Walk With a Doc: Patients, Physicians Make Strides Together

Andrea Goto

Disclosures

October 15, 2021

Columbus, Ohio–based cardiologist David Sabgir, MD, was a year into private practice when he realized something needed to change.

"I realized I couldn't do this," says Sabgir. "I didn't want to have these fruitless conversations for the next 35 years, get a gold watch, and be done with it."

The fruitless conversations are those that play on repeat every day in medical practices across the country. They go something like this:

Physician: "It's important that you lose weight. You need to start eating better and exercising."

Patient: "Yeah, okay. I can do that."

Patient returns for a follow-up visit months later without having lost weight.

Physician: "It's important that you lose weight. You need to start eating better and exercising."

Patient: "Yeah, okay. I can do that."

During one such visit in the fall of 2004, Sabgir invited the patient to join him and his family at the park on the following Saturday morning for a walk. "I wanted this patient to have to say 'No' to my face," he recalls. The patient showed up, and Sabgir started to wonder if others would do the same. Then he got to work.

In April 2005, Sabgir teamed up with the metro park system in Columbus and invited news crews and his family, friends, staff, and patients to attend the first "Walk With a Doc" (WWAD) event. More than 100 walkers showed up.

Figure 1: Dr. Sabgir and fellow Walk With a Doc physicians give a presentation to patients before their weekly walk.

And patients continued to show up on the first Saturday of every month to hear Sabgir give a brief presentation on a trending health topic and then walk a 1-mile loop alongside them. Today, there are more than 550 WWAD chapters across 47 states and 38 countries.

"I felt right away that this all made sense, and we kind of stumbled onto something," Sabgir recalls.

Beginning With Just One Step

Bridgette Walton, 51, stumbled across the WWAD program after retiring to Macon, Georgia, in early 2020. The former HR professional suffers from a number of medical conditions and disabilities that were exacerbated by inactivity and poor eating habits. "For years, doctors told me that I needed to start exercising, lose 30 pounds, and get my A1c levels down," Walton says. At the time, her A1c hovered dangerously near 10.

During a routine visit with her primary care physician at Naviscent Health, Walton noticed a flyer promoting WWAD hung up in the waiting room. Inspired by her physician's encouragement to set small, attainable goals, such as losing 3 pounds by her next visit, Walton decided to attend the next WWAD meet-up. There, she met Harry Strothers, MD, a family medicine doctor at Naviscent Health and co-lead of the Macon chapter of WWAD, and Mary Hoey, a nurse researcher. Hoey challenged her to come to the next event, and the one after, and just keep walking.

Over time, her ability to meet these smaller challenges led to bigger changes. Walton didn't lose 3 pounds by her next visit to her primary care physician; she lost 10.. The woman who admits to once routinely calling the MoonPie headquarters in Tennessee to order two or three cases at a time doesn't even want a MoonPie anymore. Since then, Walton has lost an additional 35 pounds and her A1c has dropped to 5.7.

And it all stems from taking those first steps. "The transformation that I've experienced just from starting a walking program is really amazing," Walton says.

Figure 2. Bridgette Walton waves as she leads the Macon chapter of Walk With a Doc during a monthly stroll.

Walking provides number of health benefits. According to one study, regular walkers (four times per week for at least 15 minutes) live longer and healthier lives compared with those who are less active. Walking helps maintain healthy body weight and reduces high blood pressure and the risk for type 2 diabetes.

Compound the health benefits with the benefits of participating in walking groups, and the news gets even better. A review of interventions to promote walking — programs like WWAD — found that they could contribute substantially toward increasing the activity levels of the most sedentary people.

In 2017, WWAD partnered with the Robert Wood Johnson Foundation and Limetree Research to conduct an evaluability assessment of the program. A whopping 96% of the walkers who responded to the survey strongly agree that WWAD helps them lead a healthier lifestyle, and 62.3% reported that since joining WWAD, their physical activity level has increased.

Going Virtual

During COVID, most of the group walks were put on hold for the past year, which provided an opportunity for the WWAD "headquarters" on social media, managed by Sabgir and members of the organization in Columbus, to organize virtual challenges for walkers around the world.

Participants of the past virtual challenges, which have included traversing the Grand Canyon and Mount Kilimanjaro, received race bibs, physician-led "base camp" check-ins, T-shirts, and finisher medals.

"I've been completing the virtual challenges in the top five," Walton boasts, logging the required miles faster than thousands of other participants around the world. She explains that a race app not only tracks steps but also converts other daily activities, such as strength training, cycling, cleaning, and even cooking, into steps.

With Walton's competitive spirit, these challenges keep her engaged and motivated, but she points out that the monthly WWAD events are about connection, not competition. At Macon's Amerson River Park, Walton takes to the paved walkways and meanders around playgrounds and along the river, stopping at an overlook where kids splash around in the shallow waters. She chats with her fellow walkers, sharing her health journey. "As we walk, people ask what made it click for me," Walton says. "Now I see that my journey can help others, and that motivates me."

