Not Always: A Response to Exercise Is Medicine

Did you know that there was a study published in the US National Library of Medicine which suggests that men who play sports professionally show a higher percentage of depression? What the article concluded was that “the high ratings of depression in this group indicate that they need psychological help and that exercise is not sufficient in reducing their depression.” Not everyone is a professional athlete, but the most important part of that study is the conclusion: that the athletes needed more help. This is what happens when you treat exercise like it is a cure-all when it is clearly not. Now, in the interest of full disclosure, the study had a relatively small sample size of twenty individuals. However, this doesn’t disprove the fact that exercise clearly doesn’t help decrease anxiety or depression in everyone, and these people should not be told that it does as it may prevent them from choosing other methods of assistance.

I am well-versed in mental health due to a detailed history with it. I take anxiety medication for my panic disorder. Anyone who knows anything about medication treating mental illness knows that medication is not a magic pill. Medication helps the patient achieve neutrality. One must also take personal steps and coping mechanisms toward maintaining recovery in mental health. If someone said that their medication wasn’t working for them, the doctor doesn’t tell them that they are not taking it properly. They attempt to help them find a medication or a new dosage that works for them.  Who would force someone to take a medication that doesn’t work for them or makes them feel worse? In fact, the first thing they tell you when you take medication is that you should report to a doctor immediately if your anxiety or depression gets worse. If you are determined to view exercise as a medication, of which I have no problem, you need to follow the rules. Medication is not a cure all. That is, you wouldn’t prescribe Adderall for liver cancer, or Valium for depression. We can see that cannabis oil can help with some of the cancer side effects, but we would never use it in place of chemotherapy. Even more specific, I use Celexa brand Citalopram for my anxiety, but another anxiety medication like Xanax doesn’t work for me because it gives me migraines.

First, calling exercise a “hugely under-recognized and under-utilized tool” Is laughable. Exercise is good for your body. That’s a commonly known fact. I don’t understand where these people pushing exercise like an unacknowledged cure for everything are getting the idea that nobody knows this fact. Exercise is good for obesity, diabetes, and high blood pressure? Who knew? As far as exercise helping chronic conditions goes, I followed that citation to a government site, where they state it almost word for word, and that government site got that information almost word for word from a study done by Statistics Canada, a government statistics site that got their information from a study done by the Pennington Biomedical Research Center and the Canadian Fitness and Lifestyle Research Institute.

The reason I went so far to find the direct place the information came from is because each time this information was used they conveniently worded it so that it sounded like it lowers the risk of you getting a chronic illness. The original study was that it lowered the risk of you dying from a chronic illness, because the subjects already had chronic conditions when they were studied. It’s not exactly groundbreaking information that if you have a chronic heart condition, you will live longer if you exercise. If you are sitting there thinking that I’ve misunderstood the term ‘exercise’ and that articles like these are only pushing daily light fitness, which is healthy for everyone, then you need to read the study that was being referenced because it suggests much more than moderate exercise as treatment. In other words, we aren’t talking about keeping up with a long walk or a few sit ups in the comfortability of your own home.

Second, if you are sitting thinking that we need to push exercise because high rates of obesity and mortality from chronic conditions prove that we don’t understand the benefits, you are misinformed. Let me enlighten you. I have anorexia nervosa, I am in recovery, and I am doing very well. However, I am often told by those who don’t understand or know about my illness that I should exercise to feel better about myself every day, an hour a day. Here is the problem: exercise is very difficult for someone who suffers from an illness that focuses on body dysmorphia and over exercise. I almost starved myself to death because of my anorexia, and I constantly deal with that. Having people tell me that I’ll feel better if I exercise makes me hate myself and my body even more than I already do. I understand that exercise makes you feel better and can help people with anxiety and depression. However, my point is that there are people out there for whom this is not effective. I’m lucky if I’m able to get to the gym once a week without having a full-blown panic attack. When I do, I feel proud of myself for doing something that’s hard for me, but not for exercising. It’s not about the exercise for me. It’s about conquering something that terrifies me. Pushing exercise as this treatment that people should do every day to feel better and help their illnesses has consequences. It makes the people who take such validation from that one day they can do it and feel good about conquering that hurdle feel horrible instead of proud of themselves.

Statistically, anorexia affects about 1% of the population and there is a 30-50% mortality rate usually because of suicide. Anorexia also forms early in life and starts out as innocent diet and exercise. I was told to lose weight by my peers, and I did. I took it too far, but what didn’t help was all the people in my life pushing diet and exercise on a teenager with horrible self-esteem issues. Not everyone who exercises develops anorexia, not everyone exercise to lose weight or because they feel pressured to do so. But the ones who do have it for life are in treatment for usually a few years. Therapy itself can take at least twelve months, and the mortality rate is high. Saying that we should target kids young to help their ‘mental health’ sounds a little morbidly familiar to me.

