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Movement treatment is a real revolution. The idea of Exercise is Medicine is spreading all over the world. Its promoters emphasize that exercise can help not only in the prevention of civilization diseases, but also help patients who suffer from chronic diseases such as cancer, cardiovascular diseases or diabetes. It turns out that physical activity increases the body’s efficiency, reduces the risk of obesity and reduces the incidence of many diseases. In a word, people who exercise live longer. Lek. med. Anna Plucik – Mrożek, Medical Director of Exercise is Medicine Polska and Małgorzata Perl, Sports Director of Exercise is Medicine Polska.
MedTvoiLokony: How was the idea of the “Idea Exercise is Medicine” campaign born?
Bow. med. Anna Plucik-Mrożek, MA Małgorzata Perl: About 10 years ago, in one of the fitness clubs, a doctor met a trainer conducting classes. It turned out that they had a lot of common ideas. Clients came to the trainer, showing the results of their research and asking if they could exercise or what exercises to choose. Thanks to our meeting, we started to think about how to help these clients. The “Activity at all ages” program was created, which received funding from the Starosty of the Legionowo County – the interest in the program was enormous – on the first day of registration, almost 50 people were enrolled for 100 places. In order to develop further, we started looking for access to broader knowledge about physical activity in people with chronic diseases – this is how we came across an American initiative that was also launched 10 years ago thanks to the great family doctor Robert Sallis, who claims that a packaged movement would be the best and the most widely prescribed drug in the world.
Movement treatment is a real revolution. What is Idea Exercise is Medicine and how does this program work?
Our goal is to ensure that at each medical visit the doctor assesses the level of physical activity of the patient and, if necessary, recommends the type of exercise appropriate for the patient. We have been doing this for 10 years at the Perła Wellness club in Legionowo and it works perfectly. The physician should also be able to send the patient to an Exercise is Medicine certified trainer who will know how to exercise with the patient depending on their physical condition and the presence of any chronic disease. In addition, we expanded our activities to include “Walk for Health – invite your doctor” since last year, implemented under the National Health Program at the Ministry of Health. Thanks to this project, we want to reach the general public with the information that the traffic has many varieties, starting with 30 minutes of walking a day. You only need 30 minutes a day to improve your health. We want patients with such knowledge to be able to go to their GPs and ask about the type of exercise that is best for them. As a result, we hope to accelerate changes and raise public awareness of the impact of exercise on health.
What is the leitmotif of this year’s congress, which will be held in September in Poland?
During the congress, we want to bring general knowledge about the influence of exercise on the course of chronic diseases, take up the subject of exercise as a prophylaxis, but also discuss the necessary systemic changes in the field of public health so that societies have a greater impact on their health, quality and life expectancy. Professionals in the field of medicine, physiotherapy, dietetics, psychology, personal training will gain knowledge that will allow them to take better care of patients / clients.
During this year’s congress, the European Medical Fitness Convention will be held for the first time. What is “medical fitness” and how does it affect our health?
The program of the congress includes two days of theoretical lectures on topics related to movement. However, we see a great need to provide practical knowledge as well. That is why the medical fitness convention was created – it is intended for trainers and physiotherapists who work with clients. Medical fitness, which we have been dealing with for many years, focuses on the care of people with chronic diseases, such as – heart disease, hypertension, diabetes, depression, cancer, diseases of the osteoarticular system, e.g. rheumatoid arthritis. The convention will consist of a short 15-minute theoretical introduction and 30-minute demonstration exercises. Our goal is to enable trainers to work safely with a chronically ill patient.
The idea of Exercise is Medicine has spread all over the world. It turns out that exercise can help in the prevention of civilization diseases. What and how?
