Exercise prescription: knowledge, practice and attitude among South African doctor
Background: Physical inactivity is fourth on this list of leading causes of deaths worldwide. South Africans are reported to have low physical activity (PA) levels. Increased levels of PA and aerobic fitness will have a positive influence on morbidity and mortality since sedentary lifestyles are responsible for many of the chronic diseases we face today. Prescriptions from General Practitioners (GPs) represent a well-understood interaction between patient and doctor. An exercise prescription from a GP will remind the patient that PA is part of their treatment plan and should be adhered to with the same diligence with which their mediation is taken. GPs have access to a large proportion of the sedentary population and can play a key role in motivating people to become physically more active. However, very little is known about the exercise prescription practices, knowledge and attitudes towards exercise prescription of South African GPs. Aims: This study sought firstly to determine the practices, attitudes toward and knowledge on exercise prescription among General Practitioners in South Africa (SA) and secondly to identify possible barriers why South African GPs do not prescribe exercise. Methods: A self-administered, anonymous electronic questionnaire was developed according to guidelines from literature to assess the practices, attitudes toward and knowledge on exercise prescription among GPs in South Africa. The questionnaire was circulated to a database of GPs via email on three separate occasions, two weeks apart and was completed by a total of 349 GPs. The outcomes measures consisted of the demographic information, training histories, practices of general practitioners regarding exercise prescription, attitudes of doctors towards exercise prescription as well as their attitudes toward the importance of exercise as preventative modality for chronic diseases. Knowledge on benefits, risk factors and contraindications regarding exercise prescription, as well as knowledge of doctors regarding recommendation and formulation of exercise prescriptions were also assessed. Results: The response rate from this study was considerably lower compared to the average response rate reported for online questionnaires. Despite the fact that a purposeful attempt was made to draw the participants’ attention to the fact that exercise prescription does not involve casual advice such as “you should stop smoking and exercise more”, substantially higher prescription rates (90.9%) were reported by the participants from this study compared to those from international literature. Possible reasons for these disparities between local and international findings may not only lie in possible self-report bias, but also in the different barriers to exercise prescription reported by the South African doctors compared to the international literature. A minority (18.0%) of the participants felt that exercise prescription will be too time consuming, while almost half (46.0%) of the non-prescribing doctors from this study reported a lack of confidence in their knowledge to be able to prescribe exercise. Approximately 98% of the GPs believed that it should be part of their practice to prescribe exercise to their patients, despite the fact that very few were familiar with the knowledge and safety principles inherent to a safe and effective exercise prescription. The knowledge of the GPs in this study regarding recommendations for physical activity and the formulation of an exercise prescription was poor. Conclusion: Although general practitioners reported a fairly high incidence of exercise prescription, insufficient knowledge about not only exercise prescription, but also lifestyle modifications were noticed. Barriers to exercise prescription different from international literature and should be investigated further. A lack in confidence and knowledge to enable safe and effective exercise prescription highlights a need to rethink the undergraduate medical curricula. The good news resulting from this study is the positive attitude from the medical practitioners and their acknowledgement of the ability of physical activity, in the form of exercise training, to prevent the burden of non-communicable diseases.