When your doctor writes you a prescription, you probably expect it to be for a drug that you can’t get over the counter.
But Dr. Kaberi Dasgupta from the Research Institute of the McGill University Health Centre is prescribing something else: steps.
In the SMARTER (Step Monitoring to improve ARTERial health) trial, Dr. Dasgupta and her team found that a written prescription for increased daily step count was more effective than simply telling patients to exercise. The results of the trial were published in “Diabetes, Obesity, and Metabolism” last week.
Step it up
Even though most of us know the benefits of exercise, many Canadians still don’t get the recommended 150 minutes of moderate to vigorous aerobic activity per week.
A previous study by Dr. Dasgupta found that Type 2 diabetes patients, the group she was most interested in, were only accumulating about 5,000 steps per day on average. It takes about 10,000 steps to be considered active.
That’s when she got the idea to prescribe step counts like medicine.
“[Walking] is the form of exercise most easily integrated into the daily routine,” says Dasgupta. It is also easily quantified using a simple pedometer.
Write it til you make it
In the SMARTER trial, half the patients were given written step prescriptions and half were simply told to exercise for 30-60 minutes per day. After one year, patients with the written prescription walked, on average, 1,200 more steps per day than those who didn’t. For patients with type 2 diabetes, this also translated to measurable health benefits like lower blood sugar and lower insulin resistance.
Something about the written prescription made patients more likely to follow the doctor’s advice. A similar effect is seen in personal goal-setting, where people that write down their goals are more likely to achieve them.
There is also a certain accountability when your step counts are being monitored with a pedometer and logged.
“We believe that the combination of discussion, reviewing step count logs, and writing down the prescription was what worked. Individually I don’t think they would have been as powerful,” explains Dasgupta.
The concept of prescribing exercise is promoted by the Canadian Society of Exercise Physiology, Diabetes Canada, and the American College of Sports Medicine, but it has rarely been explored in a controlled trial such as this one.
Dasgupta and her team are now planning to improve on these results by adding telephone-based support between clinic visits and peer-to-peer support networks. She is also interested to see whether this would work in other aspects of health behaviour.
Veggie prescriptions, anyone?