As for pressuring doctors to inform their patients of the benefits of exercise, I assure you that your doctor is aware. That doctor is also probably smart enough to realize that there are some conditions and individuals that would not benefit from that prescription, as with any other kind of medicine you can think of. Even if you think that promoting exercise on anyone regardless of their condition or individual experience is harmless, take the following into consideration. An individual might take a vitamin B12 supplement if they are anemic. However, even though vitamins are harmless, when an anorexic who is heavily malnourished with no body fat or very little, takes a vitamin, it does nothing because our body can’t process it. We just flush it out. So even if you won’t admit to a potential harm, there is admittedly a situation where medication of any kind just does not have an affect. It ends up not being the correct treatment for that individual. An anorexic might benefit from some B12, but that doesn’t mean that the vitamin is just magically going to work. If all you do is tell the anorexic to keep eating vitamins, they aren’t going to get any better. You’ve fundamentally misunderstood that individual’s condition.

Anorexia is just my personal experience, but claiming that exercise is a cure-all can affect all sorts of different disorders, eating or otherwise. What if someone has chronic pain? Imagine how it would feel to have everyone telling you that you would feel better if you exercised and you are sitting there immobilized by your disease feeling like a failure because you weren’t able to get an hour a day in the gym. What if over-exercising triggers that chronic pain disease? Pushing exercise can be detrimental to someone’s mental health if they are unable to.

I’m not trying to devalue the fact that exercise can be a very important part of recovery for a lot of people with chronic illness and with mental issues. I’m not trying to devalue it’s worth. Studies like the ones researched in the article provide important information and have important results that need to be disclosed in their entirety. If you have a mental illness or chronic disease or disorder and you find that exercise helps, then I am not trying to say that you shouldn’t exercise. I’m not trying to say that anyone shouldn’t exercise, I’m just trying to say that if you can’t (and many can’t), articles like these are hard to deal with. And I certainly don’t agree with the notion that we should be pushing it on people and pressuring people to exercise as treatment for mental illness. Even if you know that it shouldn’t be pushed on every individual as a cure all type treatment, when you issue blanket statements like the one that the “Exercise is Medicine” article (and many like it) has made, it’s still a problem. I feel it comes from a place of misinformation and misunderstanding and doesn’t fully consider the consequences of what it’s suggesting. This is especially true since no article I’ve come across about the pro-exercise is medicine stance seems to contain a qualifier that acknowledges the many people like me who find this difficult.

I think exercise is great, it makes me feel good about myself and I have fun doing it when I am physically and mentally able to. I want to exercise, but it’s extremely difficult for me to do it, and it’s even harder when I constantly feel like a failure when I’m unable to, and pushing exercise as a cure all magic pill makes it feel like I’m not trying hard enough. I am trying, and I’m proud of myself. But articles like this make me feel much less proud of myself. I’m not writing this response for the people who believe pushing exercise as treatment like a cure all without knowing the facts is a good idea. I’m not trying to argue with you, and I’m not going to. I’m writing it for the people who read that article and, for whatever reason, are unable to exercise regularly. If you are suffering from a mental illness or chronic illness or whatever else and you have a hard time going to the gym, or even going outside, I understand what you’re going through. I understand how hard it is. I understand the pressures you face and the way articles like these make you feel. Your feelings are valid; I feel them too. Regardless of whether you have trouble or not, you are doing the best you can. You are trying your hardest. You are not a failure because this is difficult for you. You should be commended for how far you’ve come and the hurdles that you’ve crossed. I’m proud of you, and you should be proud of you too.




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Ms. Lacey,
Thank you for engaging in this important issue and sharing your views and experiences. After reading your article, I took the time to find and read the “Exercise is Medicine” article written by Emi Vargatoth. From the way you wrote about Exercise is Medicine I thought that perhaps the original article was over stating the benefits of exercise and making claims that exercise is a magic bullet for disease. That was not the case however. Nowhere in the original article did I see a claim that made it sound like exercise cures everything or that exercise should be prescribed for everything. Nor, to my knowledge, does Exercise is Medicine Canada claim or even attempt to describe “exercise as a cure all magic pill” (your words). Exercise is Medicine (as a multi-national movement) simply wants to provide physicians with resources and information to help them prescribe exercise more appropriately and improve collaboration between physicians and other health professionals. Why? Despite knowing the benefits of exercise, doctors are often not confident in their skill to prescribe exercise (Rogers et al., 2002) and rarely provide anything more than verbal counselling regarding physical activity (such as written prescriptions, assessments of fitness, and/or referrals to other healthcare professionals; Patrella et al., 2007).
We seem to be in agreement (you, myself, and I’m sure Dr. Fowles and the Exercise is Medicine campus club would agree) that exercise, like drugs, is more appropriate and beneficial in some situations than others. However, this situations are the minority of situations. The simple fact is that exercise (which can mean anything from light walking to distance running, yoga to power lifting) is beneficial for most people in most cases. This is supported by numerous studies. For the sake of time I will simply refer to met-analyses which aggregate data from other smaller studies. Exercise has been shown to: decrease depressive symptoms of individuals diagnosed with clinical depression (Cooney et al., 2014; Craft & Landers, 1998, Josefsson et al., 2013 [this one clearly recommends exercise for those individuals with “mild and moderate depression who are willing, motivated, and physically healthy enough to engage in such a program”]), decrease depressive symptoms of chronically ill individuals (Herring et al., 2012), among older adults (Bridle et al., 2012) . Exercise has also been demonstrated to be effective in achieving long-term weight loss along with diet interventions (Wu et al., 2009) and decreasing blood lipid levels (Kelley et al., 2005) in obese populations. Exercise has also be found to reduce mortality, cholesterol, and blood lipids in individuals with coronary heart disease (Taylor et al., 2004). While clearly not covering all conditions, I believe I have presented enough evidence that we can agree that exercise has benefits for a wide range of conditions.
In closing, I, and many others in research and health care professions, can feel confident saying that exercise is indeed medicine and needs to have a more prominent role in the maintaining healthy populations and preventing and managing illness and disease.

