Physical exercise prescription

“Lack of activity destroys the good condition of every human being while movement and methodical physical exercise save it and preserve it.”

Physical activity has a massive role to play in the prevention and management of active disease

This often quoted phrase from Plato has never been so relevant as in our lifetime. Increased financial income, industrialisation, urbanisation and globalisation has led Malta, and the whole Western world, to a rapid and dramatic economic and social change. With all the good that came with this, some negative health issues have come to the forefront.

In 2008, 63 per cent of deaths worldwide were due to non-communicable diseases, including diabetes mellitus, cardiac and vascular diseases, cancers and obstructive lung disease.

Both the United Nations and the World Health Organisation have acknowledged that there is substantial evidence implicating physical inactivity as being a major contributing factor to mortality and morbidity from NCDs, such that both organisations consider physical activity as a fundamental element in the management of these diseases.

It is estimated that physical inactivity causes six per cent of all worldwide deaths from major NCDs, making it the fourth leading risk factor after high blood pressure(13 per cent), tobacco use (nine per cent) and high blood glucose(six per cent).

Notwithstanding all the major media and administrative focus on obesity and overweight statistics, this risk factor is responsible for five per cent of global mortality. In Malta, physical inactivity-related deaths alarmingly stand at 19.2 per cent, the highest in the world and way above the regional median of 8.8 per cent.

It is clear, for those that want to see, that physical activity has a massive role to play in the prevention and management of active disease. However, unlike other health risk factors such as alcohol, drugs, tobacco and diet, physical activity seems to be treated as the poor relative. The one that we tend to forget to invite when he hold family reunions.

This might be due to the erroneous concept of linking physical activity with obesity rather than as a separate risk factor is itself. All this was exceptionally highlighted in a series on physical activity by the prestigious journal The Lancet (July 2012).

Innumerable studies have shown the health benefits of regular physical activity. However, the issue goes deeper than that.

The overall well-being that comes with physical activity cannot just be pigeon-holed into the health category but should also include the improved quality of life, social belonging and the overall feel good factor that accompany physical activity.

Over the years, there has been a spew of physical activity recommendations for health made by various organisations.

Recently, emphasis has been made on the importance of activities that target muscle strength and bone health and the need of some regular form of vigorous intensity exercise to complement the low to moderate activities.

If the prescribed weekly exercise target cannot be achieved for whatever reasons, you do whatever you can because positive health benefits are seen even when physical activity levels are less than those recommended.

So where does all this leave us health professionals?

A recent consensus statement by BASES, The ABC of Physical Activity for Health (2010), produced guidelines us health professionals might use. It goes beyond the general physical activity recommendations that we should encourage our patients to undertake by giving a practical take on the issue. Hence, emphasis is placed on setting realistic expectations with short- and long-term goals and a commitment to undertake regular physical activity in order to reach and even surpass recommended levels.

The individual must take ownership for the decisions that must be taken and must understand the whole process in order to achieve better results.

Teaming up with certified exercise and sport centres is another requirement for health professionals. We cannot be expected to be the beginning-and-end-all of the exercise prescription. However, we must be viewed as the expert that will provide medical advice in matters that concern the medical preparedness and well-being of the individuals.

Success stories abound but many are individual in nature, and rarely relate to whole communities and even less so to populations at large, although this is not due to lack of commitment by some countries.

So where does this leave the policymakers? Where do they stand on this vital issue? Their mission must be to change the mindset of the population at large and especially of all the decision-makers and stakeholders.

They have to realise that an inactive population is not the norm but, rather, the contrary. An inactive population has to be viewed as abnormal and at a higher health risk, with all the financial and social implications this entails.

Yet, just adopting a programme that has worked elsewhere will not be a long-term viable solution. Each community, each city and each population has its own idiosyncrasies that have to be catered for and incorporated in the policy and eventual programme that is to be undertaken.

At the end of it all, we all want to live a healthier life and most of us want to live longer. If physical activity is undertaken regularly by the Maltese population, the gain in life expectancy is calculated at 1.12 years and the quality of life will be surely better for many of these years.

sportmedicinedoc@gmail.com

Kirill Micallef Stafrace is an executive member of the European Federation of Sports Medicine Associations.