Exercise Prescription for Health: sports instead of pills

Did you know that we can influence up to 50 percent of our health ourselves? If we eat a balanced diet and exercise regularly, this not only ensures longer independence in old age. Diseases can also be treated with exercise. But in many cases, physicians and patients still rely more on medication than on exercise.

In the interview with MEDICA-tradefair.com Prof. Herbert Löllgen explains how physical activities can now be prescribed, why the Exercise Prescription for Health should be given before medication in many cases and which trends can currently be observed in sports medicine.

Prof. Löllgen, what is the "Exercise Prescription for Health"?

Prof. Herbert Löllgen: In my medical practice I often experience that patients want clear instructions regarding physical activities. However, physician's knowledge of sports medicine is often relatively inadequate. This is why we at EFSMA (European Society of Sports Medicine) have decided to give the Exercise Prescription for Health. In this prescription it can then be shown which activity is prescribed and to what extent the patient should perform it. Of course, this should also be explained to the patient by the physician. But this is not only a topic for general practitioners, but also for clinics. Often patients come with a prescription from the hospital, on which partly 10 drugs stand. But about the physical activity not a word is lost, although we can determine – and this is also proven by usual studies – up to 50 percent of our health with a healthy lifestyle. Very few patients are aware of this personal responsibility and it is for this reason that we and the Exercise Prescription for Health must convey it to them. On the EFSMA homepage, we have compiled a complete set of tables for all diseases, in which it is stated which type of sport can be prescribed and to what extent. Our rule of thumb is that patients should do moderate physical activity for 150 minutes per week.

In which cases does it make sense to prescribe movement?

Löllgen: The Exercise Prescription for Health can be prescribed for almost all chronic diseases – be they cardiovascular, metabolic or psychiatric diseases. Physical activity, for example, has proven to be a very good additional therapeutic success in the treatment of depression. Physical activity also plays an important role in nephrology. In some clinics, patients are allowed to train with a bed ergometer during dialysis. The amazing thing is that not only do people become fitter, dialysis times can also be shortened. Many patients even ask whether they can train during dialysis. Until now, they were only in bed, watching TV or reading the newspaper. This means that time can really be used to improve health and kidney function. In diabetes patients, the first step in therapy should be to prescribe regular physical training before starting any other medication. Many physicians still pay too little attention to this today. With most diseases, the recommendation of regular physical activity is part of a conventional therapy. Every physician – no matter which specialty – should also ask about and recommend physical activity during every patient contact. The Exercise Prescription for Health should be renounced actually only with all acute illnesses.

What is the difference between this offer and physiotherapy?

Löllgen: Physiotherapy is more a therapy in which the patients are moved passively. They let something happen to them. During the physical activity prescribed with the Exercise Prescription for Health they have to become active themselves – independent of someone who takes them by the hand, so to speak. This is particularly important with older patients: those who exercise regularly have a better chance of remaining independent for longer in old age.

What role do wearables play in this?

Löllgen: In my opinion, wearables play a very important role because the patient can see what he has done per day, depending on what kind of equipment he has. This is not only about checking whether the patients are really moving, but also how much. Younger patients in particular often overtax themselves. With wearables, the patient can directly see how much he has already done and stop when it is enough. But experience has shown that the tracking of pulse, step counting and the like diminishes over time. Of course, it is also the physician's task to ask questions again and remind the patients that they have something to orient themselves on. For example, I write to the patients that they should go for a 30-minute walk five times a week. They come back to my medical practice after about two to three months and report what they have done. This monitoring is very important. The amazing thing is that the patients themselves notice the positive effect and have a real sense of achievement that motivates them to continue. In general, I consider wearables to be a very important supporting measure.

You are involved in the conception of MEDICA MEDICINE & SPORTS CONFERENCE. Which current trends in sports medicine are reflected there?

Löllgen: These are just a few! A major trend is individualized or personalized sports medicine, and that goes hand in hand with the Exercise Prescription for Health. We are therefore in a position to offer the patient a tailor-made movement therapy – according to his individual performance. Another topic is the question of genetic consideration. We know, for example, that certain genetic combinations favour the success of movement therapy. We do not yet know all the genetic factors associated with this, but there is certainly still a lot to be expected in the future. Also of interest is the so-called preconditioning, i.e. physical training prior to surgery. Of course, this is only possible with elective procedures, not with emergency procedures. For example, patients who have a bypass operation in one or two weeks can train at a low level beforehand. As a result, they have fewer complications and are back on their feet faster after the surgery. This seems to really prove itself in some surgical subjects. In my opinion, sports medicine has enormous potential overall – especially if the neighbouring disciplines cooperate with sports medicine and sports medicine with the neighbouring disciplines.