Exercise as Medicine

Not long ago I received a phone call from a very excited client of mine. I had been working as a personal trainer with her for several months. One goal we were working toward was lowering her blood sugar levels in an attempt to have her avoid going on medication. She was calling to tell me the great news about her latest blood work results: all the markers they test for diabetes had decreased, negating her need for medication.

“I just can’t believe it!” she exclaimed. “I didn’t expect exercise to help out so much!”

Trainers and exercise enthusiasts have found that physical activity confers positive medical effects. Jennifer Katt, owner of Surround Fitness in Woodbridge, VA, has several clients who have experienced health benefits, from improvements in blood sugar to decreases in blood pressure. “I have high blood pressure, along with Sjogren’s Syndrome, osteoarthritis, osteopenia, and hypothyroidism,” explains one of her clients. “I have lost inches and weight due to increased exercise and activity, which has definitely benefited my hypertension and osteoarthritis. The strength training, which I do multiple times a week, is helping prevent osteopenia from becoming osteoporosis.”

Exercise has been shown to be as effective as some medications for certain conditions. Here is a list of several common conditions, what medications are commonly used to treat them, their possible side effects, and how exercise can help reduce or eliminate the need for medication.

Type 2 Diabetes

Common Medications: Avandia, Prandin, Glucophage, Victoza, Onglyza

Possible Side Effects: nausea, vomiting, headache, kidney damage/failure, heart attack, stroke, liver disease

Expert Opinion: “One of the worst culprits in diabetic medication is the drug Avandia, which was exposed in the New England Journal of Medicine in 2007,” explains Carolyn Dean, MD, ND, a member of the medical advisory board for the Nutritional Magnesium Association. “It increases the risk of heart attacks by 43 percent. Since diabetics are at risk for heart attacks, increasing that risk is unacceptable. Avandia has been pulled in other countries, but is still available with prescription in the U.S.”

After further investigation, the FDA published a statement on 11/25/13 indicating that recent data for rosiglitazone-containing drugs, such as Avandia, Avandamet, Avandaryl, and generics, do not show an increased risk of heart attack compared to the standard type 2 diabetes medicines metformin and sulfonylurea. If you continue to read the “Important Warning” section, however, you will see that the FDA still does not recommend taking rosiglitazone-containing drugs if you have a history of congestive heart failure or other heart problems, and that taking these drugs may increase the risk that you experience a heart attack.

Just this year (February 2014), the FDA requested full data from the SAVOR trial from Bristol-Myers Squibb, the manufacturer of Onglyza (saxagliptin), to further investigate the 27 percent increased risk of hospitalization for heart failure among patients taking the DPP-4 inhibitor reported in the study.

Exercise, both aerobic and strength training, improves the body’s response to insulin, as muscle and fat become more efficient in removing glucose from the blood, says Katt.

“There is some data indicating that interval training provides the best benefit for insulin resistance (pre-diabetes),” says Amy Doneen, MSN, ARNP, co-author of Beat the Heart Attack Gene (Wiley, 2014) with Bradley Bale, MD. “Interval training requires cyclic raising of the heart rate beyond 70 percent of maximum for a period of time and then reducing the intensity back to moderate” for a similar amount of time. The intervals can run from several seconds to several minutes. (Moderate intensity is considered 50-70 percent of your maximum heart rate [MHR]; vigorous intensity is 70-85 percent of MHR. To find your MHR, subtract your age from 220. Multiply that answer by .50 and .70 to find your moderate intensity range and by .70 and .85 to find your vigorous intensity range. Check with your doctor to find the MHR that’s right for you.)

According to the American College of Sports Medicine and the American Diabetes Association joint position statement on diabetes, the combination of aerobic exercise and resistance training have the greatest effect on blood sugar management. Aerobic exercise should be done at least three days a week, with no more than two consecutive days between workouts. If done at a moderate* pace, plan on getting around 150 minutes per week. More vigorous* exercise can be done in less time—about 75 minutes per week—and has been shown to have more benefits than moderate activity. Engage in resistance training at least twice a week, ideally three times per week.

High Blood Pressure/Heart Disease

Common Medications: diuretics, beta-blockers, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), calcium channel blockers (CCB)

Possible Side Effects: depletion of minerals, including potassium, magnesium, and sodium; increased risk of diabetes; fatigue; decreased heart rate response to exercise; nagging, dry cough; dizziness; fluid retention

Expert Opinion: “Research tells us exercise will reduce blood pressure even in patients with the toughest blood pressures to control—resistive hypertension,” says Doneen. “One of the biggest causes of high blood pressure is pre-diabetes. Lots of pre-diabetic patients present with hypertension and are on several blood pressure medications. Once they start moving away from diabetes, their blood pressure will start to decrease and blood pressure medications can be reduced or stopped.”

