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Exercise is Medicine™ as A Sustainable Vision

written by Elaine O'Brien 31 July 2010

Elaine O'Brien, PhD, MAPP '08, is a positive psychology, fitness leadership, positive health promotion, movement science, aging, and well-being speaker, author, trainer, thought leader, people/project manager, educator, and consultant. Elaine creates programs promoting proactive positive health/fitness, and optimal performance. Elaine presents internationally and online. She advances health, fitness, and flourishing by inspiring people to move more and to find both enjoyment and meaning in motion via PEP: Positive Exercise Practices. Elaine's website.  Full bio. Elaine's articles are here.

Editor’s note: This is the second of two articles (first article is here) about the Exercise is Medicine™ World Congress that took place in Baltimore, Maryland, June 1-5, 2010. The first article focused on the keynote speaker, Dr. Regina Benjamin. This article discusses the congress as a whole.

Live in rooms full of light
Avoid heavy food
Be moderate in the drinking of wine
Take massage, baths, exercise, and gymnastics
Fight insomnia with gentle rocking or the sound of running water
Change surroundings and take long journeys
Strictly avoid frightening ideas
Indulge in cheerful conversation and amusements
Listen to music. ~A. Cornelius Celsus, (ca 25 BCE—ca 50)

Life is not merely to be alive, but to be well. ~Marcus Valerius Martialis (40 AD – ca. 103)

Exercise is Medicine™ World Congress

Delegates from more than 50 countries joined forces at the inaugural Exercise is Medicine™ World Congress with two goals: Unite with others across borders to build a healthier world and globalize Exercise is Medicine™ as a positive movement. Chairman Dr. Bob Sallis, M.D. reasoned, “Exercise and Physical Activity are critical to health and necessary for the prevention and treatment of virtually ALL chronic disease. The goal is to make exercise the most widely prescribed drug in the world! The world needs it.” Sallis, himself a model of health and vigor, expressed refreshing candor, “Exercise is indeed medicine. As a family physician, why am I not prescribing this to every patient?”

An idea sparked by the 2007 Health and Fitness Summit, Exercise is Medicine™ (EIM) is a “scientific merging of the Health Care and Fitness industry.” A new collaboration created by the American Medical Association (AMA) and American College of Sports Medicine (ACSM), EIM has been designed to:

  • Promote public health
  • Build public and social responsibility
  • Help people live happier, healthier lives
  • Foster public policy that gets people moving more and well
  • Build healthier communities

The Need for EIM

As EIM stakeholders, the AMA and ACSM are promoting evidence-based research and practices extolling the many virtues and benefits of exercise. Because of lifestyle and technological changes, we are reaching what they call an “an epidemic of inactivity.” Inactivity has been proven to lead to earlier incidences of heart disease, diabetes, and depression.

According to Michael O. Leavitt, U.S. Secretary of Health and Human Services (2005-2009), “We know that sedentary behavior contributes to a host of chronic diseases, and regular physical activity is an important component of an overall healthy lifestyle. There is strong evidence that physically active people have better health-related physical fitness and are at lower risk of developing many disabling medical conditions than inactive people.”

Physical Activity Assessment
Sallis recommended a physical activity assessment (PAA) as a paradigm for all patients.
Exercise is Medicine proposes a model where fitness professionals, working together with the medical community, would proffer “activity prescriptions” to people. Working in concert with physicians, evaluations including:

  • Health & exercise history
  • Anthropomorphic measurements
  • Weight/fat analysis with bioelectrical impedance and BMI calculations
  • Postural and balance evaluation
  • Range-of-motion evaluation
  • Exercise experience
  • Aerobic capacity (submaximal testing, including vo2 maximum uptake)
  • Muscle strength
  • Muscular endurance
  • Balance testing

After an evaluation, the client will receive an exercise program designed to include both cardiovascular and resistance training, as well as monitor the client’s progress and provide progress reports and follow-up information to the client and physician.

