Exercise

There are various diseases in which exercise has a potentially valuable role because of its ability to directly treat the pathophysiology of the disease. Examples of this use of exercise are given in table 2. In some cases exercise may provide benefits similar to those of medication or nutritional intervention; in others it may act through an entirely different pathway. The chronic treatment of hypertension and coronary artery disease is clearly a case for management with both standard medical treatments and exercise. Exercise Table 2 Benefits of Exercise SOURCE: Author may prevent secondary cardiovascular events as well as minimize the need and risk of multiple drug use or high drug dosages in these conditions.

The benefits of exercise are often most dramatic in individuals in whom medical treatment is already optimized and cannot be pushed further, or when the pathophysiology of the disease itself is not amenable to change. For example, in chronic obstructive pulmonary disease, once bronchospasm has been relieved and oxygen has been supplemented, exercise tolerance may still be very limited due to peripheral skeletal muscle atrophy and inability to effectively extract oxygen and utilize it for aerobic work as a result of years of disuse, poor nutrition, and other factors. However, such peripheral abnormalities can be directly and effectively targeted and treated with progressive endurance training protocols, which have been shown to significantly improve exercise tolerance, functional status, and quality of life in such patients.