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This Doctor Says: More Pushups, Fewer Pills

'The Exercise Cure' author prescribes workouts for depression, joint pain and more


Dr. Jordan Metzl rejects our “medication first” society. Instead, he prescribes exercise. But not exercise in a general way as prevention for a litany of problems.
 
With his patients and in his new book, The Exercise Cure, Metzl assigns workouts as specific treatments — for hip and knee pain, depression, trouble sleeping or concentrating, hormonal changes, high cholesterol and even heart disease.
 
“I want people to think of exercise as a drug, and as a first-line drug, for most of the problems they may be throwing other drugs at,” says Metzl, a sports medicine doctor at New York’s Hospital for Special Surgery.
 
Weaning Ourselves Off Prescriptions
 
Americans use a lot of prescription drugs. More than a third of people over 60 are taking five or more prescription medications, according to the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC).
 
The unintended side effects and drug interactions of “polypharmacy” are a growing concern.
 
Then there are pain relievers containing opiates. The milligrams prescribed per capita in the U.S. nearly quintupled from 1997 to 2007, and the CDC now calls addiction and abuse of these drugs a national epidemic.
 
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Don’t forget the costs. As a country, we spend more than $350 billion a year for prescription drugs, Metzl says. Much of that could be avoided if we made more use of exercise, which is relatively free of both costs and side effects.
 
Curing What Ails You
 
Got a bum knee? Instead of pain pills or a replacement surgery, Metzl might prescribe a “knee-saving workout” of muscle strengthening and stretches using an inexpensive foam roller.
 
He teaches patients “to maximize the function of their kinetic chain, meaning that the stronger and more flexible their muscles are, the less the loading force on the joint.” That treatment won’t change the X-ray appearance of an arthritic joint. The cartilage between the bones will still be thin and worn away, he acknowledges.
 
“But I can definitely help make the symptoms a lot better, which can put off knee replacement for many years, and sometimes forever” if patients keep doing their workouts, he says.
 
For diabetes, cardio and strength training are both effective at helping people cut their insulin use, he writes in The Exercise Cure. But research has shown that short bouts of high-intensity training are especially good for controlling blood sugar.
 
For low testosterone, the best bet is strength training and working large muscle groups with exercises like squats.
 
Unfamiliar Territory
 
Metzl says he doesn’t want anyone to bypass a doctor’s advice in favor of exercise. His goal is “empowering patients” to talk with their doctors about exercise and to try the treatments in conjunction with conventional medical help.

(MORE: How to Talk With Your Doctor)
 
This raises a question: Why aren’t more doctors writing prescriptions like Metzl’s?
 
We’ve had “an unhealthy relationship between physicians and drug companies, which I think we’re doing a better job of policing now,” he says. Another big factor has been patients who are swayed by direct-to-consumer advertising of drugs. Ultimately, though, exercise-as-treatment is still surprisingly unfamiliar territory, he says.
 
“What I’ve found is most doctors are very much in favor of their patients exercising, but don’t really know how to put them on a program,” notes Metzl, who calls fitness "the ignored vital sign."
 
How he Prescribes Exercise
 
Inactivity and low fitness are the strongest predictors of death — stronger than obesity, high cholesterol, high blood pressure, diabetes and smoking.

Doctors routinely check heart rate, blood pressure, temperature and weight, yet often neglect to ask patients about their exercise. In a meta-analysis of numerous studies published in October 2013, Metzl says, results showed that general practitioners talk with their patients about exercise less than a third of the time and by and large don’t know how to prescribe it. “I’m doing a lot of speaking to medical groups about that topic,” he adds.
 
Changing the Way We Age

The onus is partly on doctors and partly on patients for neglecting exercise, which qualifies as a “wonder drug,” in Metzl’s view.

(MORE: How Fit Are You, Really?)
 
He says research proves that exercise does good across all of the body and brain’s systems simultaneously and that it can halt and even reverse physiologic changes thought of as the “inevitable” results of aging.
 
“Particularly in your 50s, when you’re facing down mortality for the first time — things like blood pressure and memory and concentration and arthritis and osteoporosis — you know what’s the only drug that works for all these problems and has no side effects? The answer is exercise.”

Denise Logeland is a longtime business writer and editor whose beats have included the health care industry and financing for medical technology start-ups.

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