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Expanding Medical Horizons

Nicholas A. DiNubile, MD

Series Editor


When I was completing my orthopedic surgery residency in the early 1980s, a slogan on a T-shirt caught my attention: "Exercise Is Medicine." The idea made great sense to me, especially considering its rich tradition—going back to Hippocrates. At that time, however, the clinical role for exercise as medicine was minimally defined.

The Case for Exercise

Since then, the accumulation of scientific evidence has built a case for exercise that is too strong to ignore. The idea of exercise as prevention (which last year received the imprimatur of the US surgeon general) and the notion of exercise as therapy for a variety of medical conditions have both been upheld by the swell of data. Thus, the same impulse that motivated the surgeon general's report has inspired the "Exercise Is Medicine" series that begins with this issue of The Physician and Sportsmedicine (PSM).

If it sounds strange to add exercise to the standard therapeutic armamentarium of drugs, surgery, and physical therapy, this only reflects the narrow vision of yesterday's medicine, the limitations of our training, and the constraints of habit. As the research-based articles in this series will make clear, the exercise modality has much to offer patients with conditions as diverse as osteoarthritis, coronary artery disease, and depression.

Just as exercise can prevent disease, it can also be a potent form of treatment—a medicine, as defined in Dorland's Illustrated Medical Dictionary ("any drug or remedy"). Like a pharmacologic intervention, exercise produces measurable, predictable physiologic changes, both centrally and peripherally. Its effects often follow a clearly defined dose-response curve.

Beyond its efficacy, exercise seems uniquely appropriate in the modern healthcare environment. It is low-tech and cost-effective—no small issue in these times of budget consciousness. It is highly acceptable to the growing ranks of patients who wish to take an active role in their own treatment, and it addresses not just the symptom or the specific disease, but the whole person. Its positive impact on quality of life—a concern that has recently and justly come to the fore in the assessment of treatment outcomes—is beyond question.

The hospital system with which I am affiliated (Crozer-Keystone Health System, Media, Pennsylvania) believes so strongly in this philosophy that it recently constructed The Healthplex, a state-of-the-art wellness and fitness center. In a futuristic plan, patients' exercise prescriptions, fitness routines, rehabilitation regimens, and workouts are electronically linked to their computerized medical records in their physicians' offices. This interactive program, developed in conjunction with Life Fitness (Franklin Park, Illinois), as part of its LifeCenter project, brings exercise directly into the patient's chart.

Implementing Tomorrow's Medicine

The promotion of exercise as therapy was a central mission of this publication long before the data crystallized. PSM caught the wave early; the provocative T-shirt I noticed 15 years ago was, in fact, a PSM premium.

But revolutions spread slowly through the medical community. Even doctors who fully accept that "exercise is medicine" remain, for the most part, unsure of how to put it into practice. Currently, less than one third of physicians actually discuss exercise with their patients.

This is especially unfortunate because, as has been demonstrated repeatedly, doctors have a unique power to effect lifestyle change. Timely, practical, specific advice—an exercise prescription—can encourage sedentary "couch potatoes" to become active individuals who gain the considerable health benefits that even moderate exercise can bring. That's why each article in this series will provide a practical exercise prescription with tips for encouraging patients, warnings about possible hazards such as interactions with medications, and a patient handout.

Inspiring Change

Arnold Schwarzenegger, then chair of the President's Council on Physical Fitness and Sports, put it well several years ago in the preface to my book, The Exercise Prescription: "My hope is that each time physicians, regardless of their specialty, meet a patient, a category of treatment in their mental checklist is exercise, and a page of their prescription pad reflects this."

Given what we've learned, that scenario is no farfetched fantasy. Doctors with an interest in the care of active patients—the readership of this publication—have long been ahead of the curve in their appreciation of the value of exercise. To put this appreciation to clinically effective use may require no more than a dose of inspiration and a little more education. It is our hope that "Exercise Is Medicine" will provide both.



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