Chronic diseases: fighting them more effectively through physical activity
Cardiovascular disease, cancer, respiratory disorders, diabetes, depression, neurodegenerative diseases... Today, one in three French people suffers from a chronic illness. This proportion rises to three out of four French people over the age of 65.
Gregory Ninot, University of Montpellier
And the number of people affected continues to grow, due to an aging population, longer life expectancy, and early screening.
However, having a chronic illness increases the risk of complications, new illnesses, dependency, and social insecurity. In addition to the suffering of patients, these conditions are placing an increasingly heavy burden on the healthcare system and families.
On February 14, Inserm published an unprecedented report on the importance of physical activity in the prevention and treatment of chronic diseases. This collective expert assessment, conducted according to a rigorous approach established by Inserm, took three years to complete. A multidisciplinary group of 14 experts analyzed more than 1,700 bibliographic references on eleven common chronic diseases. The experts drew on cohort studies, experimental studies in animals and humans, and clinical trials published in the world's leading scientific and medical journals.
Their conclusion is simple: the benefits of participating in adapted physical activity programs clearly outweigh the risks involved, regardless of a person's age or health status. Here are the main lessons to be learned from this research.
The vicious cycle of physical and psychosocial deconditioning
Over time, the repercussions of chronic diseases often go beyond the initial "simple" organic damage. Complications may arise, either as the disease progresses or as a result of the side effects of treatment. Gradually, other disorders begin to manifest themselves, quietly.
Added to this is a tendency to rest and withdraw into oneself. Patients gradually enter a vicious cycle of physical and psychosocial deconditioning. This process leads to physical inactivity.
For example, patients with chronic obstructive pulmonary disease suffer from shortness of breath during exertion (dyspnea), which traps them in a vicious cycle of deconditioning. To avoid becoming short of breath, these patients become sedentary. However, lack of exercise makes them even more susceptible to dyspnea. The slightest effort seems insurmountable, leading to disproportionate fear and loss of confidence. Everyday activities become difficult to perform. Gradually, metabolic, muscular, and bone disorders can develop. Depression looms, quality of life and life expectancy decline...
The vicious cycle of deconditioning severely affects the 20 million French people who are weakened by a newly diagnosed chronic illness, and even more seriously those whose illness is advanced. This phenomenon can be halted by following a program of adapted physical activity, which allows patients to regain awareness of their abilities and improve them.
Making every effort to facilitate active mobility for people with chronic illnesses, by creating suitable facilities, improving accessibility to public and sports areas, and promoting the health benefits of regular physical activity, has become a priority for France's aging population, which is increasingly prone to chronic diseases.
Beyond prevention
Research conducted by Inserm shows that, in the case of heart disease, cancer, respiratory disease, joint disease, diabetes, stroke, and depression, adapted physical activity programs are effective and safe.
Prescribed by doctors, personalized and tailored to patients' lifestyles, and administered by trained professionals, they improve quality of life, reduce symptoms, prevent the onset of new conditions, and reduce unscheduled hospitalizations.
These specific programs do not conflict with conventional treatments (surgery, medication, medical devices, etc.), but rather complement them. In some cases, such as cancer, they even enhance them (preparation for surgery, reduction of chemotherapy toxicity).
Ten key points to remember
What are the 10 key lessons to be learned from this collective expertise for practical application?
1. Prescribe early
While the benefits of adapted physical activity programs have been proven for severe chronic diseases, medical prescriptions, particularly by general practitioners, should be issued as soon as the disease is diagnosed. This is all the more important given that the regulatory and procedural elements are now available in Decree 2016-1990 and the HAS guide published in 2018. Doctors now have a new range of relevant and effective treatments in their therapeutic arsenal that they are authorized to deliver appropriately as part of their patients' individual healthcare pathways.
2. "Primum non nocere" rather than "citius, altius, fortis"
"First, do no harm" rather than "faster, higher, stronger": adapted physical activity programs must ensure maximum safety for participants with chronic illnesses and not seek athletic performance against other people or the clock.
3. Respect the correct dose-response
The frequency, duration, intensity, nature of the practices, and their context must be specific to a given disease and focused on a primary health objective (for example, the anti-fatigue effect during breast cancer treatments).
4. Physical activity is an effective complementary treatment
Adapted physical activity programs, validated and continuously improved by science, are part of non-pharmacological interventions (NPIs). They directly improve the quality of life of patients with chronic diseases, who feel a direct benefit. Studies show significant effects on life expectancy (31% reduction in premature mortality in chronic obstructive pulmonary disease, which affects 1.5 million French people, for example). The prevention of recurrence risks is also improved (-38% in breast and colon cancer, for example), as is the cure rate (41% remission rate equivalent to that of antidepressants and cognitive behavioral therapies in mild to moderate depression, for example).
5. Use digital solutions to quantify activity
The widespread arrival of digital solutions for measurement (e.g., smartwatches), tracking (e.g., digital logbooks), and assessment (e.g., impedance scales that measure body composition) consolidates the data collected through questionnaires. This data is advancing the specialization of research programs and their customization in clinical practice.
6. Maintaining motivation
The risk of dropping out of adapted physical activity programs and active mobility is higher among chronically ill patients. The Inserm report reviews possible solutions to combat this dropout rate. These include freedom of choice in activities (in accordance with therapeutic constants), an emphasis on enjoyment, and support from "patient partners." Paradoxically, coming to terms with the disease (and ultimately finding meaning in it) can be a trigger for adopting a practice that becomes part of one's daily routine, much like brushing one's teeth every night before going to bed.
7. Clinical research is accelerating, becoming globalized, and must be encouraged
The exponential acceleration of clinical research and innovation in this field worldwide over the past twenty years should encourage young researchers in the life sciences, humanities, and technology to get involved.
8. Awareness-raising and training are essential
Raising awareness among the general public and improving training in the initial and continuing education of healthcare professionals (for example, by incorporating compulsory courses into medical school curricula) and physical activity professionals (assessment, programming, monitoring, safety, therapeutic alliance, motivational approach) will be essential pillars following the abundance of evidence from clinical and interventional studies.
9. Physical activity is a driver of savings and jobs
Economic data exists, particularly abroad, showing that tailored physical activity programs can help limit healthcare spending and reduce out-of-pocket costs for families. Physical inactivity costs France €1.3 billion each year, much of which is avoidable. Clinical trials are beginning to show favorable cost-effectiveness ratios.
10. A lever for transition in the healthcare system:
The development of physical activities for chronically ill patients clearly illustrates the shift in our healthcare system from "cure" ("heal at all costs") to "care" ("take care"). Adapted physical activity programs are integrated into different stages of patients' healthcare journeys, complementing other treatments. The only way to respond to complex diseases is to combine relevant therapies and preventive measures.
This collective expertise from Inserm is crucial. As was the case with smoking prevention a few years ago, it will no longer be possible to say that we did not know what measures to implement to improve the situation of chronic patients...
Now we need to take action to implement and reimburse these non-pharmacological interventions (NPIs). This is no longer a question of science...
Gregory Ninot, Professor of Health, Psychology, and Sports Science, University of Montpellier
This article is republished from The Conversation under a Creative Commons license. Readthe original article.