Evidence For Prescribing Exercise

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Evidence for prescribing exercise as therapy in chronic disease

B. K. Pedersen1,2, B. Saltin2

http://www.blackwell-synergy.com/doi/full/10.1111/j.1600-

0838.2006.00520.x

Scandinavian Journal of Medicine & Science in Sports

Volume 16 Page 3 - February 2006

Review

Considerable knowledge has accumulated in recent decades concerning

the significance of physical activity in the treatment of a number of

diseases, including diseases that do not primarily manifest as

disorders of the locomotive apparatus. In this review we present the

evidence for prescribing exercise therapy in the treatment of

metabolic syndrome-related disorders (insulin resistance, type 2

diabetes, dyslipidemia, hypertension, obesity), heart and pulmonary

diseases (chronic obstructive pulmonary disease, coronary heart

disease, chronic heart failure, intermittent claudication), muscle,

bone and joint diseases (osteoarthritis, rheumatoid arthritis,

osteoporosis, fibromyalgia, chronic fatigue syndrome) and cancer,

depression, asthma and type 1 diabetes. For each disease, we review

the effect of exercise therapy on disease pathogenesis, on symptoms

specific to the diagnosis, on physical fitness or strength and on

quality of life. The possible mechanisms of action are briefly

examined and the principles for prescribing exercise therapy are

discussed, focusing on the type and amount of exercise and possible

contraindications.

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Over the past decades, considerable knowledge has accumulated

concerning the significance of exercise in the treatment of a number

of diseases, including diseases that do not primarily manifest as

disorders of the locomotive apparatus. Today, exercise is indicated

in the treatment of a large number of medical disorders (Oldridge,

2003; & Barnard, 2005). In the medical world, it is

traditional to prescribe the evidence-based treatment known to be the

most effective and entailing the fewest side effects or risks. The

evidence suggests that in selected cases exercise therapy is just as

effective as medical treatment – and in special situations more

effective – or adds to the effect. In this context, exercise therapy

does not represent a paradigm change – it is rather that the

accumulated knowledge is now so extensive that it has to be

implemented.

In selecting diagnoses for inclusion in this review, we have taken

into account both the frequency of the diseases and the relative need

for exercise therapy. Borderline cases exist between physical

training as prophylaxis and physical training as actual therapy. The

review includes diagnoses for which there is a tradition or consensus

to offer pharmacotherapy, for example hypertension, hyperlipidemia,

insulin resistance and obesity. We exclusively describe the

foundation for exercise therapy in the form of endurance training,

metabolic training or strength conditioning. Thus, the review does

not examine other forms of therapy such as pharmacotherapy, dietary

modification or smoking cessation. The aim of this review is to

provide the evidence for exercise as therapy. We also suggest how

such therapy can be prescribed. However, the specific recommendations

are only evidence-based for some few diseases. Nevertheless, based on

evidence, experience and common sense, we have included suggestions

for specific training modes in an attempt to make this review also of

practical use.....

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Carruthers

Wakefield, UK