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Exercise prescription and the doctor’s duty of non-maleficence
  1. Jonathan Pugh1,
  2. Christopher Pugh2,3,
  3. Julian Savulescu1
  1. 1 Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
  2. 2 School of Sport, Cardiff Metropolitan University, Cardiff, UK
  3. 3 Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, United Kingdom
  1. Correspondence to Professor Julian Savulescu, Uehiro Centre for Practical Ethics, University of Oxford, Suite 8, Littlegate House, 16/ 17 St Ebbe’s St, Oxford OX1 2JD, UK ; julian.savulescu{at}philosophy.ox.ac.uk

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An abundance of data unequivocally demonstrates that exercise can be an effective tool in the fight against obesity and its associated comorbidities.1 Indeed, physical activity can be more effective than widely used pharmaceutical interventions. While metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%.2

In this context, it is notable that a group of prominent medics and exercise scientists recently sent a well-publicised letter to the General Medical Council (GMC) and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula.3 The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health among doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020.

While we agree with the need to address this apparent lack of understanding, the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonable harm to patients.

Despite the well-established long-term beneficial effects of exercise, the risk of an acute cardiovascular event may be transiently elevated during and just after vigorous physical exertion for susceptible individuals. This is the so-called ‘paradox of exercise’.4 This paradox does not mean doctors should refrain from prescribing exercise; the …

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