PM&R News   •   January 2, 2021

2020 has brought a lot of change to the practice of medicine, many of which will greatly impact our patients for years to come. This year has taught us to embrace change and make that change as impactful as possible.  For example, many were resistant to telehealth, but now I wonder how we ever lived without it?  I admit that a new patient evaluation can be difficult over telehealth, but do I really need to see a patient 4 weeks post injection to ask if their pain is improved?  That could easily be accomplished over telehealth and if red flags exist, bring the patient in.  Incorporating some telehealth into practice certainly can increase show rate, compliance, and patient satisfaction.  I personally plan to continue to use telehealth and find new ways to constantly include this technology.

Observing this change in medicine caused me to spend a lot of time thinking how else I can best impact my patients and hopefully medicine as whole.  This led me to the other common theme in 2020, PREVENTION: Preventing the spread of COVID, Preventing hospital overload, Prevention in the form of a vaccine, Prevention of bankruptcy, and the list goes on.  Prevention is well known to the practice of medicine, but I personally feel as a whole, we do a poor job of prevention.  Yes, we sign patients up for their annual physical, timely colonoscopy, immunizations, but prevention can begin long before these checkboxes in routine healthcare.  As a physiatrist, have you guessed what I am thinking?

Exercise! Let’s start with the guidelines!  The World Health Organization recommends at least 150-300 minutes a week of moderate intensity aerobic physical activity or at least 75-150 minutes of vigorous-intensity aerobic physical activity and 2 days a week of muscle strengthening that involve all major muscle groups.  It is estimated that only 23.2% of adults, aged 18 and over, meet these recommendations. It is estimated that failing to meet these guidelines equals $117 billion in extra annual health care costs and 10% premature mortality.  Can you imagine all the good that could be done for our society if we had that extra $117 billion?

To meet these guidelines, one has to do anywhere from 22-47 minutes a day of moderate aerobic activity and 2 days of resistance training. In 40 minutes a day, patients can meet the bare minimum guidelines. Sounds easy!  Then why don’t more patients do it?  I have thought about this a lot without many solutions.  I have spent countless hours counseling my patients about exercise recommendations and the importance of exercise, often met with resistance.  Of course, converting one patient, is better than none, but I know we can have a bigger impact than that.  Our society seems to often be concerned with immediate gratification.  Unfortunately exercising now, to live a healthier life, maybe not get cancer 30 years from now, maybe not get diabetes 20 years from now, just does not cut it for many.

How can we as a medical society bring immediate gratification to our patients in order for them to comply with the recommendations?  How can we convert our patients from sedentary lifestyles to exercise champions? As a society, we need help, and I know I need help in helping my patients.  I would love insight from our readers with any ideas or suggestions to help this Sedentary-demic.

My next rant…. The power of proper diet! But, now I am going to get up from my desk and walk the stairs! 😊