Is it ethical for doctors to dispense exercise advice?

I need to lose another 30 pounds, and my family doctor is really ragging at me to do some sit ups to get rid of the tummy bulge I have (though it is going down gradually)

This is an example of the exercise advice doctors give to their patients. Now, if you are looking at that and thinking it’s sound advice, then please go read this article about ab exercises and abdominal fat. Or just trust me: Sit ups are not the answer to losing belly fat.

Today another prime example was circulating on Facebook. It was an article about a shoulder surgeon whose ridiculous exercise advice includes the following gems:

all men over 40 stop doing push-ups, as well as other body-weight exercises such as pull-ups and dips
Stretching is better than resistance training for the health of the shoulder, especially the rotator cuff
Use low weight and perform high reps“[1]

When I see or hear advice like this passed on from clients, I usually roll my eyes and snicker mildly. It’s not a problem when the client happens to understand the effects of exercise better than the doctor and realizes that sit ups are not the route to losing belly fat. They come to me for guidance and I help them to get fit and work on that belly fat through full body strength and conditioning training (including abdominal work although no situps). Great. But it’s not always that easy. Sometimes the clients believe their doctor’s incorrect exercise advice. I don’t blame them: doctors hold a certain regard in our society. We trust them with our health, and they are at the top of the health care professional pyramid. If they give advice related to our health, we assume it is correct.

I, on the other hand, am a personal trainer. I am closer to the bottom of the health care professional pyramid. I say that without reservation, and with no feelings of ill-will or resentment. It is a truth with which I am very comfortable. The requirements to become a doctor far, far exceed the requirements to become a personal trainer. I respect that and have no qualms about it.

As long as everyone sticks to what they know.

Some doctors, unfortunately, have a habit of dispensing exercise advice. This might not sound like a bad thing, except that doctor’s don’t actually learn about exercise as part of their degree. Nor do they learn about it as part of their practical work. So where do they learn it? The same place that the general public does: magazines, newspapers, television, their friends, and the internet. It’s not that I have issue with people learning about exercise this way. Just understand that if this is the basis for your exercise knowledge, then you are not an expert. So what happens when doctors give out exercise advice? Their patients take for granted that this is expert advice.

Surprised that doctors don’t actually learn about exercise in school? I was too. But in hindsight, it isn’t that surprising – medicine is such a huge field, I can’t imagine how they can cover everything. I tried to find evidence of exercise being taught at medical school, but didn’t find much. I did, however, find a few studies suggesting a lack of knowledge of physical activity or exercise:

Based on a research study of 31 UK medical schools, The average number of hours devoted to teaching physical activity throughout the entire curriculum was 4.2 hours.” [2]
A recent survey showed that only 13% of U.S. medical schools provide a curriculum in physical activity” [3]
in a survey of deans and directors of 128 allopathic medical schools in the US: only 10% said their students could design an exercise prescription. Only 6% of respondents reported that their school provided a core course addressing the American College of Sports Medicine Guidelines for Exercise Testing and Prescription.“[4]

I did find evidence that Harvard was offering a Preventive Medicine and Nutrition course[5], which was encouraging. But upon further examination, it turns out they eliminated the course, noting that they now “incorporate nutrition into all four years of the curriculum”. [6] I was unable to find any evidence of exercise being included anywhere in the curriculum, although please note that this is not proof that it doesn’t exist.

Considering the quality of exercise advice from doctors that I see in the media and that my clients pass along to me, I suspect that my limited review above is accurate.

Is it a problem that doctors are not experts in exercise?

In my opinion the bigger problem is that some of them play the role of expert in exercise when they are not.

Before becoming a personal trainer, I was an engineer. In fact I was a licensed Professional Engineer. As part of the licensing process, I had to pass an engineering ethics exam, and once I was licensed, I was legally bound by the engineering professional code of conduct. This involved many elements including the concept of “do no harm”, and a responsibility that if I saw a problem with an engineering project it was my legal obligation to do something about it. Additionally, I was legally responsible for any advice I gave that a member of the general public could reasonably think is my professional opinion as an engineer. This meant that I had to be careful when giving out any engineering advice; especially in areas of engineering that were outside my realm of expertise. For example, if someone asked me about anything structural in their house, it was my legal responsibility to either not provide any advice, or to preface it with “I am really not knowledgeable in this area and so this is my personal opinion, not my professional opinion”. You probably see where I’m going with this.

If a doctor has no background in exercise science, is it legal and ethical for them to provide advice about exercise without some sort of disclaimer like the ones professional engineers are legally required to make?

 

Elsbeth Vaino, CSCS, (formerly P.Eng.), is a personal trainer in Ottawa, Canada.

 

References:
[1] Well Being: A push-up enthusiast is warned to lay off
[2] Doctors Not Being Taught About Benefits Of Exercise
[3] Physical activity curricula in medical schools
[4] Graduating medical students’ exercise prescription competence as perceived by deans and directors of medical education in the United States: implications for Healthy People 2010
[5] Impact of a preventive medicine and nutrition curriculum for medical
[6] Nutrition Education at Harvard Medical School

8 thoughts on “Is it ethical for doctors to dispense exercise advice?”

  1. No worries, I have a PT who specializes in LE, my doctor knows. I use a trainer and good form. I by no means want to proceed blythly. I know this is serious stuff.

  2. I had a feeling I wasn’t the only one. I do think some docs do have great input in this area, but for those that don’t – don’t pretend that you do!

  3. Great thoughts and thanks for the link – about to check it out. I think your oncologist is right to a certain extent – you don’t want to start upper body weight training too early, you definitely want to be cautious, and you want to be absolutely sure you’re using good form. I’ve got a client who had breast cancer surgery about a year ago, and she is doing very well with weight training, including upper body. If you don’t have a good trainer to help, then it would be a great idea to have a good physical therapist or massage therapist for some manual therapy as you start to lift weights. For one thing, they can hopefully do some work on your scar(s) as that can limit your mobility if left alone, and also to keep tabs on how your body responds. They will be able to see and feel how your body is responding and can help both advise you and keep your soft tissue in the best alignment possible. And of course, be sure to listen to your body (which it sounds like you’re doing). The body is very wise!

  4. I am a breast cancer survivor and I am cancer free. You would think with all the pinky pink breast driven awareness, that someone would have an exercise program from us younger Survivors. I have been researching my options online and much of what I could find about exercise for the breast cancer survivor is vaguely akin to stretching. I asked my medical oncologist for help and advice and he looked at me and said, upper bodywork is off limits to you. I found this study: http://extension.psu.edu/healthy-lifestyles/strongwomen/resources/strength-training-articles/weight-lifting-research-for-breast-cancer-survivors/at_download/file
    I have found weight lifting and I am going for it. I do need to be careful about lymph edema, but it seems as though, as soon as my body got used to lifting weight, any nominal swelling I was having stopped occurring. My med onc clearly does not know much about exercise. I am new to weightlifting, have been doing it for two months, my body both feels and looks better.

  5. Great article, Elsbeth!

    Just like you, I’ve had many of my clients come to me and say, “my doctor said that I should do X,Y, and Z.” And this is often times absolutely terrible advice! I’ve also had conversations with with a few doctors about working out, and far too often I leave the conversation shaking my head and saying to myself, “WOW! I can NOT believe this is the same person that is giving training advice to his/her patience when they come in for a check up!!!”

    It is not their fault that they know basically nothing about our field. But like you, it REALLY frustrates me that many of them act like they are in the know, and dish out advice when they have NO right to do so.

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