‘Exercise as medicine’ can help treat chronic diseases – if done properly

Imagine your doctor wrote a prescription for your elevated blood pressure and then sent you to an exercise facility to fill it. What if a few of your old pills magically transformed into a treadmill (with you on it) and your side effects flipped from low energy and fatigue to a feeling of vitality and vigour?

Numerous studies support the notion that medication and exercise can be beneficial tools for chronic-disease management, but, unlike pharmaceutical therapy, the concept of "exercise as medicine" 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. When it comes to exercise prescription, the same is seldom true. It's time to change this.

A better world can exist where generic advice such as "be more active" is replaced by specific exercise recommendations that include the same detail afforded to medication guidelines. Evidence-based research is the link that can connect the good intentions of your doctor with the expertise of an experienced exercise professional. The supporting science is already here, and new national programs such as Exercise is Medicine Canada (EIMC) are trying hard to bridge the gap between physicians and medical-exercise specialists.

Check out three examples below of how the right details can raise the bar on your wellness. Supervised medical exercise can be used as a complimentary tool to reduce the incidence and severity of many serious chronic diseases – especially when it follows a specific protocol that is evidence-based. (Always consult with your doctor before starting any exercise program. The examples below are for information purposes only.)

Primary issue: Management of Type 2 diabetes

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 eight to 10 repetitions.

Overall benefit from exercise: Improved glycemic control, weight maintenance and reduced risk of cardiovascular disease.

Primary issue: Management of osteoporosis

Specific exercise recommendations: According to the American College of Sports Medicine, exercise programs for elderly women and men should include not only weight-bearing endurance and resistance activities aimed at preserving bone mass, but also activities designed to emphasize core endurance and 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: Sedentary lifestyle and poor fitness level

Specific exercise recommendations: The physical activity guidelines from the Canadian Society for Exercise Physiology recommends adults of ages 18 to 64 should perform 150 minutes of moderate to vigorous physical activity a week in bouts of 10 minutes or more.

The Centers for Disease Control and Prevention set moderate intensity at 50 per cent to 70 per cent of heart-rate maximum and high intensity at 70 per cent to 85 per cent.

It is also beneficial to add in at least two resistance-training workouts that target major muscle groups.

Overall benefit: Reduce the risk of hypertension and cardiovascular disease by 33 per cent and stroke by 31 per cent, as well as the prevention of numerous other chronic conditions.

The final and most important piece of this Canadian health-care puzzle is for the public to ask for more.

Make exercise your medicine by asking your doctor for specific information about how an exercise program can be used as part of your long-term health plan and if he or she can refer you to an exercise professional for an assessment.

For more detailed health information, check out the American College of Sports Medicine (ACSM) guidelines for resistance training and The Canadian Society for Exercise Physiology (CSEP) guidelines for standards of activity based on age.

Alex Allan, a registered kinesiologist specializing in rehabilitation management and return to sport/life demands, is based out of the KIN Studio in Toronto.