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Physical inactivity affects the health not only of many obese patients, but also people of normal weight, such as workers with desk jobs, patients immobilized for long periods after injuries or surgery, and women on extended bed rest (http://www.mayoclinic.com/health/pregnancy/PR00107) during pregnancies, among others, Dr. Joyner says. Prolonged lack of exercise can cause the body to become deconditioned, with wide-ranging structural and metabolic changes: the heart rate may rise excessively during physical activity, bones and muscles atrophy, physical endurance wane, and blood volume decline.
When deconditioned people try to exercise, they may tire quickly and experience dizziness or other discomfort, then give up trying to exercise and find the problem gets worse rather than better.
"I would argue that physical inactivity is the root cause of many of the common problems that we have," Dr. Joyner says (http://www.drmichaeljoyner.com/newsroom/). "If we were to medicalize it, we could then develop a way, just like we've done for addiction, cigarettes and other things, to give people treatments, and lifelong treatments, that focus on behavioral modifications and physical activity. And then we can take public health measures, like we did for smoking, drunken driving and other things, to limit physical inactivity and promote physical activity."
Texas Health Presbyterian Hospital Dallas (http://www.texashealth.org/landing.cfm?id=115) and University of Texas Southwestern Medical Center (http://www.utsouthwestern.edu/index.html) researchers found that three months of exercise training can reverse or improve many POTS symptoms, Dr. Joyner notes. That study offers hope for such patients and shows that physicians should consider prescribing carefully monitored exercise before medication, he says.
If physical inactivity were treated as a medical condition itself rather than simply a cause or byproduct of other medical conditions, physicians may become more aware of the value of prescribing supported exercise, and more formal rehabilitation programs that include cognitive and behavioral therapy would develop, Dr. Joyner says.
For those who have been sedentary and are trying to get into exercise, Dr. Joyner advises doing it slowly and progressively.
"You just don't jump right back into it and try to train for a marathon," he says. "Start off with achievable goals and do it in small bites."
There's no need to join a gym or get a personal trainer: build as much activity as possible into daily life. Even walking just 10 minutes three times a day can go a long way toward working up to the 150 minutes a week of moderate physical activity the typical adult needs, Dr. Joyner says.
Re: Should doctors treat lack of exercise as a medical condition?
Good article. Views of which are well overdue. Lack of exercise & poor diet are the two major causes/influences of diseases. Not partaking in exercise & eating whatever tastes good go hand in hand & conveniently provides an environment of keeping people within their comfort zone... having major adverse implications on the cardiovascular system & the digestive system; providing an internal environment for disease (i.e. high acidity). Is it any wonder that there is so much disease/cancer out there... & genes play a very small role... hence it is simply poor (lazy) lifestyle choices.
We as Podiatrists should be well aware of this being that systemic conditions usually have implications on the lower limb hence why they visit or have been referred to us. I always try to put across the importance of exercise & appropriate food choices to my patients. Some give me a glazed look, some don't want to hear it, for some it goes through one ear & out the other & some consider an alternative... as their current lifestyle hasn't done them much good as far as health & vitality is concerned.
I usually say... "you are more likely to rust out than wear out" after they question the need (or provide an excuse) to exercise. There really does need to be another National campaign on this topic... once again, as people have very little idea (&/or forget)... like there was when I was a young child - "Life Be In It” (Australia)...
I know there is one showing at the moment (i.e. balloon man) from time to time but it really needs more substance.
Re: Should doctors treat lack of exercise as a medical condition?
I often despair at the natural inclination of the human species to slothfulness. I have sat in many Public Health forums, designed to look at ways we can increase the incidental exercise of the community. My fellow attendees often a group of soft, middle-aged, busy health workers who have driven to the meeting, work long hours and get no exercise themselves try to make our communities more exercise friendly. On these occaissions I challenge those at the meeting to advise how much exercise they have managed themselves in the last week. There is often an embarrassed silence- It is as if the changes they expect of the "public" is for some other class of people not themselves.
I am not sure how we reverse the trend- behavioral change should be part of the tool box of every health worker, assiting patients self efficacy in regard to exercise is very important
Re: Should doctors treat lack of exercise as a medical condition?
