Don’t take a pill, take a hike

The number of doctors prescribing their patients exercise is on the rise The result is similar to using anti-anxiety drugs, but with more positive side-effects

Carlos Arribas
Runners taking part in a Madrid half-marathon.
Runners taking part in a Madrid half-marathon.cristóbal manuel

The newspapers often carry stories that attract widespread admiration. In one case reported two years ago, a 102-year-old Frenchman named Robert Marchand (who had fought in two wars, worked as a firefighter in Paris, as a lumberjack in Canada and as a gardener until the age of 76) performed the feat of riding a bicycle for 60 minutes, during which time he covered 24.251 kilometers. Now, he is trying to beat his own record.

Marchand, who lives by himself and still drives his own car, has been closely monitored by French physiologists. The secret to his success is a strict training regime that has enabled him to actually improve his physical form despite the ageing process. "His oxygen consumption is 35 milliliters per kilogram per minute, which is the normal rate for a 45-year-old," explains the physiologist Véronique Billat in admiring tones. "Three months ago he had the oxygen consumption of a 55-year-old man... In no time he has improved by 10 years."

Billat believes there is no better example of the magnificent effects of physical exercise on health, and surely people like Carmen will not be contradicting her anytime soon. Carmen refuses to disclose how old she is ("All right, I can say that I'm over 80"), but she explains that every morning, between 8am and 9am, she goes for a bicycle ride in Madrid's Retiro Park. "I ride my bike at least one hour a day, and on the days that I don't, I feel unwell," she says.

As some specialists would put it, Carmen generates good chemistry with her workout, offsetting all the negative elements of 21st-century life in the big city: sedentary lifestyles, pollution, stress and more.

When I prescribe exercise, my patients sometimes look baffled"

In recent years, doctors from all over the world who specialize in all kinds of medicine have reached a consensus view that physical exercise is no longer just a piece of lifestyle advice one might give a patient, just like they might recommend not smoking or drinking moderately. Increasingly, physical exercise is becoming an actual prescription with the same therapeutic effects as the medication that might or might not go along with it.

It all stems from an obvious fact: we are chemistry, a product of chemical reactions inside our cells, a play of proteins. And working out also creates chemical reactions, just like any prescription drug. Exercise prevents and it cures.

Several researchers have reached similar conclusions. The International Journal of Sports Medicine describes one study conducted on 11 men and women aged 18 through 56 who walked the pilgrimage route of Camino de Santiago, covering 758 kilometers in 30 days, at an average of 25 kilometers a day and at 56 percent of their maximum heart rate. All of them were monitored before and after the journey for risk factors of cardiovascular disease: cholesterol, blood pressure, triglycerides and more. All members of the study lost around three kilos, reduced fat, lowered their blood pressure and improved their cardiorespiratory fitness.

Studies aside, dozens of physicians are using their own daily experience as a basis to prescribe exercise for conditions that, in theory at least, have nothing to do with sports.

Cristóbal Belda, an oncologist from Madrid, gets very few patients whose symptoms do not really correspond to cancer. "There are lots of early filters, but even then I occasionally get a patient whose symptoms are a somatization of an anxiety crisis or a bout of anguish, which are completely subjective feelings, as opposed to manifestations of a tumor," he says. "To all of them, before prescribing a Lexatin [bromazepam, an anxiolytic], I prescribe a good workout."

People don't realize, but walking ability is the best predictor of life expectancy"

Many patients who do not require cancer treatment get referred to a psychiatrist; these specialists, like the oncologist Belda, are increasingly prescribing a good dose of sweat rather than a bunch of pills.

"When I prescribe exercise, patients sometimes look a bit baffled, since many people think that every time they go to the doctor they should walk out with several prescription drugs, as though not doing so meant that we were taking their ailments less seriously. But they are becoming more accepting, especially if they view it as complementary therapy: sweat by day and pills by night," says the psychiatrist Carlos Mur, director of the Psychiatric Hospital in Leganés. "I am convinced of the chemical efficiency [of exercise], and not just to give patients a subjective sense of wellbeing."

Aerobic exercise, running or fast walking liberates myokines, substances that influence neurotransmitters and chemical reactions triggered by anxiety-caused somatization. It also liberates endorphins, which have a relaxing and euphoric effect. In fact, they activate the same receptors as do benzodiazepines, which are present in the most common anxiolytics. Exercise helps eliminate tension and somatization in bone and muscle tissue. It also eliminates adrenalin and testosterone, hormones that are the main culprits in the development of anxiety, anguish and panic.

"We need to get rid of the adrenalin," says Mikel Izquierdo, director of the Department of Health Sciences at the Public University of Navarre.

Izquierdo, whose research focuses on the benefits of exercise on seniors, believes that the mandatory prescription of exercise instead of medicine would, in many cases, save the health system millions of euros. This researcher illustrates his point with an example: "A man in his nineties who had been leading a functionally independent life is admitted into hospital with pneumonia. He is discharged 10 or 15 days later; his pneumonia is cured, but so many days in bed have left him so weak (if you don't move, muscle wastes away) that he can no longer walk, and he is now in a wheelchair. His functional capacity has vanished. This person will die soon, and not because of pneumonia, [...] but because he is weak and living in a wheelchair. Most people don't know it, but walking ability is the best predictor of life expectancy. Measuring the walking speed of elderly people lets you predict, down to the week, how long they have left to live."

Recomendaciones EL PAÍS
Recomendaciones EL PAÍS