{{Short description|Branch of medicine as it relates to Exercise}} {{Use dmy dates|date=April 2022}} {{Infobox medical specialty | title = Exercise medicine | image = File:Exercise class.jpg | caption = | system = Musculoskeletal, cardiovascular | focus = | subdivisions = | diseases = | tests = | specialist = Sport and Exercise Medicine (SEM) physician | glossary = Glossary of medicine | formation = }} {{Infobox Occupation | name= Sport and Exercise Medicine (SEM) physician | image= | caption= | official_names= * Physician | type= Specialty | activity_sector= Medicine | competencies= Exercise prescription | formation= * Doctor of Medicine (M.D.) * Bachelor of Medicine, Bachelor of Surgery (M.B.B.S.) * Bachelor of Medicine, Bachelor of Surgery (MBChB) | employment_field= Hospitals, Clinics, university | related_occupation= sports medicine physician }}
'''Exercise medicine''' is a branch of medicine that deals with physical fitness and the prevention and treatment of injuries and illness with exercise. In some countries, Sport and Exercise Medicine (SEM) is a recognized medical specialty (with similar training and standards to other medical specialties). Exercise medicine is therefore an emerging physician (non-surgical) specialty, but there is also a belief that exercise is treatment of such fundamental benefit that it should be incorporated into all medical specialties. Allied health practitioners also can specialize in exercise such as exercise physiologists, physiotherapists, athletic trainers and podiatrists.<ref>{{cite journal |last1=Crozier |first1=A |last2=Watson |first2=PM |last3=Graves |first3=LEF |last4=George |first4=K |last5=Naylor |first5=L |last6=Green |first6=DJ |last7=Rosenberg |first7=M |last8=Jones |first8=H |title=Clinical exercise provision in the UK: comparison of staff job titles, roles and qualifications across five specialised exercise services. |journal=BMJ Open Sport & Exercise Medicine |date=2022 |volume=8 |issue=1 |article-number=e001152 |doi=10.1136/bmjsem-2021-001152 |pmid=35136656|pmc=8788312 }}</ref>
Whereas the signature treatment of the specialty of surgery is operative procedures, and the signature treatment of most medical (physician) specialties is the prescription of pharmaceuticals, the signature treatment of Sport and Exercise Medicine is exercise prescription. SEM physician consultations are generally lengthy (over 30 minutes) and 74% involve prescription of exercise, with exercise prescription being the most common treatment.<ref>{{cite journal |last1=Gamage |first1=Prasanna J |last2=Seker |first2=Saran |last3=Orchard |first3=Jessica |last4=Humphries |first4=David |last5=Fitzgerald |first5=Kylie |last6=Fitzpatrick |first6=Jane |title=Insights into the complexity of presentation and management of patients: the Sport and Exercise Physician's perspective |journal=BMJ Open Sport & Exercise Medicine |date=November 2021 |volume=7 |issue=4 |article-number=e001228 |doi=10.1136/bmjsem-2021-001228|pmid=34925878 |pmc=8628332 }}</ref>
==Evidence for the efficacy of exercise as a medical treatment== There is an enormous amount of evidence proving that exercise (when prescribed as a medical treatment) is effective at preventing and treating most of the major chronic diseases,<ref>{{cite journal |last1=Pedersen |first1=BK |last2=Saltin |first2=B |title=Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. |journal=Scandinavian Journal of Medicine & Science in Sports |date=December 2015 |volume=25 |issue=Suppl 3 |pages=1–72 |doi=10.1111/sms.12581 |pmid=26606383|s2cid=21208328 |doi-access=free }}</ref><ref>{{cite journal |last1=Zhao |first1=M |last2=Veeranki |first2=SP |last3=Magnussen |first3=CG |last4=Xi |first4=B |title=Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study. |journal=BMJ (Clinical Research Ed.) |date=1 July 2020 |volume=370 |article-number=m2031 |doi=10.1136/bmj.m2031 |pmid=32611588|pmc=7328465 }}</ref> including cancer,<ref>{{cite journal |last1=Emery |first1=A |last2=Moore |first2=S |last3=Turner |first3=JE |last4=Campbell |first4=JP |title=Reframing How Physical Activity Reduces The Incidence of Clinically-Diagnosed Cancers: Appraising Exercise-Induced Immuno-Modulation As An Integral Mechanism. |journal=Frontiers in Oncology |date=2022 |volume=12 |article-number=788113 |doi=10.3389/fonc.2022.788113 |pmid=35359426|pmc=8964011 |doi-access=free }}</ref> cardiovascular diseases,<ref>{{cite journal |last1=Kraus |first1=WE |last2=Powell |first2=KE |last3=Haskell |first3=WL |last4=Janz |first4=KF |last5=Campbell |first5=WW |last6=Jakicic |first6=JM |last7=Troiano |first7=RP |last8=Sprow |first8=K |last9=Torres |first9=A |last10=Piercy |first10=KL |author11=((2018 Physical Activity Guidelines Advisory Committee)) |title=Physical Activity, All-Cause and Cardiovascular Mortality, and Cardiovascular Disease. |journal=Medicine and Science in Sports and Exercise |date=June 2019 |volume=51 |issue=6 |pages=1270–1281 |doi=10.1249/MSS.0000000000001939 |pmid=31095084 |pmc=6527136 }}</ref><ref>{{cite journal |last1=Myers |first1=Jonathan |last2=Prakash |first2=Manish |last3=Froelicher |first3=Victor |last4=Do |first4=Dat |last5=Partington |first5=Sara |last6=Atwood |first6=J. Edwin |title=Exercise Capacity and Mortality among Men Referred for Exercise Testing |journal=New England Journal of Medicine |date=14 March 2002 |volume=346 |issue=11 |pages=793–801 |doi=10.1056/NEJMoa011858 |pmid=11893790 |issn=0028-4793|doi-access=free }}</ref> arthritis,<ref>{{cite journal |last1=Gwinnutt |first1=JM |last2=Wieczorek |first2=M |last3=Cavalli |first3=G |last4=Balanescu |first4=A |last5=Bischoff-Ferrari |first5=HA |last6=Boonen |first6=A |last7=de Souza |first7=S |last8=de Thurah |first8=A |last9=Dorner |first9=TE |last10=Moe |first10=RH |last11=Putrik |first11=P |last12=Rodríguez-Carrio |first12=J |last13=Silva-Fernández |first13=L |last14=Stamm |first14=T |last15=Walker-Bone |first15=K |last16=Welling |first16=J |last17=Zlatković-Švenda |first17=MI |last18=Guillemin |first18=F |last19=Verstappen |first19=SMM |title=Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. |journal=RMD Open |date=March 2022 |volume=8 |issue=1 |article-number=e002168 |doi=10.1136/rmdopen-2021-002168 |pmid=35361692|pmc=8971792 }}</ref> osteoporosis,<ref>{{cite journal |last1=Sanchez-Trigo |first1=H |last2=Rittweger |first2=J |last3=Sañudo |first3=B |title=Effects of non-supervised exercise interventions on bone mineral density in adult women: a systematic review and meta‑analysis. |journal=Osteoporosis International |date=26 February 2022 |volume=33 |issue=7 |pages=1415–1427 |doi=10.1007/s00198-022-06357-3 |pmid=35218402|pmc=8881760 }}</ref> back pain,<ref>{{cite journal |last1=Pocovi |first1=Natasha C |last2=Lin |first2=Chung-Wei Christine |last3=French |first3=Simon D |last4=Graham |first4=Petra L |last5=van Dongen |first5=Johanna M |last6=Latimer |first6=Jane |last7=Merom |first7=Dafna |last8=Tiedemann |first8=Anne |last9=Maher |first9=Christopher G |last10=Clavisi |first10=Ornella |last11=Tong |first11=Shuk Yin Kate |last12=Hancock |first12=Mark J |title=Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial |journal=The Lancet |date=June 2024 |volume=404 |issue=10448 |pages=134–144 |doi=10.1016/S0140-6736(24)00755-4 |pmid=38908392 |url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00755-4/fulltext |access-date=22 June 2024|url-access=subscription |hdl=1871.1/24d79975-99c7-4295-9e8f-46c9496286ba |hdl-access=free }}</ref><ref>{{cite journal |last1=Hayden |first1=JA |last2=Ellis |first2=J |last3=Ogilvie |first3=R |last4=Malmivaara |first4=A |last5=van Tulder |first5=MW |title=Exercise therapy for chronic low back pain. |journal=The Cochrane Database of Systematic Reviews |date=28 September 2021 |volume=9 |issue=10 |article-number=CD009790 |doi=10.1002/14651858.CD009790.pub2 |pmid=34580864|pmc=8477273 }}</ref> diabetes,<ref>{{cite journal |last1=Hall |first1=KS |last2=Hyde |first2=ET |last3=Bassett |first3=DR |last4=Carlson |first4=SA |last5=Carnethon |first5=MR |last6=Ekelund |first6=U |last7=Evenson |first7=KR |last8=Galuska |first8=DA |last9=Kraus |first9=WE |last10=Lee |first10=IM |last11=Matthews |first11=CE |last12=Omura |first12=JD |last13=Paluch |first13=AE |last14=Thomas |first14=WI |last15=Fulton |first15=JE |title=Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia. |journal=The International Journal of Behavioral Nutrition and Physical Activity |date=20 June 2020 |volume=17 |issue=1 |page=78 |doi=10.1186/s12966-020-00978-9 |pmid=32563261|pmc=7305604 |doi-access=free }}</ref> depression and other mental illnesses and falls in the elderly.<ref>{{cite journal |last1=Sherrington |first1=C |author-link=Cathie Sherrington |last2=Michaleff |first2=ZA |last3=Fairhall |first3=N |last4=Paul |first4=SS |last5=Tiedemann |first5=A |last6=Whitney |first6=J |last7=Cumming |first7=RG |last8=Herbert |first8=RD |last9=Close |first9=JCT |last10=Lord |first10=SR |date=December 2017 |title=Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. |journal=British Journal of Sports Medicine |volume=51 |issue=24 |pages=1750–1758 |doi=10.1136/bjsports-2016-096547 |pmc=6243488 |pmid=27707740 |s2cid=206882055 |doi-access=free}}</ref> thumb|Exercise and mortality from certain diseases, adapted from <ref>{{cite journal |last1=Kyu |first1=Hmwe H. |last2=Bachman |first2=Victoria F. |last3=Alexander |first3=Lily T. |last4=Mumford |first4=John Everett |last5=Afshin |first5=Ashkan |last6=Estep |first6=Kara |last7=Veerman |first7=J. Lennert |last8=Delwiche |first8=Kristen |last9=Iannarone |first9=Marissa L. |last10=Moyer |first10=Madeline L. |last11=Cercy |first11=Kelly |last12=Vos |first12=Theo |last13=Murray |first13=Christopher J. L. |last14=Forouzanfar |first14=Mohammad H. |title=Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013 |journal=BMJ |date=9 August 2016 |volume=354 |article-number=i3857 |doi=10.1136/bmj.i3857 |pmid=27510511 |pmc=4979358 |url=https://www.bmj.com/content/354/bmj.i3857 |language=en |issn=1756-1833}}</ref>
Exercise has been shown to reduce all-cause mortality <ref>{{Cite news |last=Reynolds |first=Gretchen |date=2022-04-06 |title=Is 30 Minutes of Exercise a Day Enough? |language=en-US |work=The New York Times |url=https://www.nytimes.com/2022/04/06/well/move/30-minutes-exercise.html |access-date=2022-04-12 |issn=0362-4331}}</ref> in a large number of primary studies and meta-analyses.