercise level?
Could exercise be the next vital sign that could determine the fitness of a patient as a key risk factor?
Some of the country’s leading health experts and researchers in medicine converged at Discovery Health in Joburg this week to discuss how exercise had become the most potent instruction doctors needed to give patients to restore health and longevity.
“We as humans are genetically programmed to do some form of exercise every day... If we don’t, things happen to us physiologically that are to our detriment. We already know (through medical literature) that 50% of all chronic disease incidences could be reduced by exercise,” Professor Martin Schwellnus said.
South Africa has the highest obesity rate in sub-Saharan Africa. Research published in the South African Medical Journal showed that severe obesity increased healthcare expenditure by R4425 per person, split between inpatient and outpatient care. Smoking has a similar impact on healthcare costs.
Globally, one in four adults are not active enough and more than 80% of the world’s adolescent population is insufficiently physically active.
Multiple studies have highlighted insufficient physical activity as a key risk factor for NCDs such as cardiovascular diseases, cancer and diabetes.
“Patients are accustomed to leaving a doctor’s rooms with prescriptions for drugs, tests and more,” Dr Craig Nossel, head of Vitality Wellness, said.
“But this approach to illness is fast-evolving to include a powerful new vital sign that gives a doctor a multi-dimensional view of a patient’s health and longevity at the deepest level: a patient’s fitness levels.”
He added: “Patients need to leave consultations with a fundamentally different sort of prescription that instructs them to, for example, take ‘moderately intense aerobic exercise for 30 minutes, five times a week’, or ‘vigorously intense aerobic exercise for 20 minutes, three times a week’.’’
Professor Martin Schwellnus, director of the Institute for Sport, Exercise Medicine and Lifestyle research at the University of Pretoria, said that part of the problem was that doctors weren’t previously trained in prescribing exercise to patients, and that the country would only probably see a change in 10-20 years from the current crop who are benefiting from training under the new alterations to exercise prescription.
A sentiment that was echoed by Dr Sundeep Ruder, a clinical endocrinologist at Life Fourways Hospital.
“There isn’t a lot of training done on this (prescribing exercise) at university level, doctors can’t teach what they don’t know themselves - everything has to work in synergy.
“When one says ‘exercise’ people think Iron Man challenges or the Comrades Marathon, but no, the first step is doing more than you are currently doing. The prescription of exercise must be appropriate for the patient.”
Dr Elijah Nkosi, a GP in Soweto and chief executive of the South African Medical and Dental Practitioners, advised that, when exercising, one “listens to their body”.
He continued, “Even if you run for 3 minutes and walk another - it’s a process. You need to be in a zone where you feel good. Ideally, you need to put in four days a week of regular exercise for at least 30 minutes each. Even if it is a morning walk, the effect of that morning breeze can also be very spiritual for some.”
Discovery Vitality also shared clinical evidence showing that the more aware doctors were of their own health and fitness status, the more empowered they were to influence the lifestyle choices and health of their patients.
“We know that healthier doctors are more productive, they deliver better quality care and are more effective in prescribing wellness. We are trying to build a healthcare system that has healthy doctors, healthy practices and healthy patients,” Dr Maurice Goodman, head of health profession strategy at Discovery Health, said.
Goodman also spoke on the new Vitality Active Rewards for Doctors programme, challenging practitioners to simply get moving.
He said Discovery Health was partnering with doctors by providing tools that would help them improve their wellness and that of their patients.
“Physical activity is a trigger for other healthy behaviours, and so by leveraging Discovery assets, we are giving doctors access to the latest wearable devices and Active Rewards, that will enable doctors to realise significant healthcare improvements for themselves and the patients for whom they care,” he added.
The programme is unique to each doctor and uses health and wellness data to set clinically appropriate fitness goals, which adjust automatically based on their activity levels.
Nossel concluded: “There is no debate on the importance of exercise -the issue is prescribing it.
It is the one element that we’ve lost over time and we need to get that back”.