Is exercise really medicine?

Cayla Urdang has a line she comes back to: movement truly is medicine, and it looks different for everyone.

It is a good line. It is fair to ask whether it is true.

The case for calling it medicine

In 2015 two Danish researchers, Bente Pedersen and Bengt Saltin, published a 72-page review of exercise as a treatment. They went through 26 long-term conditions one at a time and set out the evidence for each, with a suggested type and amount of exercise. The list covers depression and anxiety, dementia and Parkinson's disease, type 2 diabetes and obesity, high blood pressure and heart failure, asthma and chronic lung disease, osteoarthritis, osteoporosis, back pain, rheumatoid arthritis, and cancer¹.

The World Health Organization's physical activity guidelines, updated in 2020, ask adults for 150 to 300 minutes of moderate activity a week, or 75 to 150 minutes of vigorous activity, with muscle-strengthening work on top. For the first time, the 2020 version gave specific advice for people living with long-term conditions or disability, and for women who are pregnant or have recently given birth².

So yes, the phrase holds up. For a long list of conditions, exercise is part of the treatment and has the trials to show for it.

Back pain

A Cochrane review from 2021 is the largest look at exercise for long-lasting low back pain: 249 trials and 24,486 people. Its conclusion was that exercise probably reduces pain compared with having no treatment. Compared with other non-surgical treatments it came out slightly ahead, though the difference was small³.

That is a sober finding. Exercise helps most people with a long-standing sore back, and it does not make the pain vanish.

Arthritis

People with arthritis are often afraid that exercise will wear out their joints faster. In 2018 the European rheumatology body, EULAR, put together a task force from 16 countries to ask whether ordinary physical activity advice applies to people with rheumatoid arthritis, spondyloarthritis, and osteoarthritis of the hip and knee. It agreed ten recommendations in favour of physical activity as part of their care⁴.

Autoimmune and orthopaedic conditions are among Cayla's particular interests.

Pregnancy

The 2019 Canadian guideline, written by the country's obstetricians and exercise physiologists together, says that all women without a medical reason not to should be active throughout pregnancy. It recommends at least 150 minutes of moderate activity a week, spread over three days or more, with both aerobic and resistance exercise⁵.

The words "without a medical reason not to" matter. The guideline lists conditions where exercise should be avoided or adjusted, so an assessment comes first. Cayla has completed the Fit4Two course in pregnancy and postpartum exercise.

Why it looks different for everyone

A medicine has a dose, and so does exercise. Too little does nothing. Too much, or the wrong kind, can set you back. A brisk daily walk suits one person with high blood pressure, while a 30-year-old six months after knee surgery needs something else entirely.

That is why a Biokineticist measures first and prescribes second, and why the programme changes as you do.

There are rules behind this too. The HPCSA's ethical rules say a practitioner may only do what they are properly educated, trained and experienced to do⁶. In practice, a Biokineticist who finds something outside their field should refer you to someone else. And under the National Health Act you must be told your options, the benefits and the risks before you agree to any treatment, exercise included⁷.

One more caution. Exercise works with your other treatment and does not replace it. Don't stop or change any medication because you have started exercising. Speak to your doctor first.

This article is general information and not a diagnosis. For an exercise programme that fits you, come in for an assessment.

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