Physical exercise can be prescribed as a drug in doctors’ offices, even if it is not packaged in a simple pill that we take. This is because the evidence behind it has made it more than clear that playing sports can prevent a large number of chronic diseases and even have a very good old age. But behind all this, there is also a negative part behind doing physical exercise.
Its side effects. If we accept exercise as a drug, we must also accept that every drug has a leaflet, specific dosages and of course some adverse effects.
This is why as a society we have the problem of having begun to sell the fact of “exercising” in a generic way, ignoring the fine print of this task, as recognized by the Spanish Heart Foundation itself. And it has a very simple solution: personalizing physical exercises per patient.
The problem of metaphor. The slogan “exercise as medicine” is undoubtedly an excellent marketing campaign within the world of public health, but for science there are several important flaws. As different scientific studies point out, exercise does not act like a classic drug, since it does not have a predictable response in a patient as if it occurs like a pill. This forces us to always think that the effect can be very different for each person.
In this way, by calling exercise a drug we can make invisible the diversity of individual responses. And there is no universal “squat pill”, since doing this exercise in a specific person can be very beneficial, but in another it can be the origin of a pathology due to overload. And all because we throw ourselves into exercise without planning how to do it, since we find it very easy to pick up some weights and start building biceps.
The damage numbers. We often hear that it is a great danger to stay seated in the chair, and it is true because there are many diseases related to a sedentary lifestyle. But according to different studies carried out in the United States, people who meet or exceed the recommendations for moderate or vigorous exercise are between 44 and 66% more likely to present musculoskeletal injuries than subjects who remain inactive.
In addition to this, although cardiovascular health improves with physical exercise because the heart reduces its heart rate, for example, the “maintenance cost” of the physical body increases dramatically with the amount of exercise done.
A question of biases. Without a doubt, this is one of the most critical points that scientific literature reveals regarding the lack of transparency in clinical trials related to exercise. This is something that was seen in an analysis that included 103 trials on knee osteoarthritis, where it was found that 6% of the participants suffered direct damage from this exercise.
But the most worrying thing is not the number, but the low information: many patients who abandon studies due to pain or discomfort are not classified as “victims of adverse effects”, which generates an artificially high perception of safety. This problem is repeated in oncology, where the motto “exercise is medicine in oncology” It coexists with non-trivial adverse events that have forced the proposal of much stricter monitoring systems to protect patients.
We pass each other sometimes. The underlying problem in this case is undoubtedly recommending intensive or complex programs without a clear benefit/harm relationship compared to an alternative that is much simpler.
But, on the other hand, we also fall into the phenomenon of “quaternary prevention” making medicine focus on avoiding the harm of its own interventions by excessively medicalizing, nullifying the benefits of physical exercise.
The necessary consensus. In this way, the authors who popularized the concept of ‘exercise as medicine’ explicitly recognize that exercise is not without risks. Even the WHO itself in its guidelines maintains that inactivity is the greatest population risk, but there is fine print that must be taken into account:
- Exercise should be ‘prescribed’ starting with a low intensity, and not opt for maximum intensity from the first day. This causes a person who has spent years on a couch to begin to carry a lot of weight, for example, and end up injured.
- Pain is not always bad, and the patient must be educated so that they see that fatigue from the gym does not have to be medicalized with pills.
- Patients with cardiac risk must be evaluated to prevent uncontrolled exercise from aggravating the situation.
Be supervised. The conclusion in this case is that exercise is obviously necessary and without a doubt it is one of the practices that can prevent the appearance of many diseases. But we always have to be aware of what we do. Loading the body with a large amount of exercise from minute 0 can cause significant injuries or the aggravation of diseases that are already present.
In this way, the possibility of being in a gym with trainers who can advise on the progression curve that should be followed can be an interesting idea to have the benefit of exercise without the consequences of doing it aggressively.
Images | Jonathan Borba
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