Physicians Try CrossFit, Volunteerism to Aid Patient Fitness

Kerry Dooley Young

December 19, 2018

Physicians are trying new approaches for helping their patients become more active and lose weight, including undergoing training in the CrossFit training system and mixing volunteer efforts with an exercise program.

Clinicians told Medscape Medical News about experiencing continual frustration in efforts to counsel patients to adopt healthier lifestyles to combat illnesses linked to sedentary behavior and poor diet. Physicians are called upon to treat the damage that results from a national epidemic of obesity, which has been linked to heart disease, stroke, diabetes, and certain types of cancer.

Even with antiobesity campaigns already under way through groups such as the American Medical Association, physicians are seeking new ways to motivate their patients to take better care of their bodies. The prevalence of obesity increased to 39.6% in 2015-2016 from 33.7% in 2007-2008, according to research from the Centers for Disease Control and Prevention.

Michael S. Emery, MD, from Indiana University School of Medicine in Indianapolis, said he often sees patients who are putting their health at risk through poor habits.

"People will nod their head at me or agree that they need to eat better and exercise more," Emery told Medscape Medical News. "But when they return in 3 to 6 months, they have not managed to do either. As a physician, it is frustrating sometimes to the point where you feel like you are wasting your breath."

Be a Lifeguard

Emery was one of the 340 participants in a training program aimed at physicians that CrossFit began offering this year called CrossFit MD. CrossFit offered six seminars in California and two in Brazil, which filled up within 48 hours of being open for enrollment, said Karen Thomson, a spokeswoman for the company. There were waitlists of more than 60 people, she told Medscape Medical News.

CrossFit founder Greg Glassman has been speaking in recent months with the press, including Men's Health , about his plans to "disrupt" healthcare. A Vox article on Glassman's efforts also noted some concerns about theintensity of the CrossFit workouts, including the potential for rhabdomyolysis.

Glassman, who is not a medical doctor, is arguing for more attention to poor diet and exercise habits as key contributors to common illnesses. In his view, there's more of a need for helping build better habits than for treating the results of poor ones, such as diabetes.

Based on his experience as a cardiologist, Emery endorses the beach-based analogy that Glassman often uses to discuss the pressing needs of American healthcare. Physicians now are called on to act as "lifeguards" when something goes wrong, but they could have a greater impact by teaching patients how to take better care of themselves and avoid disease in many cases.

"We as physicians really need community resources to take our patients through these stages — to be their 'swim coach,' " Emery said, using Glassman's terminology.

"Reversing the Tide of Disease"

Jill Jani, MD, an anesthesiologist from Maryland, told Medscape Medical News that she and her husband, a cardiologist, considered themselves "lucky" to be able to use their vacation time to complete the CrossFit course aimed at physicians. They both use the CrossFit program themselves.

Jani said she plans to be involved through CrossFit in creating an education series focusing on nutrition geared toward the people who need it most — the elderly and those with chronic illnesses. In her view, lawmakers, regulators, and healthcare providers too often fail to guide these patients to the lifestyle choices that can help avoid many chronic conditions.

"It is becoming the norm now to take care of patients with a [body mass index] over 30 or with multiple medical problems on multiple medications," Jani said. "We are accepting their illnesses as the norm and inevitable and merely treating their symptoms as they arise, and this is backwards."

Nima Allen Alinejad, MD, a family physician from Louisiana, told Medscape Medical News that her work as an affiliate owner of a CrossFit is "the most rewarding part" of her practice. She described it as "actively working on reversing the tide of disease — chronic disease, addiction, mental health, and other issues — one patient at a time in my patients."

"Patients genuinely want to be healthier," Alinejad said. "And they are not stupid, they want to learn. But they get discouraged when we recommend nebulous advice like "30-60 minutes of vigorous activity most of the days a week."

Heal Together

Part of the draw with CrossFit is the sense of community found in the program's "boxes," Alinejad said. (A box is what CrossFit enthusiasts call the often-bare-bones gyms where trainers and their customers work.)

CrossFit is far from the only program seeking to use community engagement to nudge people into healthier lives.

"What if the most direct path toward helping yourself was helping other people achieve their goals?" asks the website for the Heart to Start program of Providence Health and Services in Oregon. "Rather than fill a prescription in isolation, what would happen if we built a team and healed ourselves together?"

James Beckerman, MD, from Providence Heart Institute in Portland, Oregon, started a series of weekly community workouts in 2012 to train to walk or run a 5K. The Heart to Start program now operates in several locations and has 2030 followers on its Facebook page as of December 19. There's a strong emphasis on volunteerism in the group, with recent activities including work at a local food bank, Beckerman told Medscape Medical News.

"As physicians, we have a special opportunity to shepherd our patients through the process a little bit more," Beckerman said about training and volunteering as a group. "There are so many ways to get involved in your patients' community."

Beckerman is the author of Heart to Start: The Eight-Week Exercise Prescription to Live Longer, Beat Heart Disease, and Run Your Best Race. Like many physicians, he encounters resistance from some patients when he offers advice to them about improving their lifestyle. People may say that they are too busy or burdened by work and family obligations to exercise. In these cases, physicians may be able to help best by leading by example, according to Beckerman.

"I let them know that I am a full-time employed professional with a wife who works and two boys and a dog and a cat and I tell them how I do it. I exercise every day," Beckerman said. "Everybody has the ability to exercise on a daily basis."

Nieca Goldberg, MD, a New York University cardiologist, also said she seeks to lead by example when it comes to motivating patients to take better care of their bodies.

Goldberg spoke with Medscape Medical News as a representative of the American Heart Association. A clinician and the director of the Joan H. Tisch Center for Women's Health at NYU Langone, Goldberg also is the co-medical director of the 92nd Street Y's Cardiac Rehabilitation program in New York. Yet she still makes time for Soul Cycle and Pilates classes and works out with a personal trainer. Her patients want to know how she fits these activities into her schedule, she said.

"They know I have a passion for exercise," she said. "They start to ask questions. They have a curiosity."

Goldberg said she encourages her patients to find the kinds of exercise that they will like best, which may help them stick with a fitness program. Patients also need to take into account their medical conditions and current fitness level as they seek to become more active. Some have lived very sedentary lives, she said.

"I've had patients who didn't even own a pair of sneakers," Goldberg said.

One Step at a Time

Ada D. Stewart, MD, a member of the board of directors of the American Academy of Family Physicians (AAFP), also stressed the need to tailor advice to a patient's situation. Physicians may too frequently give patients advice about getting in workouts without understanding the obstacles they face, she told Medscape Medical News. The physicians then will feel frustrated when the patients return without having made any lifestyle changes, contributing to the clinicians' sense of burnout, she said.

"You've got to know your patients and meet them at the point where they are," Stewart said. "That way, you're not telling them to do something that they can't do."

Many patients lack the resources or even the transportation to get to a gym, she said. In these cases, physicians can counsel patients to find ways to add exercise into their day even if it's walking in their homes or opting for a parking spot that's further away from their work or skipping elevator rides to take the stairs. Stewart says she uses the handouts from the AAFP's Exercise: How to Get Started program.

"It's about establishing a partnership," she said. "I say, 'You and I are a partner in your health and I am here to help guide you. I can't make you do anything, but I can make some recommendations.' "

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