<ref>{{cite journal |last1=Lee |first1=DC |last2=Pate |first2=RR |last3=Lavie |first3=CJ |last4=Sui |first4=X |last5=Church |first5=TS |last6=Blair |first6=SN |title=Leisure-time running reduces all-cause and cardiovascular mortality risk. |journal=Journal of the American College of Cardiology |date=5 August 2014 |volume=64 |issue=5 |pages=472–81 |doi=10.1016/j.jacc.2014.04.058 |pmid=25082581|pmc=4131752 }}</ref><ref>{{cite journal |last1=Zhao |first1=M |last2=Veeranki |first2=SP |last3=Magnussen |first3=CG |last4=Xi |first4=B |title=Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study. |journal=BMJ (Clinical Research Ed.) |date=1 July 2020 |volume=370 |article-number=m2031 |doi=10.1136/bmj.m2031 |pmid=32611588|pmc=7328465 }}</ref><ref>{{cite journal |last1=Colpani |first1=V |last2=Baena |first2=CP |last3=Jaspers |first3=L |last4=van Dijk |first4=GM |last5=Farajzadegan |first5=Z |last6=Dhana |first6=K |last7=Tielemans |first7=MJ |last8=Voortman |first8=T |last9=Freak-Poli |first9=R |last10=Veloso |first10=GGV |last11=Chowdhury |first11=R |last12=Kavousi |first12=M |last13=Muka |first13=T |last14=Franco |first14=OH |title=Lifestyle factors, cardiovascular disease and all-cause mortality in middle-aged and elderly women: a systematic review and meta-analysis. |journal=European Journal of Epidemiology |date=September 2018 |volume=33 |issue=9 |pages=831–845 |doi=10.1007/s10654-018-0374-z |pmid=29524110|s2cid=3790367 }}</ref><ref>{{cite journal |last1=Cunningham |first1=C |last2=O' Sullivan |first2=R |last3=Caserotti |first3=P |last4=Tully |first4=MA |title=Consequences of physical inactivity in older adults: A systematic review of reviews and meta-analyses. |journal=Scandinavian Journal of Medicine & Science in Sports |date=May 2020 |volume=30 |issue=5 |pages=816–827 |doi=10.1111/sms.13616 |pmid=32020713|s2cid=211035029 |url=https://findresearcher.sdu.dk:8443/ws/files/170824032/sms.13616.pdf }}</ref>
===Exercise and osteoarthritis===
When compared to hip replacement<ref>{{cite journal |last1=Frydendal |first1=T |last2=Christensen |first2=R |last3=Mechlenburg |first3=I |last4=Mikkelsen |first4=LR |last5=Varnum |first5=C |last6=Graversen |first6=AE |last7=Kjærsgaard-Andersen |first7=P |last8=Revald |first8=PH |last9=Hofbauer |first9=C |last10=Bieder |first10=MJ |last11=Qassim |first11=H |last12=Munir |first12=MS |last13=Jakobsen |first13=SS |last14=Nielsen |first14=SM |last15=Ingwersen |first15=KG |last16=Overgaard |first16=S |title=Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis. |journal=The New England Journal of Medicine |date=31 October 2024 |volume=391 |issue=17 |pages=1610–1620 |doi=10.1056/NEJMoa2400141 |pmid=39476341}}</ref> and knee replacement<ref>{{cite journal |last1=Skou |first1=ST |last2=Roos |first2=EM |last3=Laursen |first3=MB |last4=Rathleff |first4=MS |last5=Arendt-Nielsen |first5=L |last6=Rasmussen |first6=S |last7=Simonsen |first7=O |title=Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials. |journal=Osteoarthritis and Cartilage |date=September 2018 |volume=26 |issue=9 |pages=1170–1180 |doi=10.1016/j.joca.2018.04.014 |pmid=29723634}}</ref> respectively, exercise does not provide the same level of pain relief in the medium term as these major surgeries. However, less invasive surgery is not superior to exercise for mild-moderate knee osteoarthritis.<ref>{{cite journal |last1=Palmer |first1=JS |last2=Monk |first2=AP |last3=Hopewell |first3=S |last4=Bayliss |first4=LE |last5=Jackson |first5=W |last6=Beard |first6=DJ |last7=Price |first7=AJ |title=Surgical interventions for symptomatic mild to moderate knee osteoarthritis. |journal=The Cochrane Database of Systematic Reviews |date=19 July 2019 |volume=2019 |issue=7 |article-number=CD012128 |doi=10.1002/14651858.CD012128.pub2 |pmid=31322289 |pmc=6639936 }}</ref><ref>{{cite journal |last1=O'Connor |first1=D |last2=Johnston |first2=RV |last3=Brignardello-Petersen |first3=R |last4=Poolman |first4=RW |last5=Cyril |first5=S |last6=Vandvik |first6=PO |last7=Buchbinder |first7=R |title=Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears). |journal=The Cochrane Database of Systematic Reviews |date=3 March 2022 |volume=2022 |issue=3 |article-number=CD014328 |doi=10.1002/14651858.CD014328 |pmid=35238404 |pmc=8892839 }}</ref> Early knee replacement may not be cost-effective compared to an exercise program followed by crossover to knee replacement if necessary.<ref>{{cite journal |last1=Skou |first1=ST |last2=Roos |first2=E |last3=Laursen |first3=M |last4=Arendt-Nielsen |first4=L |last5=Rasmussen |first5=S |last6=Simonsen |first6=O |last7=Ibsen |first7=R |last8=Larsen |first8=AT |last9=Kjellberg |first9=J |title=Cost-effectiveness of total knee replacement in addition to non-surgical treatment: a 2-year outcome from a randomised trial in secondary care in Denmark. |journal=BMJ Open |date=15 January 2020 |volume=10 |issue=1 |article-number=e033495 |doi=10.1136/bmjopen-2019-033495 |doi-access=free|pmid=31948990 |pmc=7044888 }}</ref> Whereas exercise leads to reduced all-cause mortality, knee and hip replacement lead initially to reduced all-cause mortality then increased mortality after 11 years or more.<ref>{{cite journal |last1=Orchard |first1=JW |last2=Tutt |first2=LE |last3=Hines |first3=A |last4=Orchard |first4=JJ |title=Associations Between Common Hip and Knee Osteoarthritis Treatments and All-Cause Mortality. |journal=Healthcare (Basel, Switzerland) |date=5 September 2025 |volume=13 |issue=17 |page=2229 |doi=10.3390/healthcare13172229 |doi-access=free |pmid=40941581 |pmc=12428238 }}</ref>
===Exercise and cardiovascular disease===
