Exercise makes you healthy – oftentimes even when you are sick. That’s why doctors hardly ever recommend taking a break from it. Even patients who are about to receive a heart transplant can benefit from sports. As is so often the case, the dose makes the poison. We asked sports medicine physician Prof. Martin Halle, what people need to consider.
Professor Halle, a few short years ago, physicians still cautioned their patients to take a break when they were sick. Today, exercise is expressly recommended. For which types of diseases can exercise be helpful?
Martin Halle: Sports therapy is important for a number of different diseases. Many studies have been conducted over the past ten years that are now also being put into practice. Several health insurance companies, among them the German Technician Health Insurance (German: Techniker Krankenkasse), already firmly established exercise as therapy. They try to communicate to patients that there are other options – aside from medication – to fight their illness. This first and foremost includes cardiovascular diseases but also various types of cancer, osteoporosis or dementia. For the most part, these are chronic inflammatory diseases and physical training is very helpful and important in this context.
Just asking patients to exercise won’t help them. What do physicians need to consider to be able to make recommendations?
Halle: As a matter of fact, the point is not to give general advice to patients as in, “take the stairs and skip the elevator”. On the contrary, this is all about making clear recommendations for the individual patient. A patient with high blood pressure actually may not always benefit from jogging three times a week for half an hour because the blood pressure of some patients can reach excessive heights, and thereby not help them at all. Taking medication and embarking on targeted low-intensity exercise would perhaps make more sense in this case. In doing so, the strain on the vascular system can be controlled which has a positive effect. Diabetes patients are in a similar situation. If diabetics exercise too intensely, it can result in elevated blood sugar levels. With the right dose, however, levels would drop. That’s why you can achieve both a positive and negative effect with training. If a physician prescribes an individualized exercise plan, certain parameters need to be tested beforehand, by using an exercise stress echocardiogram for instance. This lets you determine the optimal pulse rate. In addition, exercise needs to be coordinated with the prescribed medications. For example, it might make sense to reduce the insulin dose for a diabetic who exercises a lot to avoid hypoglycemia. So you need to determine whether the patient is able to exercise. What type of training is right for him/her? What intensity level is right for the patient’s overall condition? The answers to these questions determine the individualized training program. It is then prescribed for the patient by providing specifics on the type and scope of the workout. In some instances, training also takes place in certified facilities; if the patient’s illness is of a certain severity like in the case of cancer or heart diseases for example.
It certainly requires a lot of experience to be able to tailor this type of therapy. Are family doctors already capable of doing this today?
Halle: There are indeed still many shortfalls in this area because sports medicine has not been the focus of physicians for the longest time. It was neither a part of their training nor do many general practitioners spend a lot of time prescribing sports therapies in their daily practice. It is not a routine practice for many. That said, the awareness in this field has significantly increased over the past five years. Physicians can easily learn the tools of the trade; targeted programs are available and doctors can assist sports medicine physicians.
The interview was conducted by Simone Ernst and translated by Elena O'Meara.