Prescription for Chronic Disease: Rx Exercise!

I remember the very first day of a public health program design class I took. The professor asked the class to stand in different corners of the room to demonstrate whether we agreed or disagreed that exercise was beneficial to health. Everyone stood in the ‘agree’ corner. Then she asked us to stand in separate corners to show if we thought 3+ days, 2 days, or 1 or fewer days a week of 30 minutes of exercise was sufficient. Most of us stood in the corner to show we thought 3+ days were sufficient. Then she asked us to move to the corner that correlates with how much exercise we personally got per week. Almost everyone moved to 1 day or less. The lesson was that even though someone knows that something is good for their health, that isn’t always enough to motivate them. To get us to move our bodies, we might have to put exercise in front of our minds.


Everyone knows diet and exercise are the key to good health, but our environment can lock us out. Built for convenience at every turn, our environment can obscure opportunities for physical activity. Therefore, exercise is often thought of as an additional thing that adults have to schedule in because they don’t typically walk around the block, take the stairs, or commute by bike. Only about half of adults say they get the recommended amount of aerobic activity. Only 20% get the weekly amount of aerobic activity and muscle-strengthening exercise that is recommended.


For chronic disease sufferers, though, exercise can be just as effective as some drugs to treat chronic disease. Some doctors are including exercise in their treatment plans for patients. Moderately intense exercise produces roughly the same effect as drugs for adults dealing with coronary heart disease, rehabilitation after stroke, treatment of heart failure, and diabetes. Exercise is also healthy for your brain. Most recently, it has been shown to be beneficial for treating and preventing dementia. It also improves overall mental health, especially for people with depression. So why don’t people exercise more?


For one, people often give up before trying because they fear they can’t reach the intensity of exercise required to benefit their health. However, research has found that you don’t have to sweat for hours every day to experience a benefit. The recommended amount of exercise is 150 minutes per week of moderate intensity physical activity for adults. That could be three 10-minute walks per day, five days a week.


So with all the benefits that come with exercise, how do public health experts and doctors get their patients to exercise more? Studies have found only modest results at the population level from doctor-led interventions to increase exercise among sedentary adults. A recent meta-analysis estimated that intervening on 12 sedentary adults got just one adult to exercise at the recommended level after 12 months. This isn’t very impressive, but still better than nothing given the low-to-no cost of implementation.


The Guide to Community Preventative Services conducted a systematic review of the literature to determine which interventions to increase physical activity were effective. For adults, they found two informational interventions to be effective, which included point-of-decision prompts, such as signs that encourage stair use instead of the elevator, and community-wide campaigns that use a diverse range of media. They also found two behavioral and social interventions to be effective, which included social support in the community (such as buddy systems at work to hold each other accountable) and individually adapted health behavior change delivered in group settings or through mail, telephone or directed media. Lastly, they found enhanced access to places for physical activity coupled with informational outreach activities (such as training on fitness equipment, health behavior education, risk screening, etc.) was also effective.


Whether we consider exercise a “miracle cure” or a “the best buy for public health”, it’s clear we need to continue to prioritize physical activity promotion interventions and make activity more easily accessible no matter where people live. And although we’re talking about exercising the body, the most important change may be to make exercise easily accessible to the brain.

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