Pre­scribe the ‘pill’ of ex­er­cise for all ills

Sunday Times (Sri Lanka) - - NEWS - By Ku­mu­dini Het­tiarachchi

It was not merely a med­i­cal ses­sion -- for at the head ta­ble sat a sports of­fi­cial with the doc­tors and in the au­di­ence were many well- known names in­clud­ing Asian medal­list and ac­claimed ath­lete Sriyani Ku­lawansa.

It was also one pill for all, that was pre­scribed here and it cer­tainly was not a bit­ter pill.

The “pill” was none other than ex­er­cise which can solve many an ill-health is­sue and the in­ter­est­ing and ed­uca­tive event was the in­au­gu­ra­tion of the 4th Sci­en­tific Ses­sions of the Sri Lanka Sports Medicine As­so­ci­a­tion (SLSMA) on Novem­ber 24 at the Wa­ters’ Edge Ho­tel, Bat­tara­mulla, on the theme 'Ex­er­cise is Medicine, Ex­er­cise is Well­ness'.

The SLSMA is cur­rently headed by Pres­i­dent Dr. Eshan Jayaweera, while its Sec­re­tary is Dr. Mithila Ruwanga and Sci­en­tific Com­mit­tee Chair­per­son is Dr. Chathu­ranga Ranas­inghe. The Chief Guest at the in­au­gu­ra­tion was Sport Medicine Physi­cian Prof. Ben Tan from Sin­ga­pore and the Guest-of-Hon­our Dr. Chel­liah Thu­rairaja, Founder Pres­i­dent of the SLSMA.

The right tone was set for the in­au­gu­ra­tion when the Na­tional An­them ‘ Sri Lanka Matha’ was be­ing sung. Into the first few lines, the record­ing stopped sud­denly, but the com­pere sang on sans mu­sic and the au­di­ence lustily joined in, as if play­ing the chord that ex­er­cise will con­quer what­ever the cir­cum­stances.

Later, a large pho­to­graph of a red dou­ble-decker bus ply­ing the streets of Eng­land came up on the screen as Prof. Tan asked the ques­tion on ev­ery­one’s mind. What is its rel­e­vance to the topic of ‘Ex­er­cise is Medicine, Ex­er­cise is Well­ness’?

The bus was the sym­bol of a study on ‘Coronary Heart Dis­ease in Lon­don Bus­men: A Progress Re­port with Par­tic­u­lar Ref­er­ence to Physique’ con­ducted back in 1961, said Prof. Tan, ex­plain­ing that it com­pared driv­ers and con­duc­tors.

The re­sults were an eye-opener. When com­pared to driv­ers, the con­duc­tors had:

A lower rate of heart at­tacks.

A smaller waist cir­cum­fer­ence.

Why? The an­swer was ob­vi­ous to the au­di­ence – the con­duc­tors were more phys­i­cally ac­tive than the driv­ers who were seated all the time.

Next Prof. Tan looked at global deaths at­trib­uted to 19 lead­ing fac­tors in the World Health Or­ga­ni­za­tion’s Global Health Risks Re­port 2004 which put ‘Phys­i­cal In­ac­tiv­ity’ in 4th place.

“Phys­i­cal in­ac­tiv­ity ( seden­tarism) is a fast- grow­ing pub­lic health prob­lem that con­trib­utes to a va­ri­ety of chronic dis­eases and health com­pli­ca­tions in­clud­ing obe­sity, di­a­betes and can­cer,” he stressed.

Among the many pres­ti­gious po­si­tions Prof. Tan holds are Chief of the De­part­ment of Sports Medicine, Changi Gen­eral Hos­pi­tal and Se­nior Con­sul­tant of the Sin­ga­pore Sports Medicine Cen­tre as well as Chair­man of the Ex­er­cise is Medicine Asia Re­gional Cen­tre.

A for­mer Nom­i­nated Mem­ber of Par­lia­ment ( 2014- 2015) in Sin­ga­pore, Prof. Tan is not just a doc­tor but cur­rently serves on many sport­ing bod­ies. He is an Olympian (Asian Games 1994 and four- time con­sec­u­tive South­east Asian Games 1989, 1991, 1993, 1995) Gold Medal­list in sail­ing, while be­ing a Hall- of- Famer and three­time Sin­ga­pore Sports­man of the Year. Hav­ing re­tired from com­pet­i­tive sail­ing, Prof. Tan now sails ( in­clud­ing kite­board­ing) recre­ation­ally and has taken to marathon run­ning recre­ation­ally, com­pet­ing in more than 20 marathons across the world.

He is a reg­u­lar scuba diver and snow- skier and has vis­ited Sri Lanka fre­quently, fly­ing to Katu­nayake and head­ing di­rectly to Kal­pi­tiya.

