Exercise medicine

Exercise medicine
SystemMusculoskeletal, cardiovascular
SpecialistSport and Exercise Medicine (SEM) physician
GlossaryGlossary of medicine
Sport and Exercise Medicine (SEM) physician
Occupation
Names
  • Physician
Occupation type
Specialty
Activity sectors
Medicine
Description
CompetenciesExercise prescription
Education required
Fields of
employment
Hospitals, Clinics, university
Related jobs
sports medicine physician

Exercise medicine is a branch of medicine that deals with physical fitness and the prevention and treatment of injuries and illness with exercise. In some countries, Sport and Exercise Medicine (SEM) is a recognized medical specialty (with similar training and standards to other medical specialties). Exercise medicine is therefore an emerging physician (non-surgical) specialty, but there is also a belief that exercise is treatment of such fundamental benefit that it should be incorporated into all medical specialties. Allied health practitioners also can specialize in exercise such as exercise physiologists, physiotherapists, athletic trainers and podiatrists.[1]

Whereas the signature treatment of the specialty of surgery is operative procedures, and the signature treatment of most medical (physician) specialties is the prescription of pharmaceuticals, the signature treatment of Sport and Exercise Medicine is exercise prescription. SEM physician consultations are generally lengthy (over 30 minutes) and 74% involve prescription of exercise, with exercise prescription being the most common treatment.[2]

Evidence for the efficacy of exercise as a medical treatment

There is an enormous amount of evidence proving that exercise (when prescribed as a medical treatment) is effective at preventing and treating most of the major chronic diseases,[3][4] including cancer,[5] cardiovascular diseases,[6][7] arthritis,[8] osteoporosis,[9] back pain,[10][11] diabetes,[12] depression and other mental illnesses and falls in the elderly.[13]

Exercise and mortality from certain diseases, adapted from [14]

Exercise has been shown to reduce all-cause mortality [15] in a large number of primary studies and meta-analyses.[16][17][18][19]

Exercise and cardiovascular disease

There are multiple ways in which exercise can reduce cardiovascular disease and mortality,[20] including through lowering blood pressure and lowering LDL cholesterol levels.[21] Although multiple mechanisms are possible, the relationship between exercise as measured by accelerometer data and cardiovascular mortality is strong (inverse, non-linear).[22]

Exercise and cancer

Exercise prescription is now a recognized treatment for cancer,[23] as studies have shown that exercise is associated with superior mortality outcomes and lower recurrence rates.[24][25][26]

Exercise and mental illness

Main article: Neurobiological effects of physical exercise

Exercise both prevents and treats mental illnesses, including depression in particular,[27][28][29] with positive effects likely for anxiety,[30] bipolar disorder[31] and suicidality.[32]

Exercise dosing

Main article: Exercise prescription

Exercise prescription is not simply a matter of advising or demanding that a patient increases their exercise levels. It requires significant expertise and experience, with core competencies well described.[33] Sudden increase of exercise levels is likely to lead to painful musculoskeletal symptoms or even injury (preventing further exercise).[34][35][36]

Both underloading and overloading can lead to injury[37]
Use of wearable technology to measure exercise loads [38][39]

The lifetime prevalence of hip and knee osteoarthritis is 13% for competitive runners, 10% for non-runners, but only 4% for moderate social runners, demonstrating a U-shaped curve between running load and arthritis risk (high and low dose = higher risk; moderate load = lower risk).[40] With respect to back pain, increasing levels of exercise reduce risk of back pain,[41] but having occupational manual loading increases the risk.[42] The bottom of the U-shaped curve for injury risk and loading is sometimes referred to as the Goldilocks zone (not too little exercise but not too much).[43][44][45] There also may be a Goldilocks zone for physical activity and all-cause mortality, but at a very high level and with an eccentric U-shape (that is, low exercise levels are far riskier for all-cause mortality than extremely high exercise levels).[46]

Differentiation from Sports medicine

Main article: Sports medicine
Recreational exercise such as swimming and surfing has multiple health benefits

The difference between sport and exercise (and hence the differentiation between Sports medicine and Exercise medicine) is subtle, but important. Basically, sport is exercise with an added element of competition (whether against an opponent or oneself, aiming to maximum performance improvements).[47] There is good evidence that competitive and professional athletes have higher rates of certain conditions than the general population, such as osteoarthritis,[48][49] but equally strong evidence that the life expectancy of elite athletes is longer than the general population.[50][51]

Establishment as a medical specialty

Sports medicine is a recognized medical specialty or subspecialty in over 50 countries. In some of these countries, the formal name of the specialty is 'Sport and Exercise Medicine', emphasizing the differentiation between sports medicine (performance-orientated) and exercise medicine (health-orientated). These countries include Australia and New Zealand, with the peak body being the Australasian College of Sport and Exercise Physicians and one of Australia's 15 recognized medical specialty Colleges,[52] the United Kingdom (Faculty of Sport and Exercise Medicine UK),[53] Canada (Canadian Academy of Sport and Exercise Medicine), Belgium, Brazil, France, India and Ireland.

Exercise as an alternative treatment to low-value care

There is increasing evidence that many 'traditional' medical interventions are ineffective at best and potentially harmful at worst.[54] Examples of low-value care include knee and shoulder arthroscopy, spinal fusion surgery[55] and opiate prescription for chronic non-cancer pain.[56][57] Exercise prescription, with evidence of efficacy for treatment of knee osteoarthritis and back pain, can be used as an alternative to traditional interventions with poor efficacy and greater side effects.

