Exercise is Medicine: Expanding the Role of Exercise in Health Care

The American College of Sports Medicine is proud to publish the fourth edition of ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities. Informally known as CDD4, this edition is a substantial revision that forges the role of exercise in tomorrow’s health care systems.

  • If you are a primary care doctor, keep this book readily available in your clinic. It will become very dog-eared in short order.
  • If you are an allied health care provider working with patients who have chronic conditions but you and your co-workers aren’t knowledgeable about exercise for those with chronic diseases, then you should have this book.
  • Even if you are a clinical exercise physiologist or a physical therapist working with people who have chronic diseases or disabilities, you will benefit from this book.

Abundant data from epidemiology and clinical trials prove that physical inactivity and the lack of physical fitness are strong independent risk factors for many chronic conditions, disability and all-cause mortality (notably from cardiovascular disease and cancer). Exercise programmes and regular physical activity help with the issues that patients with chronic conditions and their families really care about—maintaining the vitality, physical functioning and independence that are slipping away. Make use of benefits such as:

  •    Counteracting metabolic states that cause cardiovascular disease
  •    Reducing disability
  •    Improving quality of life
  •    Maintaining physical independence
  •    Maintaining cognitive ability
  •    Delaying loss of independence
  •    In some circumstances, increasing longevity

While not all of these outcomes can be realised for all conditions discussed in this book, no other single prescription has the potential to achieve all of these benefits. Medical schools and postgraduate training of physicians across the globe must begin to address exercise in the contemporary training of physicians, and health care systems must begin to incorporate exercise into chronic care management. If that describes a health care system you want to create, no other textbook is so thoroughly focused on helping you achieve that transformation.

What’s New in the Fourth Edition?

CDD4 presents several substantial advances in the approach of exercise in chronic disease and disability, with five key additions and revisions:

  • A primer on exercise for health professionals—why it’s important, the basics of exercise prescription, when someone needs to have diagnostic exercise testing, how to use existing exercise community resources and an overview of counselling methods commonly used by exercise professionals
  • Guidance for primary care providers and patient-centered medical homes on the role of exercise in chronic care management
  • A new Basic CDD4 Recommendation that suits most patients, based on consensus statements and streamlined to better suit patients with chronic conditions
  • A more complete discussion of exercise in people who have multiple chronic conditions
  • Refocusing of goals of exercise toward optimising an individual’s physical functioning for full participation in life activities

Another improvement is that sample cases have been revamped into an Exercise Rounds section that not only presents the how-to of a case but also reveals the patient’s individual challenges and the limits of medical knowledge. These discussions help readers see gaps in care (and in evidence base), improving the ability to individualise and improvise care plans.

Expanding the Role of Exercise in Health Care

Health care systems need to overcome the lack of interaction between the medical and exercise professions. Few physicians are well trained in the use of medically directed exercise and could refer many more patients than they currently do. Programmes like cardiac rehabilitation and diabetes education are underused, as are exercise programmes for people with arthritis, cancer survivors, and those with many other conditions. Medically oriented fitness facilities often offer some of these programmes, but almost no gyms provide a full range of services covering the variety of conditions discussed in CDD4. Thus, perhaps the most important goal of this book is to create a more collaborative teamwork approach between medical and exercise professionals.

CDD4 is intended to help primary care physicians and staff in patient-centered medical homes while retaining the same user-friendliness for allied health and exercise professionals who liked previous editions of this book. This will help primary care practices incorporate exercise specialists into the practice team as a critical part of their referral network and will help exercise professionals find ways to avail themselves to primary care practices that need their expertise.

For exercise to be used as medicine worldwide, exercise management must become an embedded operation in primary care practices, specialty practices and health and fitness businesses. To those on the medical team (doctors, nurses, physical therapists, clinical exercise physiologists, occupational therapists, counsellors etc.) this book is about patients; to those exercise professionals who provide medical exercise programmes or gym-based programmes, these patients are commonly called clients. When the pathway from patient to client is heavily traveled, people with chronic conditions will have hope for optimising their physical functioning to remain independent and preserve quality of life.

 

This post has been written by Dr. Geoffrey Moore, co-author of ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities, 4th Edition. 

This text presents a framework for optimising patients’ and clients’ functionality by keeping them physically active. It provides evidence-based guidance on devising individualised exercise programs for persons with chronic conditions and disabilities. 

 

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