Laurence Kinsella, MD, is the most overqualified spin class instructor in St. Louis, Missouri… and perhaps the world. A former marathon runner, he is also board certified in neurology, neuromuscular medicine, and internal medicine. So, when he tells you to exercise, you should listen.
Even when you know how important it is, as most physicians do, it can be hard to make time for exercise. That’s why Kinsella says he adds in some social pressure to his own exercise routine. He rides with an outdoor cycling club, which he describes as a group of “middle-aged men in Lycra,” and he teaches spinning (stationary bike riding to music) at a local health club. He says, “The only way I could guarantee I’d get my exercise is to teach the class.”
For Kinsella, exercise is more than just a way to stay healthy, it is also a treatment for disease. He recently gave a talk titled Exercise as Medicine in Neurologic Disease at the annual meeting of the American Academy of Neurology. He spoke about neurological conditions like dementia, Parkinson’s disease, postural tachycardia syndrome (POTS), and small fiber neuropathy.
The evidence is quite strong that exercise can be an effective treatment for these conditions. Of course, knowing this and actually getting your patients to exercise are two separate issues. So, in his talk he also elaborated on ways he gets his patients to engage in exercise, and how clinicians can work exercise prescription into their treatment plans.
“Lack of exercise is not just a problem for our patients, it’s a problem for us too,” he says. One of the best things you can do for your patients is to get moving yourself. “Share your own exercise story. You have influence, and that can motivate your patients.”
There are also plenty of outside (lay-friendly) resources you can point your patients toward, like the American Heart Association’s Life’s Simple 7 program. The US Department of Health and Human Services also provides a summary of their Physical Activity Guidelines for Americans. Their recommendations—
30 minutes of moderate-intensity aerobic exercise 5 days per week (total of 150 minutes per week) or at least 75 minutes per week of vigorous aerobic exercise plus moderate- to high-intensity muscle strengthening exercise 2 days per week
—are a great place to start, says Kinsella. “Most people can start a moderate exercise program, but your recommendations need to take into account disability, exercise history, motivation, and expense.”
For disabled patients, he recommends non-weight bearing exercises like water jogging, stationary recumbent bike, rowing machine, swimming, and upright stationary bicycle. “You won’t lose a lot of weight with non-weight bearing, but you’ll gain tone and some cardiac reserve.” For those who are not able to do these kinds of activities, Kinsella recommends a floor peddler, which patients can use while sitting in a chair.
“I got one for my mom. Start with five minutes of pedaling. Have your patients get one and start with no resistance. You need to find people wherever they are in their story. If they have never exercised they may be frightened of it.”
Kinsella also encourages his patients to get a heart rate monitor, or he teaches them how to monitor their own pulse and calculate their 75 percent max target heart rate. Then he gives them exercise progression guidelines like the ones he developed below for non-disabled patients:
- Begin a graded exercise program 3 days per week with 6 minutes at your target heart rate for each session. Increase by 2 minutes per week until up to 30 minutes, 3 days per week.
- Add weight lifting with modest 3–5 lb weights to your regimen 2 days/week. Perform 4–6 sets, 12–16 repetitions each, of upper body exercises at each session. You may wish to consult a personal trainer to design a healthy regimen in line with your physical limitations.
- After 1–3 months, begin to introduce gravity sports such as running, treadmill, spinning classes, etc. as tolerated.
Kinsella says these guidelines and others can be incorporated into an EMR template to facilitate prescribing exercise for your patients. He also tells people that the first five weeks are the hardest so they know there is light at the end of the tunnel—and that goes for you too. Like Kinsella, you too can be the change you want for your patients.