Exercise in the Treatment of Chronic Disease: An Underfilled Prescription

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It is clear that chronic disease has become the plague of the 21st century. In fact, 7 of the top 10 causes of death in the United States are chronic diseases, with heart disease and cancer leading the way and accounting for almost half of all deaths (6). All told, chronic diseases cause about 70% of the deaths among Americans every year (3). This is not surprising because nearly half of all adults have one or more chronic diseases and nearly a quarter have two or more (2). In addition, the prevalence of chronic disease increases dramatically with age, suggesting these conditions will only become more common as our nation’s Baby Boom generation transitions into Medicare.
We also know that caring for patients with chronic disease can be both complex and costly. Patients with noncommunicable and chronic conditions account for nearly 86% of our nation's health care costs, which were US $2.9 trillion in 2013 and show no evidence of declining (3). It is frightening to think about the devastating effect that escalating health care costs will have on our nation’s economy, as we spend almost 18% of our gross domestic product (GDP) on health care, not to mention the ever rising amount individuals pay each month for health insurance premiums, copays, and deductibles. It is clear that we cannot continue down the same path we are on with regard to health care in the United States.
It is amazing that chronic diseases are in large part preventable, yet we tolerate the behaviors that lead to the conditions. They are typically related in some fashion to three behavioral choices — exercise, diet, and smoking. We have done a good job in the United States (and around the world) to decrease smoking. It would be hard to find someone older than 5 yr in the United States who could not tell you that smoking is hazardous to your health. And efforts to combat smoking, while slow, have been successful, because the rates of cigarette smoking in both students and adults have steadily decreased over the past 50 yr (1).
We also have devoted tremendous time and money to the issue of diet and obesity in the United States. It is hard to turn on the TV or pick up a newspaper without reading yet another story about how fat we are as a nation and the escalation of obesity rates. I think many of us in health care have become discouraged by seeing the yearly U.S. Centers for Disease Control & Prevention maps that show obesity trends in the United States over the past 35 years continue to worsen each year despite our best efforts. Unfortunately, it is hard to find consensus on any plan to reduce the burden of obesity both in the United States and around the world. And only recently we have seen an almost tectonic shift in the nutrition world regarding the dangers of dietary fat, which has been incorrectly demonized for years.
Exercise, on the other hand, has really been the forgotten risk factor, with relatively little money and effort devoted to assessing and prescribing exercise in the health care setting. Certainly, this makes no sense in light of the tremendous evidence regarding the health benefits of exercise in both the primary and secondary preventions of virtually every chronic disease.

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