The call came late on a Wednesday night. A family member's health was declining fast, and I could sense that the situation was spiraling out of control. Being the only person in my family with a health care background, questions and concerns hit me from all directions.
The next morning I was on a flight from San Francisco to Tampa. In 10 minutes of rushed packing, I made sure to include my running shoes and shorts just like someone always makes a point of packing their most critical medications. This got me thinking: My electric neon shoes and the running they enable are my medicine. I set an early alarm that first morning in Tampa and headed out for an 11-miler, a run that accomplished what otherwise might have taken several different pills. It helped reset my body and sleep-cycle to a new time zone, opened up my hips (still stiff from nine hours of flying), calmed my racing mind, eased my sadness, and perhaps most important, left me in a state of complete focus and presence for the rest of the day.
While experiences like this are fairly common amongst avid runners, the larger medical establishment is increasingly catching on as an increasing amount of evidence suggests exercise may be the best medicine for so much of what ails our society, both physical and psychological. The physical benefits of exercise have long been documented and include improvements in heart disease, hypertension, pre-diabetes, obesity, circulatory conditions, and insomnia. More recently, studies are showing that exercise is equally, if not more effective than medication in addressing certain types of depression and anxiety disorders, and that exercise may help prevent or delay dementia and Alzheimer's disease. This is especially encouraging given the risks of exercise are minimal when compared to those of the drugs often used for these conditions.
Against that backdrop, some large health systems are starting to "prescribe" exercise prior to pills for specific diseases. Within more progressive physician groups, discussing exercise is working its way into the structure of appointments and certain clinical practice guidelines are now explicitly recommending exercise as a therapy. But the proliferation of exercise as medicine won't happen overnight given this approach is a significant cultural shift for both doctors and patients.
If exercise as medicine is to overcome cultural challenges and prosper, a large emphasis must also be placed on the process of behavior change. This requires health care systems to go far beyond just telling patients to exercise; they must also connect them with the appropriate resources and support needed to succeed. This could take an array of forms including: innovative partnerships with gyms for memberships and programming, mobile technology tools to track progress, supportive social networks to foster accountability, and outright incentives to help motivate people in getting started. Much like extensive time and energy is invested in the development process for high potential drugs, so too must time and energy be invested in figuring out how to make exercise a generally effective therapy for large populations.
Health care systems that succeed in using exercise as medicine will be rewarded with happier and healthier patients, as well as significantly reduced costs. More importantly, given its proven benefits and comparatively low risks, considering exercise before medication regimens [for the appropriate conditions] is the right thing to do.
Disclosure note: Brad Stulberg works at a health system that is implementing an exercise as medicine program and considers exercise in the treatment approach to many chronic conditions