Exercise and chronic disease

Owing to historical circumstances highlighted by the careers of Drs McKenzie and White, physiatry and orthopaedics controlled neuromuscular rehabilitation, and cardiology controlled cardiovascular rehabilitation. As a consequence, medically directed exercise has tended to fall into two domains: physiotherapy and cardiovascular/pulmonary rehabilitation. This division is mainly a consequence of “turf”—that is, control of revenue stream—and is counterproductive. It has had the unintended consequence of guiding cardiovascular patients away from musculoskeletal therapists, and physically disabled patients away from cardiovascular therapists. Patients who have both problems have not been well served: in the developed world the number 1 cause of death among disabled patients is cardiovascular disease.19,20 Why then, do we not see more disabled patients in cardiac rehabilitation programmes? The American College of Sports Medicine’s textbook Exercise management for persons with chronic diseases and disabilities attempts to overcome this artificial barrier, with half of the book dedicated to chronic diseases and half to disabilities.21

Perhaps now is the time to abandon the artificial division of exercise into neuromusculoskeletal and cardiovascular/pulmonary domains. Rather than continuing our reductionist view of exercise as treatment for physiological subsystems, perhaps we should turn toward viewing exercise as a foundation of mind-body medicine.22 We should stop thinking of strength training as a specific antidote to muscle atrophy, of aerobic exercise as something specific to the heart, and stretching as a specific antidote to joint tightness. We should start looking at all forms of exercise training as integral to the physical, metabolic, emotional, and spiritual robustness of patients.

Sports medicine doctors, the few physicians who actually know something about both exercise and medicine, ought to be leading this transformation. For every injured athlete, there are a score of patients for whom exercise prescription should be the cornerstone of their medical management. We need more sports medicine doctors carrying out research on important questions such as the exercise dose-response relation in a particular disease, an area in which they are uniquely qualified. We need doctors who view sports medicine as a specialty where exercise is the prescription of choice for all their patients, athlete and non-athlete alike. When we achieve that, perhaps the dream of R Tait McKenzie will finally be fulfilled.

Appropriate exercise should be included in the treatment of all patients

  1. ↵ Hippocrates. On the articulations. The genuine works of Hippocrates, translated from the Greek with a preliminary discourse and annotations. London: Sydenham Society, 1849, circa 400 bc:part 58.
  2. ↵ Heberden W. Some account of a disorder of the breast. Medical Transactions of the Royal College of Physicians1772;2:59–67.
  3. ↵ McArdle WD, Katch FI, Katch VL. Introduction: a view of the past—exercise physiology: roots and historical perspectives. Exercise physiology: energy, nutrition, and human performance, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2001, xvii–lxv.
  4. ↵ Berryman J. Out of many, one: a history of the American College of Sports Medicine. Champaign, IL: Human Kinetics, 1995.
  5. ↵ Osler W. The principles and practice of medicine: designed for the use of practitioners and students of medicine, 7th ed. New York: D Appleton & Co, 1909.
  6. ↵ Mallory GK, White PD, Salcedo-Salgar J. The speed of healing on myocardial infarction: a study of the pathologic anatomy in seventy-two cases. Am Heart J1939;18:647–56.
  7. ↵ White PD, Rusk HA, Lee PR, et al.Rehabilitation of the cardiovascular patient. New York: McGraw-Hill Book Company, Inc, 1958.
  8. ↵ Saltin B, Blomqvist G, Mitchell JH, et al. Response to exercise after bed rest and after training: a longitudinal study of adaptive changes in oxygen transport and body composition. Circulation 1968;38(suppl vii):VII-1–VII-78.
  9. ↵ Asakura K. Collaboration of national organizations and the legislative means to advance pulmonary rehabilitation. Respir Care Clin N Am1998;4:173–81.
  10. ↵ Celli BR. Standards for the optimal management of COPD: a summary. Chest1998;113(suppl): 283S–287S.
  11. ↵ Brownell KD. The LEARN program for weight management 2000. Dallas: American Health Publishing Company, 2000.
  12. ↵ Fiatarone MA, Marks EC, Ryan ND, et al. High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA 1990;263:3029–34.
  13. ↵ Fiatarone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994;330:1769–75.
  14. ↵ Moore GE, Durstine JL. Framework. In: Durstine JL, Bloomquist LE, Figoni SF, et al., eds. ACSM’s exercise management in persons with chronic disease and disability. Champaign, IL: Human Kinetics, 1997:6–16.
  15. ↵ Moore GE. Exercise prescription in persons with multiple chronic diseases. In: Shankar K, ed. Exercise prescription. Philadelphia: Hanley & Belfus, Inc, 1998:173–82.
  16. ↵ Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273:402–7.
  17. ↵ Moore GE, Durstine JL, Marsh AP. Framework. In: Durstine JL, Moore GE, eds. ACSM’s exercise management for persons with chronic diseases and disabilities, second edition, 2nd ed. Champaign, IL: Human Kinetics, 2002:5–15.
  18. ↵ Haskell WL. Health consequences of physical activity: understanding and challenges regarding dose-response. Med Sci Sports Exerc1994;26:649–60.
  19. ↵ Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: global burden of disease study. Lancet1997;349:1436–42.
  20. ↵ Phillips WT, Kiratli BJ, Sarkarati M, et al. Effect of spinal cord injury on the heart and cardiovascular fitness. Curr Probl Cardiol 1998;23:641–716.
  21. ↵ Durstine JL, Moore GE. ACSM’s exercise management for persons with chronic diseases and disabilities, 2nd ed. Champaign, IL: Human Kinetics, 2002.
  22. ↵ Chopra D. Creating health. Boston: Houghton-Mifflin, 1987.

