Exercise-- the basis of any treatment?

Morgan Walker, B.S. Kinesiology, ACSM EP-C           September 13, 2016

I know a 97 year old who I watch go through a one-hour exercise session on three days out of the week.   This man is sharp as a tack; there is nothing that’s important to him that he doesn’t remember: his 7 children’s birthdays, the names of old friends he grew up with, the name of the horse his mother had that pulled their “buggy” (yes, their BUGGY)--the horse’s name was Shorty, by the way.  People ask him, myself included, how he’s kept his body, mind, his own teeth (no falsies--which is rare, if you didn’t know), and even his eyesight.  He tells us all the same story…

I had a horse that busted his leg wide open.  Normally I would stitch them up and care for them on my own, but this one had me a little worried. The vet came over to look and you know what he told me?  He said, wash it several times and walk him at least one mile every single day.  Since then, I fixed all my ailments with exercise.   

So, then he goes on to tell us how he rehabilitated his own shoulder after a session with a particularly spirited horse who was not thrilled with the idea of this tough and equally spirited trainer on his back.  He says he put water in a bucket tied to a rope, threw the rope over the rafters of the barn and pulled the water bucket up and let it back down just as many times as he could because he had seen how movement had healed his horse.  

Now, I’m sure this vet, whose philosophy this 97 year old has based his whole life’s wellness upon,  was not picking up scientific journals and staying up to date on the latest evidence that exercise is medicine.  That means then, that to an old, down-home southern vet in the 1940’s, the solution was common-sense...My question is--why isn’t exercise common sense any more?

For people with chronic conditions like congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), hypertension (HT) and metabolic disease (diabetes) exercise MUST be the basis of treatment.  Prescription drugs have way too many side effects to maintain a human comfortably for very long.  There is strong evidence to support that PA alone has an inverse dose-response to all-cause mortality and cardiorespiratory health, and moderate evidence for metabolic health and many more.1  Furthermore, the most current 2008 CDC-ACSM guideline for minimal health benefits is an accumulation of 150 min⋅wk-1 of light-moderate PA or 75 min⋅wk-1 or a combination of both for substantial health benefits.2  Notice it does not say exercise, walking from the car to the workplace is PA but not exercise.  So parking further away at the grocery store would be one example of increasing PA.  Making several of these small changes can add up quickly.  An important thing to know, though, is that people with chronic conditions tend to fear or despise PA.  

The fear is of hurting themselves during PA by over-exertion and the despise comes from the feeling of failure.  These people already feel defeated by having been diagnosed with chronic disease and often, must first undergo supervised, planned exercise sessions.  In this environment they are safe and have the opportunity to learn about themselves: signs and symptoms, limitations, strengths, etc.  Those are all reasons why exercise with a trained professional (ACSM EP-C or RCEP) must be the basis of any treatment.       

References

1. American College of Sports Medicine., & Pescatello, L. S. ACSM's guidelines for exercise

   testing and prescription. Ninth edition. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins

   Health; 2014. 5 p.

2. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans

   [Internet].  Rockville (MD): Office of Disease Prevention & Health Promotion, U.S. Department of   

   Health and Human Services; 2008 [cited 2016 Sep 16]. Pg vii. Available from

   https://health.gov/paguidelines/guidelines/