Exercise is medicine

Sp Sub 1bw

Physical activity presents as a prevention strategy for numerous chronic health conditions, including coronary heart disease, insulin resistance, hypertension and breast, colon, and endometrial cancer.1 However, for individuals with existing chronic health conditions, evidence is growing to support the integration of regular exercise into their treatment plans.

Multiple sclerosis

Multiple sclerosis (MS) is a chronic disease that affects the central nervous system, typically resulting in progressive and gradual disability. Approximately 25,600 Australians live with MS.2 Diagnosis of MS typically occurs between the ages of 20 and 40 years, and 75% of people with MS are women.2 There is currently no cure for MS and current therapies are aimed at easing symptoms and modifying the progression of the disease.

A systematic review published in 2013 examined 54 studies and found strong evidence that moderate intensity exercise performed two times per week increases aerobic capacity and muscular strength in MS patients with mild to moderate disability.3 The authors concluded that exercise training is effective for improving aerobic capacity and muscular strength and may improve mobility, fatigue, and health-related quality of life for people living with MS.3

It appears that the benefits of exercise for people living with MS is not limited to functional capacity and health-related quality of life. Several studies have demonstrated a positive impact of exercise on cognitive status of people living with MS4, as well as a lower annual relapse rate in people living with MS.5   

Type 2 Diabetes

Type 2 diabetes, a condition in which the body becomes resistant to the normal effects of insulin and gradually loses the capacity to produce enough insulin in the pancreas, has strong genetic risk factors and is often associated with modifiable lifestyle risk factors. In 2017-8 it was estimated that 4.9% of Australia’s total population had diabetes and approximately 1.2 million hospitalisations were associated with diabetes.6 Complications associated with type 2 diabetes include stroke, lower limb ischemia, nephropathy, retinopathy, and diabetic maculopathy.7 There is a high incidence of other risk factors for these complications among patients with type 2 diabetes e.g., hypertension, hyperlipidaemia, and cardiac and endothelial dysfunction.7  

The idea of exercise as treatment for type 2 diabetes is not new, and there is an international consensus that physical activity, along with diet and pharmaceuticals, are the foundations in the treatment of type 2 diabetes.8 There is extensive literature demonstrating the positive effects of exercise on metabolic control, fitness, muscle strength and motivation in patients with type 2 diabetes.9 Furthermore, regular exercise has several documented effects that are important for patients with type 2 diabetes such as reduction in systolic blood pressure and improvements in cardiac and endothelial vasodilatory function.9


Dementia describes a collection of symptoms that are caused by disorders affecting the brain. Dementia affects thinking, behaviour, and the ability to perform everyday tasks and due to the aging population, the number of people with dementia is constantly increasing.10 Estimations from Dementia Australia suggest that 487,500 Australians are currently living with dementia, and that the age of onset of dementia is gradually declining.11 A major challenge concerning dementia treatment is the management of neuropsychiatric symptoms such as agitation, anxiety, and depression, all of which are associated with low quality of life and increased caregiver burden.10

A recent systematic review including 13 studies and 1925 dementia patients demonstrated that regular aerobic exercise performed three to five times per week has a positive effect on neuropsychiatric symptoms.11 Interestingly the review demonstrated that combined exercise programs (aerobic and resistance exercise) did not appear to be as effective as aerobic exercise alone. Nevertheless, the study determined that resistance training programs are beneficial for dementia patients with mobility problems, with demonstrated reductions in symptoms of depression and behavioural problems.

The evidence pertaining to the benefits exercise as a treatment for chronic health conditions is growing rapidly and is not limited to the conditions discussed in this article. There is existing and emerging evidence relating to a wide range on chronic diseases including chronic obstructive pulmonary disease, asthma, osteoporosis, polycystic ovarian syndrome, obesity, Parkinson’s disease, depression, and anxiety.9 Indeed, further work is required to determine the efficacy and safety of exercise prescription for specific chronic health conditions. Nevertheless, perhaps a scenario where we see exercise prescription integrated into the treatment guidelines for most chronic health conditions is not too far away.

Sarah Joyce, PhD (Senior Consultant at My Medical Department)   


  1. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012;2(2):1143-211.
  2. What is Multiple Sclerosis (MS)? MS Australia. https://www.msaustralia.org.au/what-is-multiple-sclerosis-ms/. Accessed July 8, 2022.
  3. Latimer-Cheung AE, Pilutti LA, Hicks LA, Martin Gini KA. Effects of Exercise Training on Fitness, Mobility, Fatigue, and Health-Related Quality of Life Among Adults with Multiple Sclerosis: A Systematic Review to Inform Guideline Development. Arch. Phys. 2013; 94(9): 1800-1823.
  4. Kalron A, Zeilig G. Efficacy of exercise intervention programs on cognition in people suffering from multiple sclerosis, stroke and Parkinson’s disease: A systematic review and meta-analysis of current evidence. NeuroRehabilitation. 2015;37(2):273–89.
  5. Pilutti LA, Platta ME, Motl RW, Latimer-Cheung AE. The safety of exercise training in multiple sclerosis: a systematic review. J Neurol Sci. 2014; 343(1–2):3–7.
  6. Diabetes. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/diabetes/diabetes/contents/how-many-australians-have-diabetes/type-2-diabetes. Accessed July 8, 2022.
  7. Goyal R, Jialal I. Diabetes Mellitus Type 2. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK513253/. Accessed July 8, 2022.
  8. American Diabetes Association. Clinical practice recommendations. Diabetes Care. 2002:S1-s147.
  9. Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015; 25(S3):1-72.
  10. Kouloutbani K, Venetsanou F, Markati A, Karteroliotis K, Politis A. The effectiveness of physical exercise interventions in the management of neuropsychiatric symptoms in dementia patients: A systematic review. International Psychogeriatrics. 2022;34(2)177-190.
  11. Dementia Statistics. Dementia Australia. https://www.dementia.org.au/statistics. Accessed July 8, 2022.