Exercise medicine

Last updated

Exercise medicine
Exercise class.jpg
System Musculoskeletal, cardiovascular
SpecialistSport and Exercise Medicine (SEM) physician
Glossary Glossary of medicine
Sport and Exercise Medicine (SEM) physician
Occupation
Names
  • Physician
Occupation type
Specialty
Activity sectors
Medicine
Description
Competencies Exercise prescription
Education required
Fields of
employment
Hospitals, Clinics, university
Related jobs
sports medicine physician

Exercise medicine is a branch of medicine that deals with physical fitness and the prevention and treatment of injuries and illness with exercise. In some countries, Sport and Exercise Medicine (SEM) is a recognized medical specialty (with similar training and standards to other medical specialties). Exercise medicine is therefore an emerging physician (non-surgical) specialty, but there is also a belief that exercise is treatment of such fundamental benefit that it should be incorporated into all medical specialties. Allied health practitioners also can specialize in exercise such as exercise physiologists, physiotherapists, athletic trainers and podiatrists. [1]

Contents

Whereas the signature treatment of the specialty of surgery is operative procedures, and the signature treatment of most medical (physician) specialties is the prescription of pharmaceuticals, the signature treatment of Sport and Exercise Medicine is exercise prescription. SEM physician consultations are generally lengthy (over 30 minutes) and 74% involve prescription of exercise, with exercise prescription being the most common treatment. [2]

Evidence for the efficacy of exercise as a medical treatment

There is an enormous amount of evidence proving that exercise (when prescribed as a medical treatment) is effective at preventing and treating most of the major chronic diseases, [3] [4] including cancer, [5] cardiovascular diseases, [6] [7] arthritis, [8] osteoporosis, [9] back pain, [10] [11] diabetes, [12] depression and other mental illnesses and falls in the elderly. [13]

Exercise and mortality from certain diseases, adapted from Exercisemortality.jpg
Exercise and mortality from certain diseases, adapted from

Exercise has been shown to reduce all-cause mortality [15] in a large number of primary studies and meta-analyses. [16] [17] [18] [19]

Exercise and cardiovascular disease

There are multiple ways in which exercise can reduce cardiovascular disease and mortality, [20] including through lowering blood pressure and lowering LDL cholesterol levels. [21] Although multiple mechanisms are possible, the relationship between exercise as measured by accelerometer data and cardiovascular mortality is strong (inverse, non-linear). [22]

Exercise and cancer

Exercise prescription is now a recognized treatment for cancer, [23] as studies have shown that exercise is associated with superior mortality outcomes and lower recurrence rates. [24] [25] [26]

Exercise and mental illness

Exercise both prevents and treats mental illnesses, including depression in particular, [27] [28] [29] with positive effects likely for anxiety, [30] bipolar disorder [31] and suicidality. [32]

Exercise dosing

Exercise prescription is not simply a matter of advising or demanding that a patient increases their exercise levels. It requires significant expertise and experience, with core competencies well described. [33] Sudden increase of exercise levels is likely to lead to painful musculoskeletal symptoms or even injury (preventing further exercise). [34] [35] [36]

Both underloading and overloading can lead to injury LoadingInjury.jpg
Both underloading and overloading can lead to injury
Use of wearable technology to measure exercise loads Wearables.jpg
Use of wearable technology to measure exercise loads

The lifetime prevalence of hip and knee osteoarthritis is 13% for competitive runners, 10% for non-runners, but only 4% for moderate social runners, demonstrating a U-shaped curve between running load and arthritis risk (high and low dose = higher risk; moderate load = lower risk). [40] With respect to back pain, increasing levels of exercise reduce risk of back pain, [41] but having occupational manual loading increases the risk. [42] The bottom of the U-shaped curve for injury risk and loading is sometimes referred to as the Goldilocks zone (not too little exercise but not too much). [43] [44] [45] There also may be a Goldilocks zone for physical activity and all-cause mortality, but at a very high level and with an eccentric U-shape (that is, low exercise levels are far riskier for all-cause mortality than extremely high exercise levels). [46]

Differentiation from Sports medicine

Recreational exercise such as swimming and surfing has multiple health benefits SurfersBondiBeach.jpg
Recreational exercise such as swimming and surfing has multiple health benefits

The difference between sport and exercise (and hence the differentiation between Sports medicine and Exercise medicine) is subtle, but important. Basically, sport is exercise with an added element of competition (whether against an opponent or oneself, aiming to maximum performance improvements). [47] There is good evidence that competitive and professional athletes have higher rates of certain conditions than the general population, such as osteoarthritis, [48] [49] but equally strong evidence that the life expectancy of elite athletes is longer than the general population. [50] [51]