Exercise as a method to reduce carbon emissions from healthcare

Healthcare is responsible for 3-10% of carbon emissions in Western countries.[58] Although most healthcare is considered 'essential', it is important that the necessity of carbon-intensive healthcare options, such as surgery,[59] is critically assessed as there is an international agreement that net zero emissions must be reached to avoid breakdown of the Earth's climate.[60] Exercise as a medical treatment has perhaps the lowest carbon footprint of any medical treatment.[61] An increased focus on exercise prescription as an effective alternate to carbon-intensive medical treatments is an important part of healthcare reform, which needs to be 'transformational' to reach goals of net-zero emissions from healthcare.[62]

Differentiation from "Exercise Is Medicine" (EIM)

Main article: Exercise is Medicine

'Exercise is Medicine' is a trademarked non-profit venture of the American College of Sports Medicine. By comparison, 'Exercise Medicine' is a specific subspecialty of 'Sport and Exercise Medicine'. The concept of 'Exercise is Medicine' is that all medical specialists should be prescribing exercise regularly as an adjunct to a standard consultation.[63][64] The aims of the 'Exercise is Medicine' movement and the specialty of Exercise Medicine are generally synergistic, with both aiming to improve physical activity in the population (for whom a large proportion is inactive). Exercise Medicine specialists also consult a smaller subsection of the population who are temporarily over-active and require a slight reduction in load in order to overcome injury or chronic pain. The concept of 'Exercise is Medicine' is as a 5-minute addition to almost every medical consultation, treating exercise as a 'vital sign',[65][66] which has the potential of enormous reach. Exercise medicine specialists aim to also cater for some of those patients who don't respond to the first line measure of a brief written exercise prescription by providing longer specialized consultations with a focus solely on exercise. Exercise Is Medicine has been criticized for making exercise come across as exclusively a medical treatment when it should be seen more broadly as a public health strategy and protective risk factor that should be available to everyone.[67]

Further reading on EIM

  • Cairney, John; McGannon, Kerry R.; Atkinson, Michael (8 August 2018). "Exercise is medicine: critical considerations in the qualitative research landscape". Qualitative Research in Sport, Exercise and Health. 10 (4): 391–399. doi:10.1080/2159676X.2018.1476010. ISSN 2159-676X.

