In November 2017, Melbourne city chiropractor Dr. Shannnon wrote an article for The Australian Chiropractor outlining the importance of exercise as medicine and the role chiropractors can play in prescribing exercise therapy to their patients. This is a copy of text published in the magazine article.

Exercise Medicine – A Chiropractors Domain

When people think of sports and exercise medicine they conjure up images of locker rooms, being pitch side, working and traveling with teams and athletes, and to some extent this would be right. However, sports and exercise medicine is also about the promotion and advocation of exercise medicine. That is, prescribing exercise and dietary advice for the treatment and prevention of chronic diseases.

Today’s society is driven by technology, phones, tablets, laptops, watches, automated machines and cars, all there to make our lives easier. Yet the more we rely on technology the more sedentary we have become. People can spend as much as half of their waking day sitting, with relatively idle muscles, and as little as 4-5% of their day spent in moderate to vigorous exercise 1,2.

Sedentary Lifestyle and Physically Inactivity

This sedentary lifestyle is in part responsible for the rapid escalation in chronic preventable diseases, where global type II diabetes rates have risen from 4.7% in 1980 to 8.5% in 2016, and worldwide obesity rates have jumped significantly between 1980 and 2013, with a 9% increase in the male population and a 10% increase in the female population3,4. With developed countries such as the US, UK, Australia and New Zealand driving these alarming trends 5.

girl sitting in wing back chair with a diary in front and laptop on desk while holding mobile phone

Physical inactivity is responsible for approximately 9% of premature deaths worldwide and is the 4th ranked leading risk factor for mortality 6,7. Where those who spend 10 or more hours in a car per week, have an 82% greater risk of cardiovascular disease mortality compared to those who spend 4 hours or less8. This sedentary behaviour is leading to weight gain, even when food intake is accounted for, and there is a growing body of evidence linking sedentary behaviour to an increased risk of mortality from cardiovascular disease, type II diabetes and obesity 9.

This link is not hard to appreciate when the risk factors for cardiovascular disease, type II diabetes and obesity are examined, as all include physical inactivity 10,11,12. However, it is not only these three chronic preventable diseases that are important. Overweight and obese people have a greater risk of developing prostate and colon cancer, and weight gain is also associated with hypertension, asthma, arthritis and fair to poor health 13,14.

It is for this very reason the American College of Sports Medicine established the Exercise is Medicine® initiative to encourage primary care professionals to include exercise when designing treatment plans for patients. As primary care practitioners, it is vitally important that Chiropractors take up the mantra “exercise is medicine” and incorporate dietary advice and exercise into patient treatment plans to improve patient outcomes.

The Importance of Physical Activity

Why is exercise medicine so important? Physical activity reduces the risk of developing cardiovascular disease by 30% 15. It reduces the risk for death and disability due to diabetes, chronic kidney disease and lower respiratory disease 16. It has also been shown to reduce the risk of breast and colon cancer, with growing evidence showing it may be beneficial in reducing the risk of pancreatic and lung cancer 15.
The benefits of physical activity aren’t confined to chronic diseases, it results in lower blood pressure, enhanced insulin sensitivity, increased high density lipoproteins, lower triglycerides and it helps with weight management 17,18.

In the elderly it preserves bone mass and reduces the risk of falling19. It helps to prevent and improve mild to moderate depressive disorders and anxiety, and is associated with a lower risk of cognitive decline and dementia19. It is also beneficial in the treatment of back pain by reducing pain levels and improving physical and psychological function 20,21.

Considering the benefits of physical activity for back pain, in addition to the high-quality evidence showing that NSAID’s and paracetamol are ineffective in the treatment of back pain 22,23. Chiropractors are in a strong position to use this evidence to advocate and prescribe physical activity as a part of their patient’s treatment plan, to enhance their clinical outcomes.

They should also be advocating physical activity and dietary changes to reduce their patient’s chronic disease mortality and morbidity rates. As a result, those ‘at-risk’ patients will reduce their risk factors and aid in lowering their Metformin, anti-hypertensive and statin medications. There is growing strong evidence supporting the benefits of diet such as, the Mediterranean diet and low carbohydrate diets and physical activity, in the treatment of type II diabetes, hypertension and high cholesterol 24,25,26,27,28,29.

Physical Activity Guidelines

image: group class of people exercising

So, what and how much physical activity should we be doing? Well, according to the American College of Sports Medicine position paper on exercise, they recommend a comprehensive exercise program consisting of cardiovascular exercise, resistance, flexibility and neuromuscular exercises 19. This should involve at least 150 minutes per week of moderate intensity physical activity 19. With several studies showing a dose response between chronic physical activity and health outcomes, meaning the more one is physical activity the greater the benefits are 30.

For those patients who are at risk of cardiovascular disease, they should undertake at least 120 minutes per week of moderate to high intensity aerobic exercise 18,31. For those looking to lose weight and prevent weight gain, they should be engaging in 150-250 minutes of moderate intensity exercise along with resistance training 31,32.

Chiropractors Should Be Advocating Exercise Medicine

Assessing patients risk factors for chronic preventable diseases is not outside the scope of a Chiropractors practice and can be easily assessed using measurements such as BMI, blood pressure, waist circumference, and if available blood lipids. There is a wealth of heart health diet questionnaires available online and The Heart Foundation provides charts and calculators for establishing a patient’s 5-year cardiovascular disease risk. Whether you are involved with sports and exercise medicine or not, advocating exercise and dietary advice to improve patient outcomes, mortality and morbidity rates should be a part of all Chiropractors treatment plans.

As a Melbourne sports chiropractor Dr. Shannon utilizes exercise therapy and advocates for reductions in sedentary behaviour and increases in moderate to vigorous physical activity. If you are interested in reading more about the benefits of exercise read you blog on why exercise is beneficial for immune function. To book an appointment with Melbourne city chiropractor Dr. Shannon or remedial massage therapist Paula Pena you can book below. Our Melbourne CBD chiropractic clinic is ideally located on Collins Street in the CBD of Melbourne opposite the Melbourne Town Hall and City Square.


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