It’s time to take our medicine—Part 1: Exercise as medicine
Exercise as medicine? I’d asked Robin Daly about health and exercise, and several times he mentioned ‘prescribing’ exercise. He sees this as an important part of an overall health approach.
Professor Daly holds the position of Chair in Exercise and Ageing within the Institute for Physical Activity and Nutrition at Deakin University, Melbourne. He’s keen on developing this exercise-as-medicine approach in Australia, which was initiated in the US.
This concept of ‘exercise as medicine’ aims to encourage all medical and health professionals to consider exercise as a standard prescription for chronic disease prevention and management, says Daly.
Daly has had a long-term interest in prescribing exercise for older adults with or at increased risk for common chronic diseases, with trials—beginning in the 90s— among men at increased risk from osteoporosis. Exercise was a key factor in maintaining or preventing bone and muscle loss in these men.
‘Over 10 years and a number of studies we developed a community- and evidence-based osteoporosis prevention program, which was called “Osteo-cise: Strong Bones for Life”, that included an educational program with a train-the-trainer module where we upskilled trainers in local gyms to ensure they prescribed an evidence-based exercise program—not just a generic health and fitness program, but something targeted to optimise musculoskeletal health and function.’
The program was so successful that the Australian government gave funding to Osteoporosis Australia to roll out a program in gyms along the east coast of Australia. Unfortunately, it lasted only a short time—a change of government stopped the funding.
Doctors’ involvement in prescribing exercise
Daly has a dream that would see all medical and allied health professionals more involved with prescribing exercise as part of a holistic approach to medicine.
‘When you go to a doctor and are given a drug for your blood pressure, for example, you’re told how often to take a tablet, the right dose and whether there are any side effects,’ he says.
‘Exercise should be prescribed on the same basis. The problem is that during medical school doctors receive little or no education regarding exercise prescription for the prevention and management of chronic diseases. They’re just not trained to prescribe exercise.’
He’s hoping a time will come when those going to a doctor will receive their medical prescription and then be referred to a specialist, such as an exercise physiologist, to get their exercise prescription.
Targeting the problem
Just as a medical prescription will target a specific problem, exercise also needs to be targeted to specific conditions.
‘Because we do a lot of work with people with one or more chronic diseases,’ says Daly, ‘we’re trying to get away from just saying you need to be active. While something is better than nothing in terms of exercise, to get the best benefits people should be prescribed specific types of exercise based on their needs, preferences and health/medical condition(s).’
He uses the example of individuals with Type 2 diabetes. Many are overweight and often the focus is totally on losing weight or fat.
‘What typically happens if they focus on a weight-loss diet that doesn’t include a specific type of exercise—resistance training—is that they lose fat but they will also lose muscle. Maintaining muscle is critical for people with Type 2 diabetes because muscle is the largest mass of insulin-sensitive tissue in the body and the major storage site for glucose. Thus, if you lose your muscle it can exacerbate diabetes.’
In this case, progressive resistance or strength training exercises should be prescribed to increase muscle mass, size and strength.
‘We really want people to get the most out of their exercise programs and, if they want to get the best results, a more targeted prescription is going to help.’
What if we thought about exercise as medicine?
I’m a regular medicine taker—twice a day. When I asked what side effects there were from my medication, my specialist-doctor kept it simple: ‘It will keep you alive.’
I rarely forget to take my medication.
So, perhaps it’s time to begin to think of exercise in the same way. Like medicine, it will help keep us alive longer—healthier longer.
‘Exercise has been shown to promote longevity,’ says Daly, but does add a condition ‘as long as there’s exercise with healthy eating. That’s the key.’
We probably knew that already. However, knowing doesn’t mean doing. It’s time to think seriously about exercise—and taking our medicine.
This is the first of four posts from an extended interview with Robin Daly from the Faculty of Health at Deakin University.
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Category: Physical Health