- Physical activity has virtues to prevent, cure and to prevent mortality and recurrence for the chronically ill, a collective expertise of the Inserm revealed this Thursday.
- If health authorities validate this new non-pharmacological care, the introduction of prescription sport remains complex.
- Training of physicians, reimbursement of care, adjustment of prescription, the experts also highlight in their report the challenges of this new approach, while the national strategy sports health is being developed.
And if we would do tai-chi in the park instead of crying under the duvet? It is no longer a secret, regular and appropriate physical activity is recommended for the healthy, and even more so for patients with a chronic disease. Either one in four French … While the French health authorities have validated the effectiveness of physical activity to prevent and treat, and have set up a sports recipe since March 2017, this new therapy is effective but not reimbursed,
It is difficult to settle in the mores. A collective expertise of
the National Institute of Health and Medical Research (Inserm), at the request of the ministry of sport, is about to come on Thursday: it describes the recommended activities for ten chronic diseases, how they can improve their effectiveness, but also the challenges for parenting for this care is installed in the French landscape. Another step on which the health sports strategy & # 39; could be based, which should be disclosed in the coming months.
"As far as tobacco is concerned, we can not pretend we did not know," says Grégory Ninot, expert in psychology who participated in the Inserm report with thirteen other experts, doctors, as well as teachers in adapted physical activity. To make this expertise collective, these professionals analyzed 1,600 scientific studies on the impact of physical activity on ten chronic diseases (obesity, diabetes, heart failure, stroke, cancer but also depression …).
"An important step in the transition from curative medicine, which has demonstrated its limits, to preventive medicine, says François Carré, specialist in cardiovascular disease.It does not sound like anything, but it is a paradigm shift.We have long against our patients said to take a rest, today we ask them to move! A revolution with a slight delay in the lighting: but few patients receive a prescription for sports today. "After an infarction, about 70% of patients return home without prescription for physical activity, "said Thibaut Guiraud, Institute of Metabolic Diseases, for a pathology that has been identified for a long time and for which a sports rehabilitation is required …
A positive impact on all these diseases
The Inserm report adds new scientific evidence: adjusted physical activity reduces fatigue and pain in cancer, the risk of mortality for chronic diseases in general.
In patients with #cancer, physical activity improves the quality of life (decline in #fatigue) and reduce treatment-related side effects. The effects will be greater if the activity starts during treatment # LaSciencePourLaSanté pic.twitter.com/Ui0l5cBwpL
– Inserm (@Inserm) February 14, 2019
For an infarction, following this non-medication prescription, which invites you to dance or yoga, can reduce the risk of recurrence and rehabilitation by 20%. "For a depression, a program of physical activity must be prescribed three times a week for three months by first-line GPs before antidepressants", says Grégory Ninot.
"The sooner we start when the diagnosis is announced, the better we can maintain a good physical condition, and thus we avoid the vicious circle of muscle loss and reduced breathing capacity", says Béatrice Fervers, oncologist. Hence the first recommendation of this expertise: systematically prescribe this physical activity to patients living with a chronic illness.
Adjust according to pathologies …
On arrival, the same recommendations on the frequency side: at least three sessions per week (in addition to 30 minutes of walking per day). But the report is groundbreaking by prescribing disease cases: for obesity, experts recommend focusing on reducing waist circumference rather than weight loss with endurance program & # 39; s; For cancers, the goal is programs that combine endurance and muscle building.
Publication of our collective expertise @Inserm that will change everything in physical activity for health. More exercise is not enough, we need to prescribe personalized and well-dosed programs to chronic patients @umontpellier @IsiteMUSE @ICM_Montpellier #INM pic.twitter.com/78zSz9B838
– Gregory Ninot (@blogensante) February 14, 2019
… and the patient
"We were totally wrong, François Carré admits: if the patient is only offered a bicycle and a treadmill and he does not like one or the other, there is little chance that he will continue the treatment. , walking, tai chi and custom gymnastics offered in some hospitals or in structures or associations that support these patients.
"There is no ideal sport!" Warns François Carré. The most important thing is to adapt the recipe to each patient, according to his taste, his obligations, his abilities, his means too. That is why the report insists on adjusting the recipe. Otherwise the patient may run out of steam after a few weeks of effort. Because it is not easy to close the muscle-building session when you are back to work.
Another question that has been investigated in this report: which factors influence patient compliance or not this change in habits? First lesson: the patient must understand the importance of him to make these efforts. And in order to be able to invite this activity in its daily life in a sustainable way, this therapy requires regular monitoring and communication between the physical activity worker and the care providers.
"The problem with this therapy is that it is for life," François Carré acknowledges. "Only 30% of patients who have followed this therapy are pursuing them in the long term," says Grégory Ninot. A follow-up that can be helped by digital innovations: telemedicine, but also connected objects … "The monitoring was previously based only on the declarative, the connected objects give a more precise reality and enable the doctor to follow up on the follow-up. up to adjust ", cv & # 39; s Gregory Ninot.
Training of doctors
Another challenge was identified and recalled Thursday: the need to train doctors to prescribe physical activity. Hence another recommendation: generalize a compulsory module during medical studies (this is good, the bill that my health 2022 brings about a complete revolution in the studies of our future doctors), but also in permanent education, education on this famous physical activity.
"Young physicians seem to stick to this approach much more", François Carré assures, who offers an optional course on the benefits of physical activity in medicine at the University of Rennes. For him the reflection must go beyond. "In cardiology, we usually prescribe three weeks of rehabilitation, but perhaps we should rather present ourselves three times a week than a year to use habits."
The issue of reimbursement
Finally, subject matter of magnitude, the question of reimbursement was raised during the press conference on Thursday. "We have all the evidence to prescribe physical activity and all arguments to pay it back," say the experts, who call on the health authorities to "propose a new way of caring". Improving prevention, devising a care process in which the patient is central, generalist working together, physiotherapist, cardiologist, oncologist, these are subjects that are animal-friendly
Minister of Health. An expensive choice in the short term, but would save money in the long run.