Exercise as Medicine

One of my professors at university had a great analogy for how exercise can be used as medicine:

“If I were to put my hands around your throat and squeeze, within a few seconds, you will quickly realise that air is essential for life. If I were to release your throat but lock you in a room without any food or water, within a few hours to a day, you will realise that water is essential for life. If I were to give you water, but leave you in that locked room, within a few days, you will realise that food is essential for life. Exercise is also essential for life, however, it might take years for you to realise this fact”.

This analogy might seem extreme; however, I hope you will agree, it is impactful and difficult to argue with. Whilst exercise is essential for life, the concept of exercise as medicine is an emerging field. If you have ever read into to research for the management of pretty much any medical condition, exercise will be on the list!

The use of exercise is a key component for the management of lots of different diseases and disorders is well recognised and understood. The aim of this blog post is to educate people about the role of exercise has in the management of several areas of medicine, how exercise can be used as medicine and do some myth busting along the way. So, sit back with your favourite beverage and enjoy!

Exercise for Osteoarthritis

We have discussed osteoarthritis of the hip joint in a previous blog post “When your hips don’t lie, but they do ache”. We have also explored how exercise can help with low back pain. If you missed these blog posts and want to learn more, click on the links and enjoy!

Some of you are already thinking about the perceived paradoxical idea of exercising on an arthritic joint. I have come across this idea frequently in my clinical work, and on the surface, it appears reasonable. The most common opinions I hear from patients are:

“Exercise makes arthritis worse.”
“I should not exercise, I have arthritis.”
“I can’t exercise; I have arthritis.”

All of these statements appear logically sound; however, they are in fact myths. Exercise does not cause or contribute to the development of arthritis¹. In fact, it is likely that the opposite is true. Obesity, a lack of physical activity, loss of muscle mass and reduced muscle strength are all related to the development of arthritis². Patients with arthritis tend to be less physically active, have more sedentary lives, low muscle strength and impaired muscle function^2–4. I want to make this clear, I am not for one moment trying to say that if you have arthritis, it is your fault because you have been less active. There are more factors at play then physical activity in the development of arthritis, including genetic and family history factors, inflammatory conditions, and previous joint injury that all play a role in the development of arthritis.

Strong evidence shows aerobic and strength/resistance training on a painful, arthritic joint reduces pain and improves physical function^2,5. In fact, the pain reduction experienced by study participants in the resistance training group was comparable with the same level of pain reduction experienced when taking non-steroidal anti-inflammatory medications and the aerobic training group pain reduction was comparable to a joint injection^2,5,6.

Targeted strengthening exercises for the quadriceps muscles has been specifically shown to reduce pain and improve function of the arthritic knee². Improving muscular strength, balance and control for an arthritic joint can help with the joint instability associated with some peoples arthritis, making your feel more steady on your feel and improving your confidence.

Exercise for Mental Health

Mental health has become a large focus of modern life, so it seems prudent to mention in this blog the importance and significant impact exercise has on mental health. Physical activity has also been shown to improve depression, anxiety, reduce stress levels or simply aid in stress management.

Stress is a common and essential part of everyday life. However, sometimes stress levels can get out of control for all of us, and long-term high stress levels will lead to ill health². Having strategies in place to help manage and reduce the negative effects of long-term high stress levels is essential for health. The mechanisms behind the use of exercise in improved mental health can be summarised by improvements in physical and emotional well being by increasing dopamine and endorphin levels in the brain². Also, evidence shows improving your social activities with interactions with others in the gym also improves your overall health². Exercise also improves sleep, increases energy levels, and promotes better focus and cognitive function. Over time, consistent exercise can build resilience, boost self-esteem, and provide a healthy outlet for managing daily challenges.

Metabolic Disorders

It should come as no surprise that, exercise is used in the management of metabolic disorders such as type II diabetes^2,7,8.

Metabolic syndrome is a cluster of conditions—including high blood pressure, elevated blood sugar, excess abdominal fat, and abnormal cholesterol levels—that increase the risk of heart disease and diabetes. Regular exercise can help improve metabolic syndrome by enhancing insulin sensitivity, lowering blood pressure, reducing visceral fat, and improving cholesterol profiles. Physical activity also supports weight management and boosts overall metabolic health, making it a key part of preventing and managing the condition.

