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Exercise — The Medicine We Should All Prescribe

Best, Thomas M. MD, PhD

Current Sports Medicine Reports: May/June 2016 - Volume 15 - Issue 3 - p 131
doi: 10.1249/JSR.0000000000000255
Invited Commentaries

The Ohio State Sports Medicine Center, Columbus, OH

Address for correspondence: Thomas M. Best, MD, PhD, The Ohio State Sports Medicine Center, Columbus, OH; E-mail: tom.best@osumc.edu.

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Introduction

“Walking is the best medicine.” (Hippocrates, c. 460-c. 370 BC)

Regular exercise and a physically active lifestyle have unequivocal beneficial effects on health. Compared with drugs, exercise is available at relatively low cost and, for the most part, free of adverse effects. Exercise produces similar or, in many cases, greater benefit than prescription drugs in the secondary prevention of coronary artery disease, treatment of heart failure, prevention of diabetes, and poststroke rehabilitation (3). So the question remains — why has it taken so long for health care providers to prescribe physical activity?

The role of physicians in promoting exercise (perhaps) formally began to take shape with Exercise is Medicine®, a 2007 global initiative launched by the American College of Sports Medicine in collaboration with the American Medical Association. To that end, a group of subject matter experts was convened in April 2015 to discuss the implementation of a physical activity vital sign (PAVS) for each medical visit for every patient (5). The authors postulate that a PAVS can provide “valuable insight into a patient’s health status and lead to opportunities to advance a culture of wellness.” The authors cite three U.S. health care systems that include two questions about one’s level of physical activity embedded within the electronic medical record. Preliminary results are encouraging; in one system, at least 85% of eligible patients had a documented PAVS within the first year of implementation. Moreover, this intervention resulted in reductions in patient weight and hemoglobin A1c levels (1).

Sallis et al. acknowledge that much work remains on how to best educate medical students, residents/fellows, and practicing clinicians to become adept at exercise prescription. Unlike pharmaceutical therapy, the concept of “exercise as medicine” is seldom applied with enough detail in the physician’s office. For example, when a doctor prescribes a drug, there is a specific dose, method of administration, frequency, and duration to the treatment that should ensure optimal benefit with minimal risk. When it comes to exercise prescription, what are the dose-response parameters (intensity, duration, or frequency) that maximize one’s (personalized) response to exercise? How does that dose-response relationship change over time? Help seems to be on the way with innovative curriculum now present in at least two medical schools to address medical provider deficiencies in knowledge about exercise and its importance to human health. How this will translate to more effective exercise prescription strategies remains unknown but it is a critical step in educating all health care providers about the overwhelming importance of exercise in our daily lives.

Despite the overwhelming evidence for exercise as a “polypharmacy pill,” there is less evidence that physician-led interventions are effective, particularly at the population level. A recent systematic review of primary care-based interventions to promote physical activity revealed only a modest, short-term positive benefit (4). We also know that a major problem with exercise therapy for adults is adherence and long-term commitment to these therapies (2). Another important point that should not be overlooked regarding doctor-patient communication is that of health literacy. A 2006 report noted that only 12% of U.S. adults had an acceptable state of health literacy whereby individuals were judged capable of obtaining, processing, and understanding basic health information needed to make reasonable decisions about their health (6).

The call to action by Sallis et al. is timely and perhaps even overdue. Nevertheless, this acknowledged group of experts and champions for the PAVS has brought to the forefront the breadth of challenges confronting the medical community in recognizing the importance of physical activity in health promotion. Its implementation is critical to our nation’s health care and presents a wonderful opportunity for sports medicine to lead the way.

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References

1. Coleman KJ, Ngor E, Reynolds K, et al. Initial validation of an exercise “vital sign” in electronic medical records. Med. Sci. Sports Exerc. 2012; 44: 2071–6.
2. Jordan JL, Holden MA, Mason EE, et al. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database Syst. Rev. 2010: CD005956.
3. Naci H, Ioannidis JP. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ. 2013; 347: 155–77.
4. Orrow G, Kinmonth AL, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012; 344: e1389.
5. Sallis RE, Matuszak JM, Baggish AL, et al. Call to action on making physical activity assessment and prescription a medical standard of care. Curr. Sports Med. Rep. 2016; 15: 207–214.
6. U.S. Department of Education, National Center for Education Statistics (NCES) Web site. The Health Literacy of American’s Adults: Results from the 2003 National Assessment of Adult Literacy. 2016 Available from: http://nces.ed.gov/pubs2006/2006483.pdf. Accessed January 8, 2016.
Copyright © 2016 by the American College of Sports Medicine.