I love the idea of the CDC handing down exercise guidelines. The more we can do collectively to close the gap of perceived importance between active and passive management of disease (including aging), the better we can help people to realize greater health, in whichever ways they may choose to define it, and federal agencies paying attention to exercise can certainly contribute to that goal.
But, and maybe I’m nitpicking, I think there might be a better approach. I like fundamentals, and as much as I wholeheartedly believe in the idea of “movement as medicine” (it’s the reason I chose the career that I did), I’m not so sure that dosing exercise should be the focus that some would like it to become.
But we physical therapists (PTs) are movement experts. Shouldn’t we apply our specialist knowledge as precisely as we can?
Well, two and a half hours of moderately intense aerobic exercise is a great target, for a lot of people. Its basis is the principle that specific adaptations within the body can be elicited only by sufficiently-intense demands imposed upon its systems. But for some, this target is permanently out of reach, and for others, it’s not nearly enough to stimulate change. In perpetuating this target for individuals, we repeat the mistakes made with other population measures, like BMI.
I’ve heard the arguments of PTs who favor exercise dosing, who declare it as critically important as the dose of a medication. The principles, that exercise is a powerful intervention and that imposing the right demands leads to adaptation, are right.
But I propose a different recommendation. It isn’t sensational, there won’t be any fanfare surrounding its implementation, and most of all, we movement experts won’t be instrumental to making it work. But it will guarantee meaningfully better health for those who receive it. I propose a prescription to pursue continuous improvement. Too vague? Not clear enough to become action? I don’t think so.
News headlines that purport worsening generational health owing to sedentary lifestyles and faltering attitudes about responsibility are only accelerating, and for relatively young and healthy people in particular (but older individuals as well), the real idea we should be working to ingrain is that to stay static is to deteriorate.
Even to individuals for whom maintenance of capacity would be a successful outcome, don’t we send the wrong message by never moving the target? In any case, are the 2.5 hours of aerobic activity recommendations directed at those individuals anyway?
Why shouldn’t the CDC recommend instead to aim for doing 5% more next week, whether in terms of intensity, duration, or some other parameter, than you could do this week? Or to try something new? Or to do the same amount of activity, but require 5% less of a reward? Progress can come in many forms, and as those who live the philosophy already understand, it has to come in many forms, or plateau is inevitable.
Make a little progress, do a little better – the idea of continuous improvement is immensely more powerful than the strategy of reaching for a certain level of fitness and coasting once you’re there. And again, the idea of dosing exercise as a method of signaling its importance relative to the utility of passive interventions, like pharmaceuticals, is a great one. But I worry that it sensationalizes, for short-term gain, an idea which I take very seriously; the idea that the best way to help people realize better health is to help them solve their own problems as actively as they can.
Exercise can do more than very many of the things which we call “healthcare,” it has no negative consequence, and it costs nothing. Guidelines are good, but as we’ve seen with other public health initiatives, one size fits few. To seek improvement is the recommendation we should make (and to those for whom maintenance is success, current guidelines are not directed anyhow). Movement is medicine, and progress is the prescription.
John Corsino, PT, is a hospital physical therapist.
Last Updated September 04, 2020