Exercise is Medicine

World of Change – Change of World

Exercise is Medicine and the Epidemic of Physical Inactivity

Prof. Dr. Jürgen M. Steinacker Chair der Europäischen Initiative Exercise is MedicineThis issue is dedicated to the topic Exercise is Medicine. Why do we need such an initiative, since our German Society of Sports Medicine and Prevention (DGSP) has just turned 100 and held a brilliant Congress in Berlin with approval from all parts of our society?
The world is changing, and we are changing with the world. Just a few decades ago, we could not have predicted the great social changes resulting from the basically positive use of machines, internet, EDP and automobiles in the entire world of human life – from kindergarten, through school, into the world of employment and afterwards in retirement .
The proportion of physical activity in daily living has undergone a massive decrease and a significanrtpart of people increasingly have no access to sport and exercise. Germany also is only in mid-field of all EU countries; the northern countries and The Netherlands are far above us. We Germans are hardly above the Mediterranean countries when it comes to physical exercise.
According to the results of the Eurobarometer 2009, only about 9% of us really exercise regularly. In addition, about 40% are somewhat active and a substantial part of our population, namely 51%, is physically inactive. By contrast, 72% of the Finns and Swedes and 64% of the Danes exercise regularly and often.
The inactivity of the Germans is emphasized by the current data from the Robert Koch Institute. Between 2008 and 2011, in the second DEGS study, 7.200 people between 18 and 79 years of age were questioned and examined. According to the study, every fourth adult in Germany participates in sports at least two hours every week. Only every fifth person met the 2.5 hours per week recommended by the WHO (See page [6] of the Dossier).
If society is to change, it is necessary to examine traditional concepts. Of course, the DGSP is the nucleus of medical competence for sports medicine and physical exercise. However, our members cannot promote physical activity, sports and exercise throughout Germany by themselves. We are dependent on cooperation with other social groups and professional societies, which have something of a problem in becoming members of our initiative, since they fear losing their independence.
For this reason, Exercise is Medicine is a novel means of combining the activities of the societies and making the importance of physical exercise in all branches of medicine known through the concerted action of many interested groups (always and whenever possible under the direction of sports medicine). This definitely includes population-based approaches, like the EU concept of Health Enhancing Physical Activity (HEPA). But the local general practitioner is important, since he must advise his patients and motivate them to exercise. This gives rise to the chance that general practitioners refer patients to sports medicine in special cases. Exercise is Medicine could also make basic qualification available to general practitioners, covering less than the traditional education in sports medicine but as a supplement to the usual diploma. If we want to achieve a greater effect within medicine and within our society, diversification of our sports medicine specialization is necessary, just as we expect that a sports medicine specialist will ensure the diversification of qualification upwards.
Exercise is Medicine (EIM) is directed to all areas of medicine, to the professional societies and to the universities which educate and train doctors. EIM is also directed to politics, since the necessity of implementing exercise-oriented concepts is essential for our people. If Germany is the world champion in numbers of knee and hip surgery, it is at least improper allocation of financial resources, but also preventing patients who really need surgical and invasive medicine from obtaining adequate resources. The solution does not lie in allocating more money for invasive or surgical procedures, but rather in instructing people in prevention and exercise. Roughly about 80% of all patients in Germany trust their doctors, and 80% of the doctors do not believe that. There is therefore a great need for information and training about how to establish better comunications.
The new Helmholtz Medical Research Centers of the German Federal Government are a great achievement, but they are classically organ-centered and will only provide organ-centered medicine. These are specialist concepts, which are good and important, but which will not further promote the health of the people in the very final end. For this reason, it is necessary to work with Exercise is Medicine toward research programs focusing on exercise and the sedentary lifestyle. With the new EU research program “Horizon 2020”, there is a great chance that the European Commission will give new impetus to these areas. At the moment, the EU is also working toward a consensus on a recommendation for physical exercise. Overweight and the metabolic syndrome are primarily not only a consequence of eating too well and can therefore not be treated by nutrition specialists or by the food industry. They are a task facing the individual person, his doctor and our European Sports Medicine Associations all which must insist on more exercise in the daily life and on a less sedentary lifestyle.
This is why Exercise is Medicine is necessary and we need this initiative.