Exercise for Multimorbid Patients in Primary Care: One Prescription for All?
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CURRENT OPINION
Exercise for Multimorbid Patients in Primary Care: One Prescription for All? Philipe de Souto Barreto1,2
Springer International Publishing Switzerland 2017
Abstract The purpose of this article was to discuss guidelines for the management of the most prevalent chronic diseases treated by primary care physicians (PCPs) in order to identify the best exercise regimen for each clinical population, and to provide preliminary guidance for primary care providers on exercise counselling in the ‘real-world’ context of multimorbidity. After a search of the PubMed electronic database, the 11 most prevalent conditions currently treated by PCPs were identified. The recommendations provided by recognised learned/scientific societies for the management of each disease were then examined and any recommendations involving physical activity and exercise were identified. It was found that the best exercise regimen (i.e. exercise type, intensity, duration, and frequency) was very similar across chronic diseases, which suggests that elaborating and implementing a standardised, minimum exercise guideline for multimorbid patients in primary care may be an alternative approach to time-costly individualised exercise prescriptions. Based on this finding, I propose an example of standardised, crossdisease exercise prescription, and discuss how such a prescription could be operationalised by PCPs in their routine clinical practice.
Electronic supplementary material The online version of this article (doi:10.1007/s40279-017-0725-z) contains supplementary material, which is available to authorized users. & Philipe de Souto Barreto [email protected] 1
Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), 37 Alle´es Jules Guesde, 31000 Toulouse, France
2
UMR INSERM 1027, University of Toulouse III, Toulouse, France
Key Points Exercise is part of the management guidelines for the most prevalent chronic diseases treated in primary care. The best exercise regimen (i.e. exercise type, intensity, duration, and frequency) is very similar across chronic diseases. Elaborating and implementing a standardised, minimum exercise guideline in primary care for multimorbid patients may be an alternative to timecostly individualised exercise prescriptions.
1 Introduction Physical activity (PA) and exercise are recognised as one of an individual’s vital signs [1] and are important factors for health promotion in overall healthy adults and several clinical populations [2–5]. Exercise, a subset of PA that is planned, structured, repetitive, and purposeful, and that is frequently employed for improving or maintaining optimal levels of physical fitness and function, is often used as complementary treatment for very prevalent, burdensome, and costly noncommunicable disease (NCD), such as heart disease [6], stroke [7], osteoarthritis [8], osteoporosis [9], and diabetes [10]. Despite this recognition, PA and exercise are rarely assessed and promoted in the primary care setting [11–14]. Furthermor
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