Exercise as medicine

A walk, a cycle ride or a targeted workout – exercise is far more than just a leisure activity. Regular exercise not only keeps you fit, but can also prevent illness, support medical treatment and significantly improve your quality of life. In modern medicine, physical activity has therefore long been regarded as a cornerstone of treatment. The term ‘exercise as medicine’ refers to the targeted, evidence-based use of exercise for prevention, treatment and rehabilitation. Much like a medicine, exercise is ‘prescribed’ on an individual basis: intensity, duration and frequency are tailored to the individual and regularly reviewed throughout the course of treatment. Numerous studies have demonstrated positive effects in relation to cardiovascular diseases, diabetes, obesity, cancer, as well as musculoskeletal and mental health conditions. Othmar Moser from the Division of Endocrinology and Diabetology at the Medical University of Graz is also conducting extensive research into this topic. Among other things, he conducts research into international guidelines on diabetes and sport, as well as the combination of exercise therapy with modern pharmacological approaches. He is also a professor of performance physiology and exercise therapy at the Institute of Movement Sciences, Sport and Health at the University of Graz. A key area of research is the combination of exercise therapy with modern pharmacological treatments to enhance their effectiveness and ensure long-term treatment success: “In our department, for example, we are investigating how exercise therapy can support the effects of incretin-based therapies in obesity, improve treatment adherence in people with type 2 diabetes and oncological conditions, or reduce diabetes-related complications in the long term in people with type 1 diabetes. The aim is to use exercise therapy even more precisely, in a more personalised and disease-specific manner in future,” explains Othmar Moser.

Why whole-body exercise works

Exercise therapy is often referred to as ‘multipotent medication’ – and for good reason. Whilst medicines usually target specific individual processes, exercise affects numerous systems in the body simultaneously. According to Othmar Moser, it is particularly noteworthy that exercise therapy is one of the few therapeutic measures whose benefits have been demonstrated across almost all major disease groups. “Regardless of whether the conditions are metabolic, cardiological, oncological, neurological or orthopaedic, exercise therapy often forms an essential part of treatment.” A key factor lies in the musculature. It is now regarded as the body’s largest endocrine organ. With every muscle contraction, signalling substances – known as myokines – are released; these not only act locally but also influence, amongst other things, the brain, liver, adipose tissue, blood vessels and the immune system. “The simultaneous modulation of metabolic, cardiovascular, immunological and muscular signalling pathways explains why exercise and exercise therapy play a key role in the prevention, treatment and rehabilitation of a wide range of chronic conditions,” says Othmar Moser, describing the comprehensive effects.

Exercise as a form of therapy for chronic conditions 

These biological adaptations are also reflected in measurable health benefits: exercise reduces the risk of cardiovascular disease, improves metabolism and strengthens the immune system. At the molecular level, complex processes play a role here: “During physical exertion, muscle contraction activates insulin-independent signalling pathways, particularly via AMPK. This causes GLUT-4 transporters to be transported to the cell membrane, significantly increasing glucose uptake into the muscles. This mechanism not only improves glucose utilisation in the short term but also increases insulin sensitivity for several hours to days following exercise. At the same time, the contracting skeletal muscles act as an endocrine organ and release myokines such as IL-6, which, in this context, have an anti-inflammatory effect, inhibit the release of TNF-α and activate further anti-inflammatory signalling pathways,” explains Othmar Moser. These effects have been particularly well studied in the context of metabolic diseases. Othmar Moser explains that, particularly in type 2 diabetes and obesity, numerous randomised trials and meta-analyses show that structured exercise and exercise therapy can achieve effect sizes that are comparable to pharmacological interventions in selected areas. This enables clinically relevant improvements to be achieved in blood glucose control, body composition and key cardiometabolic risk factors. At the same time, physical performance, functional capacity and health-related quality of life are improved. It is important to note that exercise and medication are not mutually exclusive. In many cases, they complement each other perfectly and, when used together, lead to better treatment outcomes.

Exercise protects against the onset of disease

The benefits of exercise are not limited to when illness strikes. Regular physical activity is one of the most effective preventive measures. “Based on extensive epidemiological studies and meta-analyses, higher levels of physical activity are associated with a lower risk of type 2 diabetes, obesity, cardiovascular disease, certain cancers, dementia, depression and premature mortality,” explains Othmar Moser.
There is a clear dose-response relationship here: the more exercise, the greater the benefit. However, the greatest health benefit is achieved simply by making the transition from inactivity to regular exercise.
But can exercise be prescribed like a medicine? From a medical point of view, the answer is: yes. Exercise therapy is increasingly being tailored to the individual – much like drug treatment. “This is based on an initial medical examination and performance assessment procedures to measure cardiorespiratory fitness, muscle strength and functional capacity. Based on these results, the intensity, duration, frequency and type of training are determined individually according to the principle of the dose-response relationship and regularly adjusted over time,” says Othmar Moser. A combination of endurance and strength training is particularly recommended: “Both forms of training elicit different, complementary physiological adaptations and, together, achieve the greatest health benefits,” emphasises Othmar Moser. This potential is also evident in practice: according to the expert, the clinical successes to date, the high adherence rate of over 80 per cent and the extremely positive feedback from patients all underscore the benefits of a structured and personalised exercise therapy. Another key to success is interdisciplinary collaboration. Othmar Moser stresses that the best results are achieved when medical treatment, exercise therapy, nutritional medicine and psychological support are closely integrated.

Can you ever do too much exercise?

Like any form of therapy, exercise can also carry risks if the dosage is incorrect – such as injuries or strain-related complaints. Othmar Moser makes it clear, however, that the available evidence shows that the health benefits of structured exercise therapy far outweigh the potential risks. A genuine ‘overdose’ is rare under professional supervision.
Through individualised programmes and medical supervision, risks can be effectively managed – whilst a lack of exercise has far more serious consequences for health.

Every step counts

The scientific evidence is clear: exercise is one of the most effective measures for health and healthy Aging. “If I had to prescribe exercise, the prescription would look similar to that for drug therapy: First, a medical examination is carried out; based on this, a personalised exercise programme is prescribed, which in most cases comprises a combination of endurance and strength training. The key factors are the correct intensity, duration and frequency, as well as regular adjustments over time,” summarises Othmar Moser. At the same time, it’s never too late to get active. Even small changes can have a big impact. The key is to find a form of exercise that you enjoy and that fits into your daily routine in the long term. After all, hardly any other measure has such a wide-ranging impact on health, quality of life and healthy aging as regular exercise.

What happens in the body when we exercise?

During physical activity, the muscles absorb more glucose from the blood and use it as a source of energy. This improves blood sugar regulation and increases the cells’ insulin sensitivity – an effect that lasts for hours or even days after exercise. At the same time, the working muscles release myokines. These promote anti-inflammatory processes, support metabolism and contribute to recovery. Overall, exercise thus improves glucose homeostasis, increases metabolic flexibility and can reduce chronic inflammation.