Earlier this week I wrote about the Exercise is Medicine initiative and why physicians should prescribe exercise to all of their patients.
Despite the widely-known benefits of exercise, many physicians—and people in general—believe that chronic health conditions should be managed using medications, not proper nutrition and physical activity. This is a misguided approach considering that weight gain and health conditions related to weight gain accumulate over a period of years, resulting from eating too much combined with low levels of activity.
One reason that physicians are hesitant to prescribe exercise (and, similarly, good nutrition) is that in their experience, it doesn’t work. What they mean is that the results they see after recommending lifestyle modifications are typically not sufficient. So the assumption made by doctors and patients is that lifestyle modifications don’t work. But this is not necessarily the case
This debate comparing lifestyle modification with medical management of chronic diseases is familiar. Consider statins, the popular lipid-lowering medications that are currently among the most-prescribed drugs (examples include Lipitor, Zocor, Crestor and Vytorin). The effect of statin drugs on lowering blood lipids is significant in most patients. This, together with clever marketing to both patients and physicians, explains why they are so widely used.
It is possible to lower blood lipids as much as statins by carefully controlling diet and regular exercise, but it is difficult. How difficult depends on the individual, but everyone would agree that successful lifestyle modification takes more effort and dedication than taking a pill. In order for any treatment to work, it has to be followed. A patient who doesn’t follow their diet or exercise program is no different from a patient who doesn’t take their medication as directed. In both cases, the response to the treatment will fall short of expectations.
If someone didn’t take their statin medication and their blood cholesterol didn’t go down, no one would label the drug a failure. The medication may well have worked if the patient took it. But people routinely claim that diet and exercise don’t work, when the real problem is that these treatments aren’t followed. This could be because the patients weren’t provided with appropriate and actionable information or because they didn’t faithfully follow the instructions they were given.
The problem isn’t that lifestyle modification isn’t effective, it’s that people don’t implement healthy changes for the long-term. Whereas a statin drug results in rapid changes, the benefits of behavior change are realized more slowly. This can lead to the incorrect conclusion that diet and exercise aren’t working, even though they are.
In reality, medication can be part of a treatment plan, but should not be the only prescription. Long-term health benefits come from changing eating and activity patterns. Medications should be used as a “jump start” to treating a condition, with a goal of developing a new way of eating and regular activity as the long-term treatment.
For example, medications like statins can lower cholesterol quickly. Then, lifestyle changes can keep the cholesterol down, reducing the need for the drug. Since side effects depend on the dose and duration of treatment, this approach would reduce the risk of potentially dangerous side effects.
For many patients, lifestyle changes are effective on their own, meaning the medication isn’t necessary. And consider this: maintaining a healthy body weight, proper nutrition, and regular exercise has been proven to be the best—and at this point, only—way to prevent most of the health problems most of us will face. Good nutrition and physical activity really are the best medicine!