The science and practice of exercise medicine or sports medicine is taken by many to be a field which applies exclusively to the sportsman or sportswoman − people who practise sport are good at sport, or otherwise want to be actively involved in sport purely for the purpose of sport. 

What about those who would like to practise sport as a way to aid their battle against disease? To channel the anxiety, fear or grief that accompanies the disease process? Or those who yearn to practise a sport and cannot? Or at times, rather, believe they cannot? 

Beyond leisure and healthy competition, forms of exercise or sport can be adapted and scaled down for our patients to become better, fuller, stronger people in their journey of living with and pushing back against the disease process. 

Exercise medicine is a field with proven utility in patient care across the spectrum of chronic disease. 

As with pharmaceutical interventions in every other field of medicine, biomechanical (exercise) interventions will vary in form and formulation with different conditions and, at times, also with different patients living with the same condition. 

Notwithstanding the variability in exercise intervention formulation and specific programme design, some fundamental tenets apply across the board.

One such tenet is the maintenance of muscle mass, muscle strength and muscle power.  Another is the partial or complete reversal of loss across any of these three parameters central to the patient’s functional status.

Such loss of muscle mass, strength, and/or power is termed ‘Sarcopaenia’, an appreciable phenomenon across the spectrum of chronic disease, and also accompanying the ageing process above the age of 30 years.

Mike Tabone is a practitioner of functional medicine.

In a world with increasingly ageing populations, and the concerning increase in chronic disease at a relatively young age, the international health community will need improved interventional methods to reverse this loss in musculoskeletal function which brings with it increased risk for complications and premature death.

A functional approach to the functional status of patients necessitates by default the engagement in structured movement and mobility towards a defined goal, beyond what is considered normal daily physical activity.

The scientific practice of exercise as a treatment intervention can bring patients closer to their health and strength goals and, under the right guidance, also decrease treatment burden, disease progression, ageing and detriments to functional status. 

More than enough evidence is available in the scientific literature to compel traditional medicine to incorporate exercise medicine into the standard management of chronic disease along with the most successful drugs in medical history.  

When compared to medication, which is traditionally a targeted treatment aimed at applying leverage in one biochemical reaction or other within the body, the scientific practice of exercise as a biomechanical intervention affects multiple body systems at both the biochemical and the structural level. 

From the release of myokines at the atomic level which re-engineer the energetic systems of individual cells to regenerate, clean up and switch on genes that improve longevity, slow down the ageing process and dial down inflammation, to structural improvements for improved heart function, blood distribution, mobility and balance, the good practice of exercise as an applied science in medicine holds much untapped value. 

Exercise as a formal treatment intervention is an emerging management modality in chronic disease for which there is an increasing need in the communities worldwide, no less so in Malta.  

Exercise medicine is a field with proven utility in patient care across the spectrum of chronic disease

Clinical exercise interventions are the spearhead of exercise medicine in the supportive management of chronic disease care. These are targeted interventions, formulated specifically for the individual patient, taking into consideration the patient’s treatment plan, medical risks, metabolic profile, cardiac status, mental status, musculoskeletal status and ranges of motion, physical strengths and weaknesses, and overall body composition.  

Such an approach becomes ever more important when dealing with patients who have serious functional limitations, who would most often feel discouraged from engaging in anything which might be physically demanding. 

Patient performance data gathered in such interventions should be analysed and used to inform future interventions for that same patient, developing a specific exercise intervention that grows and adapts according to individual patient progress. 

The value of clinical exercise interventions goes beyond the physical benefits to health and metabolism, and is an effective facilitator of behavioural changes for patients who are looking for an improved attitude to facing and fighting disease. 

Indeed, the psychological change that accompanies the exercise intervention is the primary outcome sought with patients. One might even say that all else follows once the obstacles of the mind are overcome. 

With the right approach and delivery, the operative thought process fostered by a well-thought-out, regular and regimented engagement with physically challenging environments can be ingrained inside the mind and brain of the patient as a positive, meaningful and enjoyable process. In the former, this is ingrained as personal discipline, in the latter as a system of integrated neurological pathways. 

If this operative thought process is not “installed” for, and with the patient, through proper guidance and coaching, it is often the case that patients start to see the training process as a means to an end, and however valuable that end is, means-based motivation tends to always fall through. 

It is not, therefore, just the engagement of the patient in exercise, but also the method of delivery, the quality of care and the training experience of the patient that determines the long-term success of any clinical exercise intervention. 

This success can be summed up in the attainment of two primary outcomes:

• first, the engagement in the process of training needs to become the end in and of itself − a productive, constructive, positive process of recovery which is sought out for its own intrinsic value;

• second, the attainment of patient autonomy in the planning and execution of the fundamentals of exercise as a safe and effective intervention for the long-term, with clinical guidance from time to time as deemed necessary. 

Such long-term success spells untold value for mitigation of risk for cardiovascular, cancer and depression rates. Exercise medicine and clinical exercise interventions should be an essential component of the modern medical management of our patients, not only in functional or integrative medicine but also in general medicine, where they should play a key role in the future outcomes for chronic disease, longevity and public health. 

Mike Tabone is practitioner of functional medicine and exercise medicine at Sotogard Medical. He concluded his master’s degree in sports and exercise science and medicine at the University of Glasgow in the summer of 2023. This master’s of science was carried out following the award of a Malta Sports Scholarship Scheme financed by the government of Malta.