Journals

See also

References

  1. ^ Crozier, A; Watson, PM; Graves, LEF; George, K; Naylor, L; Green, DJ; Rosenberg, M; Jones, H (2022). "Clinical exercise provision in the UK: comparison of staff job titles, roles and qualifications across five specialised exercise services". BMJ Open Sport & Exercise Medicine. 8 (1): e001152. doi:10.1136/bmjsem-2021-001152. PMC 8788312. PMID 35136656.
  2. ^ Gamage, Prasanna J; Seker, Saran; Orchard, Jessica; Humphries, David; Fitzgerald, Kylie; Fitzpatrick, Jane (November 2021). "Insights into the complexity of presentation and management of patients: the Sport and Exercise Physician's perspective". BMJ Open Sport & Exercise Medicine. 7 (4): e001228. doi:10.1136/bmjsem-2021-001228. PMC 8628332. PMID 34925878.
  3. ^ Pedersen, BK; Saltin, B (December 2015). "Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases". Scandinavian Journal of Medicine & Science in Sports. 25 (Suppl 3): 1–72. doi:10.1111/sms.12581. PMID 26606383. S2CID 21208328.
  4. ^ Zhao, M; Veeranki, SP; Magnussen, CG; Xi, B (1 July 2020). "Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study". BMJ (Clinical Research Ed.). 370: m2031. doi:10.1136/bmj.m2031. PMC 7328465. PMID 32611588.
  5. ^ Emery, A; Moore, S; Turner, JE; Campbell, JP (2022). "Reframing How Physical Activity Reduces The Incidence of Clinically-Diagnosed Cancers: Appraising Exercise-Induced Immuno-Modulation As An Integral Mechanism". Frontiers in Oncology. 12: 788113. doi:10.3389/fonc.2022.788113. PMC 8964011. PMID 35359426.
  6. ^ Kraus, WE; Powell, KE; Haskell, WL; Janz, KF; Campbell, WW; Jakicic, JM; Troiano, RP; Sprow, K; Torres, A; Piercy, KL; 2018 Physical Activity Guidelines Advisory Committee (June 2019). "Physical Activity, All-Cause and Cardiovascular Mortality, and Cardiovascular Disease". Medicine and Science in Sports and Exercise. 51 (6): 1270–1281. doi:10.1249/MSS.0000000000001939. PMC 6527136. PMID 31095084.
  7. ^ Myers, Jonathan; Prakash, Manish; Froelicher, Victor; Do, Dat; Partington, Sara; Atwood, J. Edwin (14 March 2002). "Exercise Capacity and Mortality among Men Referred for Exercise Testing". New England Journal of Medicine. 346 (11): 793–801. doi:10.1056/NEJMoa011858. ISSN 0028-4793. PMID 11893790.
  8. ^ Gwinnutt, JM; Wieczorek, M; Cavalli, G; Balanescu, A; Bischoff-Ferrari, HA; Boonen, A; de Souza, S; de Thurah, A; Dorner, TE; Moe, RH; Putrik, P; Rodríguez-Carrio, J; Silva-Fernández, L; Stamm, T; Walker-Bone, K; Welling, J; Zlatković-Švenda, MI; Guillemin, F; Verstappen, SMM (March 2022). "Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs". RMD Open. 8 (1): e002168. doi:10.1136/rmdopen-2021-002168. PMC 8971792. PMID 35361692.
  9. ^ Sanchez-Trigo, H; Rittweger, J; Sañudo, B (26 February 2022). "Effects of non-supervised exercise interventions on bone mineral density in adult women: a systematic review and meta‑analysis". Osteoporosis International. 33 (7): 1415–1427. doi:10.1007/s00198-022-06357-3. PMC 8881760. PMID 35218402.
  10. ^ Pocovi, Natasha C; Lin, Chung-Wei Christine; French, Simon D; Graham, Petra L; van Dongen, Johanna M; Latimer, Jane; Merom, Dafna; Tiedemann, Anne; Maher, Christopher G; Clavisi, Ornella; Tong, Shuk Yin Kate; Hancock, Mark J (June 2024). "Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial". The Lancet. doi:10.1016/S0140-6736(24)00755-4. Retrieved 22 June 2024.
  11. ^ Hayden, JA; Ellis, J; Ogilvie, R; Malmivaara, A; van Tulder, MW (28 September 2021). "Exercise therapy for chronic low back pain". The Cochrane Database of Systematic Reviews. 9 (10): CD009790. doi:10.1002/14651858.CD009790.pub2. PMC 8477273. PMID 34580864.
  12. ^ Hall, KS; Hyde, ET; Bassett, DR; Carlson, SA; Carnethon, MR; Ekelund, U; Evenson, KR; Galuska, DA; Kraus, WE; Lee, IM; Matthews, CE; Omura, JD; Paluch, AE; Thomas, WI; Fulton, JE (20 June 2020). "Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia". The International Journal of Behavioral Nutrition and Physical Activity. 17 (1): 78. doi:10.1186/s12966-020-00978-9. PMC 7305604. PMID 32563261.
  13. ^ Sherrington, C; Michaleff, ZA; Fairhall, N; Paul, SS; Tiedemann, A; Whitney, J; Cumming, RG; Herbert, RD; Close, JCT; Lord, SR (December 2017). "Exercise to prevent falls in older adults: an updated systematic review and meta-analysis". British Journal of Sports Medicine. 51 (24): 1750–1758. doi:10.1136/bjsports-2016-096547. PMC 6243488. PMID 27707740. S2CID 206882055.
  14. ^ Kyu, Hmwe H.; Bachman, Victoria F.; Alexander, Lily T.; Mumford, John Everett; Afshin, Ashkan; Estep, Kara; Veerman, J. Lennert; Delwiche, Kristen; Iannarone, Marissa L.; Moyer, Madeline L.; Cercy, Kelly; Vos, Theo; Murray, Christopher J. L.; Forouzanfar, Mohammad H. (9 August 2016). "Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013". BMJ. 354: i3857. doi:10.1136/bmj.i3857. ISSN 1756-1833. PMC 4979358. PMID 27510511.
