Do We Practice What We Preach?
It is not fair to ask of others what you are not willing to do yourself Eleanor Roosevelt.
Have you ever wondered what it would be like to get into a methodical workout routine? Have you ever pondered on how many of us honestly practice what we preach? Have you ever speculated about what kind of fitness regimen our colleagues potentially find advantageous? Have you ever awed how our peers cultivate work, family and health balance? My answer to all these questions is yes.
These very factual inquiries have struck me every so often, and now I cannot casually discount them. I must find the justifications. The eventual impetus emerged from my recent conversation with a colleague: "I doubt I could ever meet the ACC recommendation of 30 minutes, five days-a-week moderate exercising. Can you believe I have never even tried?" He sounded distraught, astonished and dismal all at the same time. In all honesty, I was also in genuine dismay when I reflected at my personal exposure to recommended exercise routines.
To reinstate, the ACC currently recommends getting "at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week." It also says to get "moderate- to high-intensity muscle-strengthening activity (such as resistance or weights) on at least two days per week." While the guidelines emphasize that we propagate the idea of physical activity, healthy lifestyle and life choices, how many of us legitimately follow it? And if we do not, should we not be articulating forthrightly about it? Should we not be perceiving the loopholes and ironing them out? Should we not be perturbed about the health of our comrades as they finesse the art of benefitting others with relentless perseverance, dedication and labor? Should we not be resolving that we do not let our associates dispense their responsibilities at the tariff of their own health?
The inquisitiveness galvanized me to conduct an anonymous survey in my own cardiology practice. I included all team members in a typical private office setting: the interventional cardiologists, general cardiologists, electrophysiologists, nurse staff and clerical staff. We are a team of close to 50 "caretakers." The survey included a questionnaire with 10 basic questions. Although the results are very peculiar to our private practice, this is only a pursuit to gauge where our companions stand at this time. While those studied are a minuscule scrap of the puzzle, we must start somewhere. Let us take on asking this question at our own practices to perceive, embolden and inculcate. We ultimately need larger surveys directed to address this germane health concern among health care providers.
We distributed questionnaires to 40 of our staff members and 17 got back with their questionnaires in time for the result reporting (42.5 percent). Analyzing the responses, 41.2 percent of the participants were desk staff, 23.5 percent nurse practitioners and 35.3 percent physicians. The survey showed that 82.4 percent of the total participants responded that they counseled patients to exercise regularly, while only 70.6 percent exercised regularly. Furthermore, of those who exercised, only 23 percent exercised more than or equal to five times per week, while 61.5 percent exercised less than or equal to three times per week. When specifically asked about the listed exercise options, which are currently recommended by the ACC and American Heart Association (AHA), almost two-thirds (61.6 percent) agreed to be performing at least one of them. Of all those who participated in the questionnaire survey, 35.3 percent were satisfied with their current commitment to healthy lifestyle. When asked about the limitations, time constraints and long work hours were very common. Additional impediments reported were lack of commitment to healthy diet and alternative priorities.
When itemizing the results purely to the physicians in the group, the conclusions were appalling. While 100 percent agreed to having counseled a patient to exercise regularly, a meager 33 percent were exercising themselves. The even more harrowing fact was that of those who exercised, the frequency was less than three times per week in 100 percent of them. To add to the dismay, none of the physicians were following any of the ACC/AHA recommended exercise regimens. Two-thirds of the physicians who participated were not satisfied with their current commitment to exercising, and long work hours was the single most important constraint recognized.
We immediately notice there is a significant lacuna that still needs to be filled. The shortfall is abominable in our physician colleagues. Of course, our entire health care team does not seem to practice what they preach. It would be intriguing to weigh whether the compliance with exercising varies based upon the counselor's self-commitment to exercising. It only makes intuitive sense that to acquaint one with the most pragmatic dilemmas of any lifestyle change, one is obligated to dive in. Whether self-expedition leads to better counseling and enhanced compliance from our patients remains to be scrutinized. It is also interesting to note that of those who are participating in exercising, very few truly adhere to the ACC/AHA recommended exercise regimen, even though they are associated with health care and the easiest admittance to such knowledge! If we are not blooming, how do we envisage our patients with constrained access to such pertinent information to be adherent? Where is the cramp in the dispensed awareness and what can be done to construe this? Despite our long training which abides by focus on lifestyle modification as the center of all disease modification why are physicians performing the worst?
Long work hours seem to be the fundamental malefactor. If we cannot go to the gym, would it help to bring the gym to us? What about group classes for the health care team at their own work places made available five times per week for more than 30 minutes per workout schedule with propagation of the ACC/AHA recommended exercise regimens?
No matter how it is accomplished, it is time we start nurturing our own health affairs. Let us not ignore ourselves while we take care of those we serve. Every member of the health care team including the physician should be encouraged to balance work with their personal preferences. Healthy meal options and opportunity to exercise are both our right and duty. After all, it is not fair to ask of others what you are not willing to do yourself.
This article was authored by Nishtha Sareen, MD, FACC, cardiologist at Cardiology and Vascular Associates in Bloomfield Hills, MI.