Introductory Chapter: Exercise Medicine – Past, Present, and Future

Abstract

NOTE: This chapter will not include Abstract according to the publishing process manager. The following text is an introduction of the book. The increasing prevalence of non-communicable diseases, such as diabetes, due to physical inactivity, resulting in shortened healthy life expectancy and placing a burden on healthcare economies, has become a global concern. Although the slogan "Exercise is medicine" has been advocated for a long time, the implementation of exercise therapy is far from satisfactory. Exercise is an essential therapeutic approach in lifestyle medicine. It has become possible to incorporate exercise therapy more safely and effectively across all age groups, from children to the elderly, due to advancements in technology. This book aims to compile a comprehensive range of effective exercise modalities (from conventional to state-of-the-art) and scientific evidence concerning their impact on health. It also introduces the latest research findings on the biological mechanisms of exercise. Furthermore, it discusses new exercise therapies utilizing cutting-edge scientific technology, explores future possibilities and challenges, and provides recommendations for the advancement of Exercise Medicine.

1. Introduction

1.1 Exercise is medicine

In 1907, Dr. Theodore Toepel lamented that very few physicians possessed the necessary skills and knowledge to recommend “physical exercise” as a therapeutic method for diseases, understanding its effects and limits [1]. More than a century has passed since then, and exercise is now widely recognized as a reliable, validated, and effective form of medicine for patients with various conditions. Surprisingly, a PubMed search using the term “exercise medicine” yielded over 180,000 articles as of October 22, 2023, and the scientific evidence in this field continues to grow.

The “Exercise is Medicine” initiative began in the 1990s, based on a significant study published in 1989 that revealed a clear link between low physical fitness levels and an increased risk of all-cause mortality, including cardiovascular diseases and cancers [2]. In 2007, the American Medical Association and the American College of Sports Medicine jointly introduced the health initiative “Exercise is MedicineTM,” emphasizing that “if we had a pill that could confer all the proven health benefits of exercise, physicians would readily prescribe it to their patients, and our healthcare system would ensure that every patient had access to this wonder drug” [3].

Currently, exercise medicine is integrated into daily clinical practice for patients dealing with noncommunicable diseases, such as diabetes and cancer, and for those undergoing rehabilitation as a standard procedure. Furthermore, exercise not only ameliorates disease conditions but also helps prevent the development of certain chronic diseases. For example, exercise reduces the risk of cardiovascular diseases by improving autonomic balance and inducing a cardioprotective effect, through the release of anti-inflammatory cytokines, stimulation of myocardial regeneration, and enhancement of muscle strength and mass [4]. Substantial evidence suggests that exercise effectively reduces the risk of various cancers, including breast, colon, uterine, esophageal, stomach, and renal cancers, through physiological and biochemical changes, such as regulating cell growth, repairing DNA damage, modulating epigenetic expression, regulating apoptosis, harmonizing endocrine functions (e.g. myokines and sex hormones), improving immune function, and reducing oxidative stress and inflammation [5]. Recently, exercise has also been proposed as a potential means of reducing the risk of age-related cognitive decline and dementia, although this remains a topic of debate [6, 7]. Moreover, exercise medicine is effective in alleviating pain and improving physical function through weight loss in individuals with rheumatic and musculoskeletal diseases [8], preventing falls in older adults [9], and treating depression with supervised and group aerobic exercise (AE) of moderate intensity [10]. These results underscore the essential role of exercise medicine in promoting overall human health.

While determining the precise prescription and delivery of exercise to each patient remains challenging due to the lack of accurate information on exercise interventions in previous studies [11], exercise medicine holds promise for enhancing health outcomes, both as a standalone treatment and as a supportive therapy for various diseases, now and in the future.

2. Exercise modalities

Conventional exercise medicine typically involves structured AE and resistance training (RT). However, new exercise modalities have emerged that offer the potential for enhanced effectiveness and efficiency in improving health outcomes.