  15. ^ Reynolds, Gretchen (6 April 2022). "Is 30 Minutes of Exercise a Day Enough?". The New York Times. ISSN 0362-4331. Retrieved 12 April 2022.
  16. ^ Lee, DC; Pate, RR; Lavie, CJ; Sui, X; Church, TS; Blair, SN (5 August 2014). "Leisure-time running reduces all-cause and cardiovascular mortality risk". Journal of the American College of Cardiology. 64 (5): 472–81. doi:10.1016/j.jacc.2014.04.058. PMC 4131752. PMID 25082581.
  17. ^ Zhao, M; Veeranki, SP; Magnussen, CG; Xi, B (1 July 2020). "Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study". BMJ (Clinical Research Ed.). 370: m2031. doi:10.1136/bmj.m2031. PMC 7328465. PMID 32611588.
  18. ^ Colpani, V; Baena, CP; Jaspers, L; van Dijk, GM; Farajzadegan, Z; Dhana, K; Tielemans, MJ; Voortman, T; Freak-Poli, R; Veloso, GGV; Chowdhury, R; Kavousi, M; Muka, T; Franco, OH (September 2018). "Lifestyle factors, cardiovascular disease and all-cause mortality in middle-aged and elderly women: a systematic review and meta-analysis". European Journal of Epidemiology. 33 (9): 831–845. doi:10.1007/s10654-018-0374-z. PMID 29524110. S2CID 3790367.
  19. ^ Cunningham, C; O' Sullivan, R; Caserotti, P; Tully, MA (May 2020). "Consequences of physical inactivity in older adults: A systematic review of reviews and meta-analyses" (PDF). Scandinavian Journal of Medicine & Science in Sports. 30 (5): 816–827. doi:10.1111/sms.13616. PMID 32020713. S2CID 211035029.
  20. ^ Bove, AA (April 2016). "Exercise and Heart Disease". Methodist DeBakey Cardiovascular Journal. 12 (2): 74–5. doi:10.14797/mdcj-12-2-74. PMC 4969029. PMID 27486487.
  21. ^ Nystoriak, MA; Bhatnagar, A (2018). "Cardiovascular Effects and Benefits of Exercise". Frontiers in Cardiovascular Medicine. 5: 135. doi:10.3389/fcvm.2018.00135. PMC 6172294. PMID 30324108.
  22. ^ Sheng, M; Yang, J; Bao, M; Chen, T; Cai, R; Zhang, N; Chen, H; Liu, M; Wu, X; Zhang, B; Liu, Y; Chao, J (December 2021). "The relationships between step count and all-cause mortality and cardiovascular events: A dose-response meta-analysis". Journal of Sport and Health Science. 10 (6): 620–628. doi:10.1016/j.jshs.2021.09.004. PMC 8724621. PMID 34547483.
  23. ^ Ashcraft, KA; Warner, AB; Jones, LW; Dewhirst, MW (January 2019). "Exercise as Adjunct Therapy in Cancer". Seminars in Radiation Oncology. 29 (1): 16–24. doi:10.1016/j.semradonc.2018.10.001. PMC 6656408. PMID 30573180.
  24. ^ Christensen, JF; Simonsen, C; Hojman, P (13 December 2018). "Exercise Training in Cancer Control and Treatment". Comprehensive Physiology. 9 (1): 165–205. doi:10.1002/cphy.c180016. PMID 30549018. S2CID 56492477.
  25. ^ Cormie, P; Zopf, EM; Zhang, X; Schmitz, KH (1 January 2017). "The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects". Epidemiologic Reviews. 39 (1): 71–92. doi:10.1093/epirev/mxx007. PMID 28453622.
  26. ^ Cormie, P; Trevaskis, M; Thornton-Benko, E; Zopf, EM (April 2020). "Exercise medicine in cancer care". Australian Journal of General Practice. 49 (4): 169–174. doi:10.31128/AJGP-08-19-5027. PMID 32233341. S2CID 214751316.
  27. ^ Schuch, FB; Vancampfort, D; Richards, J; Rosenbaum, S; Ward, PB; Stubbs, B (June 2016). "Exercise as a treatment for depression: A meta-analysis adjusting for publication bias". Journal of Psychiatric Research. 77: 42–51. doi:10.1016/j.jpsychires.2016.02.023. PMID 26978184. S2CID 1012687.
  28. ^ Schuch, FB; Stubbs, B (August 2019). "The Role of Exercise in Preventing and Treating Depression". Current Sports Medicine Reports. 18 (8): 299–304. doi:10.1249/JSR.0000000000000620. PMID 31389872. S2CID 199448688.
  29. ^ Cooney, GM; Dwan, K; Greig, CA; Lawlor, DA; Rimer, J; Waugh, FR; McMurdo, M; Mead, GE (12 September 2013). "Exercise for depression". The Cochrane Database of Systematic Reviews. 2013 (9): CD004366. doi:10.1002/14651858.CD004366.pub6. PMC 9721454. PMID 24026850.
  30. ^ Stonerock, GL; Hoffman, BM; Smith, PJ; Blumenthal, JA (August 2015). "Exercise as Treatment for Anxiety: Systematic Review and Analysis". Annals of Behavioral Medicine. 49 (4): 542–56. doi:10.1007/s12160-014-9685-9. PMC 4498975. PMID 25697132.
  31. ^ Bauer, IE; Gálvez, JF; Hamilton, JE; Balanzá-Martínez, V; Zunta-Soares, GB; Soares, JC; Meyer, TD (March 2016). "Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: A systematic review". Journal of Psychiatric Research. 74: 1–7. doi:10.1016/j.jpsychires.2015.12.006. PMC 4744495. PMID 26724541.