I think we all here should know that “lack of exercise” in & of itself isn’t a medical condition... just like smoking in & of itself isn’t a medical condition & continually eating junk food isn’t a medical condition in & of itself... but the ramifications of these popular lifestyle choices have far reaching adverse health problems (costing billions of dollars & much pain) that need to put into the equation of optimal medical treatment... as they have clear correlation to the likes of obesity, CVD, diabetes etc...
"Lack of exercise" is probably not held in the same light as the more established/regarded poor lifestyle choices such as smoking... hence the article & the alarmist title.
It may seems like common sense for some but one thing we can all probably agree on is that this type of "sense" isn’t all that "common" at all... hence to get to the crux of the issue maybe we can also put “common sense” into the equation also (then we also cross over into psychology/psychiatry).
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Originally Posted by drsha
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Originally Posted by BEN-HUR
"you are more likely to rust out than wear out"
Rusting Out.... I love it
Do I quote you as coining it?
Dennis
Hi Dennis, no I certainly can’t say I coined the phrase. I thought it was a rather popular phrase – probably more so within the mechanical world than the physiology world. Yet the same/similar principles apply here with us humans. Another phrase closely associated with the... "you are more likely to rust out than wear out" would be... “if you don’t use it you will lose it” which is probably more popular phrase within the physiology realm.
Re: Should doctors treat lack of exercise as a medical condition?
Excerise should be a module in out training package, just being able to provide simple exercise packages similar to what physiotherapists provide, suitable for each person or conditions presented would help mobility as many older patients simply give up or forgot what they can achieve..
Re: Should doctors treat lack of exercise as a medical condition?
Quote:
Originally Posted by tracy lockwood
Excerise should be a module in our training package, just being able to provide simple exercise packages similar to what physiotherapists provide, suitable for each person or conditions presented would help mobility as many older patients simply give up or forgot what they can achieve..
Tracy:
Very powerful dreams you have.
But do you have direction and applications for your dreams and are they being fostered by tissue stress biomechanics, the current EBM or, dare I say it, The Podiatry Arena faithful?
What if there was a system where your patients could be profiled and classified one of a subgroup of foot types as a starting platform in practice for custom care instead of whatever you currently perform?
What if instead of the hodgepodge of biomechanics language which is difficult to understand or teach to others, someone reworked it into a communication set that could be better understood and taught to the masses and sophisticated scientists and researchers alike?
What if once you diagnose a patients subset, as a practitioner with skill to customize a program of closed chain care, you selected an optimal functional position for casting an orthotic shell along with a foot type specific starting menu of postings, cutouts and other ORF's for providing that custom care?
What if you then, presented the patient with I or II Levels of Compensatory Threshold Training that would train their supporting and powering lower extremity muscles using custom MERF's that fostered Wolf's and Davis' Laws to "reverse" developmental biomechanical changes the same way they developed?
What if you demonstrated and then monitored that program, like the physiotherapists in your dream?
What if you then educated and partnered with MD's, PT's, Chiro's, exercise trainers, yoga practitioners, etc in your community with whom you could cross refer in order to take your patients to an even higher level of your dreams with even better outcomes?
What if you had marketing tools like posters/brochures/pamphlets and well thought out hand-outs to educate patients, the MD community and the foot and postural suffering public as to what you are capable of doing and why they should seek your care?
What if you patented and trademarked this plan so that others couldn't dilute/bastardize or imitate it allowing it to grow and thrive, be researched and be promoted to maximize its health benefits to mankind?
What if it was also, as a sidebar, a profitable plan?
Re: Should doctors treat lack of exercise as a medical condition?
Quote:
Originally Posted by drsha
Tracy:
What if there was a system where your patients could be profiled and classified one of a subgroup of foot types as a starting platform in practice for custom care instead of whatever you currently perform?
What if instead of the hodgepodge of biomechanics language which is difficult to understand or teach to others, someone reworked it into a communication set that could be better understood and taught to the masses and sophisticated scientists and researchers alike?
