This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.

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Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases

Background The effect of age on optimal body weight is controversial, and few studies have had adequate numbers of subjects to analyze mortality as a function of body-mass index across age groups. Methods We studied mortality over 12 years among white men and women who participated in the American Cancer Society's Cancer Prevention Study I (from 1960 through 1972). The 62,116 men and 262,019 women included in this analysis had never smoked cigarettes, had no history of heart disease, stroke, or cancer (other than skin cancer) at base line in 1959–1960, and had no history of recent unintentional weight loss. The date and cause of death for subjects who died were determined from death certificates. The associations between body-mass index (defined as the weight in kilograms divided by the square of the height in meters) and mortality were examined for six age groups in analyses in which we adjusted for age, educational level, physical activity, and alcohol consumption. Results Greater body-mass index was as...

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The Effect of Age on the Association between Body-Mass Index and Mortality

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.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1600-0838.2006.00520.x

Evidence for prescribing exercise as therapy in chronic disease.

Overweight and obesity are important public health problems and are associated with many serious health conditions. The risk of developing overweight and obesity depends on lifestyle factors such as food intake and physical activity levels. Treatment for overweight and obesity therefore commonly involves diet and exercise. We found that exercise has a positive effect on body weight and cardiovascular disease risk factors in people with overweight or obesity, particularly when combined with diet, and that exercise improves health even if no weight is lost. No data were identified on adverse events, quality of life, morbidity, costs or mortality.

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Exercise for overweight or obesity.

This article describes the interplay among energy intake, energy expenditure, and body energy stores and illustrates how an understanding of energy balance can help us develop strategies to reduce obesity. First, reducing obesity requires modifying both energy intake and energy expenditure, not simply focusing on either alone. Food restriction alone will not be effective in reducing obesity if human physiology is biased toward achieving energy balance at a high energy flux (ie, at a high level of energy intake and expenditure). In previous environments, a high energy flux was achieved with a high level of physical activity, but in today's sedentary environment, it is increasingly achieved through weight gain. Matching energy intake to a high level of energy expenditure will likely be more feasible for most people than restricting food intake to meet a low level of energy expenditure. Second, from an energy balance point of view, we are likely to be more successful in preventing excessive weight gain than in treating obesity. The reason is that the energy balance system shows stronger opposition to weight loss than to weight gain. Although large behavior changes are needed to produce and maintain reductions in body weight, small behavior changes may be sufficient to prevent excessive weight gain. The concept of energy balance combined with an understanding of how the body achieves balance may be a useful framework for developing strategies to reduce obesity rates.

Obesity is often considered to be a result of either excessive food intake or insufficient physical activity. There is a great debate about which behavior deserves the most responsibility, but this approach has not yet produced effective or innovative solutions. We believe that obesity can best be viewed in terms of energy balance. The first law of thermodynamics states that body weight cannot change if, over a …

Energy Balance and Obesity

Clinical research has established that increases in physical activity cause weight loss among the obese, but less is known about the influence of physical activity on longer-term weight change in the general population. Data from the NHANES-I Epidemiologic Follow-up Study (1971-1975 to 1982-1984) were used to examine the relationship between self-reported recreational physical activity level (low, medium, high) and measured weight change after ten years among 3515 men and 5810 women aged 25-74 years. Cross-sectional analyses at both the baseline and follow-up surveys revealed that recreational physical activity was inversely related to body weight. Low recreational physical activity reported at the follow-up survey was strongly related to major weight gain (> 13 kg) that had occurred during the preceding ten years. The estimated relative risk of major weight gain for those in the low activity level at the follow-up survey compared to those in the high activity level was 3.1 (95% Cl = 1.6-6.0) in men and 3.8 (2.3-6.5) in women. In addition, the relative risk for persons whose activity level was low at both the baseline and follow-up surveys was 2.3 (0.9-5.8) in men and 7.1 (2.2-23.3) in women. However, no relationship was found between baseline physical activity level and subsequent weight gain among either men or women. The lack of a relationship may be due to mis-specification of physical activity because of changes in activity over time. These findings suggest that low physical activity may be both a cause and a consequence of weight gain.(ABSTRACT TRUNCATED AT 250 WORDS)

Recreational physical activity and ten-year weight change in a US national cohort

The 10-y incidence of obesity and major weight gain in black and white US women aged 30-55 y.

Objective: Because past research has focused primarily on populations of middle-aged men, the relationship between alcohol and mortality among women and the elderly has been less well substantiated Method: We examined the relationship between alcohol intake and mortality using data from the NHANES I Epidemiologic Follow-Up Study. Total mortality was examined for both sexes (N = 4,614 women, 3,573 men), but ischemic heart disease (IHD) mortality was examined only for men because the number of deaths was too small in women. Proportional hazards modeling was used to adjust for the baseline characteristics of age, race, education, body weight, smoking and physical activity. Results: For men aged 40 to 64, the adjusted relative risks (RR) of death for drinking levels of .5 drinks/day, .5 to or = 2 (compared to the nondrinking reference group) were 0.8 (95% Confidence Interval: 0.6, 1.1), 0.9 (CI:0.6, 1.2) and 1.2 (CI: 0.9, 1.6); RRs of IHD mortality were 0.6 (CI: 0.4, 0.9), 0.5 (CI: 0.3, 0.9) and 0.7...

T Byers

Papers

Recreational physical activity and ten-year weight change in a US national cohort

The 10-y incidence of obesity and major weight gain in black and white US women aged 30-55 y.

Alcohol intake and subsequent mortality: findings from the NHANES I Follow-up Study.