How AI Can Help Physicians Promote Exercise and Lifestyle Counseling

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My colleagues and I have been on a year-long mission to encourage more asthma patients to exercise. As would be expected from doctors, our plan involves writing prescriptions – only, rather than prescribing medication, we “prescribe” physical activity.

Asthma & Exercise

The logic behind this mission is straightforward: we know that people with asthma don’t exercise as much as they should.

Many asthma patients are understandably afraid of physical activity because they’ve had negative experiences with strenuous exercise. But moderate exercise is good for asthma patients! Exercise strengthens the inspiratory muscles, which helps asthma patients breathe more deeply. It also has anti-inflammatory effects on the lungs. Expert guidelines recommend that physicians counsel all asthma patients about the benefits of physical activity.

However, a doctor’s job doesn’t end after recommending physical activity. An asthma patient who has been convinced of the need for physical activity may still not know how to build an exercise plan or incorporate physical activity into their daily routines.

A Standardized Exercise Prescription

One answer to this challenge is a written prescription that includes different viable activities and target exertion levels. Our team invested months researching expert recommendations for physical activity in asthma. We pored over graphics that had been developed for other medical conditions and, using them as inspiration, ultimately produced a single-page “exercise prescription.” When it was finally published in the fall of 2022, we celebrated. For the first time, asthma specialists around the country had a template for exercise recommendations that they could customize for each patient.

Enter, AI

Flash forward to last week when I stumbled upon Doximity’s DocsGPT feature. DocsGPT is an artificial intelligence (AI) program designed to answer healthcare-specific prompts. Naturally, I asked it to generate an exercise prescription for a hypothetical patient. Within seconds I received a functional copy of our work (Figure 1). The time and energy my colleagues and I – all board-certified allergy/immunology physicians – had devoted to designing an exercise prescription was made redundant in less than a minute.

By software.

Am I bitter about it? No! Ok, maybe a little. But my initial bitterness quickly gave way to excitement about the opportunities created by this discovery.

Let me explain why I think programs like DocsGPT can be the medical profession’s greatest ally in promoting exercise and lifestyle counseling in general.

The Disconnect Between Doctors and Patients

When I was a medical student ten years ago, I sometimes heard doctors complain about patients who were resistant to lifestyle changes that could improve their health. They grumbled that their patient was reluctant to consider diet modifications or increase physical activity, or they complained that a patient relied too heavily on medication as their solution to poor health.

AI can help bridge the gap between physicians and patients

Around 2020, I discovered that much of the public had exactly the opposite perception: this time, it was patients who complained.

“My doctor just wants to push pills”

“I never learn anything about what to eat or how to be healthy.”

Both complaints may be legitimate under certain circumstances, but they are not universal truths. It’s evident that many patients are interested in living, and learning about, a healthy lifestyle from their doctors, not just what medications to take. Likewise, many doctors would be thrilled to coach healthy living rather than just ordering tests and writing prescriptions all day. This raises the question of why these two groups aren’t always aware of each other and how to facilitate contact between them.

Artificial Intelligence: The Health Coach in Your Pocket

AI can help bridge the gap between physicians and patients in a few different ways.

Saves Time

One reason for the disconnect may be that an average medical appointment doesn’t leave enough time for a doctor to effectively give lifestyle counseling. In fact, many physicians cite limited time as the primary obstacle to discussing healthy behaviors with their patients.

That’s where AI comes in. The targeted use of AI can enhance a physician’s ability to offer lifestyle counseling, which in turn can help more patients achieve lifestyle goals.

By entering a detailed prompt into AI software, like “design an exercise plan for a 60-year-old woman with severe asthma and knee arthritis” or “recommend meals for a 40-year-old vegetarian man with metabolic syndrome,” physicians will have rapid access to personalized lifestyle recommendations.