Chronic disease and the link to physical activity

Chronic diseases have become a focal point of public health worldwide with estimates of trillions of dollars in annual health care cost and causing more than 36 million deaths a year. Lifestyle factors such as physical inactivity are heavily correlated with the development of many chronic diseases. New strategies for primary and secondary disease prevention are desperately needed to aid in blunting the negative economic and social impact of these diseases. Physical activity (PA) and exercise are now considered principal interventions for use in primary and secondary prevention of chronic diseases. Currently, more emphasis in primary prevention of disease is necessary to reduce disease risk in youth and adults; however with chronic disease prevalence so high, similar emphasis is also necessary for secondary prevention in those children and adults already inflicted with chronic diseases. Conditions such as cardiovascular disease, type 2 diabetes, obesity, and cancer are drastically improved when PA and exercise are part of a medical management plan. In addition, the national PA guidelines in conjunction with PA promotion tools like Exercise is Medicine™ are needed to promote increased PA and exercise levels worldwide.

Physical activity, exercise, and chronic diseases: A brief review

Chronic diseases are the leading cause of death worldwide with increasing prevalence in all age groups, genders, and ethnicities. Most chronic disease deaths occur in middle-to low-income countries but are also a significant health problem in developed nations. Multiple chronic diseases now affect children and adolescents as well as adults. Being physically inactive is associated with increased chronic disease risk. Global societies are being negatively impacted by the increasing prevalence of chronic disease which is directly related to rising healthcare expenditures, workforce complications regarding attendance and productivity, military personnel recruitment, and academic success. However, increased physical activity (PA) and exercise are associated with reduced chronic disease risk. Most physiologic systems in the body benefit positively from PA and exercise by primary disease prevention and secondary disease prevention/treatment. The purpose of this brief review is to describe the significant global problem of chronic diseases for adults and children, and how PA and exercise can provide a non-invasive means for added prevention and treatment.

Chronic disease, such as cardiovascular disease and cancer, is the leading cause of ill health and death in Australia.

In 2014-15, more than 11 million Australians had at least one chronic disease and one-quarter of the population had two or more.

Conservative estimates say that one third of the $25 billion spent on health care in Australia each year goes towards preventable conditions.

Yet we know that 31 per cent of the burden of chronic disease could have been prevented . At the launch of the report Prevention better than cure: Spending to save Australian lives, the Heart Foundation reinforced the message that a comprehensive national preventive health program is crucial for Australians living well and staying healthy for as long as possible.

Encouraging more Australians to be physically active is at the heart of any preventive strategy. Data from the UK’s Public Health England suggests that if people were sufficiently active, it could cut the rate of many chronic diseases by as much as 40 per cent. If more people met the recommended guidelines for physical activity they could reduce their risk of:

• Dementia by up to 30 per cent

• Cardiovascular disease by up to 35 per cent

• Type 2 Diabetes by up to 40 per cent

• Colon cancer by 30 per cent

• Breast cancer by 20 per cent

Public Health England’s Everybody Active Every Day national physical activity framework was born out of the realisation that, without prevention, the health costs from inactive 40-60-year-olds would send the UK Government broke.

Through a series of concerted campaigns, the UK has doubled its rates of people meeting the recommended guidelines of 150 minutes of moderate physical activity per week – from about 35 per cent of men and 30 per cent of women to about 75 per cent and 60 per cent respectively.

Increasing physical activity rates is a great public health investment– and none more so than encouraging walking.

Most people can walk, it does not cost any money to do, it is accessible, is a great way to spend time with friends (new and old) and is a wonderful tonic for one’s mental health.

The winner of the Heart Foundation Walking program’s Golden Shoe Award, Anne Whalan, joined a Heart Foundation Walking group 20 years ago after her husband suffered heart disease. But it also helped her deal with difficult emotions following his death – Anne says the walking group helped keep her from becoming depressed and has kept her well enough to still be living independently at 90.

Heart Foundation Walking is Australia’s only network of free, community-based walking groups catering for different age groups. The Heart Foundation is delighted that we’re going to partner with the Federal Government to boost these programs further over the next two to four years to reach even more participants.

In May, the Government announced that it would allocate $10 million over two years to the Heart Foundation to lead the Prime Minister’s Walk for Life Challenge, which will support more Australians to become regular walkers and encourage people to be more active.

The Federal Government is also on the right track in having ‘preventive health through physical activity’ as one of the four key pillars of its National Sports Plan.

With the growing focus on prevention and physical activity, I feel that we are on the cusp of significant change.

This is great news for the Heart Foundation, which has worked for the past 60 years to encourage all Australians to lead healthier and more active lifestyles for better heart health.

Australia’s Health 2016 shows that chronic disease is our greatest health challenge, and we – as advocates, as governments, as decision-makers – must roll up our sleeves and enhance preventive measures if we are to help more Australians to live longer, happier, healthier and more productive lives.

This article was originally published in The Health Advocate in August 2017.

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