Why exercise is one of the most effective pills
Exercise is one of the most effective medications, says sports physiologist Arno Schmidt-Trucksäss, but it is still rarely prescribed. This should change with sports therapies tailored to the individual.
Mr Schmidt-Trucksäss, how do you keep fit?
I incorporate physical activity into my daily life and ride my bicycle every day. On my way home from work, I cover about 100 metres in altitude, which of course has a positive effect on my overall fitness level. I also go jogging and play tennis at the weekend, mostly with my son.
With this amount of exercise, you probably exceed the Swiss average.
Not necessarily. Switzerland is one of the European countries where people exercise most. According to a new survey, 76 percent of the Swiss population get a sufficient amount of exercise – i.e. 150 minutes a week of medium activity and 75 minutes of intensive activity. However, the results are based on questionnaires – where people are often generous in their assessments of themselves. Measurements with motion detectors would certainly have been more objective.
Exercise is healthy, everyone knows that. But do people who don’t exercise enough or not at all inevitably become ill?
You don't necessarily get ill, but you deny yourself the potential to stay healthy. If you rest, you rust, goes the famous saying, and it really is true. The bodily functions that protect us from chronic diseases and lower mortality are affected when the body doesn’t get any exercise.
Fewer sick people, fewer deaths: physical activity reduces the overall incidence of disease and mortality by up to 40 percent.
What effects does exercise have on the body?
There is a wide range of mechanisms responsible for the effects, and many have yet to be researched. What is clear, however, is that physical activity increases the amount of oxygen required in the muscles. The blood vessels therefore release more nitric oxide, an important messenger molecule that suppresses inflammation and protects cells. This can have a preventive effect on arteriosclerosis, diabetes and cancer.
The ways in which exercise can be used as a form of medication is one of your research areas. What is it about the subject that fascinates you?
I find it absolutely fascinating that we don’t know of any other medication with so many positive effects as exercise. Even ‘polypills’, designed to help reduce several risk factors in the future, are nowhere near as effective. We’re working with tremendous interest to understand the reasons behind these results in order to deduce which type of exercise can be used for which disease.
Do we already have any recommendations for specific diseases?
We know, for example, that a combination of endurance and strength training is effective for type 2 diabetes. This makes the muscle cells more sensitive to insulin again. Insulin can then better fulfil its function, i.e. to regulate the blood sugar level. And, with targeted training, this even works independently of insulin.
Regular exercise is particularly important for patients suffering from high blood pressure: it can lower blood pressure – and thus be just as effective as blood pressure-lowering medication.
Are patients already receiving treatment from findings like these?
Yes, this happens, but the possibilities are not yet exhausted. Nonetheless, we have at least made progress. For certain tumour diseases, for example, moderate endurance training is now increasingly being used for patients on chemotherapy. This makes the therapy more effective and easier to tolerate. Heart attack patients are also no longer sent off to bed to rest for as long as possible. Endurance training is prescribed as a therapy as soon as feasible, even if the time-gap between the acute phase and rehabilitation is still too wide.
What’s the reason for this?
Only a few doctors are trained in sports medicine – it’s not yet a compulsory subject in medical studies, which is something we want to change at the University of Basel. And collaboration with exercise therapists and physiotherapists is lacking. It would be important for medical practices and clinics to have a network of specialists in the surrounding area to whom they can refer their patients. Telling a patient to look in the telephone book or on the internet is not enough.
“You should get more exercise" – this is what patients often hear from their doctor. How effective are reprimands like this?
They’re not effective enough, and many important questions – like whether someone with high blood pressure is allowed to do weight training or if their blood pressure would then shoot up even more – remain unanswered. Concerns such as these should be discussed and sorted. Incidentally, I also consider general recommendations such as "every step counts" to be insufficient.
Why?
They may be right in principle, but they’re just not specific enough for the individual. A diabetologist wouldn’t say to his patient: every unit of insulin counts. A certain dosage, frequency and duration must be set. And this is important if we want to prescribe exercise as a medicine; only then can we fully exploit its benefits.
Regular exercise is also good for the heart: exercise reduces the mortality rate from coronary heart disease such as a heart attack by up to 40 percent.
What would you specifically recommend to a patient with high blood pressure?
We always start with a health check, especially when a disease has already been diagnosed. Then we offer a tailored workout: for example, ten minutes of endurance training on a bicycle ergometer to mentally adjust, get motivated and reset the musculoskeletal system. Afterwards, the intensity can be gradually increased and varied within the patient’s everyday life to create new training incentives.
Does every patient need a coach?
An exercise specialist – a sports scientist, for example, like the ones we train at our department – can be useful as a form of support. They can assess a person’s individual needs and what is good for them. The important thing is that the body is not subject to too much strain. Care has to be taken to avoid the situation where someone develops discomfort, like knee-pain for example, stops training because of this and maybe doesn't start again. Ultimately, we want to encourage people to stick at their training.
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