The exercise prescription is not a reality in Spain at the moment, although it is true that in some autonomous communities there are initiatives to promote physical activity as a medical prescription, which would also save costs for the national health system.
In the Exercise Physiology Laboratory of the University of Castilla-La Mancha have found that this is possible in a long-term follow-up study published in the journal “Medicine & Science in Sports & Exercise” in July 2021.
For five consecutive years they monitored the effects of high-intensity aerobic exercise (performed for four months, three days a week) on medication use and health outcomes in a group of people with metabolic
This syndrome, which affects approximately one third of the adult population in Spain, is a combination of abdominal obesity, hypertension, fasting hyperglycemia and dyspilemia (high blood triglycerides and low HDL cholesterol) for which many must take several medications with the consequent cost to public health.
The research compared the evolution of 51 people with metabolic syndrome, 60% men and 40% women divided into two groups.
The exercise group trained on a stationary bike supervised by sports specialists, while the control group continued with their daily routine, some of which included physical activity or not, but not controlled by the study’s promoters.
The main conclusion is that, after this five-year period, patients in the exercise group avoided nearly doubling their oral medication compared to the control group, and also increased their cardiorespiratory fitness by 12%.
Although it was not the aim of the study to change the dietary routine, it was also observed that body weight was reduced more in the training group (2.8%) than in the control group (1.1%), while that blood insulin levels decreased and so-called “good” cholesterol, HDL, increased only in patients with controlled exercise.
This type of aerobic exercise has a great impact on the cardiovascular system and, specifically, on the blood pressure so that it does not rise and there is a risk of a cardiovascular accident. Exercise puts the cardiovascular system into operation”, as well as avoiding continuing to increase the medication, he explains to EFEsalut Ricardo Mora Rodríguez, director of the Exercise Physiology Laboratory at the University of Castilla-La Mancha.
The consequences of polymedication
According to a study by the World Health Organization (WHO), the lack of physical activity and physical exercise will cause, in 2030, about 500 million more people in the world to suffer from chronic diseases, such as cancer, diabetes, hypertension and depression, which will cost $27 billion a year to treat.
“Spain is a country where people are aware that they have to move. For this reason, we must reach those who suffer from health problems, such as obesity, who do not have a culture of physical activity and are reluctant”, says Ricardo Mora.
When this type of person goes to the doctor, they are advised to change their lifestyle, especially diet and exercise. But many are dependent on their personal, work and financial circumstances and, above all, on their own will to undertake this challenge.
The reality is that as we age, correcting blood pressure, blood sugar or blood fat with medication becomes a multi-pharmaceutical routine.
“We are not against drugs”, points out Mora Rodríguez, but “although exercise is not the holy grail it can help a lot”.
The specialist explains that, although the combination of drugs may be optimal, after a few years there may be cases in which it is necessary to continue increasing the dose in order to maintain its effectiveness, which would lead to an increase in side effects.
For this reason, in this population with health problems, it is necessary to medicate first and then prescribe adequate and controlled exercise to precisely avoid an increase in drugs.
“We advocate for supervised exercise even for those who have a level of physical activity,” he points out.
Thus, it is not a question of just going out for a walk, but of adapting the exercise to each circumstance (women with osteoporosis, older people with loss of muscle mass, obesity…).
In the same vein, another of the authors of the study pronounces, Félix Morales Palomo, postdoctoral researcher at the Department of Sport Sciences at the University of Castilla-La Mancha.
“Asking you to change your lifestyle is an easy message to give but difficult to implement because people don’t know what exercise to do and there is also a willpower component. It is necessary to supervise the exercise for it to be effective and this is the strong point of our study”, he says.
What would save the health system with the exercise prescription
And to make this possible it would be convenient for the health system to work together with sports centers to carry out the supervision of these patients who have been prescribed exercise, even with programs for all types of people that contribute to prevent diseases, and with professionals to control it, Morales Palomo believes.
“It is curious that a country like Spain, with such a powerful public health system, has not yet achieved a synchronicity that could save a lot of money in healthcare”, points out Mora Rodríguez who gives the example of Colombia where private healthcare has indeed implemented prescribing exercise given the savings it entails.
A second part of this study, pending publication, reflects a cost-benefit measurement and concludes that for every euro invested in exercise there is a saving of three euros related to the drugs used to control the metabolic syndrome.
“Programs that have public utility and a social benefit”, concludes this researcher.
The vision of primary care
Regarding the exercise prescription, Primary Care, the first level of healthcare, has a lot to say.
Montserrat Romaguera is a doctor at a health center in Sabadell (Barcelona) and coordinator of the Physical Activity Group of the Spanish Society of Family and Community Medicine (semFYC).
It is essential to prescribe exercise and monitor the evolution of patients.
“The key is in Primary Care because there is follow-up over time for patients. But we must manage to motivate the person and also achieve adherence to this activity routine.
And this bearing in mind that it is necessary to adapt the exercise to each individual based on their age, physical condition, financial resources and even personal tastes.
Prescribing exercise correctly means that doctors have training on the most suitable physical activity for each type of patient. She has been part of different initiatives to make healthcare professionals have this information.
For the exercise prescription to be a feasible reality, the doctor considers necessary “a global project at national and international level” that has resources and adapts to the environments but also favors public transport, active breaks in work environments and ” make the population aware that we are selling them health”.
Athlete, daughter of Spain’s (1956) athletics champion Josep Romaguera and author of my doctor sends me for a walk, the expert also specializes in sports medicine.
From his double status as a doctor and athlete, he regrets that the physical activity of humanity, in the last 45 years, has dropped by 30% due to the way of life: children and teenagers move less than their parents and have higher rates of overweight and obesity.
“And to avoid this we must, on the one hand, train and sensitize healthcare professionals to prescribe physical activity, and on the other, at a social level, reverse the fact that the trend is that of minimal effort and we move more in the domestic sphere, on trips, in work and school environments and in leisure time leaving aside the screens and the sedentary lifestyle”, he concludes.