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Why every doctor needs to prescribe health and fitness

Sport on prescripton has been trialled in Strasbourg and found to help patients with chronic illnesses. Nicolas Sailly – a director of insurance company ASSU 2000 – argues that it should be rolled out across France to benefit more people – and cut State health spending

How can we stem the rising costs of medicine sales in France while safeguarding the health of French people?
How can we maintain the well-being of older people without forever multiplying prescriptions for yet more medicines?
Sport on prescription, a practice which has emerged recently, could be the answer to both these questions.
But it is time for the public authorities to embrace the idea and use it wholesale.

It has at last become law.
Adopted the first time by French MPs and then rejected by the upper house [Sénat] a year ago, the clause relating to sport on medical prescription, which was part of the new law on health, was definitively adopted in November last year.
But for the time being at least, it only relates to people with long-term health conditions [affections de longue durée (ALD)]. Other patients, who were hoping to be prescribed sport for their health, will have to wait.

Positive results for many diseases

First of all, for the patient, the effects of a sports prescription is double: doing a sporting activity adapted to the person’s condition and illness can improve general fitness.
A total 40% of world deaths are due to sedentary lifestyles; if everyone walked for an hour a day this figure would be vastly reduced. But sport prescriptions also result in reduced consumption of medication, meaning fewer side effects.
So sports prescriptions can be helpful in cases of chronic diseases like stabilised cancers, diabetes, cardiovascular disease and obesity.
In April 2015, during the hearings about this law, the MP and ex-sports minister Valérie Fourneyron said: “Studies show that doing sport reduced the risk of breast cancer and colon cancer returning by 40%”.

A look at trials so far

So how does it work in practice? The GP writes the prescription and the patient meets a team of specialist sports coaches who establish the patient’s ‘sedentary level’ and draw up a suitable programme.
An experimental health/sport-on-prescription programme was carried out in 2012 in Strasbourg, a city which is particularly advanced in this field. Sports medicine specialist Prof Jehan Lecocq in Strasbourg said the results showed patients who did cycling, tai-chi, aqua-gym, or Nordic walking lost on average 2kg in six months. Even better, of eight diabetics in the programme, seven improved their blood-insulin levels.
In 2014 alone, more than 700 patients were prescribed 48,000 hours of sport, by more than 170 doctors, which they did with seven specially licensed associations.

A long-term investment

The Strasbourg experience highlights the development of this practice, but it is still only sporadic. Without the real will of authorities to sponsor and encourage sport on prescription, it could remain something only used by motivated individuals.

In order for it to have a significant impact, it has to be adopted all over the country. The main brake to this generalised use is the financial investment needed.
The State’s coffers are empty, of course, but a long-term view is needed: spending on this could lead to money-saving results. Sports on prescription can reduce the risk of cardiovascular disease, illnesses caused by sedentary lifestyles, and even diabetes.

So many medical problems require expensive, long-term treatments, but promoting sport on prescription across the country could reduce public spending on health.
As Strasbourg deputy mayor Dr Alexandre Feltz said in 2013: “Sport on prescription reduces prescriptions for drugs, and therefore long-term the financial pressure on state health insurance and public spending.”

For that to happen, the authorities have to step in and move things forward.

Widening the field for sport on prescription

Some top-up health insurance policies have already said they will adopt this initiative by paying for sporting activities.
But, the aim is not that public health insurance [Cpam] pays for prescribed sport directly as finance could come from multiple sources, local authorities, top-up insurance policies, or patients’ associations.
We have to go further and make this more widespread.

Doctors could, for example, offer sports activities to all patients who might benefit.
To achieve that, they could be encouraged to prescribe sport by being trained and/or having access to a guide on prescribing sports, which is not currently the case.
Finally, underlining the benefits of sport for the well-being of people in general, we need to include all sports.

So it would seem logical that clubs should think of developing special sessions for these people, as the French Athletics Federation did, for example.
Sports clubs and federations are always looking to expand membership, so could benefit from offering activities for this section of the public.

This article was first published in French in It was translated for Connexion by Samantha David

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