MEDICAL MATTERS: I have often prescribed holidays for patients. Or, more accurately, I have recommended a holiday to patients.
I may have wanted to prescribe a holiday, (or other non-pharmacological treatment) but our health system has never been enlightened enough to figure out that allowing doctors prescribe a short holiday might actually save it money in the long term. So it was with interest that I read news reports last week that the Lewisham Primary Care Team has launched a scheme whereby patients with chronic illness can be "prescribed" a dog. According to a spokesman for the NHS, caring for a pet helps patients recover more quickly from illness. "They feel less isolated and undertake increased activity. This has a direct impact on their physical and mental health".
The idea of using a pet to stave off depression is a well established one. A British charity, Pets as Therapy, has been offering the therapeutic benefits of animals to people for over 20 years. Scientific research has shown a number of health benefits of having a pet, including faster recovery from heart attacks.
Quite apart from the blood pressure lowering benefits of stroking a pet, the Lewisham initiative is focused on increasing the recipient's exercise levels, thereby preventing depression in people with chronic disease.
A recent report by the UK Mental Health Foundation, Exercise and Depression, outlines the benefits of exercise for people with mood problems. Comparative studies have demonstrated that exercise can be as effective as medication and psychotherapy. "Exercise has been associated with reduced anxiety, decreased depression, enhanced mood, improved self-worth and body image, as well as improved cognitive functioning," the report states. And the body responsible for approving NHS therapies, the National Institute for Clinical Excellence (NICE) says: "For patients with depression, structure and supervised exercise can be an effective intervention that has a clinically significant impact on depressive symptoms".
In its depression treatment guidelines, NICE recommends that "patients of all ages should be advised of the benefits of following a structured and supervised exercise programme of typically up to three sessions per week of moderate duration (45 minutes to one hour) for between 10 and 12 weeks".
Exercise has several advantages in the treatment of depressive illness. It is a sustainable behaviour change and one that is easily integrated into an overall healthy lifestyle. Exercise does not carry the stigma sometimes associated with medication or attendance at a psychiatrist / psychologist. It can give patients a sense of power over their rehabilitation, a feeling which in itself helps counteract the feelings of hopelessness associated with depression. And, of course, it hits several targets at once. Diabetes, high blood pressure, obesity, raised cholesterol and depression are all helped by exercise. Not many tablets can boast such a range of benefits!
The prescribing of exercise has been formalised in the UK through exercise referral schemes. It is estimated that up to 1,300 such schemes are operating across Britain. Primary Care Trusts - the equivalent of community care areas here - have set up partnerships with local leisure services. GPs refer patients who fit the referral criteria; they are first seen by a trained exercise professional, who devises an individual activity programme. As well as swimming pools, gyms and exercise classes, yoga and even belly-dancing are provided under the exercise referral scheme.
A pilot scheme offering doctors and patients the opportunity to participate in exercise prescribing was a notable success in the former Southern Health Board some years ago. Sadly, and despite the success of the national cardiovascular strategy (which has ensured people with heart disease are offered in-hospital exercise programmes) we do not have a national exercise referral programme. Despite its significant potential - exercise is a holistic option for the many patients who have a mix of physical and psychological health problems - it cannot be prescribed by family doctors in the Republic.
Might the newly-formed Faculty of Sports and Exercise Medicine of the Royal College of Physicians in Ireland take up the gauntlet on behalf of patients and lobby the Minister for Health Mary Harney and her department for the development of exercise referral programmes here?
Dr Muiris Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he cannot answer individual queries.