“All parts of the body if used in moderation and exercised in labors to which each is accustomed, become thereby healthy and well developed, and age slowly; but if unused and left idle, they become liable to disease, defective in growth, and age quickly.”
Physical activity for health related benefit can be the most effective prescription ever written.
To be physically active is natural to human existence. Modern lifestyles – technology, transport and food – promote unnatural sedentary behaviour, and numerous disease states including obesity. Hence the promotion of physical activity, and in particular that which is intentionally structured for health related benefit· – i.e. exercise – has become a remit of the physician.· There is no more cost efficient, effective intervention for the maintenance and enhancement of health across all ages, all abilities and all diseases.
Regular exercise delays all-cause mortality. It lowers blood pressure, and CHD biomarkers such as CRP and lipid profile, decreases the risk of developing CHD, stroke, type 2 diabetes, and some forms of cancer (e.g., colon and breast cancers). Exercise helps to preserve bone mass, control and reduce weight, reduces falls, and helps anxiety / depression, well being and enhances cognitive function.
A healthy program of regular exercise should include cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living. Current recommendations state that most adults should engage in moderate-intensity cardiorespiratory exercise training for at least 30mins per day, 5 days a week, vigorous-intensity cardiorespiratory exercise training for 20 minutes per day, 3 days per week, or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of 500–1000 MET/min/week.
On 2–3 days per week, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Flexibility exercises for each the major muscle–tendon groups (a total of 60 s per exercise) on 2 days per week is recommended.
The exercise program should be modified according to the patient. Those who cannot reach these targets should be encouraged to still engage in smaller amounts, progressively building as they adapt [American College is Sports Medicine, 2011]. All should be encouraged to also simply increase non-specific activity – move more.
What about the risks?
The benefits of exercise far outweigh the risks. The most common complication is musculoskeletal injury and many of these incidences can be prevented through education and helped by prompt diagnosis and management.
Acute cardiac ischaemia and sudden cardiac death occur rarely, and typically with unaccustomed vigorous exertion on a background of known or subclinical disease.· Screening of individuals for signs, and symptoms, past history and risk factors for cardiovascular events is recommended.· Education of adults on the relevance of the onset of cardiac symptoms and signs and appropriate steps may reduce the risk. Importantly, the risk in those with CAD will be expected to decline with increasing physical fitness.
Who should be screened before exercise?
Only the minority. Young high performing athletes are screened routinely now for congenital disorders. · Adults who should be screened by a sport & exercise medicine consultant or cardiologist include: asymptomatic people with diabetes mellitus (or other metabolic disease) who plan to start moderate to vigorous exercise; those with known cardiac disease who wish to exercise vigorously; or asymptomatic men > 45 y of age and women > 55 y of age or those who meet the threshold for > 2 risk factors who plan to start vigorous exercise. Any patient with an uncontrolled cardiovascular condition should defer from exercising until stable and should have medical clearance before beginning a programme.
An Exercise Prescription Service
Where there are concerns about the safety or efficacy of an exercise programme, its design for an individual patient, or if injuries/illnesses occur, a sport and exercise medicine consultant can help.
At the time of initial assessment, clinical risks, barriers to exercise and adherence are identified and goals are set.· Some undergo further investigation.
When fully assessed, an exercise programme is written, which provides direction and enhances motivation.· The patient is offered a variety of settings in which they can pursue their programme, and a choice of follow up and support through an exercise supervisor.· As a result, compliance is maintained through continued contact with the team as appropriate during the prescribed exercise program.
Simple as it may seem, exercise prescription can have its challenges. Nevertheless it is a highly effective intervention in the promotion of health for our patients, so should never be neglected. After all, “The wise for cure on exercise depend…”
Some Professor Speed’s publications on Exercise Prescription:
- Speed CA, Shapiro LM. Exercise prescription in cardiac disease. Lancet. 2000 Oct 7;356(9237):1208-10.
- Speed CA. Exercise Prescription. Practitioner 2008.
- Speed CA. Exercise in Rheumatoid Arthritis. Geriatric Medicine 2008.