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Recently, the American College of Sports Medicine (ACSM) embarked on a campaign to educate health care providers regarding the benefits of exercise for a wide variety of diseases and conditions.1 As Cardiovascular and Pulmonary physical therapists, this idea is certainly not new to us. Several groups of which I am a part have taken up this motto and attempted to educate providers regarding the role of exercise and physical activity in the care of various patient types.
Recently, I was struck by the ways in which this motto fits, and perhaps, does not really fit what we do. Yes, exercise is like medicine in so many ways. Exercise is prescribed, in a specific dosage and formulation to each individual patient diagnosed with a disease. The prescription must be very specific regarding exercise modality, intensity, frequency, and duration. Clearly, it is not enough to have providers tell patients “you should exercise for your disease” without giving them these specifics. It would be equivalent to telling a patient to “just take some pills”—and no provider would do that! Clearly, there is much work to be done in this area and fortunately, there are many great minds focused on this task, many of whom share their work through this journal.
Dosage of a medicine is also critical to its success. Pharmacology and pharmacokinetics have informed us that a drug must be in a therapeutic range in order to have the desired effect. Too much, and you risk toxic effects, too little and there is no benefit. To relate to exercise, it is critical to know how much exercise must be “absorbed” by the patient to have the most benefit. When an exercise program does not result in any change in aerobic capacity, strength, or flexibility (depending on the mode and goal of exercise)—it is clear that the patient has not absorbed enough to have therapeutic effects. Thus, measurement of the key intended effects both at baseline and after the prescription is critical to understanding how to prescribe exercise. On the other hand, it is important to know that exercise can have toxic effects. Musculoskeletal injuries, cardiac events, bronchospasm, blood glucose, and electrolyte abnormalities are many of these known effects. So, just as a provider would not dream of telling a patient “just take as many pills as you can” to treat a disease, similarly, telling a patient “just exercise regularly” does not provide for safety in avoiding complications.
Formulation of a drug also affects its absorption, and the same applies to exercise. In this case, it is important to determine if general physical activity or specific goal-directed exercise is most appropriate for an individual patient. In this arena, we must consider each patient's stage of readiness to increase physical activity/exercise. Prescribing exercise that a patient perceives as impossible to perform is like prescribing a pill for a patient who cannot swallow. We must match the delivery method of activity to what the patient can accomplish successfully. Sometimes, that might mean not achieving the full therapeutic dose, but still getting into the range of effectiveness. Patient motivation is critical and an equal partnership between the “prescriber” and the “receiver” of exercise must exist. If a patient will not “take the medicine,” no benefits can be seen.
So, how is exercise NOT like medicine? Exercise and physical activity are preventative. No physician would prescribe a medicine to a patient who is currently healthy. However, we do need to encourage all people to be physically active on a regular basis. It is more than preventing disease or rehabilitating from disease, but staying healthy. Fortunately, there are also many great minds working in this area, and again, we are happy to share their work through this journal.
This issue of the Journal highlights two papers dealing with several aspects of exercise as medicine. Lefebvre and colleagues examine characteristics of the prescribers and potential barriers to measuring exercise's therapeutic effects. McVey and Hillegass highlight the effects of exercise in a patient with chronic kidney disease. In addition, we include the abstracts for platform and poster presentations for the 2011 Combined Sections Meeting. Certainly, there is a great diversity of research being presented, but the theme of exercise and physical activity for our patients and clients is strongly evident. So, I hope you will think, discuss, teach, and research about “Exercise is Medicine” but don't forget….it is so much more!