Death by effectiveness: exercise as medicine caught in the efficacy trap!

Beedie, Chris; Mann, Steven; Jiménez, Alfonso; Kennedy, Leonard A.; Lane, Andrew M.; Domone, Sarah; Wilson, Sandy J.; Whyte, Greg

doi:10.1136/bjsports-2014-094389

Cited by 45 publications

(41 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Yet outcomes are what matter to stakeholders, including public health commissioners and policy makers [37, 67]. A recent study comparing the behaviour (i.e.…”

Section: Resistance Training For Public Healthmentioning

confidence: 99%

“…Thus we are currently in a position whereby we have considerable evidence supporting the efficacy of RT (i.e., that it works when people do it under ideal conditions), but a considerable lack of evidence examining its effectiveness (i.e., whether people will actually do it under ecologically valid conditions). At present this is a conundrum for most of sport and exercise medicine [67], though, with its lack of emphasis in public health research, even more so for RT.…”

Section: Resistance Training For Public Healthmentioning

confidence: 99%

See 1 more Smart Citation

A higher effort-based paradigm in physical activity and exercise for public health: making the case for a greater emphasis on resistance training

et al. 2017

Self Cite

View full text Add to dashboard Cite

It is well known that physical activity and exercise is associated with a lower risk of a range of morbidities and all-cause mortality. Further, it appears that risk reductions are greater when physical activity and/or exercise is performed at a higher intensity of effort. Why this may be the case is perhaps explained by the accumulating evidence linking physical fitness and performance outcomes (e.g. cardiorespiratory fitness, strength, and muscle mass) also to morbidity and mortality risk. Current guidelines about the performance of moderate/vigorous physical activity using aerobic exercise modes focuses upon the accumulation of a minimum volume of physical activity and/or exercise, and have thus far produced disappointing outcomes. As such there has been increased interest in the use of higher effort physical activity and exercise as being potentially more efficacious. Though there is currently debate as to the effectiveness of public health prescription based around higher effort physical activity and exercise, most discussion around this has focused upon modes considered to be traditionally ‘aerobic’ (e.g. running, cycling, rowing, swimming etc.). A mode customarily performed to a relatively high intensity of effort that we believe has been overlooked is resistance training. Current guidelines do include recommendations to engage in ‘muscle strengthening activities’ though there has been very little emphasis upon these modes in either research or public health effort. As such the purpose of this debate article is to discuss the emerging higher effort paradigm in physical activity and exercise for public health and to make a case for why there should be a greater emphasis placed upon resistance training as a mode in this paradigm shift.

show abstract

“…Yet outcomes are what matter to stakeholders, including public health commissioners and policy makers [37, 67]. A recent study comparing the behaviour (i.e.…”

Section: Resistance Training For Public Healthmentioning

confidence: 99%

Section: Resistance Training For Public Healthmentioning

confidence: 99%

A higher effort-based paradigm in physical activity and exercise for public health: making the case for a greater emphasis on resistance training

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…Arguably, to inform policy and practice, such trials should replicate real-world delivery, first, in terms of how they are communicated, delivered and managed by exercise professionals, and second, in terms of how they are accessed and experienced by patients. 23 Data to emerge from studies adopting such designs has substantial relevance to public health policy and practice. 24 We report the findings of a 48-week study across multiple community fitness centres in the UK.…”

Section: Introductionmentioning

confidence: 99%

Comparative effects of three 48-week community-based physical activity and exercise interventions on aerobic capacity, total cholesterol and mean arterial blood pressure

Mann

Jiménez

Domone³

et al. 2016

BMJ Open Sport Exerc Med

Self Cite

View full text Add to dashboard Cite

AimInsufficient research examines the treatment effectiveness of real-world physical activity (PA) interventions.PurposeWe investigated the effects of 3 interventions on directly measured cardiovascular variables. All treatments and measures were administered in community settings by fitness centre staff.MethodsParticipants were sedentary individuals receiving no medication to reduce cardiovascular disease (CVD) risk (n=369, age 43 ±5 years). In a semirandomised design, participants were allocated to a structured gym exercise programme (STRUC), unstructured gym exercise (FREE), physical activity counselling (PAC) or a measurement-only control condition (CONT). Measures were: predicted aerobic capacity (VO2: mL kg min), mean arterial blood pressure (MAP: mm Hg) and total cholesterol (TC: mmol/L), and were taken at baseline and 48 weeks.ResultsData analysis indicated a statistically significant deterioration in TC in CONT (0.8%, SD=0.5, p=0.005), and a statistically significant improvement in MAP in STRUC (2.5%, SD=8.3, p=0.004). Following a median split by baseline VO2, paired-sample t tests indicated significant improvements in VO2 among low-fit participants in STRUC (3.5%, SD=4.8, p=0.003), PAC (3.3%, SD=7.7, p=0.050) and FREE (2.6%, SD=4.8, p=0.006), and significant deterioration of VO2 among high-fit participants in FREE (−2.0%, SD=5.6, p=0.037), and PAC (−3.2%, SD=6.4, p=0.031).ConclusionsSeveral forms of PA may offset increased cholesterol resulting from inactivity. Structured PA (exercise) might be more effective than either unstructured PA or counselling in improving blood pressure, and community-based PA interventions might be more effective in improving VO2 among low-fit than among high-fit participants.

show abstract

“…Beedie et al 's2 recent editorial reminds us of the importance of phase IV trials to study effectiveness, not just efficacy, of exercise, arguing that what matters to those who make funding decisions are health outcomes, not proxy measures. We argue that these are also the outcomes that matter to the people whom these interventions are supposed to help: patients and members of the public.…”

mentioning

confidence: 99%

“…It turns out that we in sport and exercise medicine have been a little overconfident about our potential to provide leadership in disease prevention 2. While exercise training is a powerful method for increasing functional capacity and preventing disease, it is the ‘what’ of disease prevention.…”

mentioning

confidence: 99%