Exercise as Medication: An Exercise
Physiologist's View
Joseph V. Russo, MS
Department of Health, Physical and
Recreation Education
University of Pittsburgh
Pittsburgh, PA 15260
Stedman’s medical dictionary
for the Health Sciences defines the term medicine as “the art of preventing,
diagnosing, and treating disease; the science concerned with disease in
all its relations” [1]. If we examine the definition
more closely, it is easily seen that the work of the exercise physiologist
is very closely tied to and aligned with the goals and practices of the
medical profession. In effect, exercise is medicine! When used
in its most natural of forms (without the use of pharmacological or technologically
advanced equipment), it is also among the most complex of "medications"
in terms of its widespread effects and multiple interactions with nearly
every body system.
While it is true that exercise physiologists
are not licensed or trained to prescribe pharmacological agents or to use
advanced clinical techniques in patient care, they are trained in the responses
of the human body to physical training. They are also skilled in
the application of exercise as a therapeutic modality for health promotion,
maintenance of functional independence, and a variety of rehabilition prescriptions.
Exercise physiologists understand that the prescription per se isn't something
that is taken lightly. Exercise for heart patients, for example,
must be monitored, titrated,and maintained to achieve a safe level of performance.
Hence, the exercise prescription as a therapeuctic modality is defined
by understanding the application of intensity, mode, frequency, and
duration.
Disease Prevention
Clearly, disease prevention is one
area in which the regular participation in a well structured and comprehensive
exercise program can have its most potent effect. Both the medical
literature and the exercise physiology literature are replete with scientific
evidence that exercise enhances a person's health status and helps to postpone
illness or impairment.. This not only applies to the obvious benefits
afforded the cardiorespiratory system, but to the functioning of the body
as a whole. For example, exercise is used to improve the structure
and function of the musculoskeletal system, the pulmonary system, the gastrointestinal
system, the nervous system, the immune system, and the endocrine system.
The benefits of exercise in various organ systems improve serum lipids
and glucose tolerance, better control of blood pressure, and prevent osteoporosis.
In this role of prevention, the exercise physiologist is not alone.
There are many healthcare practitioners who are also certified to work
with the apparently healthy population of adults and children to promote
health and adherence to a program of physical activity [2].
The benefits of exercise, however, helps the more traditional practitioners
to understand the role of the exercise physiologists in conducting and
evaluating the patient's aerobic and biomechanical condition.
Diagnosis of Disease
Exercise testing is used extensively
with a wide variety of clinical imaging techniques such as echocardiography,
thallium nuclear imaging [3]. In this realm of
medical practice, the exercise stress test is used frequently to cardiorespiratory
system to determine the function and to add to the overall diagnosis of
coronary artery disease. The test may also be used during the rehabilitation
process to determine the change in function across time. As stress
is placed on the different organ systems, the response to the graduated
stimulus imposed on the systems can be evaluated in a very prescribed manner.
Additionally, decreased exercise capacity is nearly a universal sign of
physiological dysfunction especially in the cardiac and respiratory systems.
The role of the exercise physiologist during the clinical exercise test
is to monitor the patient's physiological variables and to assist the attending
physician.
Treatment of Disease
The exercise prescription is very
similar to the pharmacological prescription that is typically provided
to patients presenting with a particular disease process. It is a
highly specialized and individualized physiological manipulation.
The specialization comes about in response to the body systems, which are
most highly involved in the disease process. For example, if the
disease process influences the peripheral muscles of the patient, then
the exercise physiologist might implement a resistance-training program.
Whether the program emphasizes muscular strength or muscular endurance
training and/or cardiovascular rehabilitation depends on the pathophysiology
of the disease. In any case, the individualization of the exercise
prescription may be one of the most important functions of the exercise
physiologist as this may determine whether and how long the patient will
comply with the exercise regimen. The limitations that the disease
process impose on an individual as well as the time, access to training
equipment, and motivation of the individual must be taken into consideration
if the disease process is to be effectively counteracted by the exercise
program.
This brief view of the role of the
exercise physiologist in the clinical setting and the use of exercise in
the prevention and treatment of diseases comes in sharp contrast with the
view of many who feel that exercise physiology has yet to establish itself
under the rubric of medicine [4]. However, through
closer scrutiny of the definition of medicine as it applies to the conduct
of patient care, it can be seen that exercise whether used to analyze the
responses of the body to physical stress or as a means through which to
deliver specific physiological manipulations is very much a part of mainstream
medicine.
References
1. Dirckx, J.H.
Editor (1997). Stedman’s concise medical dictionary for the
health professions. (3rd edition). Baltimore, MD: Williams
and Wilkins.
2. Howley, E.T.,
and Franks, B.D. Editors (1997). Health fitness instructor’s
handbook. (3rd edition). Champaign, IL: Human Kinetics.
3. Ellestad, M.H.
(1996). Stress testing: Principles and Practice. (4th
edition). Philadelphia, PA: F.A. Davis Company.
4. Goswami, A.
(2000). Exercise Physiology-The legacy with clinical areas. Professionalization
of Exercise Physiologyonline [online],
Vol. 3(No.8), 3 pages.
Available: www.css.edu/users/tboone2/asep/EPLegacy.html
[2000, August].
Related Articles
The
Effects of Exercise on Quality of Life Improvements in Cancer Survivors:
The Results of a National Survey
Eric P.
Durak,1 Jaime Harris2,
and Susan M. Ceriale2
Medical Health
and Fitness1, University of California,
Santa Barbara2
Journal
of Exercise Physiologyonline
Volume 4 Number
4 November 2001
Physical
Fitness and Quality of Life Outcomes in a Pulmonary Rehabilitation Program
Utilizing Symptom Limited Interval Training and Resistance Training
M.E. Kaelin1,
A.M. Swank2, K.L. Barnard3,
K.J. Adams2, P. Beach1,
and
J. Newman4
1Southern
Indiana Rehab Hospital, New Albany, IN; 2Exercise
Physiology Lab, University of Louisville, Louisville, KY; 3Southside
Regional Medical Center, St Petersburg, VA; 4Applied
Research and Education Center, Indiana University Southeast, New Albany,
IN
Journal
of Exercise Physiologyonline
Volume 4 Number
3 August 2001
A
Perspective On Exercise Prescription
Herb Weber
East Stroudsburg
University
East Sroudsburg,
PA
Journal
of Exercise Physiologyonline
Volume 4 Number
2 May 2001
Related
Book
Exercise Prescription
by Kamala Shankar, MD is an excellent read. It is published by Hanley
& Belfus, Inc., Medical Publishers, 210 South 13th Street, Philadelphia,
PA 19107. 215-546-7293; 800-962-1892 or Fax 215-790-9330