Exercise prescription: what does it mean for primary care?

Exercise promotion is not a new concept. The ancient Greeks were among the first to promote exercise with Hippocrates himself stating: ‘if we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health’. Little progress was made from then until the 1800s, when a physician named McKenzie was one of the first to think of exercise as a medical treatment for chronic disease rather than an activity reserved for the physically fit.1 In the UK, there have been many attempts to get the country more physically active with a host of strategies and initiatives. The government has tried to sell exercise as a low-cost, low-tech and non-drug intervention to improve the health and social welfare of the population. But how far has exercise prescription really come? And why has exercise awareness and promotion not progressed as far as other public health concerns such as smoking, diet, and alcohol? The World Health Organization (WHO) has reported that physical inactivity is one of the 10 leading causes of death in developed countries and results in about 1.9 million preventable deaths worldwide annually.2 The benefits of physical activity on various health issues including atherosclerotic vascular disease, hypertension, diabetes mellitus, osteoporosis, dyslipidaemia, obesity, mental health, and a reduction in mortality, are now undisputed. In addition, a sedentary lifestyle is shown to be a more significant risk factor for coronary artery disease than other ‘established’ risk factors such as smoking, hypertension, and hyperlipidaemia.3 There are also …