The Influence of Dr. Blair
Dr. Sallis credits Dr. Steve Blair for his influence and determination in promoting Physical Activity and Public Health. An Epidemiologist, Exercise Science icon and fitness devotee, Blair is a former president of ACSM. Blair believes we should “add exercise to the list of medical treatments, just as we apply cognitive behavioral therapy or drugs.” He passionately believes that, “There is not one, single medication that benefits as many things as exercise. “

Blair talked about the many benefits of exercise and how they have a profoundly positive effect on the quality of our lives. He added, “Exercise has an effect on reducing depression.” He spoke about the benefits of prescribing physical activity/exercise in combination with drug therapy and other therapies.”

Travel by bike

Travel by bike

Public Policy

In a compelling keynote, Dr. Jeffrey P. Koplan spoke about Physical Activity, Health, Health Care Reform and Lifestyle Reform Revisited. Koplan discussed many ways our society and communities put up barriers to prevent us from moving more saying, “Public policy can design better systems and prevent disease.” He embraces a public policy of flourishing and thriving, that:

  • Builds healthy communities
  • Cultivates green spaces
  • Is pedestrian friendly
  • Offers user-friendly bike paths, sidewalks, open attractive stairways
  • Is about safety, and where schools encourage students to cycle
  • Using schools after hours for recreation, sports and play
  • Offers work place encouragement to move more
  • Encourages Public transportation

Dr. Koplan discussed U.S. Health Care policy – Patient Protection and Affordable Care Act HR 3590. Though ungainly, this plan could have a bearing on disease prevention and health promotion. He recommends line clarification and a dose of positive behavioral economics, which “could set in motion coverage of preventative health services.” He is concerned because, “It remains to be seen how Physical Activity will be incorporated as an exercise prescription. Effective programming is key if there is going to be a serious attempt to improve the gap in health care.”

Changing Social Norms: Making Exercise Cool

Koplan discussed changing norms as a society, including how we as a culture now look at tobacco usage, underage drinking, highway safety, seat belts, child car seats, air bags, fluoride, and vaccines. He talked about tobacco regulations, secondhand smoke, no smoking bans, and taxes, saying, “The idea of smoking changed from cool and sophisticated to stupid and dangerous.”

He acknowledged that prevention encourages a healthy alternative decision, but often at first, “there is lots of opposition, like it’s a communist plot.” Koplan believes, “Physical Activity as a preventative intervention can have a profoundly positive effect in our changing world. Right here and now, we are facing an epidemic of inactivity in our homes, communities and around the world. He also talked about places in the world that are successful in encouraging physical activity like Copenhagen, China and Brazil, and U.S. programs in Arkansas, Oregon, and Wisconsin.

A Positive Call to Action

Each day has 1440 minutes. Adding daily exercise, especially enjoyable physical activities, for a minimum of 30 minutes every day is “beneficial and necessary,” in the words of Dr. Tait McKenzie, who served as the first director of Physical Education at the University of Pennsylvania back in 1909.

Positive emotions via motion is a concept that fosters greater well-being and positive engagement, while promoting autonomy, meaning, and a better quality of life. We as individuals and communities can benefit from the power of moving our bodies well. That’s a prescription we can all live with.




The Exercise Time Finder from the American College of Sports Medicine

See PPND articles by Marie-Josée Salvas Shaar for ideas about exercise:

Csiksentmihalyi, M. (1990). Flow: The psychology of optimal experience.. New York: Harper Perennial.

Elkind, D. (2007). The Power of Play: Learning What Comes Naturally. Da Capo Press.

McGill, J. S. (1980). The joy of effort: A biography of R. Tait McKenzie. Clay Publishing Company.

Mutrie, N. & Faulkner, G. (2004). Physical activity: Positive psychology in motion. In In P. A. Linley & S. Joseph (Eds.). Positive Psychology in Practice. pp. 146-164. Hoboken, NJ: John Wiley & Sons.

President’s Council on Physical Fitness and Sports (1999). Physical activity promotion and school physical education. Physical Activity and Fitness Research Digest.

Ratey, J. (2008). Spark: The Revolutionary New Science of Exercise and the Brain. New York: Little, Brown and Company.

