A new study shows that, when someone needs to be more physically active, having a GP write a “walking prescription” may be one of the best ways to stay motivated.

Walking improves cardio-metabolic health, and, for people with type 2 diabetes, walking after eating can play a big role in preventing blood-sugar spikes.

Walking is not only good for us; but it’s also cheap and accessible. For many people, it can be done more easily and regularly than, say, going to the gym.

Because of this, healthcare professionals often recommend it. But whether we, as patients, follow the recommendation can be another matter.

“To actually prescribe exercise is a really interesting way of doing it”

Dr Bryan Betty, Director of The Royal New Zealand College of General Practitioners

Enter a New Zealand research team who wanted to find out whether a formal prescription for a set amount of walking would be a motivator for people with type 2 diabetes, and, more to the point, what would help or hinder people in following the prescription?

The Royal New Zealand College of General Practitioners has just published the study, and the findings are illuminating.

What kept people walking

Some themes emerged as important motivators for the study participants:

• establishing a set walking routine

• having family or a partner’s support for the new walking regimen

• regular monitoring by a healthcare professional

• experiencing health benefits that they attributed to the walking, such as improved self-esteem, feelings of wellbeing, better sleep, better digestion, and improved blood-sugar control.

Some participants reported weight loss and/or eating less at meal times in order to feel more comfortable while walking.

What prevented people walking

Injuries and sore muscles hindered some participants’ walks, while a small number of participants found walking hard to prioritise over other activities.

Several women in the study found after-dinner walks were hard to maintain, as it was often dark by then. Unease about walking after dark was a major obstacle. Walking in bad weather was a deterrent for some participants as well.

Several participants lived alone or didn’t have family support, and this negatively affected their adherence to the walking prescription.

The role of the healthcare provider

The study suggests that patients need “purpose, reward, and incentive” to maintain a walking practice. A key finding of this and other related research is that the formalised researcher–particpant relationship plays an important part in motivating the participant. This suggests that, in real life, the relationship between a patient and the healthcare provider who writes their prescription is also crucial.

The study makes the point that healthcare providers need to understand their own role when it comes to motivating the patient. Working with the patient to set realistic goals, formally documenting physical activity prescriptions, and checking in with the patient about the prescription at follow-up are all vital. The healthcare provider can also help by encouraging family participation, reinforcing the positive health benefits of walking, enquiring about any obstacles to walking, and helping the patient figure out ways to get round them.

Dr Bryan Betty, Medical Director of The Royal New Zealand College of General Practitioners says an example of this would be, if the patient is uneasy walking alone at night, they could join with others for a night-time walking group. Or perhaps their healthcare provider could help them find another activity to do at night that has the same benefits as walking. Dr Betty says, “We know that housework is actually really good exercise... vacuuming for example.”

Why a prescription?

At his practice in Cannons Creek, Porirua, Dr Betty often uses the Green Prescription system. This is an initiative administered by the Ministry of Health, that allows patients to be prescribed a programme of physical activity that can be done at home and in their community.

However, Dr Betty says, “You don't have to do the whole green prescription.” There’s no reason why GPs or other healthcare professionals shouldn’t use a written prescription as a tool for encouraging something more modest but still incredibly beneficial, such as walking.

“The way a patient structures their day is incredibly important in terms of where you slot changes in to their routine. To actually prescribe exercise is a really interesting way of doing it.

“Saying, ‘Do more exercise,’ is vague and generic, and can be easily dropped. But writing a prescription to actually say, for example, ‘Do 10 minutes here, and 10 minutes there,’ is a way of formalising the conversation. It’s like an agreement.

“With any prescription, whether it be for medication or something else, you always move towards a point of agreement where both patient and the medical professional are agreed on what things look like going forward.

“In practice, a lot of GPs tend to do this. With the patient, we’ll agree what we're trying to achieve over the next two to three months and then, at the end of that time, review it with the patient.

“Having clear structure and clear guidance that both the clinician and the patient can agree to is a really good way to go.”

Dr Betty thinks the new study on walking prescriptions is valuable. “Having this sort of research which backs up the prescription approach gives you an extra impetus to do it.”

You can read the full report in the Journal of Primary Healthcare: www.publish.csiro.au/HC/HC20023