  32. ^ Grasdalsmoen, M; Eriksen, HR; Lønning, KJ; Sivertsen, B (16 April 2020). "Physical exercise, mental health problems, and suicide attempts in university students". BMC Psychiatry. 20 (1): 175. doi:10.1186/s12888-020-02583-3. PMC 7164166. PMID 32299418.
  33. ^ Asif, Irfan; Thornton, Jane S.; Carek, Stephen; Miles, Christopher; Nayak, Melissa; Novak, Melissa; Stovak, Mark; Zaremski, Jason L.; Drezner, Jonathan (1 April 2022). "Exercise medicine and physical activity promotion: core curricula for US medical schools, residencies and sports medicine fellowships: developed by the American Medical Society for Sports Medicine and endorsed by the Canadian Academy of Sport and Exercise Medicine". British Journal of Sports Medicine. 56 (7): 369–375. doi:10.1136/bjsports-2021-104819. ISSN 0306-3674. PMID 35012931. S2CID 246055491.
  34. ^ Burfoot, Amby (14 November 2001). "The 10-Percent Rule". Runner's World. Retrieved 2 April 2022.
  35. ^ Wang, C; Vargas, JT; Stokes, T; Steele, R; Shrier, I (July 2020). "Analyzing Activity and Injury: Lessons Learned from the Acute:Chronic Workload Ratio". Sports Medicine (Auckland, N.Z.). 50 (7): 1243–1254. doi:10.1007/s40279-020-01280-1. PMID 32125672. S2CID 211729657.
  36. ^ Griffin, A; Kenny, IC; Comyns, TM; Lyons, M (March 2020). "The Association Between the Acute:Chronic Workload Ratio and Injury and its Application in Team Sports: A Systematic Review". Sports Medicine (Auckland, N.Z.). 50 (3): 561–580. doi:10.1007/s40279-019-01218-2. hdl:10344/8522. PMID 31691167. S2CID 207899218.
  37. ^ Orchard, JW (April 2020). "Prescribing and dosing exercise in primary care". Australian Journal of General Practice. 49 (4): 182–186. doi:10.31128/AJGP-10-19-5110. PMID 32233343. S2CID 214749061.
  38. ^ Phillips, SM; Cadmus-Bertram, L; Rosenberg, D; Buman, MP; Lynch, BM (January 2018). "Wearable Technology and Physical Activity in Chronic Disease: Opportunities and Challenges". American Journal of Preventive Medicine. 54 (1): 144–150. doi:10.1016/j.amepre.2017.08.015. PMC 5736445. PMID 29122356.
  39. ^ Orchard, JW (September 2017). "Using technology to measure daily and weekly movement patterns in exercise medicine patients". British Journal of Sports Medicine. 51 (18): 1317–1318. doi:10.1136/bjsports-2016-096736. PMID 27884860. S2CID 12096034.
  40. ^ Alentorn-Geli, E; Samuelsson, K; Musahl, V; Green, CL; Bhandari, M; Karlsson, J (June 2017). "The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis". The Journal of Orthopaedic and Sports Physical Therapy. 47 (6): 373–390. doi:10.2519/jospt.2017.7137. PMID 28504066. S2CID 26434756.
  41. ^ Alzahrani, H; Shirley, D; Cheng, SWM; Mackey, M; Stamatakis, E (July 2019). "Physical activity and chronic back conditions: A population-based pooled study of 60,134 adults". Journal of Sport and Health Science. 8 (4): 386–393. doi:10.1016/j.jshs.2019.01.003. PMC 6620421. PMID 31333893.
  42. ^ Hartvigsen, J; Hancock, MJ; Kongsted, A; Louw, Q; Ferreira, ML; Genevay, S; Hoy, D; Karppinen, J; Pransky, G; Sieper, J; Smeets, RJ; Underwood, M; Lancet Low Back Pain Series Working, Group. (9 June 2018). "What low back pain is and why we need to pay attention". Lancet. 391 (10137): 2356–2367. doi:10.1016/S0140-6736(18)30480-X. PMID 29573870. S2CID 4354991.
  43. ^ Milner, PI (August 2017). "Keeping joints healthy: The Goldilocks effect of exercise". Veterinary Journal. 226: 4–5. doi:10.1016/j.tvjl.2017.06.007. PMID 28911839.
  44. ^ Straker, L; Mathiassen, SE; Holtermann, A (July 2018). "The 'Goldilocks Principle': designing physical activity at work to be 'just right' for promoting health". British Journal of Sports Medicine. 52 (13): 818–819. doi:10.1136/bjsports-2017-097765. PMC 6029635. PMID 28663212.
  45. ^ O'Keefe, JH; O'Keefe, EL; Lavie, CJ (March 2018). "The Goldilocks Zone for Exercise: Not Too Little, Not Too Much". Missouri Medicine. 115 (2): 98–105. PMC 6139866. PMID 30228692.
  46. ^ Ekelund, U; Tarp, J; Steene-Johannessen, J; Hansen, BH; Jefferis, B; Fagerland, MW; Whincup, P; Diaz, KM; Hooker, SP; Chernofsky, A; Larson, MG; Spartano, N; Vasan, RS; Dohrn, IM; Hagströmer, M; Edwardson, C; Yates, T; Shiroma, E; Anderssen, SA; Lee, IM (21 August 2019). "Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis". BMJ (Clinical Research Ed.). 366: l4570. doi:10.1136/bmj.l4570. PMC 6699591. PMID 31434697.
  47. ^ Orchard, JW (2 April 2018). "How exercise medicine has evolved from sports medicine". The Medical Journal of Australia. 208 (6): 244–245. doi:10.5694/mja17.00764. PMID 29614932. S2CID 4606643.
  48. ^ Tveit, M; Rosengren, BE; Nilsson, JÅ; Karlsson, MK (March 2012). "Former male elite athletes have a higher prevalence of osteoarthritis and arthroplasty in the hip and knee than expected". The American Journal of Sports Medicine. 40 (3): 527–33. doi:10.1177/0363546511429278. PMID 22130474. S2CID 7256358.
