Cardiovascular disease, cancer and chronic lung disease are leading causes of morbidity and mortality in America. Lifestyle risk factors contribute to these diseases and associated medical and functional decline. Exercise contributes to health and wellbeing. But only 45% of adults are physically active, 20% meet exercise guidelines and 1/3 are inactive. Disease associated with inadequate physical activity contributes to 11% of health care expenditure. Exercise guidelines exist for the healthy population. Adherence to guidelines is effective in primary and secondary prevention of disease. Long-term exercise participation in people with disabilities is poor. Barriers to participation include weakness / fatigue, accessibility of exercise equipment, lack of education and instruction in exercise, anxiety to exercise, lack of exercise recommendation by the health care team. Physiatrists are ideally situated to overcome these barriers to exercise being involved in the care of patients with cardiovascular diseases, stroke, heart disease, PAD; cancers; chronic pulmonary diseases. A comprehensive history and physical elucidates strategies to overcome identified barriers. Pre-exercise testing including exercise stress testing enables a safe exercise prescription to be written. Monitoring participation and progression of exercise enables patients to achieve optimum benefits. Creating a supportive environment fosters lifelong exercise participation key to successful secondary prevention.

Learning Objectives

  • Discuss the literature that supports the role of exercise as medicine.
  • Understand the consequences of a sedentary lifestyle and the role exercise plays in cardiovascular, cancer and chronic lung disease primary prevention, recovery and secondary prevention.
  • Outline the evaluation of patients' pre-exercise participation and the role of exercise stress testing in exercise prescription.