Establishment as a medical specialty

Sports medicine is a recognized medical specialty or subspecialty in over 50 countries. In some of these countries, the formal name of the specialty is 'Sport and Exercise Medicine', emphasizing the differentiation between sports medicine (performance-orientated) and exercise medicine (health-orientated). These countries include Australia and New Zealand, with the peak body being the Australasian College of Sport and Exercise Physicians and one of Australia's 15 recognized medical specialty Colleges, [52] the United Kingdom (Faculty of Sport and Exercise Medicine UK), [53] Canada (Canadian Academy of Sport and Exercise Medicine), Belgium, Brazil, France, India and Ireland.

Exercise as an alternative treatment to low-value care

There is increasing evidence that many 'traditional' medical interventions are ineffective at best and potentially harmful at worst. [54] Examples of low-value care include knee and shoulder arthroscopy, spinal fusion surgery [55] and opiate prescription for chronic non-cancer pain. [56] [57] Exercise prescription, with evidence of efficacy for treatment of knee osteoarthritis and back pain, can be used as an alternative to traditional interventions with poor efficacy and greater side effects.

Exercise as a method to reduce carbon emissions from healthcare

Healthcare is responsible for 3-10% of carbon emissions in Western countries. [58] Although most healthcare is considered 'essential', it is important that the necessity of carbon-intensive healthcare options, such as surgery, [59] is critically assessed as there is an international agreement that net zero emissions must be reached to avoid breakdown of the Earth's climate. [60] Exercise as a medical treatment has perhaps the lowest carbon footprint of any medical treatment. [61] An increased focus on exercise prescription as an effective alternate to carbon-intensive medical treatments is an important part of healthcare reform, which needs to be 'transformational' to reach goals of net-zero emissions from healthcare. [62]

Differentiation from "Exercise Is Medicine" (EIM)

'Exercise is Medicine' is a trademarked non-profit venture of the American College of Sports Medicine. By comparison, 'Exercise Medicine' is a specific subspecialty of 'Sport and Exercise Medicine'. The concept of 'Exercise is Medicine' is that all medical specialists should be prescribing exercise regularly as an adjunct to a standard consultation. [63] [64] The aims of the 'Exercise is Medicine' movement and the specialty of Exercise Medicine are generally synergistic, with both aiming to improve physical activity in the population (for whom a large proportion is inactive). Exercise Medicine specialists also consult a smaller subsection of the population who are temporarily over-active and require a slight reduction in load in order to overcome injury or chronic pain. The concept of 'Exercise is Medicine' is as a 5-minute addition to almost every medical consultation, treating exercise as a 'vital sign', [65] [66] which has the potential of enormous reach. Exercise medicine specialists aim to also cater for some of those patients who don't respond to the first line measure of a brief written exercise prescription by providing longer specialized consultations with a focus solely on exercise. Exercise Is Medicine has been criticized for making exercise come across as exclusively a medical treatment when it should be seen more broadly as a public health strategy and protective risk factor that should be available to everyone. [67]

Further reading on EIM

Journals

See also

Related Research Articles

<span class="mw-page-title-main">Coronary artery disease</span> Reduction of blood flow to the heart

Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the cardiac muscle due to build-up of atherosclerotic plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, and myocardial infarction.

<span class="mw-page-title-main">Insomnia</span> Disorder causing trouble with sleeping

Insomnia, also known as sleeplessness, is a sleep disorder where people have trouble sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, irritability, and a depressed mood. It may result in an increased risk of accidents of all kinds as well as problems focusing and learning. Insomnia can be short term, lasting for days or weeks, or long term, lasting more than a month. The concept of the word insomnia has two possibilities: insomnia disorder (ID) and insomnia symptoms, and many abstracts of randomized controlled trials and systematic reviews often underreport on which of these two possibilities the word insomnia refers to.

<span class="mw-page-title-main">Type 2 diabetes</span> Form of diabetes mellitus

Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, fatigue and unexplained weight loss. Symptoms may also include increased hunger, having a sensation of pins and needles, and sores (wounds) that do not heal. Often, symptoms develop slowly. Long-term complications from high blood sugar include heart disease, stroke, diabetic retinopathy, which can result in blindness, kidney failure, and poor blood flow in the lower-limbs, which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.

<span class="mw-page-title-main">Exercise</span> Physical activity that improves health

Exercise is physical activity that enhances or maintains fitness and overall health. It is performed for various reasons, including weight loss or maintenance, to aid growth and improve strength, develop muscles and the cardiovascular system, hone athletic skills, improve health, or simply for enjoyment. Many individuals choose to exercise outdoors where they can congregate in groups, socialize, and improve well-being as well as mental health.

<span class="mw-page-title-main">Tendinopathy</span> Inflammation of the tendon

Tendinopathy is a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder, elbow, wrist, hip, knee, or ankle.

<span class="mw-page-title-main">Cardiovascular disease</span> Class of diseases that involve the heart or blood vessels

Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.

<span class="mw-page-title-main">Warming up</span> Part of stretching and preparation before performing a physical activity

'Warming up' is a part of stretching and preparation for physical exertion or a performance by exercising or practicing gently beforehand, usually undertaken before a performance or practice. Athletes, singers, actors and others warm up before stressing their muscles. It is widely believed to prepare the muscles for vigorous actions and to prevent muscle cramps and injury due to overexertion.

<span class="mw-page-title-main">Tennis elbow</span> Condition in which the outer part of the elbow becomes sore and tender

Tennis elbow, also known as lateral epicondylitis or enthesopathy of the extensor carpi radialis origin, is an enthesopathy of the origin of the extensor carpi radialis brevis on the lateral epicondyle. The outer part of the elbow becomes painful and tender. The pain may also extend into the back of the forearm. Onset of symptoms is generally gradual, although they can seem sudden and be misinterpreted as an injury. Golfer's elbow is a similar condition that affects the inside of the elbow.

<span class="mw-page-title-main">Sports medicine</span> Branch of medicine for sports injuries

Sports medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Although most sports teams have employed team physicians for many years, it is only since the late 20th century that sports medicine emerged as a distinct field of health care. In many countries, now over 50, sports medicine is a recognized medical specialty. In the majority of countries where sports medicine is recognized and practiced, it is a physician (non-surgical) specialty, but in some, it can equally be a surgical or non-surgical medical specialty, and also a specialty field within primary care. In other contexts, the field of sports medicine encompasses the scope of both medical specialists as well as allied health practitioners who work in the field of sport, such as physiotherapists, athletic trainers, podiatrists and exercise physiologists.

<span class="mw-page-title-main">Sprained ankle</span> Medical condition

A sprained ankle is an injury where sprain occurs on one or more ligaments of the ankle. It is the most commonly occurring injury in sports, mainly in ball sports such as basketball, volleyball, football, and tennis.

Multimorbidity, also known as multiple long-term conditions (MLTC), means living with two or more chronic illnesses. For example, a person could have diabetes, heart disease and depression at the same time. Multimorbidity can have a significant impact on people's health and wellbeing. It also poses a complex challenge to healthcare systems which are traditionally focused on individual diseases. Multiple long-term conditions can affect people of any age, but they are more common in older age, affecting more than half of people over 65 years old.

<span class="mw-page-title-main">Extracorporeal shockwave therapy</span> Ultrasonic, non-invasive, outpatient treatment

Extracorporeal shockwave therapy (ESWT) is a treatment using powerful acoustic pulses which is mostly used to treat kidney stones and in physical therapy and orthopedics.

<span class="mw-page-title-main">Patellofemoral pain syndrome</span> Medical condition

Patellofemoral pain syndrome is knee pain as a result of problems between the kneecap and the femur. The pain is generally in the front of the knee and comes on gradually. Pain may worsen with sitting down with a bent knee for long periods of time, excessive use, or climbing and descending stairs.

Exercise is Medicine (EIM) is a nonprofit initiative co-launched on November 5, 2007, by the American College of Sports Medicine and the American Medical Association, with support from the Office of the Surgeon General and the 18th Surgeon General Regina Benjamin.

<span class="mw-page-title-main">Myocardial infarction</span> Interruption of cardiac blood supply

A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction to the heart muscle. The most common symptom is retrosternal chest pain or discomfort that classically radiates to the left shoulder, arm, or jaw. The pain may occasionally feel like heartburn.

<span class="mw-page-title-main">Knee pain</span> Medical condition

Knee pain is pain in or around the knee.

Kinesiophobia is the fear of pain due to movement.

Management of obesity can include lifestyle changes, medications, or surgery. Although many studies have sought effective interventions, there is currently no evidence-based, well-defined, and efficient intervention to prevent obesity.

The benefits of physical activity range widely. Most types of physical activity improve health and well-being.

non-pharmacological intervention (NPI) is any type of healthcare intervention which is not primarily based on medication. Some examples include exercise, sleep improvement, and dietary habits.

