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] diabetes, [11] depression and other mental illnesses and falls in the elderly. [12]

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 [14] in a large number of primary studies and meta-analyses. [15] [16] [17] [18]

Exercise and cardiovascular disease

There are multiple ways in which exercise can reduce cardiovascular disease and mortality, [19] including through lowering blood pressure and lowering LDL cholesterol levels. [20] Although multiple mechanisms are possible, the relationship between exercise as measured by accelerometer data and cardiovascular mortality is strong (inverse, non-linear). [21]

Exercise and cancer

Exercise prescription is now a recognized treatment for cancer, [22] as studies have shown that exercise is associated with superior mortality outcomes and lower recurrence rates. [23] [24] [25]

Exercise and mental illness

Exercise both prevents and treats mental illnesses, including depression in particular, [26] [27] [28] with positive effects likely for anxiety, [29] bipolar disorder [30] and suicidality. [31]

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. [32] Sudden increase of exercise levels is likely to lead to painful musculoskeletal symptoms or even injury (preventing further exercise). [33] [34] [35]

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). [39] With respect to back pain, increasing levels of exercise reduce risk of back pain, [40] but having occupational manual loading increases the risk. [41] 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). [42] [43] [44] 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). [45]

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). [46] There is good evidence that competitive and professional athletes have higher rates of certain conditions than the general population, such as osteoarthritis, [47] [48] but equally strong evidence that the life expectancy of elite athletes is longer than the general population. [49] [50]

Establishment as a medical specialty

Sports medicine is a recognized medical specialty or subspecialty in at least 30 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, [51] the United Kingdom (Faculty of Sport and Exercise Medicine UK), [52] 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. [53] Examples of low-value care include knee and shoulder arthroscopy, spinal fusion surgery [54] and opiate prescription for chronic non-cancer pain. [55] [56] 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. [57] Although most healthcare is considered 'essential', it is important that the necessity of carbon-intensive healthcare options, such as surgery, [58] is critically assessed as there is an international agreement that net zero emissions must be reached to avoid breakdown of the Earth's climate. [59] Exercise as a medical treatment has perhaps the lowest carbon footprint of any medical treatment. [60] 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. [61]

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. [62] [63] 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', [64] [65] 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. [66]

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 muscle due to plaque buildup in the hearts arteries

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 heart 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">Obesity</span> Medical condition in which excess body fat harms health

Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classified as obese when their body mass index (BMI)—a person's weight divided by the square of the person's height—is over 30 kg/m2; the range 25–30 kg/m2 is defined as overweight. Some East Asian countries use lower values to calculate obesity. Obesity is a major cause of disability and is correlated with various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.

<span class="mw-page-title-main">Type 2 diabetes</span> Type of diabetes mellitus with high blood sugar and insulin resistance

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 come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the 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> Bodily activity intended to improve health

Exercise is intentional physical activity to enhance or maintain fitness and overall 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">Achilles tendinitis</span> Medical condition of the ankle and heel

Achilles tendinitis, also known as achilles tendinopathy, occurs when the Achilles tendon, found at the back of the ankle, becomes sore. Achilles tendinopathy is accompanied by alterations in the tendon's structure and mechanical properties. The most common symptoms are pain and swelling around the affected tendon. The pain is typically worse at the start of exercise and decreases thereafter. Stiffness of the ankle may also be present. Onset is generally gradual.

<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 some countries, 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.

<span class="mw-page-title-main">Athletic heart syndrome</span> Medical condition

Athletic heart syndrome (AHS) is a non-pathological condition commonly seen in sports medicine in which the human heart is enlarged, and the resting heart rate is lower than normal.

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

Extracorporeal shockwave therapy (ESWT) is a non-invasive, out-patient alternative to surgery for those with many joint and tendon disorders. ESWT sends acoustic shock waves into bone or soft tissue, in effect reinjuring the area on a cellular level and breaking up the scarring that has penetrated tendons and ligaments. The controlled reinjuring of tissue allows the body to regenerate blood vessels and bone cells. The resulting revascularization leads to faster healing and often a return to pre-injury activity levels. ESWT is mostly used for kidney stones removal, in physical therapy and orthopedics.

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 blood supply to a part of the heart

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 chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw. Often such pain occurs in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, feeling tired, and decreased level of consciousness. About 30% of people have atypical symptoms. Women more often present without chest pain and instead have neck pain, arm pain or feel tired. Among those over 75 years old, about 5% have had an MI with little or no history of symptoms. An MI may cause heart failure, an irregular heartbeat, cardiogenic shock or cardiac arrest.

<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.

A 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

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