Lifestyle Medicine – completing the prescription (1)

Author: Dr David Glass

Finding the jackpot!

We read with envy of those rare, lucky people who win the lotto, or inherit a fortune from an unknown relative. When we receive that seductive e-mail from some unknown source informing us of prospective wealth, with little effort on our part except to share our confidential information, we are right to be highly cynical, believing that some scammer is plotting to steal what little resources we have amassed.

Although our chances of accumulating great financial wealth are remote, there is another jackpot that is within our reach – and we have a choice whether to earn a small or large bonus from our investment – depending upon how much time and effort we engage. This is the investment in physical activity or exercise. Someone will say “I knew there was a catch!”. For sedentary individuals, the thought of brisk walking, or jogging, or cycling or climbing mountains is painful or even repugnant. Yet, I see more and more young and old, of all sections of our community, discovering the rewards of regular exercise.

Once you have overcome the initial stiffness and soreness from moving little used muscles and joints – and a good rule is to start very gently – you will begin to experience the high of endorphins (happy chemicals) produced when you exercise. For some people this is almost addictive. If you can work out together with a friend/partner, the chance of persisting in your chosen form of physical activity multiplies hugely. It also helps if you can install an app on your phone or smart watch that records your activity, but this is not essential.

Besides feeling good, are there any other bonuses accrued from regular exercise, or keeping physically active? This is where research shows the huge returns on our investment. There is a significant reduction in breast cancer, (1) colon cancer, (2) diabetes, gallstones, high blood pressure, heart disease, stroke, and dementia. (3,4) It also controls bone loss, can improve sexual function, and enhance feelings of well-being and clarity of thought. In fact, regular exercise has been found in some studies from Harvard and Stanford Universities to work as well as medicines for coronary heart disease, and better than medicines for stroke. (5) Other studies have shown regular exercise to be as effective as commonly used medicines for non- severe depression, (6) and exercise is endorsed as an alternative treatment for non-severe depression by several treatment guidelines (EPA in Europe, CANMAT in Canada, NICE in the UK and RANZCP in Australia. (7) (That doesn’t mean you must stop your medicines independently of your doctor – but you may find that he/she is able to adjust your therapy as you become more active.)

So yes, you can hit the health jackpot if you are willing to invest in daily time spent in enjoyable exercise or physical activity. The recommendations are to aim for 75 minutes of vigorous activity per week (15 minutes per day for 5 days), or 150 minutes of moderate activity per week (30 minutes per day). This doesn’t have to be at an expensive gym. It may be walking around the block near home, or walking briskly up and down the Mall if you are concerned about safety. But find what works best for you. You may well be surprised how much better you feel and perform mentally, in just a few days or weeks. Even doing ten minutes a day is beneficial. The Heart and Stroke Foundation of S Africa has some good practical advice. (8)

As a doctor, or physio, how about completing your patient intervention by including a script for a physical activity plan that you and your patient have jointly developed – one that is SMART – specific, measurable, attainable, relevant, and time-based. The patient is more likely to adopt this intervention if she/he understands that physical activity is just as important to her/his well-being and recovery as pharmacotherapy.

Dr Dave Glass


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  16. The Heart and Stroke Foundation of South Africa: