Shannon Clinic – Melbourne Chiropractic and Sports Care Blog

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.

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

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.

References

• 1). Hamilton MT, Hamilton DG, Zderic TW. Role of Low Energy Expenditure and Sitting in Obesity, Metabolic Syndrome, Type 2 Diabetes and Cardiovascular Disease. Diabetes. 2007; 56(11): 2655-2667.
• 2). Bauman ON, Brown W. Too much sitting: a novel and important predictor of chronic disease risk? Br J Sports Med. 2009; 43: 81-83.
• 3). World Health Organisation. Global Report on Diabetes. Geneva: World Health Organisation; 2016. P. 6. Available from: http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf
• 4). González K, Fuentes J, Márquez JL. Physical Inactivity, Sedentary Behavior and Chronic Diseases. Korean Journal of Family Medicine. 2017; 38(3): 111-115.
• 5). Mariel M, Finucane AB, Gretchen A, Stevens Dsc, Melanie J et al. National, regional and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country years and 9.1 million participants. The Lancet. 2011; 377(9765): 557-567.
• 6). Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012; 380(9838): 219–29.
• 7). World Health Organization. Global Recommendations on Physical Activity for Health. Geneva: World Health Organization; 2010. p. 60. Available from: http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/
• 8). Warren TY, Barry V, Hooker SP, Sui X, Church TS, Blair SN. Sedentary behaviors increase risk of cardiovascular disease mortality in men. Med Sci Sports Exerc. 2010; 42: 879–885.
• 9). Hamilton MT, Hamilton DG, Zderic TW. Role of Low Energy Expenditure and Sitting in Obesity, Metabolic Syndrome, Type 2 Diabetes and Cardiovascular Disease. Diabetes. 2007; 56(11): 2655-2667.
• 10). Capewell S, Morrison CE, McMurray JJ. Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994. Heart. 1999; 81(4): 380–6.
• 11). Li J, Siegrist J. Physical Activity and Risk of Cardiovascular Disease-A Metat-Analysis of Prospective Cohort Studies. Int J Environ Res Public Health. 2012; 9(2): 391-407.
• 12). Edelmen SV. Type II Diabetes Mellitus. Adv Inter Med. 1998; 43: 449-500.
• 13). Guh DP, Zhang W, Bansback N, Amarsi Z, Birminghan CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health. 2009; 9(88): https://doi.org/10.1186/1471-2458-9-88
• 14). Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, et al. Prevalence of Obesity, Diabetes and Obesity-Related Health Risk Factors, 2001. JAMA. 2003; 289(1): 76-79.
• 15). Chomistek AK, Cook NR, Flint AJ, Rimm EB. Vigorous-Intensity Leisure-Time Physical Activity and Risk of Major Chronic Disease in Men. Med Sci Sports Exerc. 2012; 44(10): 1898-1905.
• 16). Brawner CA, Churilla JR, Keteyian SJ. Prevalence of Physical Activity Is Lower among Individuals with Chronic Disease. Med Sci Sports Exerc. 2016; 48(6): 1062-1067.
• 17). US Department of Health and Human Services. Physical Activity Guidelines Advisory Committee Report, 2008 [Internet]. Washington (DC): ODPHP Publication No. U0049. 2008 [cited 2010 Sep 24]. 683 p. Available from: http://www.health.gov/paguidelines/Report/pdf/CommitteeReport.pdf.
• 18). Kodama S, Tanaka S, Saito K, Shu M, Sone Y, et al. Effect of Aerobic Exercise Training on Serum Levels of High-Density Lipoprotein Cholesterol: A Meta-analysis. Arch Intern Med. 2007; 167(10): 999-1008.
• 19). Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, et al. Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculosketelal, and Neuromotor Fitness In Apparently Healthy Adults: Guidance for Prescribing Exercise. Med Sci Sports Exerc. 2011; 43(7): 1334-1359.
• 20). Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015; 29(12): 1155-1167.
• 21). Meng XG, Yue SW. Efficacy of aerobic exercise for treatment of chronic low back pain: a meta-analysis. Am J Phys Med Rehabil. 2015; 94(5): 358-65.
• 22). Machado GC, Maher CG, Ferreira PH, Pinheiro MB, Lin CW, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015; 31(35): doi: 10.1136/bmj.h1225.
• 23). Machado GC, Maher CG, Ferreira PH, Day RO, Pinheiro MB, Ferreira ML. Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Ann Rheum Dis. 2017; 76(7): 1269-1278.
• 24). Varady KA, Jones PHJ. Combination Diet and Exercise Interventions for the Treatment of Dyslipidemia: an Effective Preliminary Strategy to Lower Cholesterol Levels? J Nutr. 2005; 135(8): 1829-35.
• 25). Elhayany, A., Lustman, A., Abel, R., Attal-Singer, J. and Vinker, S. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes, Obesity and Metabolism. 2010; 12: 204–209.
• 26). Kelley G, McClellan P. Antihypertensive Effects of Aerobic Exercise: A Brief Meta-Analytic Review of Randomized Controlled Trials. Am J Hypertens. 1994; 7(2): 115-119.
• 27). Börjesson M, Onerup A, Lundqvist S, Dahlof B. Physical activity and exercise lower blood pressure in individuals with hypertension: narrative review of 27 RCTs. Br J Sports Med. 2016; 50: 356-361.
• 28). Esposito K, Maiorino MI, Di Palo C, Giugliano D. Adherence to a Mediterranean diet and glycaemic control in Type 2 diabetes mellitus: For the Campanian Postprandial Hyperglycemia Study Group. Diabetic Medicine. 2009; 26: 900–907.
• 29). Elhayany, A., Lustman, A., Abel, R., Attal-Singer, J. and Vinker, S. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes, Obesity and Metabolism. 2010; 12: 204–209.
• 30). Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007; 39(8): 1423-34.
• 31). Pedersen BK, Saltin B. Evidence for prescribing exercise as therapy in chronic disease. Scand J Med Sci Sports. 2006; 16(1): 3-63.
• 32). Donnelly JE, Blair SN, Jacicic JM, Manore MM, Rankin JW, et al. American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009; 41(2) 459-71.