Move it or lose it
There is mounting evidence that exercise is not just a way of staying healthy but can help treat various ailments. Marine´ Lourens reports.
The era of bed rest is dead. Globally, there is a push to get people moving. But hitting the gym is no longer being encouraged as a cure only for the unfit and overweight. It seems there are very few illnesses and injuries that can not benefit from some form of exercise.
‘‘If you could prescribe the benefits of exercise in a pill form, pharmaceutical companies would not be able to keep up with the demand,’’ says exercise physiologist Jessica Allan. ‘‘When you look at the research and the results I’ve seen firsthand, there is no question as to its benefits.’’
Experts have long been warning against the health, economic and social disadvantages of our sedentary and comfort-driven lifestyles. But are we missing the other side of the coin – the astonishing advantages of exercise in tackling our health problems?
In New Zealand, the Green
Prescription scheme was introduced in 1998 to improve health and wellbeing through physical activity and nutrition support. Through this scheme, medical professionals refer patients to physical activity providers that assist them with their health management.
According to a 2018 Green Prescription patient survey, the main reasons for patients being issued a green prescription were weight loss (52 per cent), arthritis (26 per cent), back pain or problems (25 per cent), and high blood pressure or risk of a stroke (23 per cent).
However, there is an array of other, less spoken-about health problems that are being addressed with physical exercise. These include depression and anxiety, diabetes, osteoporosis, surgery recovery, cancer, Parkinson’s disease and fibromyalgia.
The fact that exercise can be used to treat, lessen or manage serious symptoms just shines the spotlight on the need for incorporating exercise physiology into the public health system in a more significant way, says Professor Nick Draper from the College of Education, Health and Human Development at the University of Canterbury and chair of Sports & Exercise Science New Zealand.
‘‘An accredited exercise physiologist is an exercise specialist. Their training is very intensive and looks at fitness assessment and exercise prescription for individuals with a range of different illnesses and diseases, specifically their impact on a patient’s ability to exercise,’’ says Draper.
‘Unrecognised’ experts
Because every illness and every patient presents with their own unique challenges, there is no space for a one-size-fits-all approach. And that is where exercise physiology can greatly assist patients.
Exercise physiology overlaps with physiotherapy in some areas, but there is a definite need for both disciplines and an integrated approach between them, says Allan.
Allan, who is currently a PhD candidate at the University of Canterbury, completed her postgraduate study in Australia and worked there as an exercise physiologist for six years.
‘‘In Australia, physio therapists would often see clients in the initial four to six weeks of an injury, to diagnose and
initiate treatment modalities, such as hands-on manipulation and initial exercise rehabilitation. Exercise physiologists were often integrated at the four-to-six-week stage to continue to build upon the exercise rehabilitation and supervise the exercise in a gym or hydrotherapy setting.
‘‘Open communication between the physiotherapist and exercise physiologist was pivotal and worked effectively to assist the client back to activities of daily living.’’
According to Draper, although there are currently exercise physiologists practising in New Zealand and students can study for the qualification and accreditation here, consultations with exercise physiologists are currently not covered by ACC.
A spokesman for the Canterbury District Health Board said patients who are
issued a Green Prescription can be treated by an exercise physiologist ‘‘when such expertise is available’’. However, a list of allied health professionals on the Ministry of Health’s website does not include exercise physiologists.
‘‘In Australia patients can be referred to an exercise physiologist and the health service there have made significant advances in terms of how they work with people in supporting them to be active,’’ says Draper.
A 2016 Deloitte research report looking to quantify the value of accredited exercise physiologists in Australia found they delivered benefits in terms of reduced health system costs, reduced productivity losses and wellbeing gains from lifestyle interventions. The report estimated the overall benefits of accredited exercise physiologist
interventions for the representative consumer at $6562 per person.
‘‘In New Zealand the Green Prescription scheme works very well – and is definitely needed – in terms of general advice on physical exercise, but is not suitable for patients who need specialised care,’’ Draper says.
‘‘Trainers might have a sport science degree, but they haven’t got that knowledge that you really need to advise clinical patients to make exercise as safe as possible. So there is a gap in that sense.’’
Allan says that, when she returned to New Zealand after working in Australia, she found herself in an ‘‘unrecognised’’ profession.
‘‘There is not really an option to work as an exercise physiologist in New Zealand, which is why I stayed in Australia for so long. I knew that
once I moved home, I would have to be patient in forging a career in exercise physiology.
‘‘It does seem, however, that people in New Zealand are increasingly recognising the need for exercise rehabilitation and health providers who specialise in exercise alongside a solid knowledge of different health problems and illnesses.’’
Exercise in cancer care
While in Australia, Allan often worked with cancer patients before, during and after cancer treatment, and the results were astounding, she says.
‘‘Moderate-intense exercise and appropriate exercise prescription has been shown to improve quality of life, reduce cancer-related fatigue, assist with psychological distress and counteract functional declines.
‘‘People with cancer are at higher risk of developing comorbid
conditions, such as cardiovascular disease, diabetes, osteoporosis and sarcopenia (a decline in muscle mass). This causes a higher risk of losing independence and quality of life but which is where exercise can be invaluable.’’
Recently she worked with a married couple recovering from organ donor surgery. ‘‘The wife donated a kidney to her husband, and they are both recovering from the surgery. They started with very light exercise about seven weeks postop just to help them regain daily functional ability, but they have since come a long way and improved so much.’’
Exercise not only treats symptoms, but for some diseases such as Type 2 diabetes it can improve the condition to a point where it is placed into remission, Allan says. For some people who experience back pain or joint
problems, their condition can improve to such a degree through exercise that surgery can be avoided.
‘‘I think there is an increasing awareness by health professionals as to the potential benefits of exercise as a conservative intervention prior to surgery. It is great to see some GPs and specialists really getting behind this.’’
She says that, in the same way that patients trust their GPs and specialists when they advise them to get surgery or take medication, patients trust their doctors when they advise them to be more active.
‘‘Exercise physiologists can lead on the safe prescription of exercise for individuals with a range of health issues, one that is complementary to the work of GPs and consultants, working in partnership with physiotherapists.’’