  49. ^ Gouttebarge, V; Inklaar, H; Backx, F; Kerkhoffs, G (March 2015). "Prevalence of osteoarthritis in former elite athletes: a systematic overview of the recent literature". Rheumatology International. 35 (3): 405–18. doi:10.1007/s00296-014-3093-0. PMID 25037899. S2CID 6763231.
  50. ^ Antero, J; Tanaka, H; De Larochelambert, Q; Pohar-Perme, M; Toussaint, JF (February 2021). "Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians". British Journal of Sports Medicine. 55 (4): 206–212. doi:10.1136/bjsports-2019-101696. PMID 32727712. S2CID 220846618.
  51. ^ Ruiz, JR; Fiuza-Luces, C; Garatachea, N; Lucia, A (November 2014). "Reduced mortality in former elite endurance athletes". International Journal of Sports Physiology and Performance. 9 (6): 1046–9. doi:10.1123/ijspp.2013-0492. PMID 24584695.
  52. ^ "Council of Presidents of Medical Colleges".
  53. ^ Cullen, M (2010). "Developing a new specialty - sport and exercise medicine in the UK". Open Access Journal of Sports Medicine. 1: 11–4. doi:10.2147/oajsm.s7627. PMC 3781848. PMID 24198537.
  54. ^ O'Connor, Denise; Harris, Ian; Buchbinder, Rachelle (13 September 2018). "Needless procedures: knee arthroscopy is one of the most common but least effective surgeries". The Conversation. Retrieved 3 April 2022.
  55. ^ Ferreira, Giovanni E.; Harris, Ian; Zadro, Joshua; O'Keeffe, Mary (24 March 2022). "3 orthopaedic surgeries that might be doing patients (and their pockets) more harm than good". The Conversation.
  56. ^ Harper, S; Riddell, CA; King, NB (1 April 2021). "Declining Life Expectancy in the United States: Missing the Trees for the Forest". Annual Review of Public Health. 42: 381–403. doi:10.1146/annurev-publhealth-082619-104231. PMID 33326297. S2CID 229302547.
  57. ^ Els, C; Jackson, TD; Kunyk, D; Lappi, VG; Sonnenberg, B; Hagtvedt, R; Sharma, S; Kolahdooz, F; Straube, S (30 October 2017). "Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews". The Cochrane Database of Systematic Reviews. 10 (10): CD012509. doi:10.1002/14651858.CD012509.pub2. PMC 6485910. PMID 29084357.
  58. ^ Malik, A; Lenzen, M; McAlister, S; McGain, F (January 2018). "The carbon footprint of Australian health care". The Lancet. Planetary Health. 2 (1): e27 – e35. doi:10.1016/S2542-5196(17)30180-8. PMID 29615206.
  59. ^ Rizan, C; Steinbach, I; Nicholson, R; Lillywhite, R; Reed, M; Bhutta, MF (December 2020). "The Carbon Footprint of Surgical Operations: A Systematic Review" (PDF). Annals of Surgery. 272 (6): 986–995. doi:10.1097/SLA.0000000000003951. PMID 32516230. S2CID 216202267.
  60. ^ "HCWH's new global road map for zero emissions healthcare". Health Care Without Harm. 14 April 2021.
  61. ^ Orchard, JW (18 January 2023). "Sport and exercise medicine: leading the race towards net zero". British Journal of Sports Medicine. 57 (7): 386–387. doi:10.1136/bjsports-2022-106177. PMID 36653142. S2CID 255966794.
  62. ^ Charlesworth, KE; Jamieson, M (July 2019). "Healthcare in a carbon-constrained world". Australian Health Review. 43 (3): 241–245. doi:10.1071/AH17184. PMID 29731002. S2CID 19201926.
  63. ^ Lobelo, F; Stoutenberg, M; Hutber, A (December 2014). "The Exercise is Medicine Global Health Initiative: a 2014 update". British Journal of Sports Medicine. 48 (22): 1627–33. doi:10.1136/bjsports-2013-093080. PMID 24759911. S2CID 26898017.
  64. ^ Sallis, RE; Matuszak, JM; Baggish, AL; Franklin, BA; Chodzko-Zajko, W; Fletcher, BJ; Gregory, A; Joy, E; Matheson, G; McBride, P; Puffer, JC; Trilk, J; Williams, J (May 2016). "Call to Action on Making Physical Activity Assessment and Prescription a Medical Standard of Care". Current Sports Medicine Reports. 15 (3): 207–14. doi:10.1249/JSR.0000000000000249. PMID 27172086. S2CID 207179559.
  65. ^ Golightly, YM; Allen, KD; Ambrose, KR; Stiller, JL; Evenson, KR; Voisin, C; Hootman, JM; Callahan, LF (30 November 2017). "Physical Activity as a Vital Sign: A Systematic Review". Preventing Chronic Disease. 14: E123. doi:10.5888/pcd14.170030. PMC 5716811. PMID 29191260.
  66. ^ Kuntz, JL; Young, DR; Saelens, BE; Frank, LD; Meenan, RT; Dickerson, JF; Keast, EM; Fortmann, SP (June 2021). "Validity of the Exercise Vital Sign Tool to Assess Physical Activity". American Journal of Preventive Medicine. 60 (6): 866–872. doi:10.1016/j.amepre.2021.01.012. PMC 8154650. PMID 33781618.
  67. ^ Davenport, Todd E; Griech, Sean F; Deamer, Kathryn E; Gale, Lewis R (27 June 2022). "Beyond "Exercise as Medicine" in Physical Therapy: toward the Promotion of Exercise as a Public Good". Physical Therapy. 102 (9): pzac087. doi:10.1093/ptj/pzac087. ISSN 1538-6724. PMID 35778932.