References

  1. Crozier, A; Watson, PM; Graves, LEF; George, K; Naylor, L; Green, DJ; Rosenberg, M; Jones, H (2022). "Clinical exercise provision in the UK: comparison of staff job titles, roles and qualifications across five specialised exercise services". BMJ Open Sport & Exercise Medicine. 8 (1): e001152. doi:10.1136/bmjsem-2021-001152. PMC   8788312 . PMID   35136656.
  2. Gamage, Prasanna J; Seker, Saran; Orchard, Jessica; Humphries, David; Fitzgerald, Kylie; Fitzpatrick, Jane (November 2021). "Insights into the complexity of presentation and management of patients: the Sport and Exercise Physician's perspective". BMJ Open Sport & Exercise Medicine. 7 (4): e001228. doi:10.1136/bmjsem-2021-001228. PMC   8628332 . PMID   34925878.
  3. Pedersen, BK; Saltin, B (December 2015). "Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases". Scandinavian Journal of Medicine & Science in Sports. 25 (Suppl 3): 1–72. doi: 10.1111/sms.12581 . PMID   26606383. S2CID   21208328.
  4. Zhao, M; Veeranki, SP; Magnussen, CG; Xi, B (1 July 2020). "Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study". BMJ (Clinical Research Ed.). 370: m2031. doi:10.1136/bmj.m2031. PMC   7328465 . PMID   32611588.
  5. Emery, A; Moore, S; Turner, JE; Campbell, JP (2022). "Reframing How Physical Activity Reduces The Incidence of Clinically-Diagnosed Cancers: Appraising Exercise-Induced Immuno-Modulation As An Integral Mechanism". Frontiers in Oncology. 12: 788113. doi: 10.3389/fonc.2022.788113 . PMC   8964011 . PMID   35359426.
  6. Kraus, WE; Powell, KE; Haskell, WL; Janz, KF; Campbell, WW; Jakicic, JM; Troiano, RP; Sprow, K; Torres, A; Piercy, KL; 2018 Physical Activity Guidelines Advisory Committee (June 2019). "Physical Activity, All-Cause and Cardiovascular Mortality, and Cardiovascular Disease". Medicine and Science in Sports and Exercise. 51 (6): 1270–1281. doi:10.1249/MSS.0000000000001939. PMC   6527136 . PMID   31095084.
  7. Myers, Jonathan; Prakash, Manish; Froelicher, Victor; Do, Dat; Partington, Sara; Atwood, J. Edwin (14 March 2002). "Exercise Capacity and Mortality among Men Referred for Exercise Testing". New England Journal of Medicine. 346 (11): 793–801. doi: 10.1056/NEJMoa011858 . ISSN   0028-4793. PMID   11893790.
  8. Gwinnutt, JM; Wieczorek, M; Cavalli, G; Balanescu, A; Bischoff-Ferrari, HA; Boonen, A; de Souza, S; de Thurah, A; Dorner, TE; Moe, RH; Putrik, P; Rodríguez-Carrio, J; Silva-Fernández, L; Stamm, T; Walker-Bone, K; Welling, J; Zlatković-Švenda, MI; Guillemin, F; Verstappen, SMM (March 2022). "Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs". RMD Open. 8 (1): e002168. doi:10.1136/rmdopen-2021-002168. PMC   8971792 . PMID   35361692.
  9. Sanchez-Trigo, H; Rittweger, J; Sañudo, B (26 February 2022). "Effects of non-supervised exercise interventions on bone mineral density in adult women: a systematic review and meta‑analysis". Osteoporosis International. 33 (7): 1415–1427. doi:10.1007/s00198-022-06357-3. PMC   8881760 . PMID   35218402.
  10. Pocovi, Natasha C; Lin, Chung-Wei Christine; French, Simon D; Graham, Petra L; van Dongen, Johanna M; Latimer, Jane; Merom, Dafna; Tiedemann, Anne; Maher, Christopher G; Clavisi, Ornella; Tong, Shuk Yin Kate; Hancock, Mark J (June 2024). "Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial". The Lancet. doi:10.1016/S0140-6736(24)00755-4 . Retrieved 22 June 2024.
  11. Hayden, JA; Ellis, J; Ogilvie, R; Malmivaara, A; van Tulder, MW (28 September 2021). "Exercise therapy for chronic low back pain". The Cochrane Database of Systematic Reviews. 9 (10): CD009790. doi:10.1002/14651858.CD009790.pub2. PMC   8477273 . PMID   34580864.
