Exercise: not a miracle cure, just good medicineBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1416 (Published 19 March 2015) Cite this as: BMJ 2015;350:h1416
All rapid responses
It is a well-known fact that in the era of the 21st century innovations in medical treatments are at their maximum and scientists are trying to find the treatment of incurable diseases. Our body is a complex machine and various mechanisms of body functions are yet to be known completely.
As we know, physical exercise boosts the circulation of blood through all parts from the body. It is quoted that in an individual workout during chemotherapy treatment for malignancy exercise helps more blood flow to and around the tumour cells. This raises the quantity of much-needed oxygen and chemotherapy drugs taken to the cancer cells. The additional oxygen feeds normal tissue so helping its growth, while disturbing the cancerous tissue. Additionally, the excess oxygen may help to bring back the damaged mitochondria within the malignant cells, which often can transform cells in the rear to regular structure. .
We could assume our body as a clock where a small selection of cells derived from distinctive features and rhythm comparing the clock seconds and minutes. These cells switch off and on and tell our brain and others body parts what our body needs and how to proceed for its necessity. A human body organ is composed of different cellular material. Exercising each morning is known in research either to improve blood pressure level or otherwise not really to cause any change whatsoever. Later in the day, however, physical exercise was discovered to lessen the blood pressure level by 10-11% .
After working all day our body needs rest in order to restore metabolic functions and nourish cellular components to restore energy for work.
The concept that we ought to rest in eight-hour portions is comparatively the latest contrast to the concept of exercise which is much more older. The world’s inhabitants rest in several and amazing ways. An incredible number of people from our country continue to keep their heads on their own desks to get a nap of one hour or so following the afternoon meal, for instance, and a daytime nap after lunch frequently occurs in other parts of the world. .
Working one's body as the standard will give you a lot of benefits, such as much more power, significantly less body fat, reduced levels of stress, along with a contented way of thinking.
In our country, there are many varieties of physical exercise - qigong and tai chi and many more. Some concentrate on all-around health, but professionals could also recommend varieties or precise qigong exercises or heal particular organs such as muscles or exact part within the body. In China, traditional Chinese medicine has its popularity for chronic disease and includes several exercises to treat or heal incurable diseases. Some households in China believe in our conventional exercises such as “taichi” . People aged sixty to seventy still believe in exercise to cure disease rather than taking medical drugs. Some traditional families even pay lots of money to many experts to have their personal qigong training to keep them healthier.
These historical methods to health fitness and overall health have introduced optimistic wellbeing alterations to individuals across the globe. Right after the surgery, most patients commonly ask can they have some traditional exercise such as handball or leg lifting? There is not any solid reason to deny them doing that as it is useful, and we do believe that some of the mechanisms resemble physiotherapy. And the main difference is that physiotherapy treatment has done under vigilance of experts and traditional exercise is at people's discretion if they are not able to pay the experts. In our clinical practice, several patients have affirmed to us that qigong cured them of persistent ache, enhanced their harmony while keeping focused, increased their defences, assisted them handle anxiety, fought against cancers, lowered hypertension or relieved sleeplessness .
Chinese Health Balls are believed to be to have originated from Baoding, China, in the suburbs within the Heibei province. These days, Baoding balls are manufactured from several types of materials and still continue to be easy to hold. They're usually hollowed out, made of a mixture of chromium and steel, while few are even made up with chimes inside as well. Individuals occasionally call these chime balls or tranquility balls. These balls will often have been made by hand designs.
Chinese people believe that manipulating the balls within your hands not merely workouts hands muscles, but the lower arm and shoulder area. In addition, such use is related to health, harmony, and other positive forces. We know that physiotherapy is scientifically verified, and most orthopedic surgeons recommend this treatment after surgical interventions. Now the issue is how to balance conventional exercise and the emerging substantiated physiotherapy. In China, despite proven western medical treatment, most people still believe in traditional medicine and exercises.
Chinese experts are convinced that muscles remain agile; bones are strengthened and also the thoughts cleansed by continuous use of the hand balls. Other advantages are blood circulates more freely in various chronic diseases, for instance. High blood pressure levels are kept from developing. Over time practising, Baoding helps in mental performance and health, and it partly helps intellectual function and memory enhancement. Additionally, it relieves exhaustion, anxieties and ultimately your health is prolonged .
In the era of development, we believe that the equal balance of exercise and medicine should be contemplated in treatment plans forchronic diseases. I think preservation of traditional exercises is equally as uch important in keeping us fit and well.
1. Dr. Gabe Mirkin, www.drmirkin.com http://www.theepochtimes.com/n3/1310538-how-exercise-helps-to-treat-canc...
2. Belle Beth Cooper: https://blog.bufferapp.com/your-bodys-best-time-for-everything-how-to-ea...
3. FP brigette: The Unspoken Benefit Of Exercise http://blog.freepeople.com/2014/11/unspoken-benefit exercise/#ixzz3XAEer3zP
4. Karen M. Lynch http://life.gaiam.com/article/more-studies-confirm-tai-chi-and-qigong-he...
Competing interests: No competing interests
“Health Professionals fail to inform patients about wonder-treatment”. Would this headline be palatable to the general public were it to appear in the media? Would it be fair?
