In a world dominated by pharmaceutical advancements, the idea that exercise could serve as a powerful form of medicine seems almost too simple, too obvious. Yet, despite increasing evidence of its benefits, exercise is often overlooked in the medical field, and its prescription as a treatment remains a distant dream. However, a growing body of scientific research is pushing the notion that physical activity, when prescribed properly, could be as vital to health as any medication. One prominent researcher, Mikel Izquierdo, a professor at the University of Navarra’s Department of Health Sciences, claims that failing to prescribe exercise to patients could be considered malpractice. Exercise, he argues, should be treated as a legitimate, personalized treatment capable of preventing and even reversing the effects of disease.
The Therapeutic Power of Exercise
The growing body of evidence supporting the therapeutic benefits of exercise is both extensive and impressive. From reducing the effects of aging to improving mental health, exercise has been shown to enhance health in myriad ways. For instance, a recent study published in The BMJ indicates that physical activity can even accelerate recovery after surgery. The concept of exercise as medicine is not new, and ancient wisdom has long advocated for the physical activity as a tool for maintaining health. Yet, it is only in recent years that modern science has started to systematically back this intuition with rigorous evidence.
However, just as knowing the dangers of smoking hasn’t eradicated tobacco use, merely understanding the benefits of exercise has not led to mass adoption of physical activity. Many people, despite knowing the positive effects, still fail to integrate exercise into their daily routines. There is still a lack of awareness regarding the seriousness with which exercise should be prescribed and implemented, and many patients fail to receive the personalized attention required to reap the full benefits.
Exercise as a Prescription: A New Paradigm
According to Izquierdo, the current medical approach to prescribing exercise is inadequate. He emphasizes that the notion of prescribing a generic “dose” of exercise — like the ubiquitous “10,000 steps a day” — is not sufficient for most patients. “Prescribing exercise without personalization or proper dosage is as negligent as prescribing a medication incorrectly,” says Izquierdo. Inadequate exercise prescriptions, he argues, are a form of medical malpractice. The key, as he explains, is to match the right type and intensity of exercise to each individual, much like with any other medicine.
This is the main premise of Izquierdo’s recently published paper, which provides guidelines for healthcare professionals on how to prescribe exercise for older adults. The research outlines a comprehensive, three-pronged approach to exercise prescription, which includes aerobic training, strength training, and balance exercises. Aerobic training, while often the primary recommendation, needs to be supplemented with strength and balance exercises, which are crucial for maintaining muscle mass, improving functional capacity, and preventing falls — a major risk for elderly patients.
In addition to preventing diseases, the paper highlights that exercise can also serve as a treatment for existing conditions. For example, strength training has been shown to be more effective than medication in treating certain mental health disorders like depression. In one study, 61% of patients improved with strength training, compared to just 21% who received traditional pharmaceutical treatment.
Izquierdo also highlights the growing use of strength training for patients recovering from hospitalization. For example, he cites several cases where patients who underwent strength training in the hospital were able to improve their cognitive function, mobility, and reduce the risk of readmission. This demonstrates how exercise can not only serve as a preventive measure but also play an active role in recovery and rehabilitation.
Exercise as a Complement to Medication
One of the most innovative aspects of Izquierdo’s work is the idea that exercise can serve as a complementary therapy to medication. Exercise could, in some cases, reduce or even eliminate the need for certain pharmaceutical interventions. Take osteoarthritis, for example: research has shown that simple exercises, such as quadriceps strengthening at home, can be as effective as anti-inflammatory drugs in managing the pain caused by the condition.
Similarly, exercise has been shown to improve insulin sensitivity in diabetic patients, making it a crucial tool in managing type 2 diabetes. For patients with hypertension, regular physical activity can lower blood pressure, reducing the need for blood pressure-lowering medications.
“We are facing a tool that could alleviate the strain on an aging healthcare system,” says Izquierdo. As the population ages, the prevalence of chronic conditions is expected to rise, putting even more pressure on healthcare systems. If exercise could help manage these conditions more effectively, it would not only improve health outcomes but also reduce the overall burden on healthcare systems.
Barriers to Exercise Prescription in Healthcare
Despite the clear benefits, integrating exercise into medical practice remains a challenge. One major obstacle is the lack of infrastructure. In many hospitals, exercise programs are not easily accessible, especially for patients who are not able to travel or participate in group activities. While there are programs for post-heart attack rehabilitation, they are not available in all hospitals, and even when they are, they are often underfunded or understaffed.
Moreover, there is a significant gap in medical education regarding the prescription of exercise. Most doctors, particularly general practitioners, are not trained to prescribe physical activity as part of their medical treatment. Izquierdo argues that family physicians need specialized training on how to prescribe exercise, as well as the support of certified trainers to ensure that patients receive personalized, progressively challenging exercise regimens.
The challenge of adherence to exercise programs is another significant barrier. Like any other treatment, sticking to an exercise regimen requires motivation, especially for sedentary individuals. However, research shows that when exercise is done in groups or with family members, it significantly increases the chances of adherence. Izquierdo also suggests integrating exercise into daily routines, such as walking to the store or taking the stairs instead of the elevator, making it easier to stick to an active lifestyle.
To help combat these issues, Izquierdo and his team suggest starting with simple exercises, like sitting and standing from a chair, and gradually progressing to more challenging activities as patients get stronger. They emphasize that muscle soreness in the early stages should not be viewed as a barrier but as a sign that the body is adapting to the new demands.
The Future of Exercise Prescription: Precision Medicine
Looking ahead, Izquierdo envisions a future where exercise is prescribed with the same precision as any other form of medicine. Advances in technology, particularly with the use of artificial intelligence, wearable sensors, and mobile apps, will make it possible to tailor exercise prescriptions to an individual’s specific needs, taking into account their genetics, metabolism, and lifestyle. This would be a form of “precision medicine” — just as certain drugs are prescribed based on an individual’s genetic profile, exercise could be customized to suit each person’s unique characteristics.
“We are not far from a time when exercise will be as precisely dosed as any other medication,” says Izquierdo. With the help of wearable devices, doctors could monitor patients’ physical activity in real-time, adjusting the intensity and type of exercise as needed. This would ensure that each patient gets the maximum benefit from their exercise regimen.
While this future may seem distant, Izquierdo’s research is already making strides. Some hospitals and clinics are beginning to integrate exercise programs into their patient care, and there are increasing efforts to educate doctors about the importance of exercise as a treatment option.
Conclusion
The idea that exercise could be a legitimate form of medicine may seem like a forgotten therapy, but with ongoing research and the increasing recognition of its benefits, it is slowly but surely being reintegrated into modern medical practice. As Mikel Izquierdo and his colleagues have shown, exercise is not just a way to stay fit — it is a powerful tool in preventing, treating, and managing a wide range of diseases. However, to unlock its full potential, it must be prescribed with the same care and attention as any other medication. The future of healthcare may lie not just in pills and procedures but in the simple, transformative power of physical movement. If your doctor isn’t talking to you about exercise, maybe it’s time to ask them about it — after all, your health could depend on it.