  12. Hall, KS; Hyde, ET; Bassett, DR; Carlson, SA; Carnethon, MR; Ekelund, U; Evenson, KR; Galuska, DA; Kraus, WE; Lee, IM; Matthews, CE; Omura, JD; Paluch, AE; Thomas, WI; Fulton, JE (20 June 2020). "Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia". The International Journal of Behavioral Nutrition and Physical Activity. 17 (1): 78. doi: 10.1186/s12966-020-00978-9 . PMC   7305604 . PMID   32563261.
  13. Sherrington, C; Michaleff, ZA; Fairhall, N; Paul, SS; Tiedemann, A; Whitney, J; Cumming, RG; Herbert, RD; Close, JCT; Lord, SR (December 2017). "Exercise to prevent falls in older adults: an updated systematic review and meta-analysis". British Journal of Sports Medicine. 51 (24): 1750–1758. doi: 10.1136/bjsports-2016-096547 . PMC   6243488 . PMID   27707740. S2CID   206882055.
  14. Kyu, Hmwe H.; Bachman, Victoria F.; Alexander, Lily T.; Mumford, John Everett; Afshin, Ashkan; Estep, Kara; Veerman, J. Lennert; Delwiche, Kristen; Iannarone, Marissa L.; Moyer, Madeline L.; Cercy, Kelly; Vos, Theo; Murray, Christopher J. L.; Forouzanfar, Mohammad H. (9 August 2016). "Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013". BMJ. 354: i3857. doi:10.1136/bmj.i3857. ISSN   1756-1833. PMC   4979358 . PMID   27510511.
  15. Reynolds, Gretchen (6 April 2022). "Is 30 Minutes of Exercise a Day Enough?". The New York Times. ISSN   0362-4331 . Retrieved 12 April 2022.
  16. Lee, DC; Pate, RR; Lavie, CJ; Sui, X; Church, TS; Blair, SN (5 August 2014). "Leisure-time running reduces all-cause and cardiovascular mortality risk". Journal of the American College of Cardiology. 64 (5): 472–81. doi:10.1016/j.jacc.2014.04.058. PMC   4131752 . PMID   25082581.
  17. Zhao, M; Veeranki, SP; Magnussen, CG; Xi, B (1 July 2020). "Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study". BMJ (Clinical Research Ed.). 370: m2031. doi:10.1136/bmj.m2031. PMC   7328465 . PMID   32611588.
  18. Colpani, V; Baena, CP; Jaspers, L; van Dijk, GM; Farajzadegan, Z; Dhana, K; Tielemans, MJ; Voortman, T; Freak-Poli, R; Veloso, GGV; Chowdhury, R; Kavousi, M; Muka, T; Franco, OH (September 2018). "Lifestyle factors, cardiovascular disease and all-cause mortality in middle-aged and elderly women: a systematic review and meta-analysis". European Journal of Epidemiology. 33 (9): 831–845. doi:10.1007/s10654-018-0374-z. PMID   29524110. S2CID   3790367.
  19. Cunningham, C; O' Sullivan, R; Caserotti, P; Tully, MA (May 2020). "Consequences of physical inactivity in older adults: A systematic review of reviews and meta-analyses" (PDF). Scandinavian Journal of Medicine & Science in Sports. 30 (5): 816–827. doi:10.1111/sms.13616. PMID   32020713. S2CID   211035029.
  20. Bove, AA (April 2016). "Exercise and Heart Disease". Methodist DeBakey Cardiovascular Journal. 12 (2): 74–5. doi:10.14797/mdcj-12-2-74. PMC   4969029 . PMID   27486487.
  21. Nystoriak, MA; Bhatnagar, A (2018). "Cardiovascular Effects and Benefits of Exercise". Frontiers in Cardiovascular Medicine. 5: 135. doi: 10.3389/fcvm.2018.00135 . PMC   6172294 . PMID   30324108.
  22. Sheng, M; Yang, J; Bao, M; Chen, T; Cai, R; Zhang, N; Chen, H; Liu, M; Wu, X; Zhang, B; Liu, Y; Chao, J (December 2021). "The relationships between step count and all-cause mortality and cardiovascular events: A dose-response meta-analysis". Journal of Sport and Health Science. 10 (6): 620–628. doi:10.1016/j.jshs.2021.09.004. PMC   8724621 . PMID   34547483.
  23. Ashcraft, KA; Warner, AB; Jones, LW; Dewhirst, MW (January 2019). "Exercise as Adjunct Therapy in Cancer". Seminars in Radiation Oncology. 29 (1): 16–24. doi:10.1016/j.semradonc.2018.10.001. PMC   6656408 . PMID   30573180.
  24. Christensen, JF; Simonsen, C; Hojman, P (13 December 2018). "Exercise Training in Cancer Control and Treatment". Comprehensive Physiology. 9 (1): 165–205. doi:10.1002/cphy.c180016. PMID   30549018. S2CID   56492477.
