Dr. Fishkin coaches Dr. Judith Flores on the stationary bike.
	Dr. Jonah Green and Dr. Wasfy Zaki on the stationary bike.

Physicians at Woodhull Medical Center in Brooklyn are learning how to order a new type of prescription for heart health.  It’s not a pill or a revolutionary medical treatment, but a new way of making sure patients follow through on what doctors have ordered for years to stay healthy: exercise. 

Just as the typical prescription provides instructions for taking medication to get well, the new Rx lists the type of exercise, duration, intensity and frequency recommended for each patient to reach the desired level of fitness. And like any other prescriptions, it will be documented in the patient’s electronic medical record. 

But before doctors can write the right exercise prescription for their patients, they’ll first get a taste of their own medicine in a new training class that is teaching fitness to physicians.

“We get doctors to write their own personal prescription for exercise and then we teach them how to safely use a treadmill, an elliptical trainer, a stationary bike and free weights to experience first-hand the physiological effects of exercising at the target heart rates they have prescribed for themselves,” says Dr. Jonah Green, Chief of Rehabilitation Medicine and one of the teachers of the new class.

“We had a number of doctors who were very reluctant at first. After all, they had not exercised for a while,” says Dr. Green.  But soon they were convinced.

“This is not exactly how we learned about the medical benefits of exercise in med school,” says Dr. Andrew Chin, Assistant Director of the Department of Medicine, who participated in the first class. “But it is the best lesson I’ve received to help me become a more effective coach and cheerleader for my patients.”

The training session for physicians is only the beginning of the hospital’s “Wellness University,” a comprehensive program designed to not only increase physicians’ understanding of the role of exercise and fitness in health and disease, but also to assess the effectiveness of a prescribed exercise regimen and help them help patients learn how to confidently manage their exercise prescription on their own. 

The training program was conceived by Dr. Edward Fishkin, Medical Director at Woodhull, who was motivated to try something different to improve treatment outcomes for patients with the type of chronic illnesses for which regular exercise and fitness have been proven effective.

“There are three ways to treat patients who are at risk of cardiovascular disease and may have high blood pressure, elevated cholesterol, diabetes or are obese.  And that’s with diet, medicine and exercise,” says Fishkin. “As physicians, we do well in monitoring the diet and medicine piece. But we often don’t have the education or experience necessary to motivate or guide patients through an exercise regimen we can monitor and assess as any other treatment prescribed.”

By next month, patients at high risk of heart disease or those who have chronic conditions like diabetes or high blood pressure and cholesterol will begin to get their Rx for exercise. They will be referred for a “shared medical appointment” where up to six patients will get individualized coaching in the hospital fitness center and learn how to achieve the exercise Rx goals prescribed.

While patient health is the main goal of the Wellness University, everyone agrees the added bonus will be a more fit physician workforce. “I had to recommend to a patient a program of diet and exercise,” says Cardiology Chief Dr. Ronny Cohen.  “She simply turned to me and said, “And what about you?”

Dr. Cohen recently joined a bike club and has lost 80 lbs. He shared the before and after photos of his transformation with his colleagues in the class. 

Dr. Judith Flores, a pediatrician at Woodhull, noted that the training will help guide physicians to build in more structure when they talk to patients. 

“It’s not enough to just tell patients ‘go and exercise’.  It’s not useful if we as physicians don’t understand what it means,” says Dr. Flores. “I intend to adopt this strategy and engage the entire family. If I get the parents moving, I’ll get my kids moving.”

February 2012

Update 02/26/2013:  The doctors are all still practicing at Woodhull Medical Center.  Dr. Judith Flores is now Director of Ambulatory Care.