There are multiple ways in which exercise can reduce cardiovascular disease and mortality,<ref>{{cite journal |last1=Bove |first1=AA |title=Exercise and Heart Disease. |journal=Methodist DeBakey Cardiovascular Journal |date=April 2016 |volume=12 |issue=2 |pages=74–5 |doi=10.14797/mdcj-12-2-74 |pmid=27486487|pmc=4969029 }}</ref> including through lowering blood pressure and lowering LDL cholesterol levels.<ref>{{cite journal |last1=Nystoriak |first1=MA |last2=Bhatnagar |first2=A |title=Cardiovascular Effects and Benefits of Exercise. |journal=Frontiers in Cardiovascular Medicine |date=2018 |volume=5 |article-number=135 |doi=10.3389/fcvm.2018.00135 |pmid=30324108|pmc=6172294 |doi-access=free }}</ref> Although multiple mechanisms are possible, the relationship between exercise as measured by accelerometer data and cardiovascular mortality is strong (inverse, non-linear).<ref>{{cite journal |last1=Sheng |first1=M |last2=Yang |first2=J |last3=Bao |first3=M |last4=Chen |first4=T |last5=Cai |first5=R |last6=Zhang |first6=N |last7=Chen |first7=H |last8=Liu |first8=M |last9=Wu |first9=X |last10=Zhang |first10=B |last11=Liu |first11=Y |last12=Chao |first12=J |title=The relationships between step count and all-cause mortality and cardiovascular events: A dose-response meta-analysis. |journal=Journal of Sport and Health Science |date=December 2021 |volume=10 |issue=6 |pages=620–628 |doi=10.1016/j.jshs.2021.09.004 |pmid=34547483|pmc=8724621 }}</ref>
===Exercise and cancer=== Exercise prescription is now a recognized treatment for cancer,<ref>{{cite journal |last1=Ashcraft |first1=KA |last2=Warner |first2=AB |last3=Jones |first3=LW |last4=Dewhirst |author4-link=Mark Dewhirst|first4=MW |title=Exercise as Adjunct Therapy in Cancer. |journal=Seminars in Radiation Oncology |date=January 2019 |volume=29 |issue=1 |pages=16–24 |doi=10.1016/j.semradonc.2018.10.001 |pmid=30573180|pmc=6656408 }}</ref> as studies have shown that exercise is associated with superior mortality outcomes and lower recurrence rates.<ref>{{cite journal |last1=Christensen |first1=JF |last2=Simonsen |first2=C |last3=Hojman |first3=P |title=Exercise Training in Cancer Control and Treatment. |journal=Comprehensive Physiology |date=13 December 2018 |volume=9 |issue=1 |pages=165–205 |doi=10.1002/cphy.c180016 |pmid=30549018|s2cid=56492477 }}</ref><ref>{{cite journal |last1=Cormie |first1=P |last2=Zopf |first2=EM |last3=Zhang |first3=X |last4=Schmitz |first4=KH |title=The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects. |journal=Epidemiologic Reviews |date=1 January 2017 |volume=39 |issue=1 |pages=71–92 |doi=10.1093/epirev/mxx007 |pmid=28453622}}</ref><ref>{{cite journal |last1=Cormie |first1=P |last2=Trevaskis |first2=M |last3=Thornton-Benko |first3=E |last4=Zopf |first4=EM |title=Exercise medicine in cancer care. |journal=Australian Journal of General Practice |date=April 2020 |volume=49 |issue=4 |pages=169–174 |doi=10.31128/AJGP-08-19-5027 |pmid=32233341|s2cid=214751316 |doi-access=free }}</ref>
===Exercise and mental illness=== {{Main|Neurobiological effects of physical exercise}}
Exercise both prevents and treats mental illnesses, including depression in particular,<ref>{{cite journal |last1=Schuch |first1=FB |last2=Vancampfort |first2=D |last3=Richards |first3=J |last4=Rosenbaum |first4=S |last5=Ward |first5=PB |last6=Stubbs |first6=B |title=Exercise as a treatment for depression: A meta-analysis adjusting for publication bias. |journal=Journal of Psychiatric Research |date=June 2016 |volume=77 |pages=42–51 |doi=10.1016/j.jpsychires.2016.02.023 |pmid=26978184|s2cid=1012687 |url=https://kclpure.kcl.ac.uk/portal/en/publications/exercise-as-a-treatment-for-depression(6970d761-e283-46df-bb9f-2314a6ee18a9).html }}</ref><ref>{{cite journal |last1=Schuch |first1=FB |last2=Stubbs |first2=B |title=The Role of Exercise in Preventing and Treating Depression. |journal=Current Sports Medicine Reports |date=August 2019 |volume=18 |issue=8 |pages=299–304 |doi=10.1249/JSR.0000000000000620 |pmid=31389872|s2cid=199448688 |doi-access=free }}</ref><ref>{{Cite journal |last=Clegg |first=Andrew J. |last2=Hill |first2=James E. |last3=Mullin |first3=Donncha S. |last4=Harris |first4=Catherine |last5=Smith |first5=Chris J. |last6=Lightbody |first6=C. Elizabeth |last7=Dwan |first7=Kerry |last8=Cooney |first8=Gary M. |last9=Mead |first9=Gillian E. |last10=Watkins |first10=Caroline L. |date=2026-01-08 |title=Exercise for depression |journal=The Cochrane Database of Systematic Reviews |volume=1 |issue=1 |article-number=CD004366 |doi=10.1002/14651858.CD004366.pub7 |issn=1469-493X |pmc=12779368 |pmid=41500513}}</ref> with positive effects likely for anxiety,<ref>{{cite journal |last1=Stonerock |first1=GL |last2=Hoffman |first2=BM |last3=Smith |first3=PJ |last4=Blumenthal |first4=JA |title=Exercise as Treatment for Anxiety: Systematic Review and Analysis. |journal=Annals of Behavioral Medicine |date=August 2015 |volume=49 |issue=4 |pages=542–56 |doi=10.1007/s12160-014-9685-9 |pmid=25697132|pmc=4498975 }}</ref> bipolar disorder<ref>{{cite journal |last1=Bauer |first1=IE |last2=Gálvez |first2=JF |last3=Hamilton |first3=JE |last4=Balanzá-Martínez |first4=V |last5=Zunta-Soares |first5=GB |last6=Soares |first6=JC |last7=Meyer |first7=TD |title=Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: A systematic review. |journal=Journal of Psychiatric Research |date=March 2016 |volume=74 |pages=1–7 |doi=10.1016/j.jpsychires.2015.12.006 |pmid=26724541|pmc=4744495 }}</ref> and suicidality.<ref>{{cite journal |last1=Grasdalsmoen |first1=M |last2=Eriksen |first2=HR |last3=Lønning |first3=KJ |last4=Sivertsen |first4=B |title=Physical exercise, mental health problems, and suicide attempts in university students. |journal=BMC Psychiatry |date=16 April 2020 |volume=20 |issue=1 |page=175 |doi=10.1186/s12888-020-02583-3 |pmid=32299418|pmc=7164166 |doi-access=free }}</ref>