  25. Cormie, P; Zopf, EM; Zhang, X; Schmitz, KH (1 January 2017). "The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects". Epidemiologic Reviews. 39 (1): 71–92. doi:10.1093/epirev/mxx007. PMID   28453622.
  26. Cormie, P; Trevaskis, M; Thornton-Benko, E; Zopf, EM (April 2020). "Exercise medicine in cancer care". Australian Journal of General Practice. 49 (4): 169–174. doi: 10.31128/AJGP-08-19-5027 . PMID   32233341. S2CID   214751316.
  27. Schuch, FB; Vancampfort, D; Richards, J; Rosenbaum, S; Ward, PB; Stubbs, B (June 2016). "Exercise as a treatment for depression: A meta-analysis adjusting for publication bias". Journal of Psychiatric Research. 77: 42–51. doi:10.1016/j.jpsychires.2016.02.023. PMID   26978184. S2CID   1012687.
  28. Schuch, FB; Stubbs, B (August 2019). "The Role of Exercise in Preventing and Treating Depression". Current Sports Medicine Reports. 18 (8): 299–304. doi: 10.1249/JSR.0000000000000620 . PMID   31389872. S2CID   199448688.
  29. Cooney, GM; Dwan, K; Greig, CA; Lawlor, DA; Rimer, J; Waugh, FR; McMurdo, M; Mead, GE (12 September 2013). "Exercise for depression". The Cochrane Database of Systematic Reviews. 2013 (9): CD004366. doi:10.1002/14651858.CD004366.pub6. PMC   9721454 . PMID   24026850.
  30. Stonerock, GL; Hoffman, BM; Smith, PJ; Blumenthal, JA (August 2015). "Exercise as Treatment for Anxiety: Systematic Review and Analysis". Annals of Behavioral Medicine. 49 (4): 542–56. doi:10.1007/s12160-014-9685-9. PMC   4498975 . PMID   25697132.
  31. Bauer, IE; Gálvez, JF; Hamilton, JE; Balanzá-Martínez, V; Zunta-Soares, GB; Soares, JC; Meyer, TD (March 2016). "Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: A systematic review". Journal of Psychiatric Research. 74: 1–7. doi:10.1016/j.jpsychires.2015.12.006. PMC   4744495 . PMID   26724541.
  32. Grasdalsmoen, M; Eriksen, HR; Lønning, KJ; Sivertsen, B (16 April 2020). "Physical exercise, mental health problems, and suicide attempts in university students". BMC Psychiatry. 20 (1): 175. doi: 10.1186/s12888-020-02583-3 . PMC   7164166 . PMID   32299418.
  33. Asif, Irfan; Thornton, Jane S.; Carek, Stephen; Miles, Christopher; Nayak, Melissa; Novak, Melissa; Stovak, Mark; Zaremski, Jason L.; Drezner, Jonathan (1 April 2022). "Exercise medicine and physical activity promotion: core curricula for US medical schools, residencies and sports medicine fellowships: developed by the American Medical Society for Sports Medicine and endorsed by the Canadian Academy of Sport and Exercise Medicine". British Journal of Sports Medicine. 56 (7): 369–375. doi: 10.1136/bjsports-2021-104819 . ISSN   0306-3674. PMID   35012931. S2CID   246055491.
  34. Burfoot, Amby (14 November 2001). "The 10-Percent Rule". Runner's World. Retrieved 2 April 2022.
  35. Wang, C; Vargas, JT; Stokes, T; Steele, R; Shrier, I (July 2020). "Analyzing Activity and Injury: Lessons Learned from the Acute:Chronic Workload Ratio". Sports Medicine (Auckland, N.Z.). 50 (7): 1243–1254. doi:10.1007/s40279-020-01280-1. PMID   32125672. S2CID   211729657.
  36. Griffin, A; Kenny, IC; Comyns, TM; Lyons, M (March 2020). "The Association Between the Acute:Chronic Workload Ratio and Injury and its Application in Team Sports: A Systematic Review". Sports Medicine (Auckland, N.Z.). 50 (3): 561–580. doi:10.1007/s40279-019-01218-2. hdl: 10344/8522 . PMID   31691167. S2CID   207899218.
  37. Orchard, JW (April 2020). "Prescribing and dosing exercise in primary care". Australian Journal of General Practice. 49 (4): 182–186. doi:10.31128/AJGP-10-19-5110. PMID   32233343. S2CID   214749061.
  38. Phillips, SM; Cadmus-Bertram, L; Rosenberg, D; Buman, MP; Lynch, BM (January 2018). "Wearable Technology and Physical Activity in Chronic Disease: Opportunities and Challenges". American Journal of Preventive Medicine. 54 (1): 144–150. doi:10.1016/j.amepre.2017.08.015. PMC   5736445 . PMID   29122356.
