Patients of Dr Najabat Hussain may leave his surgery with an unusual type of prescription. It costs much the same as a supply of drugs on the NHS and lasts for at least 30 days. But instead of going to the nearest pharmacy, these men and women from Reddish, near Stockport, go to the gym. In an arrangement with the local swimming baths, their 'prescription' buys them 30 exercise sessions instead of a packet of pills.

Dr Hussain is one of 20 GPs, representing all the practices around Reddish, involved in an 'exercise on prescription' scheme. Hundreds of patients have been 'referred' for activities such as aqua aerobics, racket sports, yoga, weights and trampolining. The patients are asked for a contribution of pounds 4.75, the cost of one item on an ordinary NHS prescription.

Many have never used a leisure centre in their lives. They are assessed by their doctor and Jackie Carroll, the local authority health and fitness development officer, to establish appropriate exercise. After 30 sessions they return to the GP for another assessment. It is then up to them whether they continue with the exercise.

There have been some gratifying successes. One 42-year-old man reduced his cholesterol level by 50 per cent after 10 weeks of exercise. A woman in her late thirties, suffering from anxiety and agoraphobia, who took up swimming and attended the gym, is now able to go out on her own, Dr Hussain says.

He believes prescribing exercise is an effective way of treating physical and psychological conditions, in particular anxiety, depression, obesity and raised cholesterol. 'My own view is that this is a very useful alternative to medication. It does influence my prescribing because I now have an effective alternative on offer,' he says.

He encourages exercise in patients with asthma and diabetes and occasionally for high blood pressure. 'We must look at the patient as a whole, not just at their medical condition. If we think they can be helped by exercise, we prescribe it. As a result, they are often encouraged to improve their diet and lifestyle and give up smoking. They can also improve their self- image. It's a chain reaction.'

The scheme was supported by nearly pounds 11,500, largely from Stockport Metropolitan Council. Those involved in the scheme have raised another pounds 5,500 from an 'exercise on prescription' seminar last July.

The enterprising Stockport doctors are not alone. In East Sussex, the Oasis Programme is another unusual partnership between 74 local GPs and hospital consultants and the Lagoon Leisure Centre in Hailsham. Now in its fourth year, the programme is run by Wealden District Council and is the subject of a research project at the University of Brighton, where Dr Adrian Taylor is the senior lecturer in exercise and health psychology. He has received pounds 70,000 from South- East Thames Regional Health Authority for an 18-month evaluation of the programme and an investigation of the links between exercise and coronary heart disease.

The programme's pioneer GP, Dr David Hanraty, says his practice routinely refers patients with hypertension, asthma, diabetes and depression to the Oasis. Local consultants use it for pre- and post-operative open-heart surgery patients and orthopaedic problems.

Patients are issued with a referral card on which the doctor enters their details and any prohibited activity. Patients then make an appointment with a nurse (her pounds 17,000 salary is paid for by the district health authority), sports psychologist or a sports physiologist at the leisure centre to plan a 10-week programme of physical activity. They pay half the usual admission rates, starting at pounds 1.30 a session.

Dr Hanraty's success stories include a 67-year-old woman with diabetes and hypertension who was overweight and clinically depressed. After 10 weeks of one-and-a- half hours of exercise three times a week, she stopped her medication and her diabetic diet. She also came off her hypertension medication and lost two-and-a-half stone in weight. 'She now lives in a very different world,' says Dr Hanraty.

A 23-year-old woman with a serious chest condition, who suffered four to six infections a year, has followed her prescribed exercise programme for 18 months and has not had a chest infection in that time, he says.

An audit of 56 patients one year into the scheme revealed impressive results. There was an 85 per cent compliance rate and 65 per cent of patients were still taking exercise one year after being referred. Of the 11 smokers who were originally referred, nine stopped smoking; of 29 patients who were overweight, 93 per cent had lost weight - with an average weight loss of 7lb in the first six weeks. All five asthmatics were able to reduce medication, needed to see their GPs less frequently and could do more exercise without becoming short of breath. Of 12 patients with high blood pressure, all had managed to lower it, four had reduced medication and two had stopped taking medication altogether.

'The scheme has what you might call global advantages,' Dr Hanraty says. 'We are looking at a town which is a centre of poverty, deprivation and crime. We're hoping that by people making contact with each other through the Oasis Programme we can improve the social state of the town.'

He has referred two patients with schizophrenia who are now able to get along with other people, attending the programme in a way they would never have contemplated before. And their demands on GPs' time are down 75 per cent, he says.

Dr Derek Browne, a GP from Brockenhurst, Hampshire, is widely regarded as the guru of the 'exercise on prescription' phenomenon. His Healthy Village Project - recognised by the World Health Organisation as the first of its kind - has just received pounds 15,000 from Wessex Regional Health Authority and Southampton and South-West Hampshire Health Commission to fund a part-time co- ordinator for two years.

Patients are referred by their GP or can refer themselves. The co-ordinator helps them to choose from a range of physical and social activities available in the community. The idea is to encourage better- quality living, but just because there is no leisure centre on the doorstep does not mean patients cannot be encouraged to be more active, says Dr Browne. For those who wish to take exercise in a formal setting, he has forged links with the Carat Club, a health club at the local Careys Manor Hotel.

Although the project has not yet been audited, Dr Browne says there is evidence of a reduction in referrals to hospital and patients have come off sleeping tablets, medication for asthma and depression and non-steroidal medication for arthritis.

An Audit Commission report, A Prescription for Improvement, suggested GPs could cut pounds 425m off the NHS drugs bill by changing their prescribing habits. A change in the direction of the local leisure centre may be a health service development of real benefit to the patient.

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