Exercise is Medicine Part 1

Here are a few quotations to support the idea that “Exercise is Medicine”:

• “The benefits of regular physical activity on health, longevity and well-being “easily surpass the effectiveness of any drugs or other medical treatment”. Chief Medical Officer 2009
• “If we had a drug in our therapeutic armamentarium that conferred all the benefits of regular exercise it would be the single best treatment for preventing disease and improving overall health and life expectancy”. O’Keefe JH et al 2013
• “Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.” Plato (427-347BC)
• “Physical inactivity is the biggest public health problem of the 21st Century.” Dr S Blair 2009
• “The drug of movement is one of the safest and most effective forms of preventive health. We need to get the medical community fully engaged in prescribing exercise for their patients” JD Metzl 2023

Some supporting organisations

1. Exercise is Medicine (EIM) is a global health initiative managed by the American College of Sports Medicine (ACSM). It aims to make physical activity assessment and promotion a standard in clinical care, connecting health care with evidence-based physical activity resources for people everywhere and of all abilities.”EIM encourages physicians and other health care providers to include physical activity when designing treatment plans and to refer patients to evidence-based exercise programs and qualified exercise professionals. EIM is committed to the belief that physical activity promotes optimal health and is integral in the prevention and treatment of many medical conditions”.
2. Moving Medicine (MM) is an initiative of the Faculty of Sport & Exercise Medicine UK. It aims to make the medical community more aware of the importance of physical activity to health. It states “up to 40% of long-term conditions could be prevented if everyone met the UK Chief Medical Officer’s physical activity recommendations”.  MM provides clinicians and allied health professionals with accessible, evidence based, condition specific information to help give advice on physical activity at all stages of children, young peoples and adults treatment pathways. It also provides a toolkit for hospitals to help people be more active during and after their time in hospital.

Why prescribe exercise?

There is incontrovertible evidence that regular physical exercise is extremely effective in the prevention and treatment of a wide variety of diseases. The people who benefit most are those in the later stages of life and it is just these people who are least likely to  do enough physical activity to benefit their health. The level of activity slowly declines from about the mid twenties till the age of retirement after which it goes into free-fall. And this is the time of life when retirement allows more free time to increase all those activities – games, walking, etc – which might reduce the risk of all the non-communicable diseases (NCDs) of later life while prolonging the chance of prolonging both length of life and healthspan. What a shame.

The main indications

Medicine is prescribed for those who would benefit from such treatment. In the case of exercise it is not hard to identify such individuals since nearly all of us would benefit from taking more exercise. Those who would benefit most include:

1. The inactive – those who live a sedentary life. Inactivity can be identified from the subjects own assessment (which is likely to be over-optimistic) and by wearable trackers like pedometers.
2. The unfit. Fitness has been designated “The sixth vital sign”. It, too, can be judged from personal assessment (also likely to be an overestimate) like walking speed and development of breathlessness with daily activities of living. It can be measured by a variety of tests, the simplest being walking speed over a limited distance. using a stopwatch and a measured distance. The best test for an accurate measure of fitness is the Rockport walk test which uses heart rate response to a brisk one-mile walk.  I described this in more detail in my blog of 27.07.2024.
3. Those with or at high risk of developing an NCD – hypertension, heart disease, stroke, diabetes etc
4. Older age groups. These are the subjects most likely to be inactive and likely to be at risk of developing frailty.

Prescribing exercise

Next time I will tackle the thorny problem of exercise prescription.

PS – XBX and 5BX

Last time I forgot to include this recommendation from my friend Terry . If you are interested in taking the Canadian Air Force exercise programme – XBX for women and 5BX  for men – go to YouTube for an excellent video to make it easier to follow – https://www.youtube.com/watch?v=vfbh1VC-RYo