Things they didn’t teach in medical school: Part 26 – Giving fitness advice

Yesterday I wrote how medical school doesn’t teach much about giving dietary advice. Well the yin to diet’s yang is fitness and exercise. This is also a commonly asked question – what exercise can I do? Is it OK to exercise? Well this is important for both the sick and the well….and I’ll make a confession – I’m not one for formally exercising although my fitbit tells me that generally I do more than 10,000 steps a day.

In some cases it isn’t good to be physically active or to undertake certain exercises like heavy lifting – for example, if you’ve just had abdominal surgery you might increase your risk of hernia. Certain types of exercise – like heavy impact contact sports might be dangerous for a person with bone metastases. But in general keeping active, if not actually exercising is important.

After a stay in hospital many individuals are deconditioned. This happens very quickly with any bed rest – just like an athlete in the off-season. In this case getting back to exercise is very important for return to normal quality of life. There are simple things to do: use a chair for support to stand up between commercial breaks on television, climb back and forth along a small flight of stairs (with a railing) and take progressively longer walks around the neighbourhood (checking out their mail boxes).

Increasing exercise and fitness levels may be important in very specific conditions such as rehabilitation after heart attack or heart surgery, patients with chronic airways disease or after cancer. Increased activity after cancer may actually reduce risk of relapse and prolong life expectancy – the trials are ongoing. Frail and elderly patients may benefit from exercise to reduce falls.

The other aspect of exercise is how to do it. Recent evidence suggests that prolonged periods of exercise are not necessarily the best way of achieving fitness (and weight loss). Interval training with short bursts of intense activity may be more effective. Mixing up different types of exercise might be important for achieving different aims.

Doctors and future doctors need training in giving advice on fitness and exercise.

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