Bewegt Euch!

Looking at the dominant sports-medical topics in today’s press, the headlines are mostly about doping problems and sports injuries, leading to public discussion. One could almost get the impression that sport is unhealthy. We need a lot more positive public interest to bring sport into everyday routine.

That sport is very effective in the therapy of chronic diseases is evident and basically known in the general population especially for metabolic, cardiovascular, pulmonary and musculoskeletal diseases (8). Sport as therapy for psychiatric, neurological and even cancer diseases is less known (8).

Depression, for example, is a very frequent psychiatric disease which leads worldwide to extensive morbidity and mortality. Depressive patients suffer from fatigue and the feeling of being overtaxed by life. This can lead to physical inactivity, which in turn reduces physical fitness and intensifies fatigue. Usually, depression is treated with antidepressives and psychotherapy. Exercise therapy is increasingly taking on an important role. A recent meta-analysis showed moderate advantages of exercise therapy compared to purely drug or psychotherapy. Even if exercise therapy cannot supplant the other forms of therapy, combined forms of therapy which include exercise show significantly better results and a lower relapse rate (5).

Despite this positive effect of exercise on body and psyche, the real sports practice is different in the population. Inactivity and the attendant chronic Non-communicable Diseases (NCDs), the so-called “Lifestyle Diseases”, are on the rise (2).

While in developing nations malnutrition, infections and neonatal causes are in the foreground as the main cause of early death, these NCDs with the attendant chronic cardiovascular, metabolic, mental and cancer diseases are primarily increasingly responsible for morbidity and mortality in industrial countries (7).
The increasing life expectancy is certainly one cause here, but we can’t change that, since we have no fountain of youth. But we can change and influence our life habits, like unbalanced nutrition, alcohol and nicotine consumption, as well as inactivity, which have been recognized as decisive risk factors for NCDs (9).

While, for example, alcohol and nicotine consumption can be subjected to social-political influence with more stringent regulations for advertising, sales and insurance disadvantages, strategies to get everyone to implement sport and exercise in everyday life appear too little embedded in political, insurance-technical or social activities (10). And this although inactivity is one of the ten most important risk factors for premature death worldwide.

Ding and Colleagues concluded in a study of cost analysis that the physical inactivity of people cost the health systems worldwide 53.8 billion INT-dollars in 2013 (2). Moreover, the experts considered this cost analysis to be very conservative and the costs most likely actually much higher. If the medical, political and social opinion leaders do not succeed together to animate society to regular sports activity, the majority of our future patients will be primarily “lifestyle-patients“.

But there are effective strategies to animate society to sport. According to an overview by Goroberts in the Lancet 2016, provision of well-designed and comprehensive traffic lanes for bicycles is decisive for their use. While in Holland or Denmark adequate traffic lanes for bicycles have been created, this is missing in the rest of the world. According to this estimate, 34% of the distance traveled in Amsterdam and 33% in Copenhagen were traveled by bicycle, compared to only 13% in Berlin and worse only 3% in London or Paris (4).

Too few breaks for physical activity are implemented in schools, universities and on the job. This can also be controlled by legal means. Kobel and Colleagues showed that implementation of activity during breaks and defined time for school sports in the schoolday of an elementary school child means that the daily time for physical activity of a schoolchild required by the “Centers of Disease Control and Prevention“ can be achieved and maintained (1, 6).

Even for those who – like me – have to spend many hours at the desk, there is a comforting thought: the increased mortality, which is significantly coupled with longer sitting every day, can be offset by physical activity (3). This meta-analysis included more than one million persons, who were followed over a period from 2-18 years. 84,609 persons (8.4%) died in this time period. Persons in the observation group who sat less than 4h per day and had less than 16 hours of metabolic equivalence activity (MET) per week showed mortality 12-59% higher than the most active group, which also sat less than 4h per day, but had more than 35.5h MET activity per week. On the other hand, persons who had even sat more than 8h per day, –which can easily be the case in office work –, could normalize their mortality by activity of likewise 35.5h MET per week (3).

In this sense, I would like to animate the readers to integrate sport as a routine in their own daily lives and that of our patients and thus be a good example and create an understanding that exercise in everyday life is perfectly natural.

In this issue, the interesting literature review again shows the positive effects of sport on the immune system of breast cancer patients. This shows that even in tumor diseases, which are also among the NCDs, sport should be part of the therapy.