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Physical activity as a first line of defense

When I first began schooling in exercise science I wanted to train athletes. Most young personal trainers just starting out would say the same thing. “I want to help athletes reach new peaks in their performance and prevent injuries!” It’s an awesome career path.

As time passed, however, I had some perspective-changing realizations about my potential impact as a fitness professional. I realized that over half of our country’s population has a chronic disease, which is the leading cause of death in the nation.

The CDC says that currently 4 in 10 adults have 2 or more chronic diseases. As you can imagine, the number of collegiate or professional athletes walking around is much lower. I realized that I didn’t really want my career path to help a few, but rather, to help a lot of people. And a lot of people take prescription medications for pathologies that are preventable or reversible. So things shifted…and now I’m still pushing exercise. Only now, it’s exercise as medicine. Good nutrition is absolutely essential in preventing chronic disease and improving quality of life, but for now I am going to speak on physical activity.

The Miracle Drug

It’s happening slowly, but little by little, health care is becoming more holistic. Preventative medicine is peering out from behind conventional medicine’s tight corner and practitioners are focusing more attention on patient lifestyles. It’s still an uphill battle though, in a culture where symptom treatment is so much more lucrative than prevention. Exercise is Medicine, a program launched by the American College of Sports Medicine (ACSM) and the American Medical Association (AMA), is designed to increase doctor-patient conversation around physical activity levels and connect them with exercise specialists who can help. The creators of this program call exercise the miracle drug, because the proven benefits of physical activity “can be as powerful as any pharmaceutical agent in preventing and treating a range of chronic diseases and medical conditions” (

If you do a simple internet search you will find an overwhelming amount of research linking physical activity to the prevention and/or reversal of chronic disease. It’s not breaking news. We know that exercise is good for us. But I think that with many people, there is a disconnect somewhere along the line between that general statement and their own personal potential to prevent disease. This is why the importance of doctor-patient discussion of physical activity levels cannot be understated. Imagine this: A healthcare professional walks into the room where a patient is waiting to discuss some routine lab results. After a serious of questions and review of the test results, it’s apparent to the doctor that this patient presents a few risk factors that can lead to heart disease and diabetes. They discuss the patient’s diet and recommendations are made.

The doctor then asks a series of questions to assess physical activity levels, which reveals that the patient’s PA levels are well below the suggested guidelines. He shows her the current guidelines and some simple ways to meet them throughout the week. He then explains to the patient how exercise can improve heart health, blood flow and brain function, prevent stroke and diabetes, and many other benefits. He hands the patient a guide to increasing physical activity as well as referrals to local community programs, professionals, and resources to help her select activities and programs that look fun. He writes an easy to understand prescription for physical activity, and sets up a follow-up appointment to assess progress and need for further intervention.

You may have had a primary care visit like this, or perhaps this seems unrealistic. There are many professionals out there currently trying to shift our health care paradigm to put more power in the hands of the patient. That must begin with education. As a fitness professional, I’m all for it. This is NOT to say that medications or other treatments are not necessary for some people. However, it is clear that physical activity should be included in the first line of defense against chronic disease. Let’s get more specific for a moment with just one example.

Type 2 Diabetes

Diabetes impairs the body’s ability to either produce or effectively use insulin, a key hormone for moving glucose from the bloodstream to the working muscles. Diabetes is currently ranked as the 6th leading cause of death in the United States according to the CDC. The most common type is Type 2 diabetes. We’ve known for a long time now that physical activity improves insulin sensitivity, meaning that more glucose can be taken up into the cells and used.

Physical activity also naturally increases the need for that glucose, which helps to regulate blood sugar levels. It also lowers LDL (bad) cholesterol and increases HDL (good) cholesterol which is important since heart disease and diabetes are so closely correlated. The American Heart Association (AMA) says that “Adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes.” Physical activity is extremely important in reducing the risk of both of these chronic diseases. The AMA also suggests that “any type of moderate and/or vigorous intensity, aerobic physical activity—whether sports, household work, gardening or work-related physical activity” is effective.

The intensity and duration of physical activity for diabetics should vary depending on which type they have, whether or not they are at risk for other chronic diseases, and medications they may be taking. However for general populations who are type 2 diabetic or pre-diabetic, most sources suggest moderate intensity exercise accumulating to 150 minutes or more weekly. Frequency is important, since the improved insulin sensitivity lasts for about 24-48 hours.

For that reason the ADA recommends shorter, more frequent bouts of exercise (no more than 2 days apart) over infrequent long ones.

Parking a little farther from the door at Costco

I think one factor that causes people to rely more on treatment than prevention is a misunderstanding regarding what qualifies as “physical activity.” For many people who don’t have an established exercise routine, the idea of going to the gym, taking a group fitness class, or even going for a power-walk may seem daunting. I can speak for myself and other fitness professionals when I say that we need to be careful that we are not putting movement and physical activity into too small a box.

When we advocate for PA we should encourage movement through whatever means invites and excites each unique person. And for the reader who is interested in reducing their own risk of chronic disease: whatever physical activity you DO, is the right one for YOU. In other words, make it fun. Small actions that give you that proud, confident feeling are the way to go.

Parking a little further at Costco, for example, may significantly add to your weekly steps taken Inviting a friend whom you normally sit and have coffee or tea with to go on a light walk by the ocean instead is another example. It does not have to be excruciating, to count. One small increase will lead to another, and another.

Did you know there are even gaming consoles designed to increase physical activity in adults? The ADA actually suggests these “Exergames” as “an ideal way to break sedentary habits, especially for older adults with diabetes.” You may be surprised to discover just how many ways there are to increase your physical activity levels and reduce your risk of chronic disease!

Exercise to enjoy life longer

We all want to enjoy living life for as long as possible. Don’t wait until symptoms present themselves to become physically active. It’s a fact that the leading causes of death in our country are all impacted by physical activity, something that every single one of us has access to. Whether your healthcare provider prescribes it or not, you already have the most potent medicine at your finger tips. Let’s treat exercise as medicine and enjoy life longer.


Cynthia Fowler is a certified personal trainer (NASM), corrective exercise specialist (NASM), registered vinyasa yoga teacher (RYT 200), certified Enhance fitness teacher, group exercise instructor (TRX, Indoor cycling, HIIT, SMR, etc), owner of FoundationUp Fitness, blogger, and health coach. Cynthia can be contacted through her website at or directly at
Source: The Garden Island

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