Poland is the 45th Exercise is Medicine center in the world. We joined this global project over a year ago, after two years of negotiation with Exercise is Medicine Global Initiative. Over the last ten years, there has been an increase in public awareness in this regard – it turns out that every minute of physical activity is important for our health. Even isolated cases of physical activity improve blood pressure, glucose control, and inflammatory markers. There is ample evidence that regular physical activity reduces the risk of developing chronic diseases as well as developing existing ailments. Regular exercise reduces the risk of cardiovascular disease, stroke, high blood pressure, type 2 diabetes, as well as breast, endometrial and colon cancer. In the context of the recent years of fighting the obesity epidemic, moderate or vigorous exercise is an excellent prevention of excessive weight gain and is a key element of weight loss and weight maintenance programs. Physical effort has a positive effect on our psyche: it allows us to rest better during sleep, supports memory and cognitive skills. Regular training reduces the symptoms and risk of depression – not only among people diagnosed with depression. Exercise often has a more positive effect on reducing symptoms of depression than conventional treatment – and it can be used alone or in combination with other forms of therapy. Physical activity plays an extremely important role in maintaining optimal health from an early age to old age. Pregnant women who exercise care avoid excessive rapid weight gain, and are also less likely to develop gestational diabetes and postpartum depression. Promoting regular exercise has been shown to be of benefit to children between the ages of 3 and 5. Physically active children and adolescents are healthier than their less active peers, which is reflected in a healthy body weight, lower cardiometabolic risk and healthier bones, among other things. Physical activity levels tend to decline with age, contributing to an increased risk of chronic disease. Moreover, the level of physical activity is one of the strongest prognostic factors of physical disability in the elderly. Regular training reduces the risk of falls and post-fall injuries, and slows down the loss of fitness due to aging.
Apparently, it is effective even for patients suffering from cancer and diabetes?
Regular physical activity reduces the risk of breast cancer by about 17% and reduces the risk of breast cancer recurrence by as much as 50%. In addition, exercise reduces the side effects of chemotherapy – patients tolerate cancer treatment better. In the case of diabetes – regular training and a proper diet reduce the risk of developing type 2 diabetes by 58%. If we already have diabetes, exercise contributes to better glycemic control, because working muscles need more glucose than, for example, adipose tissue – glucose levels are reduced. This effect can be considered in the context of a single training session, but also as a long-term effect of regular physical activity.
How does the promotion of this idea look like in Poland? How does it work in other countries?
As part of the promotion of physical activity as a medicine in Poland, we are organizing the 7th European Congress of Exercise is Medicine in September, and we are planning another Polish congress next year and in the following years. In addition, as part of the National Health Program at the Ministry of Health, we are implementing the project “Walk for Health – invite your doctor”, in which we promote movement for everyone. As part of this project, we conduct year-round education in the field of planned movement – we publish a monthly newsletter, we have a brochure about walking, Nordic Walking. There is also a children’s fairy tale “Jump for Health” on the role of jumping in childhood. From November 2018, we are starting certified Exercise is Medicine training for doctors, trainers, physiotherapists on the principles of qualifying for physical effort and the principles of training with sick people.
There are many studies that show that physical activity reduces the risk of obesity and depression, which are a global problem. Can you cure anything with physical activity?
Physically active people simply live longer. Movement improves physical condition, but also reduces the risk of many civilization diseases. It is an adjunctive treatment in virtually every chronic disease – we have more and more scientific research on this subject.
In 2009, the World Health Organization (WHO) published a groundbreaking report, which concluded that lack of physical activity is the fourth risk factor for mortality, more important than traditionally mentioned risks, such as overweight and obesity, or high blood cholesterol levels. According to research by American scientists for the journal The Lancet in 2012, lack of physical activity is the cause of 9 percent. premature deaths worldwide, which is similar to more established risk factors for cardiovascular disease such as smoking and obesity. Based on these results, lack of physical activity was described by public health authorities as “new cigarettes”.
One hour of sitting shortens your life by 22 minutes, and one smoked cigarette by 11 minutes.
About 5 percent. Poles declare that they regularly practice sports. We see overcrowded gyms / fitness clubs. Which would prove that Poland is a very active nation. Unfortunately, the disease statistics are still alarming. What could it be the result of?
5% of Poles regularly play sports, a further 23% with some regularity, and 18% sometimes – the data is worse than the rest of Europe, as 54% of Poles do not move at all. The awareness of the impact of exercise on health is still insufficient, and on the other hand, people already suffering from chronic diseases are afraid of taking up physical effort because they do not see what kind of exercise is safe for them. This is what we want to change – talk about the beneficial influence of exercise on health, and at the same time show how to qualify and exercise with sick people.
Poles have bad eating habits, which affects obesity and diabetes. It will be even worse if they do not change the lifestyle they lead. How to convince Poles to change?
