Research Focus – Exercise is Medicine

The advances in modern medicine have led to the development of many pharmacological agents and surgical procedures that control and treat non-communicable and lifestyle-induced diseases like hypertension, dyslipidemia, obesity, and type II diabetes. As a result, prescription medications and surgical procedures are often the first lines of treatment for these conditions with little consideration given to lifestyle change as a viable solution. There are estimates that some 300,000 deaths each year in the U.S. likely are the result of physical inactivity. Over the past few decades, physical activity has been engineered out of our lifestyles. Physical inactivity is a persistent public health problem with recent estimates indicating that one-third of the global population fails to meet physical activity guidelines and that 9% of the overall global premature mortality, ≈5.3 million deaths, is directly attributable to physical inactivity, a figure comparable to the global smoking-related mortality (5.1 million). Also, inadequate physical activity commands a substantial economic burden, recently quantified as 11% of the aggregated healthcare expenditures in the United States or about $120 billion per year.

However, amidst what epidemiologists have identified as a “hypokinetic epidemic”, the importance of widespread lifestyle alteration is becoming increasingly clear and, in fact, necessary. For example, routine exercise is not only as effective in forestalling and reversing these conditions, but also offers a long-term solution to the problem and helps to reduce the growing financial burden of healthcare.

Despite the scientific evidence that exercise is important in the promotion of a healthier lifestyle for patients of all ages, exercise referral schemes by the medical community in the United States do not exist. The current predominant healthcare approach is essentially favoring “sick care,” a system that attempts to treat acute diseases or acute worsening of non-communicable diseases after sickness occurs. Clinicians and patients have come to expect immediate pharmaceutical solutions for instant cure or symptom relief. Not only is this treatment concept inappropriate, it largely ignores the subclinical stage of disease development and lacks the ability and incentive to properly address disease-promoting lifestyles, the underlying causes of non-communicable diseases. Less than 10% of the total outpatient visits have included exercise counseling or education. In fact, it has been shown that most physicians do attempt to discuss diet and exercise with their patients, but the average discussion lasts only about 90 seconds. It is apparent that the medical community is not interested in prescribing exercise as medicine.

While exercise is not the panacea to every health problem, it can prevent and reverse most including overweight-obesity, cardiovascular diseases, type 2 diabetes mellitus, and the risk factors that contribute to hypertension, dyslipidemia, insulin resistance, systemic inflammation, and endothelial dysfunction. That said, there is irrefutable evidence that exercise improves immune system function and decreases the risk of many cancers.  The figure on the right, based on research, illustrates how physical inactivity increases over thirty-five chronic diseases.

Undoubtedly, physical inactivity is “the” public health threat of the 21st century. If qualified healthcare professionals were to prescribe exercise programs, such programs would help cut the costs, deaths, and disabilities that result from chronic diseases.  If society deems it important to embrace regular exercise as an “exercise medicine” to improve its health and well-being, then, the physical inactivity related mortality and disability would decrease. As the world-renown father of functional medicine, Dr. Jeffrey Bland, has preached for decades:

“Real change will require a significant perspective shift from a disease-centric approach to a system based on the concept of scientific wellness. The system must be reconfigured from top-down, command-and-control delivery of care to a distributive team approach that utilizes health care extenders who are trained and empowered in managing personalized wellness programs.”