  39. Orchard, JW (September 2017). "Using technology to measure daily and weekly movement patterns in exercise medicine patients". British Journal of Sports Medicine. 51 (18): 1317–1318. doi:10.1136/bjsports-2016-096736. PMID   27884860. S2CID   12096034.
  40. Alentorn-Geli, E; Samuelsson, K; Musahl, V; Green, CL; Bhandari, M; Karlsson, J (June 2017). "The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis". The Journal of Orthopaedic and Sports Physical Therapy. 47 (6): 373–390. doi:10.2519/jospt.2017.7137. PMID   28504066. S2CID   26434756.
  41. Alzahrani, H; Shirley, D; Cheng, SWM; Mackey, M; Stamatakis, E (July 2019). "Physical activity and chronic back conditions: A population-based pooled study of 60,134 adults". Journal of Sport and Health Science. 8 (4): 386–393. doi:10.1016/j.jshs.2019.01.003. PMC   6620421 . PMID   31333893.
  42. Hartvigsen, J; Hancock, MJ; Kongsted, A; Louw, Q; Ferreira, ML; Genevay, S; Hoy, D; Karppinen, J; Pransky, G; Sieper, J; Smeets, RJ; Underwood, M; Lancet Low Back Pain Series Working, Group. (9 June 2018). "What low back pain is and why we need to pay attention". Lancet. 391 (10137): 2356–2367. doi:10.1016/S0140-6736(18)30480-X. PMID   29573870. S2CID   4354991.
  43. Milner, PI (August 2017). "Keeping joints healthy: The Goldilocks effect of exercise". Veterinary Journal. 226: 4–5. doi:10.1016/j.tvjl.2017.06.007. PMID   28911839.
  44. Straker, L; Mathiassen, SE; Holtermann, A (July 2018). "The 'Goldilocks Principle': designing physical activity at work to be 'just right' for promoting health". British Journal of Sports Medicine. 52 (13): 818–819. doi:10.1136/bjsports-2017-097765. PMC   6029635 . PMID   28663212.
  45. O'Keefe, JH; O'Keefe, EL; Lavie, CJ (March 2018). "The Goldilocks Zone for Exercise: Not Too Little, Not Too Much". Missouri Medicine. 115 (2): 98–105. PMC   6139866 . PMID   30228692.
  46. Ekelund, U; Tarp, J; Steene-Johannessen, J; Hansen, BH; Jefferis, B; Fagerland, MW; Whincup, P; Diaz, KM; Hooker, SP; Chernofsky, A; Larson, MG; Spartano, N; Vasan, RS; Dohrn, IM; Hagströmer, M; Edwardson, C; Yates, T; Shiroma, E; Anderssen, SA; Lee, IM (21 August 2019). "Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis". BMJ (Clinical Research Ed.). 366: l4570. doi:10.1136/bmj.l4570. PMC   6699591 . PMID   31434697.
  47. Orchard, JW (2 April 2018). "How exercise medicine has evolved from sports medicine". The Medical Journal of Australia. 208 (6): 244–245. doi:10.5694/mja17.00764. PMID   29614932. S2CID   4606643.
  48. Tveit, M; Rosengren, BE; Nilsson, JÅ; Karlsson, MK (March 2012). "Former male elite athletes have a higher prevalence of osteoarthritis and arthroplasty in the hip and knee than expected". The American Journal of Sports Medicine. 40 (3): 527–33. doi:10.1177/0363546511429278. PMID   22130474. S2CID   7256358.
  49. Gouttebarge, V; Inklaar, H; Backx, F; Kerkhoffs, G (March 2015). "Prevalence of osteoarthritis in former elite athletes: a systematic overview of the recent literature". Rheumatology International. 35 (3): 405–18. doi:10.1007/s00296-014-3093-0. PMID   25037899. S2CID   6763231.
  50. Antero, J; Tanaka, H; De Larochelambert, Q; Pohar-Perme, M; Toussaint, JF (February 2021). "Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians". British Journal of Sports Medicine. 55 (4): 206–212. doi: 10.1136/bjsports-2019-101696 . PMID   32727712. S2CID   220846618.
  51. Ruiz, JR; Fiuza-Luces, C; Garatachea, N; Lucia, A (November 2014). "Reduced mortality in former elite endurance athletes". International Journal of Sports Physiology and Performance. 9 (6): 1046–9. doi:10.1123/ijspp.2013-0492. PMID   24584695.
  52. "Council of Presidents of Medical Colleges".