High-intensity interval training (HIIT) has shown promise as a more effective means of enhancing cardiorespiratory fitness in healthy individuals when compared to traditional AE [12]. It is also similarly effective in improving body composition in overweight and obese adults [13]. Additionally, HIIT exhibits pleiotropic effects, including improvements in cardiorespiratory fitness, physical fitness, muscle strength, cardiac function, mitochondrial citrate synthase activity, and reductions in blood triglycerides and glucose levels in older individuals at risk of sarcopenia [14]. HIIT has proven to be safe, effective, and time-efficient, even in patients with type 2 diabetes [15]. Similarly, sprint interval training, which requires even higher intensity but shorter exercise duration than HIIT, is effective in promoting fat oxidation in overweight or obese individuals [16] and enhances cardiorespiratory fitness and exercise performance in physically active young individuals and athletes [17].

Whole-body vibration has demonstrated benefits, including pain relief and increased knee extensor muscle strength when compared to stretching exercises alone, especially in patients with knee osteoarthritis [18]. It has also shown potential to improve mobility in patients with neurological disorders like stroke and Parkinson’s disease [19] and increase bone mineral density in the lumbar spine of postmenopausal women [20].

While the exercise intensity in non-exercise activity thermogenesis (NEAT) and low-intensity resistance exercise with slow movements and tonic force generation (LST) is generally low-to-moderate, and the effects of NEAT and LST may appear relatively modest compared to moderate-to-vigorous intensity exercises, NEAT and LST hold promise in improving health outcomes for patients with chronic diseases [21, 22, 23, 24, 25, 26, 27, 28].

Looking ahead, it is likely that new exercise modalities will continue to be developed. Clinicians should remain vigilant and stay informed about these advancements.

3. Technological advancements in exercise medicine

To objectively measure or monitor the PA of individuals, pedometers have been widely used. However, pedometers fall short in accurately measuring the intensity of PA and energy expenditure. To address this issue, accelerometers have emerged as a solution since the 1990s [29]. This technology has steadily advanced, leading to numerous studies exploring the health benefits of light-intensity PA [30]; the relationship between specific PA patterns (such as intensity, bout duration, or frequency) and health outcomes [31]; the relationship between PA, sedentary time (measured by accelerometers), and mortality [32]; and even the detection of concussion episodes in male football players [33]. Today, this technology is regularly incorporated into smartphones [34], enabling people to monitor their daily PA for health management. Furthermore, wearable technologies have proven to be practical and useful in promoting PA in patients with diabetes [35]. The COVID-19 pandemic, which began in 2019, had a detrimental impact on PA and overall health worldwide. If an effective network can be established between healthcare organizations and wearable users, it will also assist people in preventing physical inactivity and health problems during future pandemics [36].

Recently, ChatGPT, a generative artificial intelligence (AI), has significantly impacted the human world and is poised to bring about significant changes in medicine [37]. Within the field of exercise medicine, AI has the potential to effectively promote PA to the same extent as conventional in-person counseling [38]. AI-based interactive exercise has proven more effective in improving cardiorespiratory fitness than conventional gaming exercise, particularly in individuals with obesity [39]. Advanced AI, armed with vast, precise, and practical knowledge about exercise medicine, could provide valuable advice to humans when used appropriately.

Additionally, virtual reality (VR) technology has made remarkable strides. Cardiac rehabilitation using VR enhances exercise capacity, reduces stress and depression, and improves the quality of life [40]. VR exergaming has also shown promise in positively impacting cognitive function in older adults [41]. VR-based exercise therapy can improve upper extremity motor function in patients undergoing rehabilitation after a stroke [42]. VR technologies are expected to play a pivotal role in rehabilitation in the future. Further studies examining the effectiveness of these advanced technologies on health outcomes are warranted.

Figure 1 illustrates the past, present, and future of exercise medicine.

Figure 1.

Past, present, and future of exercise medicine.

4. New horizons of exercise medicine

This book aims to compile a comprehensive range of effective exercise modalities (from conventional to state-of-the-art) and scientific evidence concerning their impact on health. It also introduces the latest research findings on the biological mechanisms of exercise. Furthermore, it discusses new exercise therapies utilizing cutting-edge scientific technology, explores future possibilities and challenges, and provides recommendations for the advancement of exercise medicine. In my role as an academic editor, I sincerely hope that you, as readers, will enjoy delving into each excellent chapter authored by today’s eminent researchers. May you deepen your understanding and find valuable insights for applying exercise medicine in both your daily life and clinical practice.

Acknowledgments

No funding was received to assist with the preparation of this chapter.

Conflict of interest

The author declares no conflict of interest.