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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Pay to Play

I recently posted about an article that was published in the British Medical Journal (BMJ 2009;338;b688) entitled "Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort." As you will recall, the objective of the study was to examine how change in level of physical activity after middle age influences mortality and to compare it with the effect of smoking cessation. The results were that the absolute mortality rate was 27.1, 23.6, and 18.4 per 1000 person years in the groups with low, medium, and high physical activity, respectively. The benefits of exercise for decreasing mortality (and presumably improving health) were deemed to be as dramatic as those of smoking cessation.

The question remains, of course, as to how we are going to 1) convince people that exercise is good for them, and 2) actually get them to exercise. Since physical activity seems to be as good as smoking cessation, perhaps we should take a lesson from the smoking cessation literature. In an article in the New England Journal of Medicine entitled "A randomized, controlled trial of financial incentives for smoking cessation," Kevin G. Volpp and colleagues (N Engl J Med 2009;360:699-709) noted that smoking is the leading preventable cause of premature death in the United States, and then proceeded to describe a study in which they randomly assigned 878 employees of a multinational company based in the U.S. to receive information about smoking-cessation programs or to receive information about prorgrams plus financial incentives. The financial incentives were $100 for completion of a smoking-cessation program, $250 for cessation of smoking within 6 months after study enrollment, and $400 for absinence from smoking for an additional 6 months after the initial cessation.

The results were that the incentive group had significantly higher rates of smoking cessation than did the information-only group 9 to 15 months after enrollment. Incentive-group participants also had significantly higher rates of enrollment in a smoking-cessation program, completion of a smoking-cessation program, and smoking cessation within the first 6 months after enrollment. The conclusion was that financial incentives for smoking cessation significantly increased the rates of smoking cessation.

Well, why not pay people to become healthy in other ways? Why not pay them to lose weight, manage their blood lipid levels, keep their blood pressure under control, and exercise? If we know that physical activity (exercise) of certain varieties has the same impact as smoking cessation upon mortality in certain populations, and we know that people can be effectively paid to stop smoking, why not pay them to exercise? It would be great to do a study to determine if this could be done. It may not seem right to have to pay people to do the correct thing, but if the alternative is to watch people become unhealthy, have severe medical problems, and expect society to foot the bill, why not? If it's less expensive for all concerned to "pay to play," rather than "save to suffer," I say let's consider giving it a try.

Better yet, give it a try yourself. If you are an employer, give people paid time off if (and only if) they use the time to participate in the physical activities that will truly improve their health. Compare that to your health insurance premiums, productivity, and time lost from work, and perhaps you will find it an attractive way to improve the general health and well-being of your employees.

Preview the Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 24-29, 2009.

Join me from January 24 to February 2, 2010 for an exciting dive and wilderness medicine CME adventure aboard the Nautilus Explorer to Socorro Island, Mexico to benefit the Wilderness Medical Society.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.