The clinic that prescribes exercise

Joan Ratera weighed 120 kilos. “He walked six meters and I got tired,” he recalls. He now walks between 6 and 10 kilometers every day and his scale moves between 77 and 80 kilos. Joan is one of the patients in the new clinic specializing in physical activity prescription for chronically ill patients that has opened at CAP Iguadada Nord (Anoia). In this medical center, chronic patients not only receive pharmacological treatment but also individualized guidelines for physical activities to increase their longevity and well-being.

The proposal of this clinic is based on the WHO programs on physical activity as a means of disease prevention and management. “Physical exercise is very accessible for the healthy population with a high socioeconomic level, but it is not so much for vulnerable people or for the chronically ill,” explains the center’s director, Aurora Garriga. “And it has been shown that it improves the physical and mental situation of chronically ill patients, that it helps reduce medication, improve quality of life and lengthen survival.”

The objectives: improve the quality of life of patients, reduce medication and lengthen survival

The initiative of the CAP Igualada Nord is currently aimed at three types of pathologies: people with heart failure, diabetics with poor control of the disease and post-covid patients. Later, those affected by chronic obstructive pulmonary disease will be added, for whom exercise “represents as much or more improvement than any drug”, explains Garriga.

The patient suffers from heart failure

Llibert Teixido

Joan Ratera, 63, suffered heart failure two years ago. He had practiced swimming, but for the last 15 years he led a sedentary life. Adolf Castro, a primary care nurse specialized in physical activity and pathologies (as well as an INEF student) has been in charge of preparing a specific activity program adapted to his pathology, age, sex or physical conditions. In the case of Ratera, who should not make any other kind of effort, it consists of walking. Walk every day and stretch to avoid injuries. “At the beginning he did a kilometer and ended up creaking,” he recalls. He now he does not drop below six.

Movement is life

The Department of Health has promoted the promotion of physical activity in the health system since 2005, given that the lack of exercise leads to a decrease in the health of the population and this has repercussions on care pressure that falls in the first instance on the primary care. According to the WHO guidelines on physical activity and sedentary habits (2020), between four and five million deaths could be avoided worldwide each year if all people were more physically active. In the case of adults, the Organization attributes health benefits, as a weekly guideline, to more than 300 minutes of moderate-intensity aerobic physical activity (running, walking, cycling, swimming, Nordic walking) or 150 minutes of aerobic activity vigorous intensity, or an equivalent combination.

Castro attends to these patients once a week and carries out a personalized follow-up of each one. “It is about creating a habit, that they see that they are finding each other better. For those who have never practiced physical activity and you have to convince them that it will benefit them, it is a bit of a struggle. It is difficult to make a diabetic person who has never exercised understand that if they do, they will lower their sugar level, ”he explains. The program is complemented with guidelines for a balanced diet.

In the case of post-covid patients, the activity focuses especially on respiratory work and muscle rehabilitation.

04 - 14 - 2022 / Igualada / The CAP Igualada Nord opens a consultation specialized in physical activity prescription for chronic patients (heart failure, diabetes, postcovid).  They will be Aurora Garriga, director of the CAP;  Adolf Castro, a nurse specialized in physical activity and chronic diseases, and a patient (Joan) .  / photo: Llibert Teixidó

Preparation of the physical activity program

Llibert Teixido

In addition to developing the program, the nurse keeps track of the intensity and frequency of the activity, evaluates its results and periodically adjusts the recommended pattern. In addition, it works in collaboration with the cardiology and physiotherapy services of the Igualada hospital. The medical literature on physical activity in chronic pathologies is scarce. “Until now it was ‘go for a 20-minute walk’ for everyone and for any illness,” Castro reasons, but nursing in countries like the US or Australia is more advanced in this area than European countries.