March 14, 2016
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Exercise often overlooked as treatment for common chronic conditions

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Primary care physicians often overlook exercise as a prescribed treatment for many chronic conditions, favoring pharmaceutical or surgical solutions, despite evidence that exercise can be similarly effective, according to a review published in the Canadian Medical Association Journal.

Pooling evidence from recent studies, the researchers assembled a list of appropriate exercises for various conditions, including osteoarthritis of the hip and knee, chronic nonspecific lower-back pain, falls, chronic obstructive pulmonary disease (COPD), type 2 diabetes, chronic fatigue syndrome, coronary heart disease and heart failure. According to the review, a lack of awareness among physicians and patients regarding the effectiveness of exercise, and a dearth of knowledge about what counts as an effective exercise intervention, may be the cause of its lack of use.

“Mortality benefits from exercise are similar to pharmacologic interventions for secondary prevention of coronary heart disease, stroke rehabilitation, treatment for heart failure and prevention of diabetes,” Tammy C. Hoffman, BOccThy, PhD, of the Center for Research in Evidence-Based Practice at Bond University in Robina, Australia, and colleagues wrote. “The morbidity benefits of exercise for diseases that are not life-threatening, such as back pain and osteoarthritis, are substantial.”

In addition to appropriate exercises, listed by condition, the review includes information regarding the type of care provider that should be overseeing or administering the activity, the materials needed, benefits, contraindications and possible adverse effects. Some of the exercises can be prescribed by family physicians, while others require referrals to clinicians with special expertise.

For Osteoarthritis of the knee and hip, the review recommends muscle strengthening, and aerobic and range-of-motion exercises, on land or in water, to help alleviate pain.

Patients with lower-back pain should seek supervised sessions with a physiotherapist, performing motor control exercises and graded activity, over 8 to 12 weeks.

Supervised group or individual exercises with a physiotherapist focusing on improving balance, posture control, strength and coordination are recommended for patients seeking to prevent falls.

Patients with COPD should be referred to pulmonary rehabilitation, and should be taught how to manage breathlessness during exercise. For type 2 diabetes, aerobic exercise, progressive resistance training, or a combination of the two, can improve glycemic control, according to the review. Those with heart failure should work within their exercise tolerance, progressing gradually at first through supervised resistance training.

“Unless clinicians can access sufficient details about exercise interventions to prescribe them, they either guess at how to use them, or do not use them at all,” Hoffmann and colleagues wrote. “General practitioners have identified the need for exercise details and resources to assist them with exercise prescription. Even when a family physician may not be involved in delivering the exercise intervention, they should know the main elements of an evidence-based exercise intervention so they can discuss with patients and refer appropriately.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.