What if once you diagnose a patients subset, as a practitioner with skill to customize a program of closed chain care, you selected an optimal functional position for casting an orthotic shell along with a foot type specific starting menu of postings, cutouts and other ORF's for providing that custom care?
What if ....
What if it was also, as a sidebar, a profitable plan?
Would you send me a cast?
Dennis
What if you bottled some snake oil and made up a bunch of wonderful things that the snake oil could do. Just drink it and don't ask any questions. Someone will make some money.
Eric
The Following User Says Thank You to efuller For This Useful Post:
Re: Should doctors treat lack of exercise as a medical condition?
Quote:
Originally Posted by Eric Fuller
What if you bottled some snake oil and made up a bunch of wonderful things that the snake oil could do. Just drink it and don't ask any questions. Someone will make some money.
Just for you, Eric.....
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: Should doctors treat lack of exercise as a medical condition?
Quote:
Originally Posted by Kevin Kirby
Just for you, Eric.....
Thanks, Kevin.
I'm pretty sure that my contracted cords would feel better after drinking the snake oil than if I sent Dennis a cast. He still hasn't said what he'd do differently with that cast.
Re: Should doctors treat lack of exercise as a medical condition?
I think that rather than trying to answer this particular question the debate should be enlarged to include more general questions on the topic of medicalisation.
What is the function of medicine? What can be medicalised? How does something become medicalised? What are the individual advantages /disadvantages of medicalisation? What are the alternatives to medicalisation? What are the advantages/disadvantages for the medical profession of increasing medicalisation?
In France, if you want to play any sport competitively you must be insured. Before you can be insured you must be healthy enough to play in competitions. Who decides whether or not you can play your sport competitively? Your doctor of course.
Is this form of social control necessary? Is it good for the individual or for society?Is it an intrusion upon the liberty of the individual, eg if I am prepared to take the chance of having a heart attack while I am playing football should I be allowed to? Are doctors able to predict the risks so accurately that they can reasonably make these decisions?
Bill
The Following User Says Thank You to wdd For This Useful Post:
Re: Should doctors treat lack of exercise as a medical condition?
I think this is the first serious post I have made, so I hope it's of at least some use!
My biggest problem that I have with medicalising things like lack of exercise is that I would imagine it turns something that one afflicts oneself with (through poor habits/discipline) into something that one is afflicted WITH (by fate etc).... Although I have never taken one of these patients myself I have had a good chuckle hearing from people who's patients 'have obesity' in the same way that they might pick up a common cold, or be born with blue eyes. It would almost appear the understanding of their condiation has a complete removal of cause from affect!!
By medicalising lack of exercise, I could only imagine that more and more people will simply feel that their lack of drive is not something that they themselves can control, but something that requires counselling, pharmacotherapeutics or whatever ends up being the way they decide to go. Of course, good practitioners always try to involve the patient in whatever way they can in therapies but I would fear that even so, self responsibility would decrease in a lot of individuals if it became a 'Medical Diagnosis'
As far as the argument that says medicalising it will better allow us to treat it.....
We are already encouraging patients to maintain fitness and assisting them in whatever capacity we can as Podiatrists, we already have dietitians and PTs and medical practitioners specialising in fitness readily available to the public and we already have the Public health sector going overtime educating people about how healthy exercise is. There are plenty of aspects about this system that need working on, sure, but the fact is if people don't have the discipline and desire to go and use these resources, how on earth are they going to sustain the effort required for a lifetime of healthy living, particularly if their situations change and shock horror things get MORE difficult?
Enough of this (probably naive and perhaps a little too unsympathetic) rant.... simply said I feel that medicalising lack of exercise will do just that, make it OUR problem and even less of their's than it is now.
Re: Should doctors treat lack of exercise as a medical condition?
Quote:
Originally Posted by Lachw89
I think this is the first serious post I have made, so I hope it's of at least some use!
My biggest problem that I have with medicalising things like lack of exercise is that I would imagine it turns something that one afflicts oneself with (through poor habits/discipline) into something that one is afflicted WITH (by fate etc).... Although I have never taken one of these patients myself I have had a good chuckle hearing from people who's patients 'have obesity' in the same way that they might pick up a common cold, or be born with blue eyes. It would almost appear the understanding of their condition has a complete removal of cause from affect!!