Dear Readers,
I thank Ms Lacey and Mr Deal for further conversation around this important issue. As may not have been completely clear in the citations provided in the original article, there is overwhelming and controvertible evidence that physical activity is important and essential for health and well-being across a range of conditions and states. There are numerous meta-analyses and systematic reviews showing that physical activity, in reasonable amounts, prevents the incidence and progression of most chronic diseases by 25-60% (recent reviews by Pedersen and Saltin, 2015 Scand J. Med Sci Sports; and Hoffman et al., CMAJ, 2016 present direct evidence in over 30 conditions). The Hoffman article also acknowledges the evidence that PA and exercise is often overlooked in health care, because many health care professionals lack the knowledge, confidence and know-how to talk to their patients about physical activity or exercise. In my research in this area, most health care professionals report receiving little or no training on PA counseling or exercise in their training, and most feel unprepared to do this as part of regular clinical care. Recent reports show that less than 15% of physicians receive any education on PA or exercise as part of their medical school, whereas 92% of physicians would like more training on the topic (Solmundson et al., 2016 Can Medical Education J). Although half of physicians ‘recommend’ PA as part of regular clinical care, less that 10% provide specific instruction on what to do or how to do it, making the recommendation to ‘be more active’ a very difficult one for people to act on – as your article identifies.

And this is where we all share some very common ground. As Chair of Exercise is Medicine Canada, I understand your perspective and empathize greatly. More than 4 out of 5 Canadians do not get sufficient physical activity for their health, and yet, 80% of chronic disease is mostly preventable by many lifestyle behaviours which include healthy amounts of physical activity. I understand that many people in our society struggle to get sufficient amounts of physical activity because of the many barriers and challenges that people face; from competing demands on time with work and kids, to challenges with resources (for transportation, access or to have a decent pair of shoes), to challenges created by underlying disease. That is where the goal of ‘Exercise is Medicine’ is for physical activity to be an important part of the prevention and management of chronic disease in the Canadian Health Care system, so that more people can lead healthy active, lives. The goal is to educate health care professionals on appropriate counseling around PA, so they understand people that have challenges, and to meet them where they are; i.e. to become a little more active – because the evidence is so clear that moving a little more than what most people do now, benefits almost every aspect of health – not to “tell everybody to exercise”. That is actually what we are trying to change – and is one of the most important outcomes of the Exercise is Medicine initiative ‘ that HCPs who attend workshops and receive education/training in this area, have 25-30% lower barriers to doing PA counseling in clinical practice, and have 25-30% higher confidence in their patients to do PA that may be recommended. That is because we promote and adopt a motivational counseling framework that support patients to find PA that is relevant to them, and help to find resources to support them in the process – such as qualified exercise professionals. The kinesiologists and certified exercise physiologists that graduate from our program have the knowledge, skills, and training to help all people, to become more active by helping to overcome barriers. Ms Lacey mentioned stated ” it’s extremely difficult for me to do it, and it’s even harder when I constantly feel like a failure when I’m unable to.” That is why I believe that more kinesiologists and certified exercise physiologists, are needed in communities to help people where they are, to be more active, as you also state “exercise is great, it makes me feel good about myself and I have fun doing it when I am physically and mentally able to”. Exactly. The whole point of Exercise is Medicine, is to help people such as yourself, to enjoy the benefits of being active, by providing you with the support that you need, when and where you need it. We have examples of this at work from our kinesiology students working with aging individuals with multiple challenges, to cardiac rehab and diabetes populations, to individuals with mental health, to athletes. In each situation, the overwhelming report from participants is that they value the kinesiologists’ being able to help them along the way, guiding them to being a little more active or in specific exercise, so that they can experience the health and wellness that they want. So thank you Ms Lacey for writing your post, if you would like some more support to be more active, just reach out to one of the people in our Exercise Is Medicine on Campus program at Acadia, and I am sure that they would help; to lend you a hand when you need it, or to give you a motivational pep talk if you want it, or just to listen. We can all help each other to be healthier, in a society where there are numerous challenges to do so.