Prof. Tan speaks of the ben­e­fits of phys­i­cal ac­tiv­ity, with ev­i­dence in hand. He points out that there is “strong” ev­i­dence of lower risk of early death; lower risk of coronary heart dis­ease; lower risk of stroke; lower risk of high blood pres­sure; lower risk of ad­verse blood lipid pro­file; lower risk of type 2 di­a­betes; lower risk of metabolic syn­drome; lower risk of colon can­cer; lower risk of breast can­cer; pre­ven­tion of weight gain; weight loss; im­proved car­dio-res­pi­ra­tory and mus­cu­lar fit­ness; pre­ven­tion of falls; and re­duced de­pres­sion.

There is “mod­er­ate to strong ev­i­dence” that phys­i­cal ac­tiv­ity brings about bet­ter func­tional health (for older adults); re­duced ab­dom­i­nal obe­sity; weight main­te­nance af­ter weight loss; and bet­ter cog­ni­tive func­tion ( for older adults), he says, adding that there is “mod­er­ate ev­i­dence” of lower risk of hip frac­ture; lower risk of lung can­cer; lower risk of en­dome­trial can­cer; in­creased bone den­sity; and im­proved sleep qual­ity.

The body of ev­i­dence show­ing ben­e­fits of ex­er­cise is “un­equiv­o­cal” and grow­ing ex­po­nen­tially, but it has not trans­lated to a pro­por­tion­ate in­crease in phys­i­cal ac­tiv­ity among peo­ple, he laments, re­fer­ring to Sin­ga­pore’s 2010 Na­tional Health Sur­vey which found that 39.1% of res­i­dents are phys­i­cally in­ac­tive (ex­er­cis­ing less than once a week).

Quot­ing Ex­er­cise is Medicine Task Force Chair­man Robert E. Sal­lis, Prof. Tan asks: “What if there was one pre­scrip­tion that could pre­vent and treat dozens of dis­eases such as di­a­betes, hy­per­ten­sion and obe­sity? Would you pre­scribe it to your pa­tients?”

Point­ing out that 25% of pa­tients look to their doc­tor first for ad­vice on ex­er­cise and phys­i­cal ac­tiv­ity, he says re­fer­ring to an­other sur­vey that 24% of pa­tients turn next to fit­ness and health web­sites. Nearly two- thirds of pa­tients ( 65%) would be more in­ter­ested in ex­er­cis­ing to stay healthy if ad­vised by their doc­tor and given ad­di­tional re­sources.

How­ever, only four of 10 physi­cians ( 41%) talk to their pa­tients about the im­por­tance of ex­er­cise, but don’t al­ways of­fer sug­ges­tions on the best ways to be phys­i­cally ac­tive, he says.

Prof. Tan states cat­e­gor­i­cally: “Phys­i­cal ac­tiv­ity should be­come a ‘Vi­tal Sign’, with health­care providers rou­tinely dis­cussing it with each of their pa­tients. (Vi­tal signs are clin­i­cal mea­sure­ments which in­clude the pulse rate, tem­per­a­ture, res­pi­ra­tion rate and blood pres­sure that in­di­cate the state of a pa­tient's es­sen­tial body func­tions).

“The physi­cian should ei­ther pre­scribe ap­pro­pri­ate phys­i­cal ac­tiv­ity to each pa­tient or re­fer the pa­tient to a cer­ti­fied health and fit­ness pro­fes­sional to get a phys­i­cal ac­tiv­ity pre­scrip­tion. There is a need to put in place a frame­work for al­lied health and fit­ness pro­fes­sion­als to work with physi­cians in im­ple­ment­ing the ex­er­cise plan and for the peo­ple to be­gin to ask for and ex­pect physi­cians to dis­cuss phys­i­cal ac­tiv­ity dur­ing each visit.”

His strong plea is that physi­cians and other health­care pro­fes­sion­als can make a dif­fer­ence by un­der­scor­ing that “Ex­er­cise is Medicine”.

The physi­cian should ei­ther pre­scribe ap­pro­pri­ate phys­i­cal ac­tiv­ity to each pa­tient or re­fer the pa­tient to a cer­ti­fied health and fit­ness pro­fes­sional to get a phys­i­cal ac­tiv­ity pre­scrip­tion. There is a need to put in place a frame­work for al­lied health and fit­ness pro­fes­sion­als to work with physi­cians in im­ple­ment­ing the ex­er­cise plan and for the peo­ple to be­gin to ask for and ex­pect physi­cians to dis­cuss phys­i­cal ac­tiv­ity dur­ing each visit.”

Prof. Ben Tan

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