Exercise is Medicine

What is an Exercise Vital Sign (EVS)?

‘Exercise is medicine’ is a current catch cry that is becoming increasingly common. This is for good reason, with the list of health benefits that stem from regular exercise growing rapidly.

In this article from December 2018 (published by the Mayo Clinic promoting the benefits of exercise), exercise controls weight, combats health conditions and diseases, improves mood, boosts energy, promotes better sleep, puts the spark back into your sex life, can be fun … and social.

Recognising that such a simple ‘therapy’ can have such far-reaching benefits means that allied health professionals should be promoting, recording and tracking patients exercise habits.

How much is enough?

A lot of people are pleasantly surprised to learn that it does not take a lot of effort to get a huge amount of benefit. Just 30 minutes of brisk walking undertaken 5 x per week coupled with 2 sessions of body weight exercises targeting some big muscles (glutes, hamstrings, quadriceps and calves) will enable adults to get the maximal health benefits from exercise.

Can people do too much?

Quite possibly. A prospective observational Danish study of 1098 healthy joggers and 3950 healthy non-joggers which have been followed since 2001 showed a U-shaped association between all-cause mortality and dose of jogging as calibrated by pace, quantity, and frequency of jogging. This paper, published in 2015 (The Copenhagen City Heart Study JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY VOL. 65, NO. 5, 2015), showed light and moderate joggers have a lower mortality than sedentary non-joggers. However strenuous joggers have a mortality rate not statistically different from the non-jogging controls. The bottom of the U-shaped curve (the ‘sweet spot’) was found between 1 and 2.4 hours of jogging per week, with no more than 3 running days per week, at a slow or average pace. Strenuous joggers were defined by a jogging pace of >5.3 mins/km (11.27kph) for a total time of > 4 hours/week.

A number of large studies utilizing cumulative doses of exercise, rather than focusing just on jogging, have shown similar U-shaped, or J-shaped curves. Current thinking is that there is an upper limit of exercise for optimizing cardiovascular benefits and longevity.

How should this be recorded?

An Exercise Vital Sign (EVS) can be simply calculated and entered into patient/client records as the total minutes per week of physical activity.

  1. On average, how many days per week do you engage in moderate to strenuous exercise (like a brisk walk)?
  2. On average, how many minutes do you engage in exercise at this level?
  1. 1 X 2 = total minutes per week of physical activity = EVS

The EVS should sit alongside other patient baseline measurements like height, weight, Body Mass index (BMI), abdominal circumference, blood pressure, alcohol and smoking history. A number of studies from North American have concluded that the EVS has discriminant validity and is a valid proxy measure of physical activity in patients.