Re-expands Physician Knowledge Base

A second obstacle is the lack of physician preparedness to discuss subjects like diet and exercise. For example, critics of medical education contend that physicians undergo sparingly few hours of training in nutrition (scattered across thousands of hours of total education). Wherever this is true, it should be corrected. I was fortunate that my medical curriculum did include lessons on diet and exercise (as well as sleep and even meditation). However, unless a physician actively maintains that knowledge, it’s unlikely to be consistently reinforced throughout his or her career. (Contrast lifestyle counseling with physiology, anatomy, and pharmacology, the maintenance of which together occupies much of the average physician’s bandwidth. For instance, a Western-trained physician is required to maintain daily familiarity with an ever-expanding lexicon of drugs.)

Figure 2 illustrates how a non-specialist physician could use DocsGPT.

With AI, mid-career doctors can dust off some of the knowledge they may have forgotten. AI programs don’t require continuous reinforcement to preserve their memory of a knowledge set, unlike doctors, who are, after all, human. With the correct AI prompt, an asthma specialist, even one with little or no fitness expertise, could produce reliably accurate physical activity recommendations for their patient.

Reduce The Burden of Responsibilities

AI also has the potential to alleviate physician burnout. Burnout is a widely discussed phenomenon in medicine, with much research exploring its sharp rise in recent years. It seems to partially arise from a feeling of being over-extended. A physician might feel burned out when attempting to juggle numerous professional responsibilities, including providing optimal patient care and staying abreast of recent advances.

A physician who hasn’t kept a particular interest in the science of nutrition or fitness may struggle to offer specific lifestyle advice. Further, a burned-out physician has little desire to further their knowledge in those domains. Such a physician can rely on AI to guide decision support for patient lifestyle counseling instead of adding it to their already extensive task list.

Why Patients Need To Hear About Healthy Living

It remains extremely important that patients hear lifestyle counseling messages from their doctor. No procedure, pill, or cream can replace the fundamentals of health. Maybe you’ve heard the cliche, “You can’t outrun a bad diet.” I would add that you can’t out-medicate an unhealthy lifestyle.

Unfortunately, we in the United States are a deeply unhealthy population with a shrinking life expectancy. The prevalence of chronic diseases like asthma, diabetes, and obesity are increasing at frightening rates. Much has been written about how the United States spends more money on healthcare per capita than any other nation. But a state-of-the-art grenade launcher can’t stop an avalanche. Amplifying healthcare resources in the form of procedures and pills will not indefinitely blunt the effects of a poor lifestyle. As long as unhealthy lifestyles are abundant, the healthcare system will face an uphill battle.

you can’t out-medicate an unhealthy lifestyle

Counseling is Key

Counseling interventions are an important part of the solution. Better health education leads to greater adoption of healthy lifestyles, which improves the management of asthma and other chronic diseases.

While there will always be a role for modern medicine, particularly in the many ailments that can’t be reversed by lifestyle change, pursuing healthy behaviors is synergistic with taking necessary medications. Healthy life choices equip a body to better recover from injury and illness. Furthermore, the beneficial effects of a drug are amplified in a healthy individual, like the effects of an oil change are most pronounced in a well-maintained automobile.

Imagine what would happen to heart and lung disease rates if all Americans met the recommended goal for physical activity of 150 minutes per week. Imagine if they also ate a diet rich in protein and fresh, whole, organic ingredients. Now imagine if they avoided smoking, reduced alcohol consumption to moderate levels, got eight hours of sleep every night, and had enough exposure to sunlight. Disease would still be present, but there’s no question that we’d have a much healthier citizenry at baseline.

Of course, AI technology is no substitute for medical expertise (Figure 3). It would be a mistake to advise patients to get feedback from AI software without it being reviewed by a qualified physician. Still, any innovation that can allow pro-health messages to be exchanged between doctors and patients represents a step in the right direction. I believe that AI can be one such tool.

In Conclusion

Integrating AI technology will bring many changes to the practice of medicine. Physicians should embrace these exciting digital HealthTech tools and use their potential to reinforce the cornerstones of human health.

Physicians should view the AI revolution as an opportunity to increase lifestyle counseling by making it more time-efficient and personalized. I look forward to the day, probably soon, when I meet a patient who credits their AI-generated exercise prescription with helping to bring their asthma under control.