Regular exercise has been shown to improve insulin sensitivity, blood lipids (fats) and reduce the risk of developing type 2 diabetes and in the management of type 2 diabetes².

Types of Exercise as Medicine

Well done for making it this far in the blog, I commend you for making it this far. The burning questions that everyone has when it comes to using exercise as medicine are; what type of exercise should I do to get these benefits? And how often should I be doing them? The evidence shows it doesn’t really matter about what type of exercise; the benefits are the same. However, intensity of the exercise, exertional effort and consistency are intrinsically linked to the outcome. It is therefore important to begin your exercise journey with something that is sustainable and something you can stick to. In my humble opinion, resistance training is probably the most important training type for several reasons, some of which we have covered. However, one benefit we haven’t discussed is longevity, and improved quality of life in our later years^9,10. In their systematic review of the literature, Sheilandra and colleagues (2022) showed resistance training reduces all cause mortality including cardiovascular disease, and cancer-specific mortality rates¹⁰.

Frequency, how often should you train? This is a more complex question that it first sounds. The most commonly accepted answer to this question is three training sessions per week of 30 minutes or more. However, some people great benefits from more frequent but less intense exercise sessions in a week. Others get better results with less frequent sessions, twice a week could be your key number of sessions per week. There are several tests you can do to investigate your peak exercise type and frequency, including genetics tests that can shed light on your optimal training types and times for you! I can’t link any specific brands or tests in this blog, but if you search for them online, you will find the best one for you.

I hope you enjoyed this blog post as much as I enjoyed writing it. These blogs are a great thing for me to do, because I get to collate the journal articles I read and share them with you. A lot of effort goes into these blogs, so I am always chuffed to talk to people who read and benefit from them. Feel free to make comments in the comments section or follow us on social media to keep up to date with the blogs or suggest one you might like to learn more about.

By Mark Spriggs DC, MChiro, MSc, PGcert, FRCC

References:

Timmins KA, Leech RD, Batt ME, Edwards KL. Running and Knee Osteoarthritis: A Systematic Review and Meta-analysis. Am J Sports Med. 2017;45(6):1447-1457. doi:10.1177/0363546516657531
Pedersen BK, Saltin B. Exercise as medicine – Evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sport. 2015;25:1-72. doi:10.1111/sms.12581
Roos EM, Herzog W, Block JA, Bennell KL. Muscle weakness, afferent sensory dysfunction and exercise in knee osteoarthritis. Nat Rev Rheumatol. 2011;7(1):57-63. doi:10.1038/NRRHEUM.2010.195
Hurley M V. THE ROLE OF MUSCLE WEAKNESS IN THE PATHOGENESIS OF OSTEOARTHRITIS. Rheum Dis Clin North Am. 1999;25(2):283-298. doi:10.1016/S0889-857X(05)70068-5
Zhang W, Nuki G, Moskowitz RW, et al. OARSI recommendations for the management of hip and knee osteoarthritis. Part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartil. 2010;18(4):476-499. doi:10.1016/j.joca.2010.01.013
Fransen M, McConnell S, Harmer AR, Van Der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med. 2015;49(24):1554-1557. doi:10.1136/BJSPORTS-2015-095424
Knowler W, Barret-Connor E, Fowler S, et al. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med. 2002;346(6):393-403.
Tuomilehto J, Lindstrom J, Eriksson J, et al. Prevention of Type 2 Diabete Mellitus by Changes in Lifestyle Among Subjects with Impaired Glucose Tolerace. N Engl J Med. 2001;344(18):1343-1350.
Fernandes L, Antunes R, Matos R, Monteiro D, Amaro N, Couto N. Effects of Strength Training on the Quality of Life of Older Adults with Sarcopenia : A Systematic Review of Randomized Controlled Trials. Published online 2025:1-12.
Shailendra P, Baldock KL, Li LSK, Bennie JA, Boyle T. Resistance Training and Mortality Risk: A Systematic Review and Meta-Analysis. Am J Prev Med. 2022;63(2):277-285. doi:10.1016/j.amepre.2022.03.020

Exercise as Medicine