Prescribe the ‘pill’ of exercise for all ills
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.”