Read other articles:

Calendario

Este artículo o sección necesita referencias que aparezcan en una publicación acreditada.Este aviso fue puesto el 5 de septiembre de 2011. Mapa de los calendarios utilizados por los países del mundo. En los países en que se utiliza más de un calendario se encuentran los colores de ambos calendarios en franjas. El calendario es una cuenta sistematizada del transcurso del tiempo, utilizado para la organización cronológica de actividades. Se trata de un conjunto de reglas o normas que t...

 

Bernhard Caesar Einstein

Bernhard Caesar EinsteinLahir10 Juli 1930JermanMeninggal30 September 2008(2008-09-30) (umur 78)Amerika SerikatWarga negaraSwissAmerika SerikatPendidikanETH ZürichPekerjaanFisikawanSuami/istriAude Ascher Einstein (Swiss), M.D., Universitas ZürichAnakDr. Thomas Martin Einstein (Santa Monica, CA, AS, 1955),Paul Michael Einstein (1959) (Prancis),Eduard Albert (Ted) Einstein (1961-) (Los Angeles, CA, AS),Mira Einstein-Yehieli (1965-) (Israel),Charles Quincy Ascher Einstein (Charly) (1971-)...

 

Sulfinalol

Sulfinalol Names IUPAC name 4-[1-Hydroxy-2-[4-(4-methoxyphenyl)butan-2-ylamino]ethyl]-2-methylsulfinylphenol Identifiers CAS Number 66264-77-5 Y 3D model (JSmol) Interactive image PubChem CID 44439 UNII PH7O14792O Y InChI InChI=1S/C20H27NO4S/c1-14(4-5-15-6-9-17(25-2)10-7-15)21-13-19(23)16-8-11-18(22)20(12-16)26(3)24/h6-12,14,19,21-23H,4-5,13H2,1-3H3Key: PAQZZCOZHPGCFW-UHFFFAOYSA-N SMILES CC(CCC1=CC=C(C=C1)OC)NCC(C2=CC(=C(C=C2)O)S(=O)C)O Properties Chemical formula C20H27NO4S M...

Jang Do-yeon

Dalam nama Korean ini, nama keluarganya adalah Jang. Jang Do-yeonLahir10 Maret 1985 (umur 39)Kabupaten Yeonggwang County, Provinsi Jeolla Selatan, Korea SelatanMediaLawakan tunggal, TelevisiTahun aktif2007-sekarangGenreObservasional, Sketsa, Wit, Parodi, Lelucon kasar, Dramatis, Komedi situasiNama KoreaHangul장도연 Alih AksaraJang Do-yeonMcCune–ReischauerChang To-yŏn Jang Do-yeon (lahir 10 Maret 1985), adalah pelawak asal Korea Selatan, menandatangani kontrak dengan KOEN Group.[...

 

Georgian era

Period in British history from 1714 to c. 1830–37 For other uses of Georgian, see Georgian (disambiguation). Georgian era1714 – 1830 (1837)The Georgian architecture of the Royal Crescent in the city of BathIncludingRegency eraMonarch(s)George IGeorge IIGeorge IIIGeorge IVWilliam IVLeader(s)George, Prince of Wales[1]Queen Caroline[1]George, Prince Regent[1] Prime ministers Sir Robert Walpole Lord Wilmington Henry Pelham Duke of Newcastle Duke of Devonshire ...

 

Menara KVLY-TV

Menara KVLY-TVMenara KVLY-TVInformasi umumJenisMenara televisiLokasiBlanchard, County Traill, Dakota Utara, Amerika SerikatKoordinat47°20′32″N 97°17′21″W / 47.34222°N 97.28917°W / 47.34222; -97.28917Koordinat: 47°20′32″N 97°17′21″W / 47.34222°N 97.28917°W / 47.34222; -97.28917Rampung13 Agustus 1963PemilikHoak MediaTinggi6.288 m (20.629,9 ft)Desain dan konstruksiArsitekHamilton DirectorsKontraktor utamaKline Iron...

Kota Lavender

Kota Lavender (Jepang: シオンタウンcode: ja is deprecated , Hepburn: Shion Taun, Shion Town) adalah sebuah kota fiksi dalam permainan Pokémon Red dan Blue . Bergaya sebagai lokasi berhantu, Lavender Town adalah rumah dari Pokémon Tower, tempat pemakaman bagi Pokémon. Musik latar Kota Lavender terkenal karena menambah suasana menyeramkan kota dan pada tahun 2010, hal itu memunculkan 'Sindrom Kota Lavender' creepypasta, yang menunjukkan bahwa lebih dari 3400 anak-anak Jepang bunuh diri...

 

Women in prison film

Film genre Women in Prison redirects here. For the TV series, see Women in Prison (TV series). For the incarceration of women, see incarceration of women. The women in prison film (or WiP film) is a subgenre of exploitation film that began in the early 20th century and continues to the present day.[1] Their stories feature imprisoned women who are subjected to sexual and physical abuse, typically by sadistic male or female prison wardens, guards and other inmates. The genre also featu...

 

Новотитаровское сельское поселение

Сельское поселение России (МО 2-го уровня)Новотитаровское сельское поселение Флаг[d] Герб 45°14′09″ с. ш. 38°58′16″ в. д.HGЯO Страна  Россия Субъект РФ Краснодарский край Район Динской Включает 4 населённых пункта Адм. центр Новотитаровская Глава сельского пос�...

Universitas Krisnadwipayana

Artikel ini memiliki beberapa masalah. Tolong bantu memperbaikinya atau diskusikan masalah-masalah ini di halaman pembicaraannya. (Pelajari bagaimana dan kapan saat yang tepat untuk menghapus templat pesan ini) Artikel ini menggunakan kata-kata yang berlebihan dan hiperbolis tanpa memberikan informasi yang jelas. Silakan buang istilah-istilah yang hiperbolis tersebut. (Pelajari cara dan kapan saatnya untuk menghapus pesan templat ini) Artikel ini tidak memiliki referensi atau sumber tepercaya...

