Medical implications of exersize for M.E.

[Guest guest]

Dr Shepgerd

www.meassociation.org.uk

MAY BE REPOSTED

With increasing numbers of patients being prescribed exercise

programmes on the NHS, doctors in the UK have once again been issued

with guidance by one of their medical defence organisations and the

Department of Health (DoH)on the medico-legal aspects of some of the

common dilemmas they face when making referrals for exercise

treatment.

This guidance is particularly important in view of the fact that

people with ME/CFS are now being coerced into undertaking various

types of graded exercise programmes - sometimes in a form that is

totally inappropriate to their clinical situation.

Key points in this new joint guidance include:

1 Doctors should not go against existing General Medical Council

guidance on patient referrals, which states:

" Usually you will refer patients to another registered medical

practitioner. If this is not the case, you must be satisfied that

such health care workers are accountable to a statutory regulatory

body, and that a registered medical practitioner, usually a GP,

retains overall responsibility for the management of the patient. "

One exception in relation to exercise treatment appears to be sports

professionals who are on the Register of Exercise Professionals (REP)

as this organisation is a DoH recognised body.

2 The DoH has produced a National Quality Assurance Framework on

exercise referral programmes. This advises health professionals on

what to consider when referring patients to exercise programmes. It

also recommends that when patients are referred to fitness

instructors, they are members of the Register of Exercise

Professionals that are qualified as advanced, Level 3, instructors.

3 Doctors without specialist knowledge of exercise medicine - which

will inevitably include most GPs and psychiatrists - should

only " recommend " exercise rather than " prescribing " it. This is

because referral and prescribing processes carry a greater legal

implication and they have very specific meanings in the medical

context. For example, if a doctor " prescribes " exercise for a

patient who then suffers a heart attack while exercising, the doctor

could then face a claim for damages. So exercise programmes have to

be " prescribed " with just as much caution as is applied to the use of

drugs.

4 When completing forms for supervised exercise programmes, doctors

without special expertise should state that they know of no reason

why a patient should be unfit to exercise, rather than certifying

them as being " fit to exercise " .

5 The DoH have also announced that they will be offering three year

training courses in exercise medicine to doctors in an attempt to try

and avoid some of the medico-legal dilemmas that are clearly

associated with this approach to management.

Further Information

Exercise Referral Systems: A National Quality Assurance Framework,

Department of Health, 2001. Can be accessed on the DoH website

(www.doh.gov.uk)

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For details on the Register of Exercise Professionals telephone: 0208

686 6464

Dr Shepherd

Medical Adviser, ME association

8 March 2005

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ENDS