MacAuley, Bauman and Fremont rightly state that it is “extraordinary how long mainstream medicine is taking to accept the importance of physical activity”1. If we are serious about doing the best thing for every patient every time, then surely something with proven efficacy in increasing happiness, helping to prevent and treat over 40 chronic diseases, and significantly increasing life expectancy2 would be a key weapon to not only help treat disease, but also achieve health.
In our view the authors are right to conclude that efforts based within health and social care are necessary, but not sufficient in themselves to produce a tangible increase in population physical activity levels. A co-ordinated, collaborative, cross-sectoral approach is required to secure lasting change and improvement. This requires action and input from colleagues in education, transport, urban design, communications, workforce settings, sport and active recreation as well as health and social care. Parallels can be drawn with the efforts in the UK over the last 60 years to reduce cigarette smoking, where physicians worked with and across many sectors, supported by government in order to achieve change at the cultural and behavioural level. It would be hard to find any doctor who feels that promoting the health benefits of smoking cessation falls beyond their duty to “make the care of your patient your first concern”3. In Scotland, we have benefited from input and knowledge from experts who emphasized that this cross-sectoral approach, taken at national, local, and community levels was required in relation to physical activity. These suggestions were incorporated into “Investments that work for physical activity4” and embraced within Scotland as a route map to guide change.
It is likely that this input, applied systematically is responsible for the most recent Scottish Health Survey5 data showing an, albeit modest, increase in physical activity levels in both adults and children.
Concrete examples of such collaborative efforts already exist: within education where about 96% of primary school children receiving a minimum 2 hours of Physical Education each week, (up from 5% in 2003, and 55% in 2010) whilst in transport 20mph speed limits are increasingly replacing 30mph in cities across Scotland to allow for safer engagement in physical activity and fewer road traffic accidents.
Everyone can make a contribution to increasing physical activity, and the NHS and Social Care are no different. Although further study is required, brief advice and brief intervention can be highly cost effective, at £40-440 per QALY, where the ceiling for cost effectiveness is £30,0006. The authors share the example that only 1 in 6 patients with hypertension or diabetes receive advice regarding physical activity; 2 conditions where this should clearly be part of routine care. As health professionals, it would seem we are not yet collectively taking proportionate responsibility, nevermind disproportionate responsibility.
There is a real opportunity for Health and Social Care to increase its collaborative contribution and for individual clinicians, service leaders and policy makers to take concrete actions7 that can lead to real change and improvement in physical activity levels, happiness, and health for our patients and populations. Furthermore, since physical activity can put a big fat smile on our face, as health professionals perhaps we can facilitate ways for ourselves and NHS staff (the world’s third biggest workforce) to be more active too.
Dr Andrew Murray1,2
Mr Nathan Stephens3
1) Clinical Leadership Fellow, Royal College of Physicians and Surgeons of Glasgow.
2) Centre for Sports and Exercise, University of Edinburgh.
3) Clinical Leadership Fellow, Royal College of Surgeons Edinburgh and NHS Education for Scotland
1) MacAuley, Bauman, Fremont. Exercise: not a miracle cure- just good medicine. BMJ 2015;350:h1416
2) Department of Health. “Start Active, Stay Active” - a report on physical activity for health from the four home countries’ Chief Medical Officers. 2011
3) Good medical practice (2013), General Medical Council, http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp
4) Global Advocacy for Physical Activity (GAPA) the Advocacy Council of the International Society for Physical Activity and Health (ISPAH). NCD Prevention: Investments that Work for Physical Activity. Br J Sports Med 2012;46:8;70 9- 7 12.
5) Scottish Government. Scottish Health Survey 2013. Scottish Government. 2014.
6) NICE. Four Commonly used methods to increase physical activity. National Institute for Health and Clinical Excellence. 2006. http://www.nice.org.uk/ nicemedia/pdf/
7) Scottish Academy of Medical Royal Colleges and Faculties. The Role of Health and Social Care in Increasing Physical Activity. Scottish Academy of Medical Royal Colleges and Faculties. 2015 accesed online April 2015 http://www.rcpsych.ac.uk/pdf/SA%20Position%20Statement.pdf
Competing interests: No competing interests
In your article “Exercise: not a miracle cure, just good medicine”, you rightly state that the Academy of Medical Royal College conclusions on the health impact of physical inactivity are not new! And indeed, that a multifaceted approach, from political level to the individual (not just via a doctor consultation) is needed to facilitate the UK public to be more active. But you appear to question if such an approach will ever happen.
In the next two paragraphs I hope to show will show you evidence that unfortunately doctors knowledge of the risks of physical inactivity on health, and the converse benefits physical activity has on health is worrying low. This is certainly not ‘good medicine’. But, on the other hand the Scottish Government, NHS Scotland and other partners have recently put in place the elusive multifaceted approach to address physical inactivity which you appeared to seek in your article.
