When Steph* developed insomnia and depression in her late teens, she was told to stay away from technology and try to exercise.
“It was annoying,” she says. “Because I already know that helps. If I’m at the doctor, I’m looking for something else. It’s kind of condescending.”
It may not be what Steph (who asked that her full name be withheld) wanted to hear, but doctors are increasingly looking beyond standard treatments for their patients in a trend known as “social prescribing”.
Now the Royal Australian College of General Practitioners (RACGP) has partnered with parkrun Australia to help tackle ballooning rates of chronic illness.
The free, timed 5km events that take place around Australia are run by volunteers and open to anyone every Saturday morning – some run to improve their personal best, but participants of all abilities are encouraged to attend whether they want to walk, jog, volunteer or just watch.
The community partnership allows general practices to make ties with one of 450 local events and prescribe parkrun to their patients for health and wellbeing.
A 2019 report from the RACGP and the Consumers Health Forum (CHF) found the practice of social prescribing – referring patients to non-medical activities such as fitness programs, yoga and meditation – could improve health and wellbeing outcomes for people with chronic illness.
It’s also cheaper – treatment of chronic diseases now accounts for more than a third of Australia’s health spending.
The approach is similar to the model used in the UK, where local agencies including pharmacies, GPs and even police refer people to “link workers” who connect patients to community groups and statutory support services.
The RACGP president, Dr Karen Price, says the ongoing coronavirus pandemic and associated lockdowns exacerbated chronic illness, but it has been hard to find concrete, practical recommendations for her patients.
It is estimated that 20% of Australians live with two or more chronic conditions. Half of people with mental health issues have a chronic disease.
“As a GP I see firsthand how rising chronic illness like obesity and depression is impacting patients,” she says. “Although restrictions have been a necessary step to stop the spread of Covid-19, it’s led to increasing social isolation, anxiety and depression.”
Price says Covid has also encouraged “fragmented programs” for mental health that lacked human connection.
“That bothers me because … getting out in the community and finding a sense of belonging is a significant component of good health,” she says. “Health is mental, social and physical wellbeing, not just the absence of disease.”
Price says social prescribing is a “powerful tool” for preventive healthcare, but it needs more resourcing and formal recognition.
“It might seem simple, but helping a patient with anxiety and weight concerns to join a social exercise group can make a huge difference … long term, it can help keep them out of hospital,” Price says.
“Many GPs know it can improve their patients’ health and wellbeing but they lack formal links to local community activities.
“It’s not a one size fits all: GPs know their patients extremely well … there may be people who prefer a walk alone in nature or art classes that connect them to a community.”
But it has been a challenge to find suitable programs that are free, accessible and inclusive for patients.
“We’ve found people with low socioeconomic resources suffer most from chronic disease and have least ability to pay for activities – they’re isolated, they can’t afford a yoga class, these are vital things to help people manage their lives,” Price says.
“Exercise itself is a key component of virtually every chronic disease I can think of in terms of treatment and prevention.”
Price says social prescribing also helps to tackle Australia’s opiates issue – helpful for acute pain but not chronic conditions.
“Long-term with opiates you’ll get addicted and you’ll need more, there’s a cycle of disaster,” Price says. “Opioids have no role in chronic pain management, but exercise does.
“We’ve been used to seeing reactive medicine: go in, get a prescription and you’re done. Your lifestyle, and how you approach your world has a much bigger effect and it’s much freer of side effects in terms of what we can dispense.”
Cancer nurse Alicia Hopper has attended parkrun in Adelaide for six years.
Hopper says a friend recommended the event as a way to exercise that didn’t involve the gym, but it took her a while to “get the nerves up” to attend.
“I thought: what if I go and everyone’s a super-fit athlete in their Lorna Jane activewear and I’m the slow odd one out at the back of the pack?” she says.
“But the first one I attended I was like, ‘Oh my god, they look just like me’ and knowing that is reassuring. Gyms are incredibly intimidating to a lot of people who haven’t always been fit and active.”
Now she spends “half the day” talking about it.
“Having to go on antidepressants made me feel weak, feelings a lot of people still have about mental illness. But staying fit and active really helps,” she says.
“The important thing is the consistency … in dark times I’ve gone along and just sat there and had a coffee afterwards.
“For my own physical and mental health it’s been really profound. And I’ve made incredible friendships.”
Hopper, who was diagnosed with depression in her early 30s, says it would have been “really helpful” if her GP had recommended a concrete activity like parkrun when she received her diagnosis.
“You get told you should do activity regularly, it will help, but that’s where it ends, there’s no formal guidance or suggestions,” she says.
“I look forward to seeing an expansion of social prescribing beyond GPs to specialists. Oncologists have clear guidelines around prescribing drugs and side effects, but where’s the guidance around prescribing exercise?”
Dr Michelle Redford, a GP based in Newcastle, says there is “good evidence” parkrun encourages physical activity among people not traditionally active, who have “most to gain” from moving and being more socially connected.
“GPs see people from some of the hardest-to-reach sections of our community every day,” she says. “I encourage people to start small … and when they build their confidence they can challenge themselves further. We often need support to make lasting change.”
Doctors stress “social prescribing” is not a replacement for medical treatment, but an additional measure. Not everyone is convinced.
Steph ended up changing GPs, and her current doctor works with her on a range of strategies, including apps for insomnia and the prescription of melatonin, a natural hormone that regulates sleep-wake cycles.
“If I am struggling to sleep I have a sleep meditation app on my phone,” she says. “I think part of me always feels like I’m being told I’m fat or unhealthy when they tell me to exercise too. My current GP doesn’t say that stuff as much or it’ll be more in passing like ‘you already know that helps’.”
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