Back in the mid 1980s I read my first article in a publication called Fitness Management on exercise as it could be used with the medical profession. As I was starting my career at that time – I thought the idea would catch on and exercise would establish itself as a bona fide part of healthcare.
Over the years it has chiseled itself away as an integral part of specific medical conditions – but as much as it has been founded in its physiology, there still has been a disconnect from the policy side as to what role exercise should have within our healthcare system.
A recent report by Joyner in the Journal of Physiology looks at a specific medical condition known at POTS (post orthostatic tachycardia syndrome), and the reversal of this condition by an interval training program performed on the subjects over a three month period of time. The results were impressive, but the underlying theme from Joyner was that the condition itself (POTS) resembles chronic deconditioning. His comment: “should deconditioning be considered a medical condition?”.
I would answer his question with a question: “Why hasn’t it been over the past 30 years?”. We know from the extensive health promotion literature from the 1980s that exercise plays a role in not only acute cardiac rehab, but also reduction of re-infarctions, and ancillary health care costs related to going back into a sedentary lifestyle after a heart attack.
In the 1990s David Eisenberg from Harvard reported that Americans pay more out of pocket for complementary medicine (in our case – health club memberships, yoga, Pilates, personal training) than they do for their primary care physician. This raised a firestorm of controversy in medicine – but over the years more of an acceptance of what types of services patients value, and what services physicians may offer (or recommend) as part of their patient care. The 1990s also solidified some of the research by Dr. Ken Pellitier and Andrew Weil on the benefits and costs savings of adding health promotion services into the mix of what we would consider a traditional health care package.
The 2000s saw a rise in services such as Pilates and personal training, and movement towards more organic foods, healthier eating, and more ways to improve health. This was done by a percentage of Americans – as a wider swath of the country continue to grow their waistlines and in many respects – the overall health of the nation worsened with less physical education in schools, wars overseas, and an economy that worsened – taking a serious hit on the behavioral health of the nation.
So now we are here in 2012, 24 years after that initial article from Fitness Management, and I see an article from Dr. Joyner, and ask – “is he on the right track?” Are we now ready as a nation to not only look at being out of shape as a “medical condition”, but also to give incentives for people to regain a level of fitness that will be in everyone’s best interest?
Joyner states that if deconditioning is to be medicalized, then what conditions should we consider? He states that medical conditions such as fibromyalgia and chronic fatigue syndrome are good candidates – as they are associated with poor exercise capacity and are similar to POTS regarding their etiiology. I would add that almost EVERY other medical condition – from diabetes to cancer, osteoporosis to depression, hypertension to Guillian-Barre, scoliosis to insomnia are all good candidates for regular and progressive exercise training. We could take a chunk out of the costs associated with the top five medical conditions in the US (obesity, cancer, diabetes, depression, and back pain) by using even the most basic types of exercise programs methodically over time. The costs are minimal. The results (as savings) would be astronomical.
Joyner concludes that physical deconditioning is one of the most common preventable causes of morbidity and mortality and may be the final common pathway for conditions like POTS (and many other diseases). He ends with the sentence – “it would be easier to educate the general public and medical community about the one universally effective treatment for disease – exercise training”.
Black, S. A. Evidence-based exercise programs. Athletic Business. 2007. Found at: http://athleticbusiness.com/articles/article.aspx?articleid=3234&zoneid=7 <http://athleticbusiness.com/articles/article.aspx?articleid=3234&zoneid=7>
Joyner, MJ. Standing up for exercise: should deconditioning be medicalized? Journal of Physiology. August 2012. Found at:
Mark G. Wilson, Priscilla B. Holman, and Angie Hammock (1996) A Comprehensive Review of the Effects of Worksite Health Promotion on Health-related Outcomes. American Journal of Health Promotion: July/August 1996, Vol. 10, No. 6, pp. 429-435.
Kenneth R. Pelletier (1996) A Review and Analysis of the Health and Cost-effective Outcome Studies of Comprehensive Health Promotion and Disease Prevention Programs at the Worksite: 1993–1995 Update. American Journal of Health Promotion: May/June 1996, Vol. 10, No. 5, pp. 380-388.