The process of changing habits sometimes takes up to two years. Changing your lifestyle is a multi-stage process, but knowledge about the impact of exercise on health and, above all, the quality of life supports such changes. During the “Walk for Health – invite your doctor” we show all participants that movement can be pleasant, simple and requires little preparation. Start with minor changes – for example, you can get off the bus one stop earlier, or choose the stairs instead of the elevator – these are extremely simple things. You can invite friends for a walk, during which we can talk about various things while doing something good for our health. There are many possibilities – you just have to start looking. Doctors imparting knowledge to patients about the influence of movement also have a huge impact on the patient’s behavior.
How to properly plan physical activity to bring the desired effect?
WHO recommends 150 minutes of moderate exercise a week – healthy people can start their adventure with sports without performing additional tests. You need to pay attention to the current lifestyle, if you have led a sedentary lifestyle so far, training should be moderate. The latest recommendations speak of an assessment of 3 factors:
- Your current level of physical activity
- Planned level of physical activity
- Symptoms of chronic diseases
An important element of qualification for physical effort is the creation of cooperation between doctors and trainers. The patient receives a prescription for movement from the doctor, with which he goes to an appropriately trained trainer. The trainer starts a program of physical activity tailored to a specific patient. A meta-analysis of studies using this patient management regimen showed an 11% increase in the number of patients achieving the WHO recommendations for moderate physical activity.
Physical activity is safe for most patients with chronic diseases if properly qualified. There is no evidence that the risks of exercise outweigh the health benefits. Rather, lack of physical activity has more adverse health effects than any recreational sport risk.
Safety of exercise is extremely important to patients, so screening should be performed before starting any planned activity.
The extent of the screening depends on the patient’s preferences regarding the intensity of planned physical activity. If the patient wants to play low- or medium-intensity sports – the risk of sudden cardiac events is low. If the patient is planning to engage in high-intensity sports – the risk is greater, so a more extensive screening is necessary.
What is physical activity like for middle-aged people and for older people?
The most common diseases among seniors are high blood pressure, type 2 diabetes, osteoarthritis, coronary artery disease and depression. Each of these diseases should be dealt with slightly differently, but none of them disqualifies from fitness classes. The most important thing is to monitor the course of diseases, i.e. measuring blood pressure before each class, sometimes also after class, glycemic control, adjusting exercises to the limitations of the locomotor system. Exercises for seniors must be adjusted to their physical condition and oriented towards the presence of chronic diseases in this group. In old age, it becomes more important to pay attention to the limitations of osteoarthritis, so we definitely avoid jumps, jumps and sudden changes in body position. The latter is due to the greater stiffness of the blood vessels, and therefore the appearance of dizziness when suddenly changing the position of the body. Training loads are also lower at the beginning, exercises are performed more smoothly, slower. The trainer should be more attentive, he must pay attention to the well-being of the participants of the classes, their limitations. Despite these limitations, all types of classes can be carried out in the senior group – from pilates to tabata with elements of dance, HIIT training is extremely liked by seniors and studies have reported that it improves the physical condition of older people very well, improving their efficiency and heart function.
The senior who enters class requires special care at the beginning of the exercise program because he does not yet believe that exercise can help him. He has doubts whether he can do it in class, because he can barely climb the stairs, he is afraid of the group’s reaction. Then the seniors are the most motivated group in the fitness club, they look after each other, they always justify their absence from classes. A group of exercising seniors creates a community that always helps new participants and supports each other.
Can extreme exercise be toxic to the body?
The greatest health benefits are achieved by following the WHO recommendations, i.e. at least 150 minutes of moderate exercise per week, greater health benefits can be obtained by practicing sports within 300 minutes of moderate exercise per week. Further increasing the range of physical activity reduces the health benefits, which nevertheless remain greater than in the case of a sedentary lifestyle. Extreme sport increases the risk of injury considerably. The most important element of regular sports is the pleasure of exercise – only then is there a good chance of regularity. However, we should not follow trends without reflection and adjusting physical activity to the body’s capabilities. A person with obesity leading a sedentary lifestyle so far should not get up from behind a desk and run a marathon – he simply will not be able to do it and will put himself at unnecessary risk to health.