==Exercise dosing== {{Main|Exercise prescription}} Exercise prescription is not simply a matter of advising or demanding that a patient increases their exercise levels. It requires significant expertise and experience, with core competencies well described.<ref>{{cite journal |last1=Asif |first1=Irfan |last2=Thornton |first2=Jane S. |last3=Carek |first3=Stephen |last4=Miles |first4=Christopher |last5=Nayak |first5=Melissa |last6=Novak |first6=Melissa |last7=Stovak |first7=Mark |last8=Zaremski |first8=Jason L. |last9=Drezner |first9=Jonathan |title=Exercise medicine and physical activity promotion: core curricula for US medical schools, residencies and sports medicine fellowships: developed by the American Medical Society for Sports Medicine and endorsed by the Canadian Academy of Sport and Exercise Medicine |journal=British Journal of Sports Medicine |date=1 April 2022 |volume=56 |issue=7 |pages=369–375 |doi=10.1136/bjsports-2021-104819 |pmid=35012931 |s2cid=246055491 |url=https://bjsm.bmj.com/content/56/7/369 |language=en |issn=0306-3674|doi-access=free }}</ref> Sudden increase of exercise levels is likely to lead to painful musculoskeletal symptoms or even injury (preventing further exercise).<ref>{{cite news |last1=Burfoot |first1=Amby |title=The 10-Percent Rule |url=https://www.runnersworld.com/training/a20781512/the-10-percent-rule/#:~:text=The%2010%2Dpercent%20rule%20(10PR,running%20injuries%20are%20overuse%20injuries. |access-date=2 April 2022 |work=Runner's World |date=14 November 2001}}</ref><ref>{{cite journal |last1=Wang |first1=C |last2=Vargas |first2=JT |last3=Stokes |first3=T |last4=Steele |first4=R |last5=Shrier |first5=I |title=Analyzing Activity and Injury: Lessons Learned from the Acute:Chronic Workload Ratio. |journal=Sports Medicine (Auckland, N.Z.) |date=July 2020 |volume=50 |issue=7 |pages=1243–1254 |doi=10.1007/s40279-020-01280-1 |pmid=32125672|s2cid=211729657 }}</ref><ref>{{cite journal |last1=Griffin |first1=A |last2=Kenny |first2=IC |last3=Comyns |first3=TM |last4=Lyons |first4=M |title=The Association Between the Acute:Chronic Workload Ratio and Injury and its Application in Team Sports: A Systematic Review. |journal=Sports Medicine (Auckland, N.Z.) |date=March 2020 |volume=50 |issue=3 |pages=561–580 |doi=10.1007/s40279-019-01218-2 |pmid=31691167|hdl=10344/8522 |s2cid=207899218 |url=https://figshare.com/articles/journal_contribution/19821931 |hdl-access=free }}</ref>
thumb|Both underloading and overloading can lead to injury<ref>{{cite journal |last1=Orchard |first1=JW |title=Prescribing and dosing exercise in primary care. |journal=Australian Journal of General Practice |date=April 2020 |volume=49 |issue=4 |pages=182–186 |doi=10.31128/AJGP-10-19-5110 |pmid=32233343|s2cid=214749061 }}</ref> thumb|left|Use of wearable technology to measure exercise loads <ref>{{cite journal |last1=Phillips |first1=SM |last2=Cadmus-Bertram |first2=L |last3=Rosenberg |first3=D |last4=Buman |first4=MP |last5=Lynch |first5=BM |title=Wearable Technology and Physical Activity in Chronic Disease: Opportunities and Challenges. |journal=American Journal of Preventive Medicine |date=January 2018 |volume=54 |issue=1 |pages=144–150 |doi=10.1016/j.amepre.2017.08.015 |pmid=29122356|pmc=5736445 }}</ref><ref>{{cite journal |last1=Orchard |first1=JW |title=Using technology to measure daily and weekly movement patterns in exercise medicine patients. |journal=British Journal of Sports Medicine |date=September 2017 |volume=51 |issue=18 |pages=1317–1318 |doi=10.1136/bjsports-2016-096736 |pmid=27884860|s2cid=12096034 }}</ref>
The lifetime prevalence of hip and knee osteoarthritis is 13% for competitive runners, 10% for non-runners, but only 4% for moderate social runners, demonstrating a U-shaped curve between running load and arthritis risk (high and low dose = higher risk; moderate load = lower risk).<ref>{{cite journal |last1=Alentorn-Geli |first1=E |last2=Samuelsson |first2=K |last3=Musahl |first3=V |last4=Green |first4=CL |last5=Bhandari |first5=M |last6=Karlsson |first6=J |title=The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. |journal=The Journal of Orthopaedic and Sports Physical Therapy |date=June 2017 |volume=47 |issue=6 |pages=373–390 |doi=10.2519/jospt.2017.7137 |pmid=28504066|s2cid=26434756 }}</ref> With respect to back pain, increasing levels of exercise reduce risk of back pain,<ref>{{cite journal |last1=Alzahrani |first1=H |last2=Shirley |first2=D |last3=Cheng |first3=SWM |last4=Mackey |first4=M |last5=Stamatakis |first5=E |title=Physical activity and chronic back conditions: A population-based pooled study of 60,134 adults. |journal=Journal of Sport and Health Science |date=July 2019 |volume=8 |issue=4 |pages=386–393 |doi=10.1016/j.jshs.2019.01.003 |pmid=31333893|pmc=6620421 }}</ref> but having occupational manual loading increases the risk.<ref>{{cite journal |last1=Hartvigsen |first1=J |last2=Hancock |first2=MJ |last3=Kongsted |first3=A |last4=Louw |first4=Q |last5=Ferreira |first5=ML |last6=Genevay |first6=S |last7=Hoy |first7=D |last8=Karppinen |first8=J |last9=Pransky |first9=G |last10=Sieper |first10=J |last11=Smeets |first11=RJ |last12=Underwood |first12=M |last13=Lancet Low Back Pain Series Working |first13=Group. |title=What low back pain is and why we need to pay attention. |journal=Lancet |date=9 June 2018 |volume=391 |issue=10137 |pages=2356–2367 |doi=10.1016/S0140-6736(18)30480-X |pmid=29573870|s2cid=4354991 |url=https://cris.maastrichtuniversity.nl/en/publications/950569e0-85cb-4562-9fb4-e53f25723cc0 |hdl=1871.1/79cd95b7-4b74-4c5a-bf1f-adf61bcc71f5 |hdl-access=free }}</ref> The bottom of the U-shaped curve for injury risk and loading is sometimes referred to as the Goldilocks zone (not too little exercise but not too much).