Why aren't exercise and healthcare more integrated?
Health: the condition of being sound in body, mind, or spirit.
Healthcare: efforts made to maintain or restore physical, mental, or emotional well-being especially by trained and licensed professionals.
These definitions are brought to you by Merriam-Webster, and they very much so align with other definitions out there. Of note is that the definition above paints a pretty optimistic picture of what healthcare is — or rather, what it should be. The definition’s inclusion of “maintain” implies that prevention in a healthcare context is on the same level of importance as restoration. Unfortunately in practice, healthcare tends to be much more on the restorative side than the preventative side.
Healthcare as a concept was first designed to get people back on their feet, not to prevent them from falling down in the first place. This legacy ideology may have been acceptable back when people didn’t live to be 80, 90, or even 100, and half the population wasn’t overweight, but both of these things are now a reality. We are seeing unprecedented levels of chronic disease due to increases in longevity (the older you get, the more likely you are to develop a chronic condition) and unhealthy living. And as long as we as a system adhere to traditional practice, we will never get ahead of the problem; forever playing catch-up.
So what do we know helps with prevention (and ultimately helps us to get to a “condition of being sound in body, mind, or spirit”)?
Being more educated about one’s health? For sure.
Eating a healthy diet? You bet.
But what I want to focus on here is a third pillar that I think has for far too long been underappreciated/ignored as part of a holistic plan to help one achieve an optimal state of health: exercise.
Exercise is a phenomenal thing. It can help protect you from just about every disease or condition that is out there. Unfortunately, it is still something that is largely disconnected from the healthcare system.
Based on a 2015 JAMA “Viewpoint” piece, 34% of adults report being counselled about physical activity during primary care visits (visiting your family doctor). This actually doesn’t sound terrible on paper, and I have no data to back this up, but if you were to do the same analysis back in the 1990s or early 2000s, my guess would be that the percentage would be close to 0.
But despite this increase in awareness, here is another stat that is more troubling: in 2013 more than half of the physicians trained in the United States received no formal education in physical activity. More than half! So a third of them are prescribing exercise, but half of them don’t know a pull-up from a push-up. Ok, maybe that is an exaggeration, but this is still a serious issue.
How are we going to unlock the true potential of exercise as a form of preventative treatment if the people recommending it don’t really know how to use it?
My vision is for the primary care doctor’s office to truly become a wellness and prevention hub, with a fully-staffed gym/fitness studio under the same roof. This would be the most effective way to ensure consumers are getting the exercise-oriented advice they need, from professionals who are actually trained in this area.
You go in to see your family doctor;
They determine that you are erring on the side of unhealthy, but feel that being more active would benefit you over the long-term more than going on meds;
They “prescribe” you exercise and instead of sending you into the cold, harsh world with a very broad, non-specific recommendation that you as an unhealthy middle-aged human have no idea how to action, they right away introduce you to a trainer/health coach at the Hub who can help you build (and subsequently execute) a plan that is catered to your realities and goals;
Your progress, if willing, can be concurrently monitored from both the fitness and medical side of the equation, and your preventative care plan can be appropriately updated in real-time to maximize results.
This type of model offers potential benefits from a consumer experience and cost-savings perspective. Health consumers would feel more involved in the development and execution of their care plans, which could not only lead to higher satisfaction and levels of empowerment, but better care plan adherence. And care plan adherence in this context isn’t about taking your meds three times a day as prescribed; it is about introducing necessary lifestyle change and helping to make it stick. Committing to a tailored care plan like this can stop and reverse downstream problems which could vastly improve the consumer’s quality of life, while potentially saving the healthcare system tens of thousands of dollars in future costs.
There are obviously a number of hurdles that need to be overcome to make something like this a reality (i.e. health information privacy, getting physician buy-in, aligning and updating reimbursement models, the capital expenditures that come with opening and operating a gym-like facility), but I think the potential benefits are truly unique, inspiring, and far outweigh any of the downfalls and costs that could come along the way. And while this is still merely a half-baked idea, I think the vision is something worth exploring further.
Primary care and healthy living are both integral to population health, so let’s reimagine the doctor’s office and make it the best, and healthiest it can be.