Back in the 1980s, Dr. Robert Butler, director of the American Institute on Aging, stated: "If exercise and physical activity could be packaged as a pill, it would be the most widely prescribed and beneficial drug for the population." Since then, the World Health Organization (WHO) has repeatedly confirmed that physical inactivity and a sedentary lifestyle worsen chronic health problems, including hypertension, cardiovascular and cerebrovascular diseases, diabetes, depression, and dementia. In addition, 2020 estimates indicated that not complying with physical activity recommendations is the fourth leading cause of death in the world, responsible for more than 5 million deaths worldwide each year. To top it all, it has been proven that reducing the number of daily steps for 14 days is sufficient to increase the risk of future metabolic disease and insulin resistance, typical of type II diabetes and obesity. It is confirmed that we are designed to move. And that, if we don't, the burden of disease and mortality will skyrocket exponentially. If Dr. Butler raised his head, 33 years later, he would confirm what he already suspected: physical activity and sport should be essential activities in public health policy, and more so in times of pandemic. And shoes and weights are our best allies.
In the world population, however, only 18% of adults aged 65 to 74 and 15% of those over 75 meet the minimum practice recommendations of physical activity: get more than 150 minutes of moderate-vigorous aerobic physical activity per week and perform muscle-strengthening exercises at least twice a week. But what is really worrying is that this "deficiency in the practice of physical activity" is observed from the first stages of life. It is the real problem that causes childhood obesity.
"The evidence on the positive effects of physical exercise has led him to equate it to the best of medicines"
Despite the great advances in science, at the moment, there are no drugs (or combinations of them) that can improve physical capacity in people, and it is likely that none will be developed in the foreseeable future. The evidence on the positive effects of physical exercise has led it to equate it to the best of medicines. It must be recognized, however, that not all drugs cure cancer, nor do all types of exercise (cardiovascular, strength training, balance) have the same effects on disease and functional capacity. Walking is not enough and it is not advisable to follow some of the YouTube trends of influencers wearing tracksuits.
Despite the regrets, exercise has not been fully integrated into the usual practice of primary or geriatric medicine and is still practically absent from the basic training for most doctors and other healthcare professionals. It is something that covid-19 has made even more evident, both in the general population, who had been practicing little physical activity, and in which a greater decrease in its practice is observed, and in patients with persistent covid , in which it is becoming increasingly clear that physical exercise will once again play a central role in the recovery of symptoms of physical and mental fatigue.
Nowadays, it is also evident that more research studies are needed on exercise interventions for older adults, the largely overlooked in medical studies. Important questions remain about the safety, efficacy, and inherent variability between people in response to exercise. Understanding this variability is essential to identify the best treatment method (simple exercises or multi-component exercises) and intensity (low, moderate or high intensity resistance exercises) to preserve and ideally improve physical capacity in very advanced ages.
"Doctors should be the first 'prescribers of physical exercise' and medical schools should teach students that skeletal muscle remains a plastic and adaptable tissue throughout human life"
In an age where science, and especially precision medicine, is advancing the individualized treatment of disease and even the improvement of life expectancy, we must not forget the simple and important message: exercise is not just for children. and younger adults, older people can adapt to exercise and deserve to benefit from it. It is never too late, and you are never too old, to contract your muscles. In addition, in these times, physical exercise is also the only cheap, effective and safe "vaccine", without supply problems, queues or shifts and that everyone could start taking it from this moment.
We would have to abandon policies of the Ministry of Disease and evolve towards one more focused on health and quality of life. Physicians in almost all specialties, but especially those in primary care and geriatrics, should advise all patients, regardless of age, to be as active as possible. Physicians should be the first "prescribers of physical exercise" and medical schools should teach students that skeletal muscle remains a plastic and adaptable tissue throughout human life.
Physical activity practice and physical educators, They should have a more relevant and priority role in solving this problem and should be considered that way: essential activity with an impact on public health. This should be one of the great pending challenges for public health and sanitary policy in the coming years. PP Mikel Izquierdo is professor and director of the Department of Health Sciences at the Public University of Navarra. Principal investigator of the Physical Exercise, Health and Quality of Life (E-FIT) group of Navarrabiomed. Professor of the Master in High Sports Performance of the Spanish Olympic Committee. He is currently participating as a researcher at the CIBER on Aging and Fragility (CIBERFES) and is the scientific director of the VIVIFRAIL project. @mikelizquierdo_
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