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Death by effectiveness: exercise as medicine caught in the efficacy trap!
  1. Chris Beedie1,2,
  2. Steven Mann2,
  3. Alfonso Jimenez2,3,
  4. Lynne Kennedy2,4,
  5. Andrew M Lane5,
  6. Sarah Domone2,
  7. Stephen Wilson2,
  8. Greg Whyte2,6
  1. 1 Department of Psychology, Aberystwyth University, Ceredigion, Wales, UK
  2. 2 ukactive Research Institute, London, UK
  3. 3 Faculty of Health, Exercise & Sport Sciences, Universidad Europea, Madrid, Spain
  4. 4 Department of Clinical Sciences & Nutrition, University of Chester, Chester, UK
  5. 5 University of Wolverhampton, Walsall, UK
  6. 6 Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
  1. Correspondence to Dr Chris Beedie, Department of Psychology, Aberystwyth University, Aberystwyth, Ceredigion, Wales SY23 3UX, UK; chb44{at}

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Sport and Exercise Medicine (SEM) has had a good run. For a while it was the low-cost magic bullet. With efficacy demonstrated in study after study, the conclusion was clear: ‘Exercise is Medicine’, a potential public health panacea.

Sadly, the early promise waned. While we continue to be bombarded by original research and reviews extoling the efficacy of exercise, there is an apparent dearth of evidence of its effectiveness. This fact is highlighted in 2014 reports from the UK Government1 and Public Health England.2

It is often argued that the major challenge to the effectiveness of exercise is adherence. Adherence to exercise, variously reported at between 40% and 50%3 is no lower than that reported for drugs.4 However, while there is general confidence that licensed drugs are effective when taken, reports cited above1 ,2 suggest that this confidence does not currently extend to exercise.

Confidence in drugs results from their demonstrating efficacy and effectiveness in clinical trials. Efficacy, demonstrated in phases I–III of a trial, refers to “the extent to which a drug …

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