THE SCIENTIFIC AND EVIDENCE BASE OF ACTIVITY THERAPY
Although the benefits of activity for disease prevention have been understood and accepted for decades, it is only in the last 5 years that the consequence of loss of fitness following the onset of disease has been understood and appreciated. Looking back to the era in which healthcare had little effective treatment to offer bed rest was the standard therapy for long term conditions but we now have better scientific understanding of what happens to us after the development of a long term condition, and of the impact of 'rest'. Three changes have taken place:
1. BETTER UNDERSTANDING OF THE HARMFUL EFFECTS OF 'BED REST' AND THE DECONDITIONING SYNDROME
We now know that many of the problems that develop after the onset of a long term health problem like heart disease or type 2 diabetes and which were always assumed to be effects of disease are in fact the result of loss of fitness due to inactivity. Rest and inactivity is necessary of course in the acute phase of a health problem but we now know that once the acute phases over it is very important to prevent the accelerated loss of fitness that affects many people. The effects of inactivity become even more important the older the person because the one of the effects of ageing is to reduce resilience, the ability to cope with challenges, such as inactivity. In older people the effects of becoming more inactive as the result of disease can be seen within a week in what is now called the Deconditioning Syndrome Furthermore the inactivity resulted not only from the direct affects of the disease but also from the mistaken beliefs and pessimistic attitudes of both the people with the long term conditions, and their families and, too often, the healthcare professionals.
2. THE DEVELOPMENT OF A STRONG EVIDENCE BASE FOR THE BENEFITS OF EXERCISE
The second advance has been the development of an evidence base showing the benefits of physical activity for a very wide range of conditions. It can be said that all common long term conditions have a strong evidence based consisting of systematic reviews of randomised controlled trials demonstrating the benefit of activity. This was published as a single document in 2015 by the Academy of Medical Royal Colleges, the document being entitled, Exercise, The Miracle Cure. In addition Exi Life an innovative company set up by 2 physiotherapists to deliver digital support, advice and activity therapy to people with long term conditions, has reviewed all of the evidence since 2015 and has found a large number of systematic reviews, the majority of which show clear benefit.Furthermore the evidence is strong that activity, particularly in groups, for example in dance classes for people with Parkinson's Disease has cognitive and emotional benefits as well as physical benefits and there are 142 systematic reviews of the benefits of activity therapy for people with depression.
The same message was published in the prestigious Journal of the American Medical Association and is reproduced on the linked page
3. AGREEMENT THAT ''BENEFITS OUTWEIGH RISKS
The third important scientific advance has been agreement about the relative benefits and harms of exercise. In 2022 a consensus statement was published by the RCGP, the Office of Health Improvement and Disparities, Sport England, and the Faculty of Sport and Exercise Medicine and its headline is that this Consensus Statement on the risks of physical activity for people living with long term conditions determines that the benefits far outweigh the risks and it is safe, even for people living with symptoms of multiple long term conditions, to be active.
The British National Activity Therapy Formulary
Based on this evidence a Formulary is being developed
