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Where Is The Evidence? Exercise as medicine

Posted on 3rd September 2013 by Abu Abioye

Evidence Reviews
running

After attending a conference in which Ann Gates spoke about her work at @exerciseworks, I became increasingly interested in exercise (physical activity) and its health benefits as a form of medicine. I knew that we should do regular exercise to stay fit but I didn’t know how much. I knew that cardiovascular diseases such as strokes, heart attacks, and hypertension were reduced by exercise. I also knew that exercise helped with mental illness such as anxiety and depression, after all who has not heard about the ‘happy endorphins’ that are released by doing exercise.

On the recommendation of Ann Gates, I went home and watched 23 and a half hours by Dr Mike Evans. This YouTube video has been a hit across the world, but why would a video about the health benefits of exercise prove so popular? I think the main reason is because it shows clearly and concisely why exercise is so important; not just as a way of staying trim but as a way of life. Dr Mike talks about how evidence shows that exercise improves rates of dementia, diabetes, hip fractures, anxiety, depression, disability, and mortality. He talks about how exercise is great and increases quality of life!

The video does away with the preconceptions that I think many health professions have. These preconceptions are that the modifiable risk-factors such as hypertension, obesity, high cholesterol, and smoking are what patients need to be educated about in order to improve their health. Dr Mike Evans puts forward evidence that shows that “low fitness” is the strongest predictor of death out of these factors.

So now we know that exercise is good and no exercise is bad, but how much should adults be doing? The National Institute of Health and Care Excellence produced guidelines earlier this year to help guide health professionals. They state that the evidence suggests that the minimum amount of physical activity that an adult should do a week is 150 minutes of moderate or 75 minutes of moderate-to-vigorous physical activity split over 5 days during a week. In addition, adults should be doing strengthening exercises on 2 days a week. Unfortunately most adults in the UK do not achieve this minimum level of activity.

Although there is an abundance of evidence that shows that regular exercise is beneficial for health and is a cheap, cost-effective way of preventing disease, there seems to be a disconnect between the evidence and clinical practice. Why is this? One of the reasons is that there are not enough incentives to encourage doctors, especially general practitioners (GPs) to promote exercise to their patient population. In medicine, one of the topics that is often complained about is that there is not enough onus placed on preventative medicine, such as exercise. It can take a long time to see some of the effects of regular exercise and this makes it seem like a soft treatment.

This brings me on to another reason why physical activity is not pushed as hard as it should be. Why spend time, which you desperately lack, trying to encourage someone to exercise when they don’t want to? After all, you can give them statins and anti-hypertensive drugs to help reduce their cardiovascular risk. This attitude stems from a lack of information and promotion about the health benefits of exercise. During my time in medical training, I have been bombarded with free gifts from various representative of various companies. As a doctor, the same happens and pharmaceutical representatives (drug reps) often visit doctors and sponsor events in a bid to increase awareness of their products. Unfortunately for the health of the country, it is not possible to patent exercise and therefore there is no money to be made by the pharmaceutical companies. Without the ability to profit from it, no-one is going to spam doctors with adverts about how much great exercise is.

Lack of time, money, and information makes exercise low on the agenda for health promotion and prevention when it really should be at the top. There is evidence that shows that exercise not only helps you look and feels good, but it also helps you live longer and healthier. If only you could package it into a pill or health shake rather than having to go to the gym and sweating it out in order to reap the benefits.

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Abu Abioye

Hi, my name is Abu. I am a medical student at Oxford University, currently in my 6th and final year. I also work as a tutor in Neuroscience, Physiology, and Critical Thinking at various Oxford colleges. My academic interests include neuroscience, mental health, alternative medicine, exercise medicine, and surgery. View more posts from Abu

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5 Comments on Where Is The Evidence? Exercise as medicine

  • minervation

    Great blog Abu!

    I’ve blogged today about exercise and depression on my Mental Elf website: http://www.thementalelf.net/mental-health-conditions/depression/what-kind-of-exercise-is-best-for-depression-new-cochrane-review-says-we-need-more-trials-before-we-can-be-sure/

    The blog is getting a great response on Twitter, so there’s clearly a lot of interest in this subject.

    One thing that I find interesting is that the evidence (a Cochrane review in the case of my latest blog) seems to be lagging behind the public perception of the issue, i.e. most people think exercise helps reduce depression, but we don’t have the high quality RCTs to prove it (yet).

    Maybe it’s just a matter of time, but what should health professionals do when the evidence doesn’t exist for a lifestyle intervention such as exercise? Should GPs ‘prescribe’ exercise to depressed patients without the evidence that shows it works?

    Cheers,
    André

    12th September 2013 at 12:53 pm
    Reply to minervation
    • Abu Abioye

      Thanks for your comment André.

      Your blog post was great!

      I understand what you are saying about there being a lack of good RCTs showing strong evidence to support the use of exercise to help depression. My view on this is that as long as exercise is not harmful then it should be promoted for all, regardless of whether the person has depression or not. Exercising has been shown to reduce mortality and morbidity, and therefore there may not be evidence to support GPs prescribing exercise instead of antidepressants and psychotherapy, however as an adjunct I have not seen any evidence to show that it is deleterious.

      13th September 2013 at 4:42 pm
      Reply to Abu
      • minervation

        I couldn’t agree more Abu.

        However, what I’ve started to notice (mostly on social media, so not sure how representative it really is) is a shared view that exercise can be used INSTEAD of conventional treatments (drugs and psychotherapy). This may be true for some, but it’s certainly not a cure all.

        My concern is that people with depression may not approach their GP but self-manage with exercise and as a result not get the outcome they need. Clearly antidepressants are not suitable for everyone, and with waiting lists for talking treatments still quite long, people are understandably looking for alternatives.

        This discussion will run and run (excuse the pun), so let’s hope that high quality evidence is published soon that shows conclusively what types of exercise are best for people with depression.

        Cheers,
        André

        16th September 2013 at 9:50 am
        Reply to minervation
  • David Lincoln

    Exercise can be easily integrated into daily routine by cycling to work or school. No need to invent the pill or health shake. No need for expensive gyms. Probably needs #space4cycling i.e. safe road infrastructure to convince most people to cycle or let their kids cycle.

    31st December 2013 at 11:04 am
    Reply to David
  • Dora Phill

    Abu,
    You have made practical points and your writing style is quite easy to understand. Thanks for sharing all the info at one place :) Really helpful..!
    My favorite part of this post…
    “Although there is an abundance of evidence that shows that regular exercise is beneficial for health and is a cheap, cost-effective way of preventing disease……………………..such as exercise. It can take a long time to see some of the effects of regular exercise and this makes it seem like a soft treatment.”
    Brilliant explanation and selection of words in the next para where you talked about reason!

    2nd June 2019 at 5:35 am
    Reply to Dora

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