I recently conducted a study of almost 800 final year medical students (now practising doctors!) from ten UK medical schools which showed:
• 50% underestimated the risk of physical inactivity in comparison to other non-communicable disease risk factors
• Only 36% of students reported they were aware of the current UK physical activity guidelines, while 94% knew UK alcohol guidelines
• Only 9% were able to adequately define ‘moderate/vigorous exercise intensity’, key aspects of the UK CMO physical activity guidelines. A number of responses could be considered dangerous to patient’s health.
These results, substantiate previous research in Scottish Medical Schools and Scottish GPs & Health Care workers.1,2
Regarding the Scottish model, I refer you to the Scottish Government Document ‘A More Active Scotland’. It outlines their commitment to a multifaceted evidence based approach to increase the physical activity levels of the Scottish public.3 A key part of which is education of all health professionals. Surely doctors and health professionals can only be expected to ‘make every contact count’ regarding physical activity, if they know the facts themselves.
Further details and endorsement of this approach can be seen through the below Faculty of Sport and Exercise Medicine (FSEM) news and The Knowledge Network Scotland links below. To my knowledge such a strategic rounded committed plan does not exist outside of Scotland, but I would welcome being made aware of evidence against this.
References and links
1. Dunlop, M. and Murray, A. D. (2013) 'Major limitations in knowledge of physical activity guidelines among UK medical students revealed: implications for the undergraduate medical curriculum', British Journal of Sports Medicine, 47(11), 718-720.
2. Douglas, F., Torrance, N., van Teijlingen, E., Meloni, S. & Kerr, A. (2006). Primary care staff’s views and experiences related to routinely advising patients about physical activity: A questionnaire survey. BMC Public Health, 6, n138.
3. Global Advocacy for Physical Activity (GAPA) the Advocacy Council of the International Society for Physical Activity and Health (ISPAH). NCD Prevention: Investments that Work for Physical Activity. British Journal of Sports Medicine 2012;46:8;704-707.Also available from: www.globalpa.org.uk/investimentsthatwork
• FSEM: http://www.fsem.ac.uk/
• The Knowledge Network Scotland: http://www.knowledge.scot.nhs.uk/home/portals-and-topics/health-improvem...
Competing interests: No competing interests
We have read the article by Dr MacAuley and colleagues about the benefits of exercise on health in your journal (1). Regular physical activity helps to maintain body strength, stamina and ability to function well.
Physically active people live about 7 years longer than those who are not active. Regular physical activity delays or prevents chronic illnesses and diseases associated with aging and help to maintain good quality of life (2). Physically active people have better mindfulness skills and mental health (3). Lifestyle changes show improved outcome in coronary artery disease (4). In athletes of developing countries the prevalence of oral diseases like dental caries, dental erosion, and periodontal disease is high (5, 6). The ageing process and chronic inflammatory diseases are associated with cellular modifications, and telomere shortening. Chronic periodontitis is associated with telomere shortening (7). Good oral health contributes to good general health.The yoga practices and meditation practices provide considerable health benefits, including improved cognition, respiration, reduced cardiovascular risk, BMI, blood pressure, and diabetes mellitus.(8)
1. MacAuley D, Bauman A, Frémont P Exercise: not a miracle cure, just good medicine. BMJ. 2015 Mar 19; 350:h1416.
2. Physical activity improves quality of life - American Heart Association
http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/FitnessBas... life_UCM_307977_Article.jsp March 2, 2015
3. Kangasniemi A, Lappalainen R, Kankaanpää A, Tammelin T Mindfulness skills, psychological flexibility, and psychological symptoms among physically less active and active adults Mental Health and Physical Activity Volume 7, Issue 3, September 2014, Pages 121-127
4. Govil SR, Weidner G, Merritt-Worden T, Ornish D Socioeconomic status and improvements in lifestyle, coronary risk factors, and quality of life: the Multisite Cardiac Lifestyle Intervention Program. Am J Public Health. 2009 Jul;99(7):1263-70.
5. Needleman I, Ashley P, Fine P, Haddad F, Loosemore M, de Medici A, Donos N, Newton T, van Someren K, Moazzez R, Jaques R, Hunter G, Khan K, Shimmin M, Brewer J, Meehan L, Mills S, Porter S Consensus statement: Oral health and elite sport performance. Br Dent J. 2014 Nov;217(10):587-90. doi: 10.1038/sj.bdj.2014.1000.
6. Ashley P, Di Iorio A, Cole E, Tanday A, Needleman I. Oral health of elite athletes and association with performance: a systematic review.Br J Sports Med. 2015 Jan;49(1):14-9. doi: 10.1136/bjsports-2014-093617. Epub 2014 Nov 11.
7. Steffens JP, Masi S, D'Aiuto F, Spolidorio LC. Telomere length and its relationship with chronic diseases - new perspectives for periodontal research. Arch Oral Biol. 2013 Feb;58(2):111-7.
8. Balaji, P.A., Varne, S. R., & Ali, S.S. Physiological effects of yogic practices and transcendental meditation in health and disease. North American Journal of Medical Sciences, 2012. 4(10), 442-448.
Competing interests: No competing interests