Physicians Finding Fulfillment

While there are endless more stories of the positive effect WWAD has had on patients, that's only part of the story. The participating physicians, as Sabgir puts it, "get an overwhelming sense of purpose," when that feeling often wanes in the medical community.

Figure 3. Dr. Sabgir walking with a patient.

In the wake of the COVID-19 pandemic, only 6 in 10 doctors say they are happy outside of work, according to the 2021 Medscape Physician Lifestyle & Happiness Report. This has a trickle-down effect, given that a physician's self-reported satisfaction is strongly linked to patient satisfaction. This sense of professional fulfillment positively correlates with patients' following the advice of their doctors when it comes to medication, exercise, and diet. Physicians grow frustrated when patients don't comply. "We may be refilling Lipitor scripts and watching a patient's weight go up maybe 3 pounds," says Sabgir, "but there isn't as much purpose as one would have expected."

The walks, where Sabgir can spend a morning outside, build community with patients, share his knowledge, answer their questions, and revel in the positive changes he sees them making, helps restore that sense of purpose. "It's counterintuitive to think about giving up an hour on a Saturday morning when you may be burnt out, but it turns out, it's the reverse," Sabgir says. "You get that instillment of purpose. It adds so much to your fulfillment as a provider."

However, promoting WWAD and convincing already overworked physicians that the program could bring greater fulfillment would prove to be more difficult. "Initially, the program's limiting factor was physician involvement," Sabgir explains, but within 5 years, WWAD expanded beyond Columbus, catching on with physicians around the country, and then around the world.

"There are 880,000 doctors in the United States and many more advanced-level practitioners, and we aren't going to get all of them," admits Sabgir. "But the wider net that we cast out there, we capture those who realize this is exactly what they're looking for." The program's greatest asset is word-of-mouth advertising, where physicians share their positive experiences with others.

"I get the most joy from seeing other healthcare providers feel the same fulfillment that I feel," says Sabgir.

Rizwan Bukhari, MD, or "Dr Riz" as he's known by patients, can attest to having that sense of fulfillment. A cardiovascular specialist in the Dallas area, Bukhari, along with his wife Maya Acosta, also run an organization called Plant Based DFW, which they use to promote healthy living and healthy choices. So when Bukhari got word from the Texas Medical Association that they were partnering with WWAD and encouraging physicians to set up chapters, he was all in. He launched the Dallas WWAD chapter in 2019.

"As physicians, we have gotten caught up in this daily grind where we're just treating problems and I encourage my colleagues to look at the bigger picture," Bukhari says. "We need to ask, how can we help our patients and our community begin to prevent having these problems?"

Bukhari acknowledges that he and his colleagues aren't afforded a lot of time with their patients, but WWAD offered a solution: to be with patients in a nonthreatening environment, talking about ways to improve health and prevent the very advanced illnesses he treats. "If we look at the roots of what we are — we're physicians and healers — there's reward in teaching people how not to get sick."

When it came to surveying WWAD physician chapter leaders for the evaluability assessment, the conclusions prove the program's ability to provide fulfillment. Physicians like that WWAD gives them the opportunity to lead by example, lets them interact with other people in a relaxed and health-promoting setting, and helps them educate walkers about their health. According to the assessment, "WWAD is meaningful to physicians, it represents peace, hope and a promise for change."

The Bigger Picture

Sabgir's objective is to have 1500 WWAD chapters around the world by 2025. He hopes to accomplish this by creating more partnerships with hospital systems and medical schools (they currently partner with about 300 hospital systems and 50 schools). The simplicity of the model for participants, along with the ease of launching and maintaining a chapter (a toolkit is provided) are key to the program's sustainability, as is its robust scholarship program, thanks to a generous $25,000 bequest from WWAD advocate Dr Annemarie Sommers in 2018. (WWAD is, and always will be, free to participants, though physicians pay a minimal fee to establish a chapter, which allows the nonprofit to operate).

But the greater goal is to have the program and others like it become part of the DNA of practicing medicine. "In fact, I feel like I would have failed if it doesn't," he adds. Sabgir's vision is one where there's a different level of involvement on the part of the physicians, putting them at the same level as the patient to create a more open, nonthreatening environment.

Sabgir likens the physical activity portion to WWAD to a kind of Trojan Horse for making meaningful and intentional changes to the practice of medicine, in the way that it can promote diversity, equity, and inclusion. "This is all about breaking down any kind of barrier that there is and have us all there together," Sabgir says. "I think that facilitates much better medicine as a whole."

"Everything about this program is meaningful," Sabgir says. "Seeing smiles, meeting new people, and having conversations that go well beyond, 'It's important that you lose weight. You need to start eating better and exercising.'"

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