Exercise - the 'cure-all'

Don't be surprised in future if your doctor asks about your fitness regimen and prescribes a cure that does not involve drugs.

Brisk walk three times a week and swim once a week, or he may refer you to a certified fitness trainer for your "medicine".

"If you can have one drug that can treat all those issues, would you want it?" asks Dr Benedict Tan, who chairs Exercise is Medicine Singapore (EIMS).

"That drug is exercise. It kills many birds with one stone."

EIMS is the local chapter of a global initiative aimed at encouraging doctors and other healthcare providers to include exercise in treatment plans for patients.

Dr Tan, who heads Changi General Hospital's Changi Sports Medicine Centre, which spearheads EIMS, says he hopes to build a "critical mass" of doctors and allied health and fitness professionals in five years.

It is a long road ahead. Since 2012, EIMS has certified just 109 doctors and 113 allied healthcare professionals.

Its website says it aims to train at least half of the 10,000 primary care doctors and fitness professionals in Singapore in five years.

EIMS has just started talking to Singapore Polytechnic, the first on the EIM on-campus programme, to get students to be active.

The National Parks Board has also been roped in to ensure that, right at the design stage, fitness corners feature equipment for a broad range of users.

One was launched in Simei last March. Another is coming up in Yishun. EIMS also helps SG Enable, which provides services to the disabled, by training its trainers.

It wants to get the message that exercise is medicine across to new doctors, as exercise prescription is now not part of the core undergraduate curriculum for medicine.

"Even in medical school, there's a lag. Hopefully in 20 years, it will be okay," said Dr Tan, who is on the EIM global education committee.

"We are in the process of drawing up a module on exercise prescription and will be giving it free to universities around the world."

In Singapore, EIMS works with healthcare group SingHealth to certify those on the family medicine residency programme.

It is also trying to incorporate exercise prescription into the sports medicine diploma course at Nanyang Technological University's Lee Kong Chian School of Medicine.

"Exercise is a useful adjunct therapy to improve overall physical fitness, especially in those with medical conditions such as hypertension, diabetes, heart and lung conditions, as well as certain bone or joint problems," says Dr Michael Wong, deputy medical director at Raffles Medical.

However, barriers remain. Patients may be reluctant to be in an exercise programme or find it inconvenient to undergo a pre-exercise test, he says.

"The most difficult part in prescribing exercise is in initiating discussions about exercise," says Dr Kelvin Koh, general manager of Q&M Medical Group (Singapore).

"There is an initial awkwardness as patients do not usually expect physicians to discuss physical activities, and most do not view exercise as medicine."

Dr Lim Ing Haan, a consultant interventional cardiologist at Mount Elizabeth Hospital, says heart attack patients need cardiac rehabilitation which involves doing prescribed exercises under the supervision of nurses.

The main challenge, she adds, is to get patients to do them on their own after that.

Doctors, on their part, need to motivate patients and find ways to spend more time assessing and educating them on exercise, says Dr Muhammad Sabith Salieh of SingHealth Polyclinic (Sengkang).

This article was first published on July 7, 2015.
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