“Exercise is known to lower blood pressure and is considered a cornerstone of blood pressure management,” adds Doneen. “The average reduction is approximately 3 mmHg systolic (the top number) and 2.5 mmHg diastolic (lower number). This amount of reduction translates into a significant reduction in mortality risk from stroke and heart attack of around 9 percent and 6 percent respectively. The mechanism of blood pressure reduction from exercise is derived from decreased vascular resistance due to decreased autonomic nervous system response, decreased renin, and increased insulin sensitivity. The good news is that studies show that both aerobic and resistance training improve blood pressure.”

A recent study, done as a collaboration between researchers at Harvard Medical School and the Stanford University School of Medicine, showed that exercise can be as effective as drugs in lowering risk for diabetes and decreasing risk of death from coronary heart disease and stroke.

The primary form of exercise that has been shown to improve blood pressure and heart disease risk is aerobic exercise, which includes activities that involve large muscle groups moving rhythmically, including cycling, walking, running, and swimming. To improve overall cardiovascular health, the American Heart Association (AHA) recommends at least 150 minutes of moderate* activity per week or 75 minutes per week of vigorous* activity. No time for a full workout? Divide your workouts into 10- or 15-minute segments that add up to 30 minutes total in a day. To lower blood pressure or cholesterol, the AHA recommends 40 minutes of aerobic exercise of moderate to vigorous intensity 3 to 4 times a week to lower your risk of heart attack and stroke.

Insomnia

Common Medications: Ambien, Lunesta, Silenor, Rozerem, Sonata

Possible Side Effects: sleep walking, sleep eating, sleep driving, amnesia, dizziness, heartburn, diarrhea, constipation, dry mouth or throat, gas, uncontrollable shaking of certain areas of the body, stomach pain or tenderness, difficulty keeping balance, burning or tingling in hands, arms, feet or legs

Expert Opinion: Sleeping pills are meant for short-term use only, says Dean. “However, patients are given prescriptions for these addictive medications for years at a time. When they want to come off these drugs, it’s often very difficult, producing withdrawal effects and rebound insomnia.”

Exercise: Studies have long shown that exercisers tend to sleep better. While it was once believed that exercising too close to bedtime inhibited sound sleep, new data is showing otherwise. In a survey of 150,000 people, conducted by the Centers for Disease Control and Prevention, found that people who did any exercise, no matter how light, reported significantly better sleep than non-exercisers. And a 2013 National Sleep Foundation Poll  found:

  • 83 percent of vigorous exercisers reported very or fairly good sleep quality, vs. 56 percent of non-exercisers.
  • 67 percent of vigorous exercisers reported a good night’s sleep on all or most work nights, vs. 39 percent of non-exercisers.

For true insomnia sufferers, however, a recent study in the Journal of Clinical Sleep Medicine shows that exercise is not a quick-fix. It can take up to four months to see improvement in sleep with regular exercise. Researchers say the reason it takes longer for insomniacs to see improvements is due to a heightened level of brain activity; it takes longer to re-establish a normal level of brain activity that will facilitate sleep. They encourage those who suffer from insomnia to stick with an exercise program and not get discouraged. The results will be forthcoming.

Depression

Common Medications: Cymbalta, Lexapro, Wellbutrin, trazadone, Zoloft, Prozac, Paxil,

Possible Side Effects: nausea, increased appetite, weight gain, decreased sex drive, trouble reaching orgasm, fatigue, drowsiness, insomnia, dry mouth, blurred vision, constipation, dizziness, agitation, restlessness, anxiety, tics, spasms, impaired brain function, heart palpitations, hypertension

Expert Opinion: “SSRIs are the most commonly prescribed antidepressants,” says Dean. “Most studies now show that they are only 40 percent effective and even less effective than placebo. They can cause serious side effects, such as suicidal and homicidal tendencies.”

“Exercise can reduce the need for medications in this case, because it can improve mood, sleep, and a person’s sense of self-efficacy and self-esteem,” explains Katt. “It can also reduce stress and increase energy.”

Research published in The Primary Care Companion Journal of Clinical Psychiatry suggests that exercise frequency is more important regarding depression than intensity and duration, at least at first, until exercise as a habit is established. Both aerobic exercise and resistance training have been shown to be effective in reducing depressive symptoms. The key is to find something you like and will enjoy, whether it’s hiking, Zumba, yoga, running or swimming.

In Conclusion

It’s clear that many prescription drugs used to treat common conditions have serious side effects that often prompt the need for additional medications. This vicious disease-drug-more drugs cycle can be eliminated or lessened when patients use exercise and other non-medication approaches, in conjunction with medication when necessary, to treat their illnesses.


Carrie Myers

Carrie Myers

Carrie Myers is the mother of four sons, owner of CarrieMichele Fitness, and author of Squeezing Your Size 14 Self into a Size 6 World: A Real Woman’s Guide to Food, Fitness, and Self-Acceptance (Champion Press/Sourcebooks).


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