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In this Canadian Academy of Sport and Exercise Medicine (CASEM)-led issue, we highlight the myriad benefits of physical activity. Evidence continues to emerge for the role of chronic workload in sport injury prevention, this time in rugby league players.195973 Just as an optimal training stimulus will enhance performance and decrease injury in elite sport, it appears similar principles may apply to patients with cancer or chronic disease.
Pushing the envelope in exercise medicine too
The emergence of paradoxes extends to both sports and exercise medicine. Higher chronic match and training workloads, once thought to cause injuries, are now being reconsidered as a protective ‘vaccine’.2 Where we used to treat cancer and chronic disease with kid gloves, now we are setting new guidelines for higher activity levels. In recent years, this counterintuitive thinking has led to studies regarding high-intensity interval training in disease states such as coronary artery disease and heart failure.3 For far too many years, rest was considered the mainstay of treatment for lower back pain, an inconceivable notion to today’s young doctors. Ten years from now, we may be shaking our heads that we didn’t think to push the limits of physical activity in other disease states as well.
Physical inactivity is a global pandemic, and given the poor uptake in many countries including my own (Canada), it is worth wondering, are there grounds for personalising physical activity in chronic disease? Many authors in this issue would likely respond with a resounding yes.
Ciaran Fairman from Ohio, USA, suggests that while a minimum of 2 days a week of resistance training should serve to maintain or even improve lean body mass during cancer treatment, patients with cancer represent a very heterogeneous population and as such general principles may not always apply.4
Furthermore, both indirect and direct effects of exercise may be therapeutic in this population, as demonstrated by Robert Thomas’ group.5 We see this concept of individualisation make a reappearance in the review article regarding exercise and brain health by Canada Research Chair, Dr Teresa Liu-Ambrose .6
Countering this to a degree, are the findings on exercise training and C reactive protein.7 . While CRP levels showed greater improvement with exercise and a concomitant decrease in body mass index or per cent body fat, exercise training alone was associated with improvement, regardless of age or sex of the individual. Therefore, perhaps the most important strategy is to get people moving in any way possible.
Does exercise mitigate the harm of alcohol intake?
Finally, while studies abound on exercise as prevention and now management of chronic disease, we know less about a topic increasingly important in today’s society: harm reduction. In an unusual analysis , we see that physical activity can have a startling attenuating influence on the harmful effects of alcohol consumption.8 The conclusion is a resounding endorsement for encouraging our patients to meet minimum physical activity guidelines.
While exciting new pathways are being forged, much work remains and as Fairman suggests, we must adopt improved reporting methods, a thought shared by other experts.9 10 The crucial task will be taking these results out of the lab and onto the field of play or into the clinic to see what can be done in ‘real life’.
Enough talk, time to act!
We cannot overstate the importance of initial and ongoing education among our fellow and future physicians.11 12 This past year I presented a motion as CASEM delegate to the annual Canadian Medical Association General Council meeting. The motion to ensure education on the prescription of physical activity in Canadian medical schools was passed and now the real work begins.13–15
As clinicians and healthcare providers we must leverage the accumulating evidence for physical activity, structured or unstructured, to advocate for patients who would not normally think of physical activity as a treatment strategy. The magnitude of benefits from physical activity and sport demands a response.
From preseason to post-diagnosis, it is clear that physical activity’s benefits (and dose) are ever increasing. It’s time to take action as a collective community of practice and make this common knowledge.
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Footnotes
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.