Ryff, C. D., & Singer, B. (2002). From social structure to biology: Integrative science in pursuit of human health and well-being. In C. R. Snyder & S. J. Lopez (Eds.), Handbook of Positive Psychology. (pp. 541-555). New York: Oxford University Press.

Shusterman, R. (2006). Thinking through the body, educating for the humanities: A plea for somaesthetics. Journal of Aesthetic Education, 40, 1-21.

Image Credits
Prescription sign courtesy of Ano Lobb
Playing skip rope courtesy of Mike Baird
Travel by bike courtesy of Polly Heninger
Make it cool to move courtesy of wraggy

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oz 31 July 2010 - 3:19 pm

Elaine – I couldn’t agree more. Now amount of PP can beat the feeling and legacy of a good spin class, weights workout or a run with dogs.

Dan Bowling 31 July 2010 - 9:26 pm

Great job, E! This is so important a topic, and you present it so well. Here it is Saturday night, and I was debating whether to get just one more glass of wine, and maybe a small snack, but instead was inspired to up the mileage on my Sunday AM run tomorrow. So instead of going back down to the cellar – well, ok, maybe half a glass but no snack! – I am putting out my running gear. Thanks for the positive intervention you just provided in my life – and I imagine, a lot of other people’s lives. Have fun in China – you will “represent” well, I am sure.


Elaine O'Brien 1 August 2010 - 7:19 am

Yes, Oz. Doesn’t it feel so good to move, spin, lift! I like that expression, “Walk your dog whether you have one or not.” Thanks for your comment. Elaine

Elaine O'Brien 1 August 2010 - 7:23 am

Your note made me smile, DB. Hope you savored your wine and ran with a smile today! Thanks for writing and for your lovely comments. Elaine

Kathryn Britton 1 August 2010 - 8:57 am


Marie-Josee and I have been thinking a lot about the relationship between exercise and positive emotion. People seem to fall into different categories:

1. Those who associate positive emotion with actually performing the exercise. You sound like one of those. My sister is another — she’s about 1400 miles into a 3000 mile bike tour of Virginia, North Carolina, Tennessee, Kentucky, Ohio, and Pennsylvania. That’s her idea of an extended vacation. When my sister doesn’t get to exercise, she gets as grumpy as somebody who is denied a favorite food.

2. Those who associate positive emotion with having exercised — that is, they know they feel better after they have exercised. That’s not quite as motivating, but it has its own power. I was feeling blue earlier this week, hopped on the bike, and felt much better when I got off.

3. Those who attach exercise — often intentionally — to something else that gives them positive emotion. A friend of mine likes the people in her gym — she goes to the gym at least partly because she likes to listen to them talk. While there, she happens to be exercising.

4. Those who haven’t made the connection yet, think exercise in general is dreary, and haven’t perceived that they feel better afterwards.

This is just observational — but I think it is interesting to think about the best ways to help people associate positive emotion with exercise. With the first, most powerful way, I think there’s a threshold that people have to get over before they make the association. It’s so obvious to people like you, that you perhaps can’t remember how completely foreign it seems to people who haven’t experienced it.

So what are good ways you’ve found to help people make the connection?


oz 1 August 2010 - 3:02 pm

Kathryn – I’m a combination of the first three

A couple of tricks
1. You have to work hard enough to get the exercise high
2. Learn to savour the experience of exercise. For example the warm glow of an exercise class is still lingering 3-4 hours after a class.
3. Read the research – you only have to do 6 mins of exercise per session if you do it properly
4. Don’t set up frustration – exercise doesn’t help with weight loss – only maintenance
5. The dogs motivate me to go on a run – their enthusiasm gets me out the door
6. Exercise to your personality – I get bored easily so I mix it up
7. And people are motivating – I enjoy the conversations at a yoga class.
8. Get an exercise buddy – I have done this on several occasions when I was struggling

Hope this helps

Elaine O'Brien 1 August 2010 - 7:39 pm

Kathryn, thanks for engaging this discussion.

