Exercise is a health issue so let's help people get moving
Written by Professor Garry Jennings
Had you been an older person with high blood pressure as late as the 1980s, you would have found yourself given medication and told not to exert yourself, to avoid excitement, and importantly, avoid strenuous activity.
What a long way we have come. While medication still has an important role to play in the management of high blood pressure, we now know that inactivity not only contributes to high blood pressure, but continued inactivity will exacerbate the condition. We tell patients now to move — walk, ride a bike, do the gardening, even go to the gym, depending on their physical capacity, if they want to improve their health and manage their blood pressure.
Clinical and scientific studies confirm the myriad benefits of exercise on a range of conditions — from depression to type 2 diabetes. Studies show the changes in cells brought on by exercise help us better understand what common wisdom told us — going for your daily constitutional is the key to happiness and health.
We know that activity lowers blood pressure, lowers blood glucose levels, improves blood fats and, importantly, protects against disease progression. It contributes both to prevention and to cure and our obesity problem would be greatly alleviated if more people built exercise into their daily lives.
For some who are greatly overweight, getting started might be a problem without help and support, and for others, seeking to manage conditions such as type 2 diabetes — one in three adults has type 2 diabetes or pre-diabetes, its precursor condition — a tailored approach is called for.
But research also tells us that one of the disincentives to exercise is cost. A walk is free, but a bike isn't and neither is an accredited program designed especially for your health and age requirements.
Ideally, doctors should be able to write a prescription for exercise under an accredited, tailored program, as easily as writing a script for medicine — and with a similar subsidy.
The world of personal trainers and gym memberships is inhabited by the rich, as if fitness and health can be simply bought. But we know it is the lower socio-economic groups who carry the disease burden and this is where government efforts should be concentrated.
Governments can also help by making the general environment more conducive to physical activity.
Perhaps we can consider here what can be seen in some streets in Beijing (and are starting to show up in some parts of Queensland) — open public outdoor gymnasiums with basic treadmills, bicycle ergometers and other weatherproof equipment.
Breaking down the barriers between medical treatment and lifestyle change is another step governments can take, especially as some of our research suggests that different programs work better for, say, diabetes prevention than lowering blood pressure.
As a clinician who has spent years studying how exercise can be so healthy and how it can be exploited, I would welcome a policy that included Medicare rebates for GP-referred, accredited and supervised exercise programs. Obviously care would have to be taken to ensure that such a measure was not exploited by commercial organisations.
Gyms are known to be aggressive marketers, some have punitive contract arrangements with their clients and from time to time they fail financially and so a system of monitoring and accreditation might be necessary. But it is a direction worth investigating. After all, if we had a pill that could do all the same things as exercise it would certainly be available on the Pharmaceutical Benefits Scheme.
With an ageing population getting fatter — and with the projections for what this state of health means for our community socially and economically — we should encourage prevention, management and cure as strongly through non-medical interventions (such as exercise) as we do through medical intervention.
Public health is a public issue and our policies need to catch up with our understanding of health and disease.
Professor Garry Jennings is director of the Baker IDI Heart and Diabetes Institute and immediate past president of the Association of Australian Medical Research Institutes.