  53. Cullen, M (2010). "Developing a new specialty - sport and exercise medicine in the UK". Open Access Journal of Sports Medicine. 1: 11–4. doi: 10.2147/oajsm.s7627 . PMC   3781848 . PMID   24198537.
  54. O'Connor, Denise; Harris, Ian; Buchbinder, Rachelle (13 September 2018). "Needless procedures: knee arthroscopy is one of the most common but least effective surgeries". The Conversation. Retrieved 3 April 2022.
  55. Ferreira, Giovanni E.; Harris, Ian; Zadro, Joshua; O'Keeffe, Mary (24 March 2022). "3 orthopaedic surgeries that might be doing patients (and their pockets) more harm than good". The Conversation.
  56. Harper, S; Riddell, CA; King, NB (1 April 2021). "Declining Life Expectancy in the United States: Missing the Trees for the Forest". Annual Review of Public Health. 42: 381–403. doi: 10.1146/annurev-publhealth-082619-104231 . PMID   33326297. S2CID   229302547.
  57. Els, C; Jackson, TD; Kunyk, D; Lappi, VG; Sonnenberg, B; Hagtvedt, R; Sharma, S; Kolahdooz, F; Straube, S (30 October 2017). "Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews". The Cochrane Database of Systematic Reviews. 10 (10): CD012509. doi:10.1002/14651858.CD012509.pub2. PMC   6485910 . PMID   29084357.
  58. Malik, A; Lenzen, M; McAlister, S; McGain, F (January 2018). "The carbon footprint of Australian health care". The Lancet. Planetary Health. 2 (1): e27–e35. doi: 10.1016/S2542-5196(17)30180-8 . PMID   29615206.
  59. Rizan, C; Steinbach, I; Nicholson, R; Lillywhite, R; Reed, M; Bhutta, MF (December 2020). "The Carbon Footprint of Surgical Operations: A Systematic Review" (PDF). Annals of Surgery. 272 (6): 986–995. doi:10.1097/SLA.0000000000003951. PMID   32516230. S2CID   216202267.
  60. "HCWH's new global road map for zero emissions healthcare". Health Care Without Harm. 14 April 2021.
  61. Orchard, JW (18 January 2023). "Sport and exercise medicine: leading the race towards net zero". British Journal of Sports Medicine. 57 (7): 386–387. doi:10.1136/bjsports-2022-106177. PMID   36653142. S2CID   255966794.
  62. Charlesworth, KE; Jamieson, M (July 2019). "Healthcare in a carbon-constrained world". Australian Health Review. 43 (3): 241–245. doi:10.1071/AH17184. PMID   29731002. S2CID   19201926.
  63. Lobelo, F; Stoutenberg, M; Hutber, A (December 2014). "The Exercise is Medicine Global Health Initiative: a 2014 update". British Journal of Sports Medicine. 48 (22): 1627–33. doi:10.1136/bjsports-2013-093080. PMID   24759911. S2CID   26898017.
  64. Sallis, RE; Matuszak, JM; Baggish, AL; Franklin, BA; Chodzko-Zajko, W; Fletcher, BJ; Gregory, A; Joy, E; Matheson, G; McBride, P; Puffer, JC; Trilk, J; Williams, J (May 2016). "Call to Action on Making Physical Activity Assessment and Prescription a Medical Standard of Care". Current Sports Medicine Reports. 15 (3): 207–14. doi:10.1249/JSR.0000000000000249. PMID   27172086. S2CID   207179559.
  65. Golightly, YM; Allen, KD; Ambrose, KR; Stiller, JL; Evenson, KR; Voisin, C; Hootman, JM; Callahan, LF (30 November 2017). "Physical Activity as a Vital Sign: A Systematic Review". Preventing Chronic Disease. 14: E123. doi:10.5888/pcd14.170030. PMC   5716811 . PMID   29191260.
  66. Kuntz, JL; Young, DR; Saelens, BE; Frank, LD; Meenan, RT; Dickerson, JF; Keast, EM; Fortmann, SP (June 2021). "Validity of the Exercise Vital Sign Tool to Assess Physical Activity". American Journal of Preventive Medicine. 60 (6): 866–872. doi:10.1016/j.amepre.2021.01.012. PMC   8154650 . PMID   33781618.
  67. Davenport, Todd E; Griech, Sean F; Deamer, Kathryn E; Gale, Lewis R (27 June 2022). "Beyond "Exercise as Medicine" in Physical Therapy: toward the Promotion of Exercise as a Public Good". Physical Therapy. 102 (9): pzac087. doi:10.1093/ptj/pzac087. ISSN   1538-6724. PMID   35778932.