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Doctors Aren't Doing Enough to Get Patients to Exercise

Bert R. Mandelbaum, MD, DHL (Hon)

Disclosures

October 01, 2015

A Sports Doctor's Most Important Job

Like most physicians in the United States, sports medicine specialists get paid for fixing problems, not for preventing them. Patients come to us with a torn anterior cruciate ligament (ACL) injury or ulnar collateral ligament. We operate or prescribe therapy and coach them through rehabilitation. After performing these services, we get paid our fees.

But I believe that we all have a higher calling. Our most important job is to motivate our patients to take control of their fitness—and to get their family members to join them. And in the long run, what's best for our patients is best for us as well.

The idea that doctors should prescribe exercise goes back to the dawn of medicine. In the Greek pantheon, Panacea and Hygeia, the goddesses of intervention and prevention, were held in equal esteem as daughters of Aesculapius, the god of medicine. Even before Hippocrates, Herodicus, a fifth-century BCE Athenian physician, recommended treating patients with exercise.

What these forefathers of medicine understood, and what too many of us have forgotten, is that human beings are hardwired to be athletes. Homo sapiens evolved to go out and hunt and gather. That history is embedded in our genes. If we don't exercise, our bodies don't function well. And lack of exercise is contributing to most of the common diseases we now face.

The Leading Cause of Preventable Death

As Steven N. Blair, PhD, a professor of exercise science, epidemiology, and biostatistics at the Arnold School of Public Health at the University of South Carolina, has noted, inactivity has surpassed obesity and smoking as the leading cause of preventable death in the world.[1]

A rational healthcare system would provide incentives for physicians to encourage exercise. The potential impact of getting just a few people to exercise more can be huge. Diabetes costs the US healthcare system $245 billion per year.[2] Stroke adds another $34 billion.[3] Sarcopenia adds $19 billion.[4] All could be mitigated with exercise programs.

But the fact that we don't work in a rational system doesn't relieve us of the responsibility to lead, inspire, and motivate.

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