<ref>{{cite journal |last1=Milner |first1=PI |title=Keeping joints healthy: The Goldilocks effect of exercise. |journal=Veterinary Journal |date=August 2017 |volume=226 |pages=4–5 |doi=10.1016/j.tvjl.2017.06.007 |pmid=28911839}}</ref><ref>{{cite journal |last1=Straker |first1=L |last2=Mathiassen |first2=SE |last3=Holtermann |first3=A |title=The 'Goldilocks Principle': designing physical activity at work to be 'just right' for promoting health. |journal=British Journal of Sports Medicine |date=July 2018 |volume=52 |issue=13 |pages=818–819 |doi=10.1136/bjsports-2017-097765 |pmid=28663212|pmc=6029635 }}</ref><ref>{{cite journal |last1=O'Keefe |first1=JH |last2=O'Keefe |first2=EL |last3=Lavie |first3=CJ |title=The Goldilocks Zone for Exercise: Not Too Little, Not Too Much. |journal=Missouri Medicine |date=March 2018 |volume=115 |issue=2 |pages=98–105 |pmid=30228692|pmc=6139866 }}</ref> There also may be a Goldilocks zone for physical activity and all-cause mortality, but at a very high level and with an eccentric U-shape (that is, low exercise levels are far riskier for all-cause mortality than extremely high exercise levels).<ref>{{cite journal |last1=Ekelund |first1=U |last2=Tarp |first2=J |last3=Steene-Johannessen |first3=J |last4=Hansen |first4=BH |last5=Jefferis |first5=B |last6=Fagerland |first6=MW |last7=Whincup |first7=P |last8=Diaz |first8=KM |last9=Hooker |first9=SP |last10=Chernofsky |first10=A |last11=Larson |first11=MG |last12=Spartano |first12=N |last13=Vasan |first13=RS |last14=Dohrn |first14=IM |last15=Hagströmer |first15=M |last16=Edwardson |first16=C |last17=Yates |first17=T |last18=Shiroma |first18=E |last19=Anderssen |first19=SA |last20=Lee |first20=IM |title=Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. |journal=BMJ (Clinical Research Ed.) |date=21 August 2019 |volume=366 |article-number=l4570 |doi=10.1136/bmj.l4570 |pmid=31434697|pmc=6699591 }}</ref>
==Differentiation from Sports medicine== {{Main|Sports medicine}} thumb|Recreational exercise such as swimming and surfing has multiple health benefits The difference between sport and exercise (and hence the differentiation between Sports medicine and Exercise medicine) is subtle, but important. Basically, sport is exercise with an added element of competition (whether against an opponent or oneself, aiming to maximum performance improvements).<ref>{{cite journal |last1=Orchard |first1=JW |title=How exercise medicine has evolved from sports medicine. |journal=The Medical Journal of Australia |date=2 April 2018 |volume=208 |issue=6 |pages=244–245 |doi=10.5694/mja17.00764 |pmid=29614932|s2cid=4606643 }}</ref> There is good evidence that competitive and professional athletes have higher rates of certain conditions than the general population, such as osteoarthritis,<ref>{{cite journal |last1=Tveit |first1=M |last2=Rosengren |first2=BE |last3=Nilsson |first3=JÅ |last4=Karlsson |first4=MK |title=Former male elite athletes have a higher prevalence of osteoarthritis and arthroplasty in the hip and knee than expected. |journal=The American Journal of Sports Medicine |date=March 2012 |volume=40 |issue=3 |pages=527–33 |doi=10.1177/0363546511429278 |pmid=22130474|s2cid=7256358 |url=https://lup.lub.lu.se/record/2274734 }}</ref><ref>{{cite journal |last1=Gouttebarge |first1=V |last2=Inklaar |first2=H |last3=Backx |first3=F |last4=Kerkhoffs |first4=G |title=Prevalence of osteoarthritis in former elite athletes: a systematic overview of the recent literature. |journal=Rheumatology International |date=March 2015 |volume=35 |issue=3 |pages=405–18 |doi=10.1007/s00296-014-3093-0 |pmid=25037899|s2cid=6763231 }}</ref> but equally strong evidence that the life expectancy of elite athletes is longer than the general population.<ref>{{cite journal |last1=Antero |first1=J |last2=Tanaka |first2=H |last3=De Larochelambert |first3=Q |last4=Pohar-Perme |first4=M |last5=Toussaint |first5=JF |title=Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians. |journal=British Journal of Sports Medicine |date=February 2021 |volume=55 |issue=4 |pages=206–212 |doi=10.1136/bjsports-2019-101696 |pmid=32727712|s2cid=220846618 |doi-access=free }}</ref><ref>{{cite journal |last1=Ruiz |first1=JR |last2=Fiuza-Luces |first2=C |last3=Garatachea |first3=N |last4=Lucia |first4=A |title=Reduced mortality in former elite endurance athletes. |journal=International Journal of Sports Physiology and Performance |date=November 2014 |volume=9 |issue=6 |pages=1046–9 |doi=10.1123/ijspp.2013-0492 |pmid=24584695}}</ref>
==Establishment as a medical specialty== Sports medicine is a recognized medical specialty or subspecialty in over 50 countries. In some of these countries, the formal name of the specialty is 'Sport and Exercise Medicine', emphasizing the differentiation between sports medicine (performance-orientated) and exercise medicine (health-orientated). These countries include Australia and New Zealand, with the peak body being the Australasian College of Sport and Exercise Physicians and one of Australia's 15 recognized medical specialty Colleges,<ref>{{Cite web|url=https://cpmc.edu.au/|title=Council of Presidents of Medical Colleges}}</ref> the United Kingdom (Faculty of Sport and Exercise Medicine UK),<ref>{{cite journal |last1=Cullen |first1=M |title=Developing a new specialty - sport and exercise medicine in the UK. |journal=Open Access Journal of Sports Medicine |date=2010 |volume=1 |pages=11–4 |doi=10.2147/oajsm.s7627 |pmid=24198537|pmc=3781848 |doi-access=free }}</ref> Canada (Canadian Academy of Sport and Exercise Medicine), Belgium, Brazil, France, India and Ireland.