By medicalising lack of exercise, I could only imagine that more and more people will simply feel that their lack of drive is not something that they themselves can control, but something that requires counseling, pharmacotherapeutics or whatever ends up being the way they decide to go. Of course, good practitioners always try to involve the patient in whatever way they can in therapies but I would fear that even so, self responsibility would decrease in a lot of individuals if it became a 'Medical Diagnosis'
As far as the argument that says medicalising it will better allow us to treat it.....
We are already encouraging patients to maintain fitness and assisting them in whatever capacity we can as Podiatrists, we already have dietitians and PTs and medical practitioners specializing in fitness readily available to the public and we already have the Public health sector going overtime educating people about how healthy exercise is. There are plenty of aspects about this system that need working on, sure, but the fact is if people don't have the discipline and desire to go and use these resources, how on earth are they going to sustain the effort required for a lifetime of healthy living, particularly if their situations change and shock horror things get MORE difficult?
Enough of this (probably naive and perhaps a little too unsympathetic) rant.... simply said I feel that medicalising lack of exercise will do just that, make it OUR problem and even less of theirs than it is now.
Lachw89:
Your posting certainly has value for me.
I took the liberty to right click on words in your post that have a red underlining to correct spellling (right click on spellling to correct) of recognized words as you create, edit or quote them. Once you click submit, the red underlinings disappear and your posting suffers.
That leaves you with words that are red underlined that are not recognized as words like medicalising (which is your attempt to get a word that clarifies a concept that needs better defining and deserves to be printed here on The Arena). This includes biomechanics, PT's and pharmacotherapeutics as well as SALRE and dorsiflectory or plantarflectory (as in stiffness).
In general, The Arena allows these red underlined acronyms, new words and currently unaccepted words that one is trying to get accepted that relate to their agenda and deride others that ability as they bully or defame those with opposing views them off the site (witness the infantile snake oil stuff on this thread). So be prepared to be personally bombarded by the same 6-7 posters if your philosophy, work or theories don't conform.
That said, I have years of anecdotal clinical success and as a blogger setting up and calling for networking partnerships with or without walls that comprise a biomechanically oriented podiatrist, a lower extremity specialized foot and ankle surgeon (DPM or MD) and a therapist with expertise in functional lower extremity prehab and rehab and in compensatory threshold training (physical therapist, yoga practitioner, Pilates trainer, exercise therapist or trainer, chiropractor) under the umbrella of Wellness Biomechanics
This team can then each function as primary or consultation performers and as a team provide a Custom foundational platform for the exercise pillar of a structured fitness/diet/medical health tripod medicalisation program.
I prefer to think that I am leading an Acculturation or Socialization of Biomechanics.
Re: Should doctors treat lack of exercise as a medical condition?
Lack of exercise is no more a medical condition than eating junk food is a medical condition. However, since exercise has been known for decades to be therapeutically beneficial with a minimum of side effects, then not exercising regularly will increase the health risk of certain pathologies for individuals.
Even though we, as podiatrists, are only legally allowed to treat a certain area of the human body, as healthcare professionals we are still responsible for the general well-being of our patients. In that regard, we need to inform our patients of the health risks that they face by making poor lifestyle choices such as exercising too little (or too much) or eating the wrong foods (or too much).
My practice philosophy is that if I can prescribe something that has the greatest amount of potential therapeutic benefits with the least amount of potential detrimental side effects and also costs nothing or very little, then I am providing a valuable service by recommending this to my patients. That is why I discuss the importance of exercise with nearly all my patients since, when done regularly, it improves both physical and mental health, causes very few side effects and is inexpensive. I feel that is part of my job as a healthcare provider that has taken an oath to try to heal the individuals who seek my medical expertise. Podiatrists need to be part of this healthcare team that strongly recommends the benefits of regular exercise to our patients for the benefit of their health and well-being. If you are not already doing this as a podiatrist, then, in my opinion, you are not doing enough for your patients.
