Who should advise patients about exercise?

In 2015, 20.9% of Americans exercised as recommended every week. Not sure what that recommendation is?

You’re not alone.

According to the CDC, the average American adult should try to get at least 150 minutes a week of moderate-intensity aerobic physical activity, or 75 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of the two. This means walking, running, biking, bowling, gardening, etc.

Less than 21% of Americans actually get this amount of exercise. And several studies show that few people know what the guidelines are, including a British study that shows only 14% of respondents even knew how much exercise they are supposed to get.

We are all busy. It is hard to know what the very latest research says.

But a new study shows the problem may run deeper.

Let’s say you have been diagnosed with cancer and are now undergoing a treatment regimen with an oncology specialist. Would it seem reasonable to ask your doctor for advice on exercise?

A study published in May in the Journal of the National Comprehensive Cancer Network says just that: “Patients want advice and support about exercise while enduring the physiological and psychological side effects of treatment. Furthermore, they prefer that the exercise recommendations come from the oncology provider.”

The gap between what the patient wanted and what the oncologist did in this small study is instructive. 95% of patients told interviewers they felt physical activity was “very important during their cancer treatment.” When focus groups and individual patients were asked, “From whom and how would you like to receive exercise information?” 80% of participants said they wanted advice from their oncologist. Ideally, the patients said, they’d like their doctor to recommend a home-based exercise program.

But more than half of providers wanted to refer patients to another health care professional for exercise recommendations.

Even discussing exercise options was difficult for oncologists, for several reasons. Time constraints, lack of knowledge of a patient’s fitness level, or what kind of program would be appropriate, cost of rehabilitation, lack of transportation, side effects of treatment (for example, fatigue) were all cited as barriers to oncologists recommending exercise programs.

In this particular study, nearly all of the cancer patients wanted their oncologists to discuss physical activity with them, but in reviewing patient-physician transcripts, the researchers found such conversations were “nonexistent.”

As with many best practices in health care, although the evidence-base supports physical activity for most cancer patients undergoing treatment, that doesn’t mean patients can get reliable information on exercise programs from their trusted heath care professionals. In part, the oncologist does not get paid for this interaction. Even if an exercise therapist or similar health care professional were able to collaborate with the oncologist, it might be difficult for the patient to either attend another doctor’s visit, or pay for such a visit. A “shared-care” clinic visit might work well if the focus is to provide health care provider focused care. But the study indicated what these cancer patients really wanted was a home exercise program.

While policymakers and others talk about “patient-centered care,” when it means moving care from a health care institution to a home setting, or asking a trusted provider to be trained in something he or she may not feel expert in, it is very hard to get the system to do what works best for the patient. Bridging the gap between the system we have and the system we want requires patients and physicians to behave differently, but it also requires payers and health systems to change their ways as well.