Exercise: A Timeless Medicine - Annals of Internal Medicine: Fresh Look Blog


Wednesday, September 20, 2023

Exercise: A Timeless Medicine

“Did you do your exercise today?” This question is frequently asked by my father when we have our overseas calls. I haven’t always said yes. That did not stop him from asking me about my exercise as he believes exercise is a timeless medicine. While counseling a patient on exercise, I recognized the importance of practicing what I advise. So, I began exercising for at least 10 minutes every day. This made my dad happy, and it also instilled a sense of integrity when counseling my patients on the merits of physical activity.

Sitting without much movement is common everywhere—at work, at home, when we travel, and during leisure activities, we’re often asked or expected to sit. Even though I am walking at hospitals during rounds, I am sitting while writing notes and reviewing charts for a significant amount of time. Prolonged sedentary time is connected to harmful health effects, regardless of an individual’s level of physical activity. Biswas and colleagues did a meta-analysis of observational studies to examine the association between sedentary time and various health outcomes (1). The analysis revealed that prolonged sedentary time was linked to a heightened risk for all-cause mortality, cardiovascular disease mortality, and cancer mortality. Additionally, it was connected to increased incidences of cardiovascular disease, cancer, and type 2 diabetes.

Extensive research across various age groups and health conditions highlights the profound positive effects of regular exercise on well-being. This applies to both healthy individuals and those with chronic conditions or disabilities. Physical activity reduces the risk for cardiovascular disease, diabetes, depression, cognitive problems, and declining physical function. A study published in Annals of Internal Medicine highlighted the benefits of physical activity for an elderly population at high risk for mobility limitations and other health conditions (2). The LIFE (Lifestyle Interventions and Independence for Elders) study demonstrated a significant reduction in major mobility disorder (MMD) incidence among elderly participants through physical activity. Over a 3.5-year period, the physical activity group exhibited notable benefits, including a nearly one-third decrease in transitions from no MMD to MMD and an almost one-half decrease in transitions from no MMD to mortality (3). The intervention also led to improved disability recovery and a reduced likelihood of subsequent disability episodes.

Physical inactivity ranks as the fourth leading cause of death and disability in moderate- to high-income countries according to the World Health Organization. Surprisingly, only 1 in 4 adults and 1 in 5 adolescents in the United States adheres to recommended physical activity guidelines for aerobic and muscle-strengthening activities, despite substantial evidence of exercise benefits from numerous studies (4). Physicians and other health care professionals wield significant influence as sources of advice for lifestyle modifications, including adopting a consistent exercise routine. Challenges in health care settings include time constraints and a lack of compensation for exercise recommendations. The prescription of regular exercise is as vital as medication prescription, possibly holding even greater importance for preventing midlife weight gain and health-related complications in many patients.


  1. Biswas A, Oh PI, Faulkner GE, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults. A systematic review and meta-analysis. Ann Intern Med. 2015;162:123-32. [PMID: 25599350] doi:10.7326/M14-1651
  2. Gill TM, Guralnik JM, Pahor M, et al; LIFE Study Investigators. Effect of structured physical activity on overall burden and transitions between states of major mobility disability in older persons. Secondary analysis of a randomized trial. Ann Intern Med. 2016;165:833-840. [PMID: 27669457] doi:10.7326/M16-0529
  3. Pahor M, Guralnik JM, Ambrosius WT, et al; LIFE study investigators. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA. 2014;311:2387-96. [PMID: 24866862] doi:10.1001/jama.2014.5616
  4. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans. 2nd ed. 2018. Accessed on 7 September 2023.

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