Is lack of exercise a medical condition? No. But lack of exercise, will, over time, increase the risk of medical conditions developing that will ultimately injure, cause pathology or decrease the quality of life of the individual. We, as podiatrists, need to see to it that our patients understand the many health benefits of regular exercise so they can be properly informed of the best lifestyle choices for their health and continued well-being.
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Clin Geriatr Med. 1992 Feb;8(1):35-50.
Benefits of exercise for older adults. A review of existing evidence and current recommendations for the general population.
Elward K, Larson EB.
Abstract
Currently available data are of variable rigor and from a variety of sources, yet they do support several conclusions about the potential value of exercise for whole groups of elderly persons. (1) Exercise of moderate intensity may benefit many elderly persons in numerous and complementary ways (e.g., cardiovascular status, fracture risk, functional ability, and mental processing). (2) There are few complications associated with such increases in activity. Indeed, a remarkable aspect of research on exercise in the elderly has been the virtual absence of reports of serious cardiovascular or musculoskeletal complications in any published trials. Cardiac rehabilitation programs, enrolling many persons over 65 years of age with known coronary artery disease, also report few major cardiovascular complications. Thus, exercise should be viewed as safe for most older adults. (3) Exercise in the elderly probably needs to be tailored, and when possible, individualized, with the specific objectives of the person or group in mind. Some benefits are probably related to the intensity of exercise (e.g., cardiovascular disease), others due to the type of exercise (weight-bearing versus nonweight-bearing for osteoporosis, or racket sports for hand-eye coordination), and still others possibly relate to the setting in which exercise occurs (social-psychological benefits). (4) The authors believe the known physiologic effects of exercise on age-related changes and existing clinical research support the general notion that vigorous weight-bearing exercises such as walking are the safest, cheapest, easiest, and most widely beneficial for the average senior. (5) Research has yet to define good ways by which to stimulate large numbers of sedentary elderly persons to exercise regularly. The potential and complementary benefits appear to be great enough to justify widespread efforts at the community and individual level, however.
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Current Opinion in Psychiatry:
March 2005 - Volume 18 - Issue 2 - p 189-193
Exercise and well-being: a review of mental and physical health benefits associated with physical activity
Penedo, Frank J; Dahn, Jason Ra
Abstract
Purpose of review: This review highlights recent work evaluating the relationship between exercise, physical activity and physical and mental health. Both cross-sectional and longitudinal studies, as well as randomized clinical trials, are included. Special attention is given to physical conditions, including obesity, cancer, cardiovascular disease and sexual dysfunction. Furthermore, studies relating physical activity to depression and other mood states are reviewed. The studies include diverse ethnic populations, including men and women, as well as several age groups (e.g. adolescents, middle-aged and older adults).
Recent findings: Results of the studies continue to support a growing literature suggesting that exercise, physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes. Generally, participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions. Similarly, participants in randomized clinical trials of physical-activity interventions show better health outcomes, including better general and health-related quality of life, better functional capacity and better mood states.
Summary: The studies have several implications for clinical practice and research. Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes. Therefore, assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several populations. Several limitations were noted, particularly in research involving randomized clinical trials. These trials tend to involve limited sample sizes with short follow-up periods, thus limiting the clinical implications of the benefits associated with physical activity.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: Should doctors treat lack of exercise as a medical condition?
Quote:
Originally Posted by Kevin Kirby
My practice philosophy is that if I can prescribe something that has the greatest amount of potential therapeutic benefits with the least amount of potential detrimental side effects and also costs nothing or very little, then I am providing a valuable service by recommending this to my patients. That is why I discuss the importance of exercise with nearly all my patients since, when done regularly, it improves both physical and mental health, causes very few side effects and is inexpensive. I feel that is part of my job as a healthcare provider that has taken an oath to try to heal the individuals who seek my medical expertise. Podiatrists need to be part of this healthcare team that strongly recommends the benefits of regular exercise to our patients for the benefit of their health and well-being. If you are not already doing this as a podiatrist, then, in my opinion, you are not doing enough for your patients.
Yes, good point - I do likewise.
I think the following cartoon is quite appropriate for this thread... maybe I could use something similar, strategically placed in my waiting room ... not sure how that would go down though ....
