Physical activity (or exercise — the terms are often used interchangeably) is known to help prevent and treat each of these conditions and many others.
I-Min Lee, ScD, an epidemiologist at Brigham and Women’s Hospital in Massachusetts, believes in the value of medications, but she says physical activity should be prescribed as well, and for a variety of conditions, to “preserve and enhance” health. Lee led a study last year showing that women who walk just 4,400 steps a day — a feat requiring about 44 minutes at a typical “brisk” walking pace — are at a 41% lower risk of dying prematurely.
“Physical activity is beneficial in preventing disease progression among persons with chronic conditions ranging from arthritis to cancer,” Lee says. Exercise can reduce anxiety and improve sleep, she adds, and it can be “very helpful” for people who can’t tolerate the side effects of antidepressants.
The opioid crisis alone illustrates the crucial need for prescriptions to include more than drugs.
Chronic low-back pain is “one of the most common reasons for which patients are treated with opioids,” Drs. Jennifer Waljee and Chad Brummett wrote in a commentary in the journal JAMA Open Network. “However, there is growing evidence that opioid analgesics are not superior to nonopioid treatment strategies for low-back pain.” Instead, they write, “For chronic low-back pain, comprehensive care should ideally include exercise, physical therapy, behavioral therapy, and, in some cases, complementary and alternative medicine.”
Exercise releases feel-good, painkilling chemicals called endorphins that bind to the same brain receptors as opioids, alleviating some pain without the grave risk of addiction (unless you consider the “runner’s high” addictive). “Exercise therapy can address posture, weakness, or repetitive motions that contribute to musculoskeletal pain; reduce lower-back pain; improve fibromyalgia symptoms; and reduce hip and knee osteoarthritis pain,” the CDC states. “Exercise therapy can also be used as a preventative treatment for migraine.”
The trillion-dollar pill
For all these reasons and more, federal guidelines say adults should get at least 2.5 hours weekly of moderate aerobic activity, which can be as simple as brisk walking, or at least 75 minutes of vigorous aerobic exercise, or some combination of the two. Adults should also do muscle-strengthening activity of at least moderate intensity, involving all major muscle groups, at least twice a week. The advice holds for people with chronic health conditions and disabilities if they are at all able to move about and in consultation with a physician. The message is this: Even if you don’t feel like exercising, you should do it anyway, and you’ll almost surely feel better for it.
Yet fewer than 20% of adults meet these thresholds.
Exercise is so vital to well-being that U.S. health care conglomerate Kaiser Permanente now asks patients about their exercise habits and includes the information as a vital sign in their electronic records alongside things like blood pressure, forcing discussions between health professionals and patients about the importance of physical activity.
Scott Lear, PhD, a professor in health sciences at Simon Fraser University in Canada, is a big fan of that step forward and an equally big critic of Western medicine’s failure to prescribe exercise as a preventive strategy.
“Exercise as a therapy is mentioned in almost all prevention and treatment guidelines, which are written by doctors themselves,” Lear says. “Still, most patients never hear their doctor talk about it.”
Lear, who studies the prevention and management of heart disease, has exercised since he was a teen. You could say his work is his life. He has a condition called exercise-induced arrhythmia, which sometimes causes his heart rate to spike above 200 beats per minute. In seeking treatment for the condition two years ago, at age 47, Lear learned he also has a 20% blockage in one of his main arteries — not a life-threatening situation, he says, but a surprise nonetheless. Had he not exercised vigorously most of his life, “I definitely think it would be worse,” he says.
The revelation led Lear to not only continue vigorous exercise but also cut out sweets and replace his regular evening dessert with a walk. He lost eight pounds and has kept it off, and the combination of medication, exercise, and a better diet has him feeling better than ever. The experience spurred him to start a weekly blog about the benefits of healthy lifestyles and the need for doctors to prescribe exercise.
“If it was a pill, exercise would be a trillion-dollar moneymaker prescribed to everyone,” Lear says.
That’s not hyperbole. People who meet or exceed the minimum guidelines for aerobic exercise — 2.5 hours of walking a week — have lower health care costs by about $2,500 a year on average compared to sedentary people, according to a 2016 study in the Journal of the American Heart Association. If 100 million more Americans got on the exercise bandwagon, simple math suggests annual savings of $250 billion.
The possible cost savings from improved eating patterns are similarly dramatic. Research earlier this year modeled the potential health and economic impact of prescribing fruits and vegetables to people enrolled in Medicare and Medicaid — a third of all U.S. residents — coupled with a 30% subsidy or discount on those purchases. It could prevent 350,000 cardiovascular deaths and save $40 billion in health care costs over the lifetimes of the people currently enrolled. The projections are based in part on a similar program in Massachusetts, where a 30% subsidy did increase consumption of fruits and vegetables by 26% among food stamp recipients, explains study leader Yujin Lee, PhD, a postdoctoral fellow at the Friedman School of Nutrition Science and Policy at Tufts University.
Expanding such a program to prescribe and subsidize fruits, vegetables, whole grains, nuts and seeds, seafood, and plant oils could prevent even more premature deaths and save $100 billion, the researchers reported in the journal PLOS Medicine.
Meanwhile, in yet another stark example of the nation’s focus on treatment rather than prevention, the number of visits to emergency rooms — often the first stop on an unhealthy person’s unpleasant journey of treatment — has grown at twice the rate of population growth in recent years, while the cost per visit ballooned from $600 to $1,322 between 2009 and 2016.
Doctors don’t get paid to prescribe diet or exercise. Many of them, however, make small fortunes prescribing drugs.
An investigation published by ProPublica finds that more than half of U.S. doctors take money from pharmaceutical companies, which collectively dole out more than $2 billion a year to encourage prescriptions. The payments range from speaking fees to travel and meals, as well as royalties. Between 2014 and 2018, thousands of doctors each took in more than $100,000 from makers of drugs and medical devices, more than 2,500 were rewarded with upwards of $500,000, and more than 700 raked in $1 million or more, the analysis showed. Walid Gellad, an associate professor of medicine and health policy at the University of Pittsburgh, told ProPublica the amount doctors earned for activities other than patient care was “quite striking.”