 

بزرغ أباد

بزرغ أباد تقسيم إداري البلد إيران  [1] إحداثيات 37°23′30″N 45°11′43″E / 37.39166667°N 45.19527778°E / 37.39166667; 45.19527778   السكان التعداد السكاني 203 نسمة (إحصاء 2016) الرمز الجغرافي 139944  تعديل مصدري - تعديل   بزرغ أباد هي قرية في مقاطعة أرومية، إيران.[2] يقدر عدد سكانها ب�...

 

Concert of Europe

European balance of power in the 19th century This article is about the 19th-century diplomatic term. For the jazz album, see European Concert. Concert of Europe1815 to 1848/1860s – 1871 to 1914The national boundaries within Europe as set by the Congress of Vienna, 1815Including Regency era Bourbon Restoration Revolutions of 1830 Revolutions of 1848 Causes of World War I Chronology Napoleonic era League of Nations The Concert of Europe was a general agreement among the great powers...

GKN

British multinational automotive and aerospace company For other uses, see GKN (disambiguation). GKN LtdCompany typelimited companyIndustryAutomotiveAerospacePredecessorJohn Lysaght and Co. Founded1759; 265 years ago (1759)(Dowlais, Wales)HeadquartersRedditch, England, UKKey peopleMichael Turner, CBE(Chairman)Nigel Stein(Chief executive officer)ProductsVehicle and aircraft componentsRevenue£9,671 million (2017)[1]Operating income£699 million (2017)&#...

 

Cam and Dursley railway station

Railway station in Gloucestershire, England Cam and DursleyGeneral informationLocationCoaley, StroudEnglandCoordinates51°43′05″N 2°21′32″W / 51.718°N 2.359°W / 51.718; -2.359Grid referenceSO753021Managed byGreat Western RailwayPlatforms2Other informationStation codeCDUClassificationDfT category F2HistoryOriginal companyRailtrackKey dates14 May 1994Opened for limited service30 May 1994Opened for full servicePassengers2018/19 0.191 million2019/20 0.226 millio...

 

Ms. Foundation for Women

Non-profit organisation in the U.S. Ms. Foundation for WomenFormation1972FounderGloria Steinem, Patricia Carbine, Letty Cottin Pogrebin and Marlo ThomasTypeNon-profit organizationHeadquartersBrooklyn, New YorkWebsitehttp://forwomen.org/The Ms. Foundation for Women is a non-profit organization for women in the United States, which had a deep commitment to diversity[1] and was founded in 1972 by Gloria Steinem, Patricia Carbine, Letty Cottin Pogrebin and Marlo Thomas. The organization w...

Steven Curtis Chapman

American contemporary Christian music singer-songwriter Steven Curtis ChapmanChapman performing in 2004Background informationBirth nameSteven Curtis ChapmanBorn (1962-11-21) November 21, 1962 (age 61)Paducah, Kentucky, U.S.OriginNashville, Tennessee, U.S.GenresContemporary Christian musicOccupation(s) Musician singer songwriter record producer actor author Instrument(s)Vocals, guitar, pianoYears active1987–presentLabels Sparrow EMI Epic PolyEast Sony BMG Provident Websitestevencurtisch...

 

Moville

Port town in County Donegal, Ireland For the small city in the United States, see Moville, Iowa. Town in Ulster, Republic of IrelandMoville Bun an PhobailTownMoville Market SquareMovilleLocation in IrelandCoordinates: 55°11′20″N 7°2′26″W / 55.18889°N 7.04056°W / 55.18889; -7.04056CountryRepublic of IrelandProvinceUlsterCountyCounty DonegalElevation30 m (100 ft)Population (2022)[1]1,390Irish Grid ReferenceC648397 Moville (moh-VIL; Iris...

 

Beatification

Solemn declaration by the pope about the holy life of a person on earth For the process of making something beautiful, see Beautification. Pope Pius IX (1792–1878), beatified on 3 September 2000 by Pope John Paul II Pope John Paul II (1920–2005) beatified more people than all his predecessors had during the previous 400 years, and was himself beatified six years after his death, on Divine Mercy Sunday 2011. Beatification (from Latin beatus, blessed and facere, to make) is a recognition ac...

ميركسهآيم (ناهه)

ميركسهآيم    شعار   الإحداثيات 49°47′40″N 7°33′44″E / 49.794444444444°N 7.5622222222222°E / 49.794444444444; 7.5622222222222   [1] تقسيم إداري  البلد ألمانيا[2]  التقسيم الأعلى منطقة باد كرويتسناخ  خصائص جغرافية  المساحة 17.05 كيلومتر مربع (31 ديسمبر 2017)[3]  ارتفاع 172 م...

 

Hengelo

This article is about the city and municipality in Overijssel. For the town in Gelderland, see Hengelo, Gelderland. Municipality in Overijssel, NetherlandsHengelo Hengel (Twents)MunicipalityTwentekanaal through Hengelo FlagCoat of armsLocation in OverijsselHengeloLocation within the NetherlandsShow map of NetherlandsHengeloLocation within EuropeShow map of EuropeCoordinates: 52°15′55″N 6°47′35″E / 52.26528°N 6.79306°E / 52.26528; 6.79306CountryNetherla...