Re: Should doctors treat lack of exercise as a medical condition?
Obesity, cigarette smoking, high cholesterol and high blood pressure are all medicalised so why not add lack of exercise to the list.
Should we also medicalise poverty?
As the size of the medical domain increases does the political power of medicine increase proportionately? Is it a good thing?
The increasing sphere of influence of medicine, associated with the move from treating frank disease to treating the causes of disease, ie preventative medicine, is problematic and needs discussion.
Is preventative medicine a good thing full stop or does it need parameters?
Re: Should doctors treat lack of exercise as a medical condition?
Press Release: Couch-potato kids are biggest child health problem in the U.S., adults say
‘Not enough exercise’ cited as top children’s health concern, obesity second, according to U-M’s National Poll on Children’s Health annual top 10 list
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ANN ARBOR, Mich. – Adults across the U.S. rate not getting enough exercise as the top health concern for children in 2012, according to a new University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health.
In the poll’s annual top 10 list, a nationwide sample of adults were asked to identify the top 10 biggest health concerns for kids in their communities.
For the first time, not enough exercise was rated by most adults at the top of the list (39 percent). That was followed closely by childhood obesity (38 percent) and smoking and tobacco use (34 percent).
“Childhood obesity remains a top concern, and adults know it is certainly linked to lack of exercise,” says Matthew M. Davis M.D., M.A.P.P., director of the C.S. Mott Children’s Hospital National Poll on Children’s Health. “The strong perception that lack of exercise is a threat to children’s health may reflect effective recent public health messages from programs such as First Lady Michelle Obama’s ‘Let’s Move’ campaign.
“But adequate exercise offers many more benefits other than weight loss or preventing obesity – such as better attention and learning in school and improved sense of well-being,” says Davis, associate professor of pediatrics and internal medicine at the U-M Medical School and associate professor of public policy at the Gerald R. Ford School of Public Policy.
The rest of the poll results were:
4. Drug abuse (33 percent)
5. Bullying (29 percent)
6. Stress (27 percent)
7. Alcohol abuse (23 percent)
8. Teen pregnancy (23 percent)
9. Internet safety (22 percent)
10. Child abuse and neglect (20 percent)
“The strong connection of many of the top 10 child health concerns to health behaviors among children and adolescents underscores the importance of public programs and communication initiatives — for example, those designed to prevent drug abuse, tobacco use, alcohol abuse and teen pregnancy,” Davis says.
The poll’s results varied based on race/ethnicity. Hispanic adults were more likely to rate childhood obesity first (44 percent), followed by not enough exercise (38 percent), and also rated drug abuse higher than smoking and tobacco use. Black adults had higher levels of concern about smoking and tobacco use, ranking that most often (43 percent). They also had high levels of concern about racial inequality, ranking it seventh on the list, and gun-related injuries, ranking that ninth. Black and Hispanic adults both identified sexually transmitted infections as a greater concern for kids in their communities than did white adults.
“Child health varies across communities, and these results emphasize a need for local programs that respect and address community-specific health priorities for youth,” Davis says.
Re: Should doctors treat lack of exercise as a medical condition?
Quote:
Originally Posted by wdd
Obesity, cigarette smoking, high cholesterol and high blood pressure are all medicalised so why not add lack of exercise to the list.
Should we also medicalise poverty?
As the size of the medical domain increases does the political power of medicine increase proportionately? Is it a good thing?
The increasing sphere of influence of medicine, associated with the move from treating frank disease to treating the causes of disease, ie preventative medicine, is problematic and needs discussion.
Is preventative medicine a good thing full stop or does it need parameters?
Bill
This debate in the U.S. is largely controlled by the insurance companies, the pharm industry and the government in the sense that if these mega-powers choose not to fund or pay for prevention, performance enhancement and quality of life upgrading, then the only way one can get them is to pay out-of-pocket.
Prevention is future thinking and the CEO's and politico's are more interested in the next quarter or election.
EBM has become a means by which these groups can refuse payment or services as prevention is difficult to prove if at all.
Salutogenesis vs. Pathogenesis, Wellness vs. Get Sickness and Homeopathy vs Allopathy are buzzwords that divide and polarize the sides like so many other issues.
