If exercise was sold as a pill, it would be the most popular drug on the market. Often I hear clients tell me about their prescriptive medication, dosages, frequencies, and types. What if we can replicate the action of those medications with exercise, without the disastrous adverse effects?
Numerous studies support the notion that ‘prescriptive’ exercise as medicine can be a beneficial tool for chronic disease management. However, the concept is seldom applied with enough detail. For example, when a doctor prescribes a drug to a patient, there is a specific dose, volume, method of administration, frequency and duration to the treatment that ensures optimal benefit while mitigating risk. In that token, rehabilitative exercise is administered in the same way.
Supervised medical exercise can be used as a medical tool to reduce the incidence and severity of many serious chronic diseases – especially when it follows a specific protocol that is evidence-based. For example:
Specific exercise recommendations: For people with Type 2 diabetes, the American Diabetes Association recommends at least 150 minutes a week of moderate-intensity aerobic physical activity, at 50 per cent to 70 per cent of maximum heart rate, and/or at least 90 minutes a week of vigorous aerobic exercise, at 70 per cent of maximum heart rate. The physical activity should be distributed over at least three days a week and with no more than two consecutive days without physical activity. Resistance training should be performed three days a week, target all muscle groups and build up to three sets of 8 to 10 repetitions.
Overall benefit from exercise: Improved glycaemic control, weight maintenance and reduced risk of long term microvascular disease.
Specific exercise recommendations: Management of osteoporosis. According to the American College of Sports Medicine, exercise programs for the elderly should include not only weight-bearing endurance and resistance activities aimed at preserving bone mass, but also activities designed to emphasize core endurance, and that support daily balance training. Activities should consist of four to six weight-bearing, lower-body strength exercises performed two to three days a week using one to three sets of five to eight repetitions. Additional resistance may be applied gradually and conservatively. Avoid impact and comprehensive exercise, spinal flexion against resistance, excessive spinal extension and quick trunk rotation.
Overall benefit from exercise: Reduced rate of bone density breakdown while improving balance and muscular ability in those who have osteopenia or osteoporosis.
Primary issue: Obesity, sedentary lifestyle and poor fitness levels.
Specific exercise recommendations: The physical activity guidelines from the Canadian Society for Exercise Physiology recommends that adults of ages 18 to 64 should perform 250-300 minutes of moderate to vigorous physical activity a week in bouts of 10 minutes or more.
The Centre for Disease Control and Prevention set moderate intensity at 50% to 70% of heart-rate maximum, and high intensity at 70% to 85%. It’s understood that a minimum exercise regimen of >250 minutes per week can have a caloric expenditure of 500 calories. It is also beneficial to add in at least two resistance-training workouts that target major muscle groups. An increase in lean body mass has a substantial effect on metabolic rate.
Overall benefit: Reduced risk of hypertension and cardiovascular disease by 33% and stroke by 31%, as well as the prevention of numerous other chronic conditions. Reduce all chances of mortality by 30% for every MET (a single MET is defined as the amount of oxygen a person consumes (or the energy expended) per unit of body weight during 1 minute of rest) increase.
