What if there were one prescription that could prevent and help treat dozens of diseases such as diabetes, hypertension and obesity? Exercise is that prescription and physicians and healthcare providers need to prescribe it to patients who are not exercising regularly.
Exercise is Medicine™ is an important new initiative being promoted to all physicians and healthcare providers. The program is a shared vision of the American College of Sports Medicine (ACSM) and the American Medical Association (AMA). Exercise is Medicine is designed to help improve the health and well being of our nation through a regular physical activity prescription from doctors, including podiatric physicians and other healthcare providers. Each podiatrist should become a vital part of this bold new initiative and incorporate its message into daily practice.
The American Academy of Podiatric Sports Medicine (AAPSM) is actively participating in this endeavor. This past spring, our Academy co-signed a letter to the United States House and Senate leadership in support of reviewing and publishing physical activity guidelines every five years in order to address America’s emergent public health issues. The epidemic of obesity leads these issues today. However, if we have success with implementing physical activity benchmarks for our citizens, we may begin to lessen the epidemic and improve health trends. 
The guiding principles of this exercise program have been well documented in a new textbook called Exercise Is Medicine. This book has the support of the ACSM and is written by Harvard-trained Steven Jonas, MD, MPH.
Dr. Jonas emphasizes the importance of exercise and regular physical activity for health and how they play significant roles in prevention and treatment for many chronic diseases. He also urges all physicians and other healthcare providers to do more to address physical activity and exercise in healthcare settings.
Healthcare organizations (including the AAPSM), physicians and other professionals, regardless of specialty, are being challenged to assess, to advocate for and to review every patient’s physical activity program during every comprehensive visit.
It has been suggested that the hardest part of “regular exercise” is the regular, not the actual exercise. Encourage unfit patients to undertake healthy lifestyle changes. These changes include regular exercise, smoking cessation and consuming smaller, healthier food portions. Be a role model for patients and lead by example.
The U.S. Surgeon General, Rear Admiral Steven Galson, MD, MPH, and Robert E. Sallis, MD, the Immediate Past-President of the ACSM, recently presented the foundation for the Exercise is Medicine initiative at the ACSM’s Annual Meeting in Indianapolis. Listed below are highlights, which DPMs can use to discuss with patients, friends and families.
• Our longevity depends on three factors: genetics, environment and behavior. It is our behavior that is most problematic and has lead to the leading causes of death (cardiac disease, cancer and stroke) in the U.S.
• The most preventable factors of premature death are tobacco use and physical inactivity. In 2004, a “tipping point” occurred with tobacco when the number of ex-smokers outnumbered the number of current smokers.
• The death rate for a fit 80-year-old is lower than that of a sedentary 60-year-old.
• Exercise is a “wonder drug” and everyone should take it.
• Our insurance industry needs to change. Why will insurance pay to refer a patient for bariatric surgery but will not pay to refer a patient to an exercise specialist?
• We need to move from a treatment-oriented society to a prevention-oriented society.
• Seven out of 10 Americans will die from a preventable disease.
• Childhood obesity is our number one health problem in the U.S. For the first time in our history, our youth will have a shorter life span than adults. This is a terrible, embarrassing comment on our nation’s current health.
• Each of us can play a key role to increase exercise in the U.S. Start by being a fit personal role model and incorporate Exercise is Medicine into practice.
• Healthy food choices and lifestyle choices need to be parts of the solution for healthy living.
As podiatric physicians, we can play an additional preventive role in exercise injuries by providing our newly exercising patients with an appropriate athletic shoe prescription on each comprehensive visit. The athletic shoe prescription should include: proper athletic shoe type, athletic sock recommendation, lacing techniques and supportive insoles or orthoses if necessary.
Our Academy’s shoe review committee has made a tremendous effort to update our athletic shoe Web pages (www.AAPSM.org ), which include a wealth of contemporary knowledge needed to write an athletic shoe prescription. This is useful for the novice as well as the experienced podiatric practitioners.
The ACSM and the American Heart Association (AHA) recently released updated physical activity recommendations for adults (www.acsm.org ). This message should be clear and consistent for all sports and medical organizations.
The recommendations are that patients should undertake moderate intensity aerobic physical activity for a minimum of 30 minutes on five days each week. As an alternative, patients should undergo vigorously intense physical activity for a minimum of 20 minutes on three days each week. These recommendations are an update and clarification of the 1995 recommendations on the types and amounts of physical activity needed by healthy adults and older adults to improve and maintain health.
The core recommendation of the ACSM/AHA Physical Activity Guidelines is to promote and maintain health. The intent is to provide a more comprehensive and explicit public health recommendation based upon available evidence-based research of the health benefits of physical activity. The preventive recommendation specifies how adults, by engaging in regular physical activity, can promote and maintain health and reduce the risk of chronic disease and premature mortality.
We must continue to emphasize a single evidence-based message into the daily routine of all Americans if we are to be successful in altering the exercise and activity behaviors in the U.S. This effort must involve everyone from the Surgeon General to the coach, from the healthcare provider to the physical educator, and from the school administrator to the health insurance provider.
Please visit www.ExerciseisMedicine.org  for a more detailed description of Exercise is Medicine, including ways to counsel patients on their exercise regimens and information on how physical activity can be an integral part of any patient’s healthcare program.
Dr. Werd is the Immediate Past President of the American Academy of Podiatric Sports Medicine and a Fellow of the American College of Sports Medicine. He is the Chief of Podiatric Surgery at Lakeland Regional Medical Center in Lakeland, Fla.
Dr. Richie is an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University. He is a Fellow of the American Academy of Podiatric Sports Medicine.