Oz, I agree and like your 8 points. I’m also keen on the savoring aspect, cross training, building progression in exercise bouts, learning new skills, the exercise buddy/cohort system,and the values clarification exercise provides. Generally speaking a well rounded fitness goal is for cardiovascular, strength/resistance training, flexibility training, balance and core awareness. Adjuncts like relaxation, plyometrics, interval training, outdoor exercise and periodization can boost mood and fitness levels.

Oz, I’m glad you mentioned personality. Dr. Jim Gavin, Concordia University, is one of my favorite researchers in the emergentfield of exercise and personality. He also discusses the Psychology of Exercise http://ahsc.concordia.ca/gavinj.html

Adding to Oz’s list and Kathryn’s point about exercise and positive emotion, I’d include Jonathon Haidt’s idea of “communitas.” The Group Exercise dynamic can be an intriguing, effective strategy for promoting positive emotions. There is a positive power in the context of people moving, swaying together, especially to inspirational or fun music. There is a positive spillover that occurs when we move well together, that last far beyond the final cooldown.

Finally, there is the possibility to build meaning in your training by helping others. Joining forces for the greater good also builds positive communities.

Kathryn Britton 1 August 2010 - 8:10 pm


Love your list of tricks. Yes, I meant to say something about it being a mix. I just think we need to figure out how to use types 2 and 3 to help people get to the point that they experience 1.


I am one of those people who absolutely hated group exercising as a child. PE was torture to me. I guess I wish I’d learned the joy of exercising together from a young age. The only time I can really remember experiencing it was when I took folk dancing in college — and then joined folk dancing clubs through graduate school. There’s not enough dancing in life.


Elaine O'Brien 1 August 2010 - 9:01 pm

Kathryn and Oz,
My dear friend and student, Judith Jones Ambrosini is a wonderful and inspirational writer/advocate for DESA: Diabetes, Exercise and Sports Association. DESA has lots of great information about the importance of exercise and a “Game Plan: Be Active, Get Fit, Get Healthy.” http://www.diabetes-exercise.org/desa-game-plan.html

K-I think your point of view of torture and Group Exercise has a lot to do with the leadership, or lack thereof in your early movement experience. I’m so sorry to hear about that feeling, because a love of movement needs to be cultivated. I know I was a terrible dancer with no training until college. I was the WORST student in my dance-fitness instructor training class. My mentor guided me with understanding and patience. I got to the point where I felt if I could learn to teach, my goal would be for others to leave my programs feeling happy and successful. I believe with positively people-centered leadership, we can offer people of all ages,shapes and sizes the ability to enjoy moving more.

My idea is around Positive Exercise Program (PEP) Leadership which includes strategies like helping people feel welcome, included, and engaged,leading people to more optimal experiences by offering a challenging but rewarding bout, applying Active Constructive Response during training, being sensitive to music selection, having people leave group exercise wanting more,feeling exhilarated but not exhausted afterward. I also love folk dancing and learning more about other cultures movements and dance rituals. What fun!

Finally, I’d like to share with you one of my favorite dance quotes from Martha Graham to Agnes DeMille in “Dance to the Piper.” Please enjoy:
“There is vitality, a life force, an energy, a quickening that is translated through you into action… and because there is only one of you in all time, this expression is unique… You have to keep open and aware directly to the urges that motivate you…Keep the channel open…There is a blessed unrest that keeps us marching and makes us more alive than the other.”

Dan Tomasulo 2 August 2010 - 9:13 pm

Elaine, this was such a beautifully written and informative piece! Naturally I am a futon potato tonight, but I am inspired to workout tomorrow 🙂 Here are some of the lates articles from Proof Positive. Enjoy the rest of the summer. Dan

Elaine O'Brien 3 August 2010 - 6:15 am

Hey Dr. Dan, Thanks for reading, and for your great note! I really like your Proof Positive articles on Psych Central, and appreciate your sharing those. Your article on Flow, especially Group Flow as Optimal Experience, is certainly a compelling point. The possibility of Group Flow during exercise offers a great incentive in positive programming toward this end. Happy Summer to you, Elaine


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