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Exercise – under prescribed in the treatment and management of chronic disease
- Andrew P Hills, Nuala M. Byrne (13 November 2002)
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Andrew P Hills, Associate Professor Queensland University of Technology, Queensland, Australia 4059, Nuala M. Byrne
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EDITOR – Thomas et al 1 provided an overview of the benefits of a home based exercise programme for sufferers of the common musculoskeletal conditions, knee pain and knee osteoarthritis. In our experience, the prudent use of exercise is beneficial for the health and well-being of all such patients. Additional benefits may be derived when an individualised prescription of exercise is the platform of treatment and management. Today, osteoarthritis and other chronic diseases are seen in younger individuals rather than being limited to older adults. We believe that this phenomenon is related to overweight and obesity, one of the common denominators for many individuals who experience knee pain and knee osteoarthritis. Obesity significantly increases the risk of developing an ensemble of medical conditions including hypertension, stroke, respiratory disease, type 2 diabetes, certain cancers, gout, osteoarthritis, and other musculoskeletal disorders.2-3 Physical inactivity tends to exacerbate these health problems. The flip-side of this is that regular physical activity and appropriate exercise is one of the critical elements in the prevention, treatment and management of these chronic diseases. In support of this contention, van Mechelen 4 has purported that physical activity is ‘public health’s best buy’. According to standard BMI cut-offs, subjects in the study by Thomas et al 1 were overweight. Devoid of other movement limitations (as defined in the selection criteria for the study), the reported improvements are not unexpected. What additional benefits might be derived if the graded introduction to physical activity was followed by an individualised prescription of exercise? Despite the recent recognition of the importance of physical activity and exercise there is still a generally poor understanding of how best to promote activity and prescribe exercise, particularly in the context of chronic disease management. To enable a greater number of patients to benefit from exercise and to maximise the exposure for those who already ‘exercise’, a multi-disciplinary approach is required. As the traditional gate-keepers of patient care, general practitioners would benefit from an enhanced knowledge and understanding of the mechanisms of exercise and the specialist skills of exercise science professionals. Exercise scientists are best placed to contribute to the functional restoration of patients with musculoskeletal problems such as knee pain. As such, exercise scientists should be an important part of the rehabilitation process working alongside medical practitioners and physiotherapists. While the findings of Thomas et al 1 are both interesting and encouraging, it is of interest to speculate on the magnitude of improvement that may have been possible with an individualised program of exercise. Andrew P Hills, associate professor.
Nuala M Byrne, lecturer.
1. Thomas KS, Muir KR, Doherty M, Jones AC, O’Reilly SC, Bassey EJ. Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. BMJ 2002; 325: 752-756. 2. Hills AP, Hennig E, Byrne NM, Steele JR. The biomechanics of adiposity - structural and functional limitations of obesity and implications for movement. Obesity Reviews 2002; 3: 35-43. 3. James WPT. A public health approach to the problem of obesity. Int J Obes 1995; 19 (Suppl 3): S37-S45. 4. Van Mechelen W. A physically active lifestyle – public health’s best buy? Br J Sports Med 1997; 31(4): 264-265. Competing interests: None declared |
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