The bottom line is that we, the doctors, are not in control of the future of this debate, even though we are at its heart and soul.
My leanings have changed from the latter to the former as I have matured. Where do you live?
Re: Should doctors treat lack of exercise as a medical condition?
Quote:
Originally Posted by drsha
This debate in the U.S. is largely controlled by the insurance companies, the pharm industry and the government in the sense that if these mega-powers choose not to fund or pay for prevention, performance enhancement and quality of life upgrading, then the only way one can get them is to pay out-of-pocket.
Thanks drsha, that's more the direction I hoped things might take. You've highlighted a number of players with a vested interest in 'exercise levels'.
I would want to extend the list of players slightly, to include the individual, medicine, business in general and government. I have separated medicine from business because in Britain medicine is only lately following the American model.
Prevention is future thinking and the CEO's and politico's are more interested in the next quarter or election.
EBM has become a means by which these groups can refuse payment or services as prevention is difficult to prove if at all.
Salutogenesis vs. Pathogenesis, Wellness vs. Get Sickness and Homeopathy vs Allopathy are buzzwords that divide and polarize the sides like so many other issues.
The bottom line is that we, the doctors, are not in control of the future of this debate, even though we are at its heart and soul.
This is part of my dilema. Many of the postings in this thread point the finger at the individual suggesting slothfulness, laziness, stupidity but what is the responsibility of the other players, ie medicine, business and the government?
What I would call free exercise (exercise that you take as an integral part of other activities, eg walking to and at work, lifting things at home and at work, climbing stairs, etc. has been designed out of our lives. Starting just after the second world war the idea of 'labour saving' took hold. That meant washing machines, dishwashers, vacuum cleaners in the home and automation at work. Then as now the idea of luxury was and is frequently associated with increased inactivity. The car, which must take a large responsibility for todays levels of inactivity and related obesity, was originally a luxury item. Luxury models nowadays still focus on taking less and less physical effort. The seat is adjusted automatically, the windows operate automatically, you don't even have to pick up a map book and turn the pages.
At the time when the idea of 'labour saving' took hold people, men and possibly more so women, spent too much time as drudges. However over the decades there has been a blind acceptance of, 'physical work as bad' and leisure as being for many synonymous with physical inactivity.
Who gains from the increasing inactivity and obesity of the population of the developed world? I would suggest business and medicine gain financially and that the indiviual is on to a hiding to nothing. There are tremendous financial gains to be made by business and medicine from physical inactivity of the population and even greater financial gains to be made if the physical inactivity is interspersed with short term but fruitless bursts of activity.
What's the governments role in this? That depends on your politics but it's possible to see that government could intervene say in the planning and design of shopping malls and offices to ensure that say, car parks were a certain minimum distance from buildings, lifts and escalators were minimised and were designated for the handicapped?
However that would potentially increase the level of 'free exercise' and another feature of free exercise is that it doesn't cost the individual in financial terms. That is unattractive both to business and an increasing part of the population who are seduced by commercialism.
My leanings have changed from the latter to the former as I have matured. Where do you live?
Like you my leanings have changed as I have aged (matured might be a bridge too far for me). However as it seems to me that as it is in the interest of business and medicine to maintain or exacerbate levels of inactivity and obesity, with the individual playing a role somewhere between a victim and a cash cow, that only leaves government to do something about the problem? In western world governments where does the power balance lie between government and business and within governments where does the power blanace lie between national interest and self interest?
More and more I see decreasing physical activity and growing obesity as indicators of the success of runaway capitalism. The operative word is 'runaway'.
Born in Scotlan and lived a large part of my working life in England and now live in France.
Re: Should doctors treat lack of exercise as a medical condition?
I think a little professional self-interest is called for here.
Why should medicine be the only profession to gain from the advancing obesity pandemic?
How about seeding the idea that obesity is the result of 'excessive' subtalar joint pronation and that normal body weight can be attained, without effort, by visiting a podiatrist and buying a pair of orthoses - preferably a new pair every six months?
Should doctors treat lack of exercise as a medical condition?
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