Exercise is Medicine Part 2

Prescribing Exercise

You do not have to be a doctor to prescribe exercise. However, written advice about exercise often carries the caveat the you should consult your doctor before increasing your exercise level. This strikes me as stuff and nonsense. I reckon that you should consult your doctor if you are thinking of not taking more exercise.

There are exceptions – mainly related to the state of health of the individual. Those with heart disease are better off being supervised, at least to start with. Warning symptoms and signs include angina (pain in the chest arms or throat with exercise), undue breathlessness or light-headedness with effort, ankle swelling and palpitations.

Five principles

Ideally the five principles for exercise prescription are type, duration, frequency, intensity, and volume. The last four of these comprise the exercise dosage.

Exercise type

There is a number of categories of exercise and there is some evidence that some forms are more effective than others for particular conditions. An example is that muscle strengthening is more effective than aerobic exercise for treating high blood pressure. However the differences are small and the overall message must be that it does not matter what exercise you choose, it is the dose and the long-term compliance that matter.

The strongest evidence of the effectiveness of exercise is the association between cardio-respiratory fitness (CRF)  and health benefits. There is little difference between the various types of exercise and the resulting increase in CRF.

A recent meta-analysis compared the effectiveness of  five modes:

1. Continuous aerobic exercise (ie cycling, running etc) increased CRF by 3.8 units
2. High Intensity interval training (HIIT) increased CRF by 6.1 units.
3. Resistance training(weight lifting etc) increased CRF by 2.1 units.
4. Combined aerobic and resistance training increased CRF by 3.0 units
5. Water based training increased CRF by 4.1 units.

The fact of taking exercise and persisting with it is far more important  than the type of exercise prescribed. So the horses for courses mantra applies and the prescriber of exercise should emphasise how important it is for the exerciser to choose what they fancy.

Exercise Dosage

As far as dosage is concerned, a recommended level has been set by the Department of Health – 150 minutes per week of moderate to vigorous exertion per week with strength training on two days of the week. This should be the minimum level – more is always better, but less likely to be complied with.We all know that exercise is “good for us” so we should be receptive to recommendations to take more.

Where to exercise

It is really helpful to have a large repertoire of possible types and venues. In Alton we have an excellent “Active Alton” directory which can be found on-line at https://altonevents.co.uk/active-alton/ . The Directory is also printed as a booklet which can be found at the library, Community Centre, doctors’ surgeries and other public places.

The choices are generally group activities – sports clubs, gymnasia etc, or  activities like walking, running, cycling etc which can be taken alone or in the company of others.

The Doctors Prescription

Most doctors are not good at recommending exercise and directing their patients to information to help them to make the choice.

In practice, exercise is seldom prescribed and when it is prescribed we tend to be non-compliant. Most people are more likely to take a regular dose of a drug than a regular dose of exercise.

I will discuss this further next time