Skilled Exercise is Medicine


Exercise is critical to your health – for most of us, this is nothing new.  What is new is the concept of exercise as medicine.  Exercise is, in fact, so necessary for your health, it is considered a 5th vital sign by some healthcare practitioners; that is, exercise habits are as critical during physical exam and health assessments as heart rate, blood pressure, etc.1


Non-communicable diseases (NCDs) are the most common cause of disability and death in the U.S. and worldwide2.  NCDs are related to lifestyle choices, including physical activity.  As such, exercise serves as preventative medicine for many non-communicable diseases (NCDs), including stroke, heart disease, and type 2 diabetes. 3 Besides NCDs, exercise assists with the management of chronic disease across body systems.4


To acquire these medicinal effects, HealthyPeople 2020 (and the American College of Sports Medicine) recommend a minimum of 150 minutes of moderate intensity physical activity or 75 minutes of high intensity physical activity with at least 2 sessions of strength training per week for adults.5  For children, the recommendation is a minimum of 60 minutes of moderate to vigorous intensity physical activity a day.6   Older adults are to follow similar recommendations for adults, with added sessions of balance training.7


 Research has demonstrated that indeed, for some individuals, the above recommendations are not enough to accumulate the cardiovascular benefits of exercise (this person is called a “non-responder”),8 an important consideration as the recommendations are a minimum – if you can do more exercise, you will continue to accumulate benefits.  However, there is a ceiling.  Individuals, particularly competitive athletes and weekend warriors, can overtrain, leading to injury.9   Overtraining is, in part, related to an individual’s hormonal system, stress response, and allostatic load.  Exercise is well-known to reduce stress;10 however, caution should be used when exercising with an individual under high levels of stress, as exercise, particularly intensive exercise, can be an additional stressor for an already taxed system.11  Type and quality of exercise is important to balance your physiological need for exercise as well as restoration and injury/overtraining prevention.


It is worth noting that exercise professionals can fall into the trap of over-prescription of exercise and should demonstrate caution, both to avoid the risk of stressing an already hampered system as well as to simplify the client's life and not more "To-dos".  Indeed, some clients are not "compliant" in their exercise programs, simply from being overwhelmed by the sheer number of "required" exercises (I should know as I was one of those non-compliant clients).  If you are an exercise professional, how do you monitor system stress and exercise compliance and manage their exercise program accordingly?


Physical therapists are exercise specialists experienced with system-wide screening for stress and various medical conditions (that might indicate overtraining such as heart rate abnormalities) as well as educating and training clients in stress management and sleep hygiene techniques for restoration.  Interested in working out with a physical therapist to maximize physical activity without needlessly over-burdening your system? – contact a clinic in your area or email me at



Written by Dr. Allison Mitch, PT (DPT) (they/she), CSE, CSC, RYT 500, reiki master

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