Why prescribe exercise?

At this moment in time we have greater access to information than ever before. Whether via television, the internet or in the countless number of tabloid magazines we are constantly bombarded by what we should be doing to become healthy. According to the statistics very few of us participate in the one intervention that can improve not only our health but our social welfare – exercise. As an exercise physiologist, I know that greater progress has been made to raise awareness of other health concerns, such as smoking and high cholesterol, while an intervention that has the advantages of being low-cost and non-drug dependent remains underutilised and undervalued. Universally healthcare systems are struggling with the rising cost, not only financially but to society, of non-communicable diseases which, in many cases, are preventable. So great is the concern for our future health that in 2007 the Exercise is Medicine initiative was formulated and has been adopted across 39 countries. As the name suggests the key ingredient to improving health is exercise and, just like medicine, is most effective when prescribed.

The concept of exercise prescription is hardly new as the origins date back to ancient times. Before Hippocrates, a physician credited with being the “father of medicine” who lived 2400 years ago, Susruta advocated the prescription of regular moderate exercise to provide resistance to, and form a defence against, physical decay. Perhaps the most apt quote from Hippocrates to express the importance of exercise to maintain health reads “that which is used develops, and that which is not used wastes away …… if there is any deficiency in food or exercise the body will fall sick”. Together with Galen who lived from 129 – 210ad and believed that health is a physiological state, not merely the absence of disease, they formed the ideal that the greatest influence on health stem from those factors that a person has control over – diet, exercise and rest. While I must thank Mr Tipton for his comprehensive historical account of exercise prescription for “Exercise is Medicine”, Mr Berryman also included the association between health and exercise in more modern times.

The introduction of physical education in the 19th century concentrated on health, not only exercising the body but instruction on how the body functioned. The link between health and exercise remained until the medical world changed focus to fighting infectious disease and improving surgical technique. The western world had, in the early 1900s, moved from using exercise to advance health to finding a way to combat illness and infirmity. Early evidence that the shift from exercise for health was, indeed, detrimental to the general population came at the end of World War I when a third of the three million drafted soldiers were considered physically unfit. In 1949 the Morris Group, epidemiologists who investigated the patterns, causes and effects of disease in a given population, determined those who were more physically active were less likely to die from coronary heart disease. Thus began the link between physical inactivity and a variety of chronic diseases or, as relevantly, the diseases produced by lack of exercise. To clarify any confusion between the two terms, the definition of exercise is a planned, structured, repeated component of physical activity.

As health care professionals we value exercise prescription for the improvement of health and to prevent and combat disease. Our difficulty is getting the message through to the general public.

Exercise is Medicine