Doctors Consider Exercise a Powerful Medicine

[Guest guest]

By Billhartz Gregorian

St. Louis Post-Dispatch

Tuesday, May 5, 2009

Kichura looked at Marc Leeke and his blood tests last fall and gave

him a diagnosis of metabolic syndrome.

Leeke, 50, of Ballwin, Mo., weighed 258 pounds (too heavy), had triglyceride

levels near 300 (twice what they should be) and low HDL levels (that's the

good cholesterol). He was also complaining of becoming tired and winded

while working in his yard.

Kichura, an interventional cardiologist and clinical lipidologist in St.

Louis, worried that Leeke might also become diabetic.

So he pulled out a notepad and wrote a prescription for something cheap but

effective: dietary changes and a walking program.

Now, three or four times a week, Leeke heads to a recreation center before

sunrise and walks for 10 minutes, then whirs away on the elliptical trainer

for 20 minutes. He estimates that, on those days, he walks 5,000 to 7,000

steps, about three times more than he once did in a typical day.

Leeke has lost 17 pounds, lowered his triglyceride to 180 and raised his

HDL.

Doctors have long prescribed exercise as part of rehabilitative programs for

patients who've had heart attacks, undergone coronary bypass surgery or

experienced other cardiac problems. Insurance usually covers that

rehabilitation for a few weeks.

But a growing number of doctors nationwide are prescribing detailed exercise

plans as a preventive measure before the health of high-risk patients

deteriorates. And they'd like to see insurance cover those patients as well.

" I'm not an economist, but from a health standpoint, exercise is

invaluable, " said Mike Cannon, an assistant professor in the department of

family and community medicine at St. Louis University. " Prescribing it is a

very effective way of preventing chronic disease, which is not only having a

profound effect on the quality of our lives but it's also bankrupting our

health-care systems. "

The Agency for Healthcare Research and Quality reports that in 2006,

Americans older than 18 spent $38 billion on prescription drugs that lower

cholesterol and control weight and diabetes. They spent an additional $33

billion on cardiovascular drugs such as blood pressure medicine. Both drug

categories top the list of most money spent on prescription medicines,

accounting for 34 percent of the $208.1 billion spent in 2006.

Cynetra McNeil, an assistant professor of pharmacy practice at St. Louis

College of Pharmacy, said more than 47 million of those people have

metabolic syndrome. That is, they have at least three of these five risk

factors: excess abdominal fat, abnormal triglyceride levels, elevated blood

sugar levels, high blood pressure and diabetes.

McNeil estimates that each of those patients spends more than $300 a month

on prescriptions such as a simvastatin for cholesterol, ACE inhibitors for

blood pressure, metformin for blood sugar.

" They're also sometimes on insulin if their diabetes is advanced, " she said.

" Of course, exercise is always good, too. Most people who have metabolic

syndrome are overweight or obese, and a 5 percent weight loss will help

lower the amount of medication they need. "

Kichura notes that popping pills is easy. But they're costly and don't

reverse underlying problems. Exercise does.

Writing itemized prescriptions to, say, walk 15 minutes a day and do

specific strength-training exercises has proved more successful than merely

discussing the benefits of exercise with patients.

To begin, Kichura gives patients a blank diary, instructs them to buy a

pedometer and record the number of steps they take each day. Then he works

with them to increase those steps by 10 percent a week and has them send

their daily logs to him.

" It forces patients to at least make an effort, and it also makes them a

part of their own health-care plan, " he said.

It also lowers the risk of injuries and complications of diseases, so

patients can maintain their fitness program.

Prescribing exercise for some patients, such as diabetics, is complicated,

Cannon says. At first, their sugar levels go up with exercise; after a few

minutes, those levels can drop too far. And because they sometimes have loss

of feeling in their feet, they run the risk of developing sores or losing

their balance while walking.

" Diabetics don't have any room for error, " Cannon said. " They need to do it

right in order to do well over time. "

That's where physical therapists and such programs as Fitness First, at St.

's Mercy Heart and Vascular Hospital in St. Louis, can play a role.

With Fitness First, a team of exercise specialists and nurses helps patients

build confidence and teaches them to exercise effectively and safely. The

program, priced at $45 a month, is not covered by all insurance plans.

That's not to say that the insurance industry as a whole is ignoring

exercise as preventive medicine.

" Over 70 percent of health-care costs go to diseases that are the result of

unhealthy behaviors such as overeating, sedentary lifestyle and smoking, "

says Zirkelbach of America's Health Insurance Plans, an association

that represents nearly 1,300 health insurance providers. " So there is a

growing recognition of this, and you are seeing the health insurance

industry implementing programs to encourage people to take better care of

their health. "

Leeke wasn't surprised when Kichura prescribed exercise. " What did surprise

me was if I didn't see results in the first three months, he was going to

put me on medication, which I was really scared of. But it's been working, "

Leeke says.