Physical exercise in disease management and prevention

Scientific evidence confirms convincingly that exercise training, including both endurance and strength training added to daily habitual physical activity achieve well-known health benefits.

When looking for the most recent publications in the field, especially in the epidemiological point of view, it seems that good physical fitness addressing both cardiorespiratory and musculoskeletal  fitness has a dominant protective role to prevent metabolic and cardiovascular diseases or even premature death. Very often the evidence of health enhancing effect of good physical fitness is even independent among other reported risk factors both in the prevention of diseases and in disease management as well.

For example, we reported (Korpelainen et al.) recently the prognostic significance of exercise test  findings for cardiovascular and all-cause mortality in 3033 men and women at aged about 50 years referred to clinical exercise test (Annals of Medicine 2016). After an average follow-up of 19 years, among all measured exercise test variables maximal exercise capacity was the strongest predictor of cardiovascular and all-cause mortality in both genders, and especially cardiovascular deaths in women. Similarly, Legrand et al. (J Am Geriatr Soc 2014) showed that in people aged 80 and older, physical performance is a strong predictor of mortality, hospitalization, and disability, and muscle strength is a strong predictor of mortality and hospitalization and all those relationships were independent of muscle mass, inflammatory markers, and comorbidity.

Nowadays health care decision-making requires in addition of clinical evidence the economic evaluation of medical therapies when planning the optimal utilization of resources. We evaluated (Hautala et al.) the cost-effectiveness of an exercise- based cardiac rehabilitation of one-year in patients with acute coronary syndrome (Scand J Med Sci Sports 2016). The exercise training program included e.g. self- monitoring of physical activity and tailored counselling by a physical therapist in our HUR cardiac rehab gym. The cost-effectiveness was estimated based on intervention and health care costs and quality- adjusted life years gained. The total average cost per patient was €1000 lower in exercise group than in usual care group yielding an incremental cost-effectiveness ratio of -€24,511/quality-adjusted life years. In Finland, we have about 25,000 acute coronary events yearly. If we can implement exercise training concept effectively to daily practice, we are talking about marked savings in our health care costs.

Despite the proven clinical effectiveness exercise training, many individuals with increased risk factors or chronic diseases do not become or remain regularly active, mainly due to low referral, uptake and adherence rates. Ades et al. calculated that increasing cardiac rehabilitation participation from 20% to 70% would save 25,000 lives and prevent 180,000 hospitalizations annually in the United States (Mayo Clin Proceedings 2016). Therefore, there is an urgent need for comprehensive individually tailored exercise training programs with effective risk-factor management, appropriately adapted to the medical, cultural and economic settings of a country. Hopefully the increasing number of scientific evidence showing benefits of exercise training for all age groups, both in terms of prevention and disease management, will help and justify policy makers charged to decide how limited health care resources should be allocated best.

Arto Hautala, author
HUR, Director of Research and Education
Physical Activity Guidelines Expert appointed by the Finnish Medical Society Duodecim and the Executive Board of Current Care
Chair and editor in the working group planning Finnish Current Care Guideline for exercise-based cardiac rehabilitation appointed by the Finnish Association of Physiotherapists