==Exercise as an alternative treatment to low-value care== There is increasing evidence that many 'traditional' medical interventions are ineffective at best and potentially harmful at worst.<ref>{{cite news |last1=O'Connor |first1=Denise |last2=Harris |first2=Ian |last3=Buchbinder |first3=Rachelle |title=Needless procedures: knee arthroscopy is one of the most common but least effective surgeries |url=https://theconversation.com/needless-procedures-knee-arthroscopy-is-one-of-the-most-common-but-least-effective-surgeries-102705 |access-date=3 April 2022 |work=The Conversation |date=13 September 2018 |language=en}}</ref> Examples of low-value care include knee and shoulder arthroscopy, spinal fusion surgery<ref>{{cite news |last1=Ferreira |first1=Giovanni E. |last2=Harris |first2=Ian |last3=Zadro |first3=Joshua |last4=O'Keeffe |first4=Mary |title=3 orthopaedic surgeries that might be doing patients (and their pockets) more harm than good |url=https://theconversation.com/3-orthopaedic-surgeries-that-might-be-doing-patients-and-their-pockets-more-harm-than-good-179370 |work=The Conversation |date=24 March 2022 |language=en}}</ref> and opiate prescription for chronic non-cancer pain.<ref>{{cite journal |last1=Harper |first1=S |last2=Riddell |first2=CA |last3=King |first3=NB |title=Declining Life Expectancy in the United States: Missing the Trees for the Forest. |journal=Annual Review of Public Health |date=1 April 2021 |volume=42 |pages=381–403 |doi=10.1146/annurev-publhealth-082619-104231 |pmid=33326297|s2cid=229302547 |doi-access=free }}</ref><ref>{{cite journal |last1=Els |first1=C |last2=Jackson |first2=TD |last3=Kunyk |first3=D |last4=Lappi |first4=VG |last5=Sonnenberg |first5=B |last6=Hagtvedt |first6=R |last7=Sharma |first7=S |last8=Kolahdooz |first8=F |last9=Straube |first9=S |title=Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. |journal=The Cochrane Database of Systematic Reviews |date=30 October 2017 |volume=10 |issue=10 |article-number=CD012509 |doi=10.1002/14651858.CD012509.pub2 |pmid=29084357|pmc=6485910 }}</ref> Exercise prescription, with evidence of efficacy for treatment of knee osteoarthritis and back pain, can be used as an alternative to traditional interventions with poor efficacy and greater side effects.
===Exercise as a method to reduce carbon emissions from healthcare=== Healthcare is responsible for 3-10% of carbon emissions in Western countries.<ref>{{cite journal |last1=Malik |first1=A |last2=Lenzen |first2=M |last3=McAlister |first3=S |last4=McGain |first4=F |title=The carbon footprint of Australian health care. |journal=The Lancet. Planetary Health |date=January 2018 |volume=2 |issue=1 |pages=e27–e35 |doi=10.1016/S2542-5196(17)30180-8 |pmid=29615206|doi-access=free }}</ref> Although most healthcare is considered 'essential', it is important that the necessity of carbon-intensive healthcare options, such as surgery,<ref>{{cite journal |last1=Rizan |first1=C |last2=Steinbach |first2=I |last3=Nicholson |first3=R |last4=Lillywhite |first4=R |last5=Reed |first5=M |last6=Bhutta |first6=MF |title=The Carbon Footprint of Surgical Operations: A Systematic Review. |journal=Annals of Surgery |date=December 2020 |volume=272 |issue=6 |pages=986–995 |doi=10.1097/SLA.0000000000003951 |pmid=32516230|s2cid=216202267 |url=http://sro.sussex.ac.uk/id/eprint/90473/1/__smbhome.uscs.susx.ac.uk_tjk30_Documents_carbon%20footprint%20SR%20annals%20of%20surgery%20manuscript%2015.pdf }}</ref> is critically assessed as there is an international agreement that net zero emissions must be reached to avoid breakdown of the Earth's climate.<ref>{{cite news |title=HCWH's new global road map for zero emissions healthcare |url=https://noharm-europe.org/articles/news/europe/hcwhs-new-global-tool-zero-emissions-healthcare |work=Health Care Without Harm |date=14 April 2021 |language=en}}</ref> Exercise as a medical treatment has perhaps the lowest carbon footprint of any medical treatment.<ref>{{cite journal |last1=Orchard |first1=JW |title=Sport and exercise medicine: leading the race towards net zero. |journal=British Journal of Sports Medicine |date=18 January 2023 |volume=57 |issue=7 |pages=386–387 |doi=10.1136/bjsports-2022-106177 |pmid=36653142|s2cid=255966794 }}</ref> An increased focus on exercise prescription as an effective alternate to carbon-intensive medical treatments is an important part of healthcare reform, which needs to be 'transformational' to reach goals of net-zero emissions from healthcare.<ref>{{cite journal |last1=Charlesworth |first1=KE |last2=Jamieson |first2=M |title=Healthcare in a carbon-constrained world. |journal=Australian Health Review |date=July 2019 |volume=43 |issue=3 |pages=241–245 |doi=10.1071/AH17184 |pmid=29731002|s2cid=19201926 }}</ref>
==Differentiation from "Exercise Is Medicine" (EIM)== {{Main|Exercise is Medicine}} 'Exercise is Medicine' is a trademarked non-profit venture of the American College of Sports Medicine. By comparison, 'Exercise Medicine' is a specific subspecialty of 'Sport and Exercise Medicine'. The concept of 'Exercise is Medicine' is that all medical specialists should be prescribing exercise regularly as an adjunct to a standard consultation.<ref>{{cite journal |last1=Lobelo |first1=F |last2=Stoutenberg |first2=M |last3=Hutber |first3=A |title=The Exercise is Medicine Global Health Initiative: a 2014 update. |journal=British Journal of Sports Medicine |date=December 2014 |volume=48 |issue=22 |pages=1627–33 |doi=10.1136/bjsports-2013-093080 |pmid=24759911|s2cid=26898017 }}</ref><ref>{{cite journal |last1=Sallis |first1=RE |last2=Matuszak |first2=JM |last3=Baggish |first3=AL |last4=Franklin |first4=BA |last5=Chodzko-Zajko |first5=W |last6=Fletcher |first6=BJ |last7=Gregory |first7=A |last8=Joy |first8=E |last9=Matheson |first9=G |last10=McBride |first10=P |last11=Puffer |first11=JC |last12=Trilk |first12=J |last13=Williams |first13=J |title=Call to Action on Making Physical Activity Assessment and Prescription a Medical Standard of Care. |journal=Current Sports Medicine Reports |date=May 2016 |volume=15 |issue=3 |pages=207–14 |doi=10.1249/JSR.0000000000000249 |pmid=27172086|s2cid=207179559 }}</ref> The aims of the 'Exercise is Medicine' movement and the specialty of Exercise Medicine are generally synergistic, with both aiming to improve physical activity in the population (for whom a large proportion is inactive). Exercise Medicine specialists also consult a smaller subsection of the population who are temporarily over-active and require a slight reduction in load in order to overcome injury or chronic pain. The concept of 'Exercise is Medicine' is as a 5-minute addition to almost every medical consultation, treating exercise as a 'vital sign',<ref>{{cite journal |last1=Golightly |first1=YM |last2=Allen |first2=KD |last3=Ambrose |first3=KR |last4=Stiller |first4=JL |last5=Evenson |first5=KR |last6=Voisin |first6=C |last7=Hootman |first7=JM |last8=Callahan |first8=LF |title=Physical Activity as a Vital Sign: A Systematic Review. |journal=Preventing Chronic Disease |date=30 November 2017 |volume=14 |pages=E123 |article-number=170030 |doi=10.5888/pcd14.170030 |pmid=29191260|pmc=5716811 }}</ref><ref>{{cite journal |last1=Kuntz |first1=JL |last2=Young |first2=DR |last3=Saelens |first3=BE |last4=Frank |first4=LD |last5=Meenan |first5=RT |last6=Dickerson |first6=JF |last7=Keast |first7=EM |last8=Fortmann |first8=SP |title=Validity of the Exercise Vital Sign Tool to Assess Physical Activity. |journal=American Journal of Preventive Medicine |date=June 2021 |volume=60 |issue=6 |pages=866–872 |doi=10.1016/j.amepre.2021.01.012 |pmid=33781618|pmc=8154650 }}</ref> which has the potential of enormous reach. Exercise medicine specialists aim to also cater for some of those patients who don't respond to the first line measure of a brief written exercise prescription by providing longer specialized consultations with a focus solely on exercise. Exercise Is Medicine has been criticized for making exercise come across as exclusively a medical treatment when it should be seen more broadly as a public health strategy and protective risk factor that should be available to everyone.<ref>{{Cite journal |last1=Davenport |first1=Todd E |last2=Griech |first2=Sean F |last3=Deamer |first3=Kathryn E |last4=Gale |first4=Lewis R |date=2022-06-27 |title=Beyond "Exercise as Medicine" in Physical Therapy: toward the Promotion of Exercise as a Public Good |journal=Physical Therapy |volume=102 |issue=9 |article-number=pzac087 |doi=10.1093/ptj/pzac087 |pmid=35778932 |issn=1538-6724}}</ref>
===Further reading on EIM=== * {{cite journal | last1=Cairney | first1=John | last2=McGannon | first2=Kerry R. | last3=Atkinson | first3=Michael | title=Exercise is medicine: critical considerations in the qualitative research landscape | journal=Qualitative Research in Sport, Exercise and Health | volume=10 | issue=4 | date=8 August 2018 | issn=2159-676X | doi=10.1080/2159676X.2018.1476010 | pages=391–399}}
==Journals== * ''Medicine & Science in Sports & Exercise'' * ''Exercise and Sport Sciences Reviews'' * ''British Journal of Sports Medicine'' * ''[https://www.sciencedirect.com/journal/journal-of-exercise-science-and-fitness Journal of Exercise Science & Fitness]'' * ''[https://bmjopensem.bmj.com/ BMJ Open Sport & Exercise Medicine]'' * ''[https://exercmed.org/ Exercise Medicine]'' * ''[https://journals.plos.org/plosone/browse/sports_and_exercise_medicine PLOS One sports and exercise medicine]'' * ''[https://www.tandfonline.com/journals/rqrs21 Qualitative Research in Sport, Exercise and Health]''
==See also== {{colbegin}} * Exercise * Exercise physiology * Physical fitness * Physical therapy * Sports science * Sports training {{colend}}
==References==
{{reflist}}
{{Sport}} {{medicine}}
Category:Sports medicine Category:Medical specialties