Home All Medical Wellness In Action: Exercise is Medicine®

Medical Wellness In Action: Exercise is Medicine®

written by Elaine O'Brien 25 July 2011

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.

In their new book, Practical Wisdom: The Right Way to Do the Right Thing, Barry Schwartz and Kenneth Sharpe call for excellence in action: wisdom centered on human values, character strengths, moral purpose, and our and society’s positive transformations. Practical wisdom, or phronesis, is the solution-based concept Aristotle identified as “the essential human quality that combines the fruits of individual experiences with our empathy and intellect.” Practical wisdom is acting wisely, where we are guided by the proper aims (telos), or goals of a particular activity. Practical wisdom combines will with a moral skill that enables us to flourish, as individuals and a society.

Evening Jogger

Happily, important practical wisdom is part of the American College of Sportsmedicine’s (ACSM) multi-organizational, multi-national initiative, promoting moderate physical activity: Exercise is Medicine® (EIM). This global enterprise aims to prevent disease and improve health. EIM is sparking some positive changes in health and medical care. Since its launch at the first World Congress of Exercise Is Medicine last year, the momentum is building internationally.

Recognizing physical inactivity as a major life/health risk factor, the EIM intention is to recognize, validate and roll out the powerful benefits of moderate exercise in our life, health and well-being. The ACSM/EIM exercise guidelines call for a minimum of 150 minutes of moderate physical activity a week for adults, and a minimum of 420 minutes a week for children

Dr. Karim Khan: Inactivity even Worse than Smokadiabesity

The recent ACSM conference had a record number of participants with over 6,000 in attendance. Eminent professor (in departments of exercise science, epidemiology and biostatistics at Arnold School of Public Health, University of South Carolina), Dr. Steve Blair, reported a highpoint moment when Dr. Karim Khan spoke about “smokadiabesity,” (smoking, diabetes, obesity). Dr. Khan’s “creative and thought-provoking” presentation, “Supersize my Exercise: Learning from Mad Med, the Marlboro Man and Freakonomics to Promote Physical Activity,” educated and inspired people to make/find more time to be active. This keynote was aimed at those trying to influence government, health authorities, professional organizations, schools and community groups to embrace the vital physical activity message.

Dr. Kahn provided striking new findings related to the power of exercise for health domains, such as brain function, cancer prevention, and depression. Kahn showed data supporting the view that inactivity/low fitness causes more deaths than smokadiabesity! “At epidemic proportions, smoking, diabetes and obesity are major public health concern, … yet low physical fitness kills more people than all these in combination!”

Dr. Bob Sallis: Exercise as a Vital Sign

Leader and founder of the ACSM’s program, Exercise is Medicine, Dr. Bob Sallis, Kaiser Permanente, recently posted a robust editorial for the British Journal of Sports Medicine titled Developing Health Care systems to Support Exercise: Exercise as a 5th Vital Sign. At Kaiser Permanente, Dr. Sallis has instituted the idea of Exercise Vital Signs. He believes all physicians need to ask patients how many minutes of moderate exercise they perform in a week.

Children need activity

Dr. Sallis’ important message is that exercise as a vital sign is a “minimal standard of care.” Exercise reporting should be a part of every patient’s intake, and part of their medical chart, as much as the other vital signs of blood pressure, heart/pulse rate, respiration rate, and body temperature. In addition to documenting his patient’s exercise, he also charts their body mass index (BMI). To date he has collected exercise as a vital sign for over 3.5 million people in Southern California, with the goal of charting over 12 million people in the next year!

Dr. Sallis, a model of fitness, writes with passion and verve, “The importance of physical activity to health and wellness has been established incontrovertibly. There is a linear relationship between physical activity and health. Those who maintain an active and fit way of life live longer, healthier lives.”

He further discusses how sedentary, unfit behaviors “predictably” develop chronic diseases prematurely and die at a younger age. Asking Dr. Sallis, about moderate physical activity/exercise as a medical vital sign, he urges, “The goal is in ensuring that physical activity levels are assessed and prescribed at every visit.” This is the basic standard of care he expects.

In discussing medical school’s current standards of training, he opines, “It may be easier to change standards of care, and then medical schools will follow suit.”

U.S. National Physical Activity Plan

Dr. Blair encourages people who are interested in physical activity and health to get involved in promoting and implementing the U.S. National Physical Activity Plan, which was released in May 2010. The plan focuses on strategies and tactics in multiple sectors such as education, public health, clinical medicine, worksites, urban planning and transport, and other areas. Dr. Blair wisely acknowledges, “We have a huge public health problem of inactivity, and it will take extensive efforts by many groups over many years. Please review the Plan and find a way to get involved.”

Dan Henkel, ACSM Senior Director of Communication & Advocacy, concurs, “We can each look at the National Physical Activity Plan and see how we can help bring about changes in our own communities to make them more conducive to healthy and active lifestyles.” He discusses advocating for more bike lanes, hiking trails, pocket parks, and workplace wellness programs that reduce health care costs and absenteeism. He believes there are opportunities and rewards in helping our fellow citizens become more active and healthy.

Human Choreography

Human Choreography and Lifestyle Medicine

In his recent presentation on passion, President-elect of International Positive Psychology Association (IPPA), Dr. Robert Vallerand discussed recent research around Harmonious Passion, where we can experience positive emotions that feed us and lead us to developing positive relationships.

I believe that we can find harmonious passion in moving well. I believe we can merge areas on Positive Psychology and Positive Physical Activity, and establish Positive Exercise Prescriptions (PEP) for flourishing individuals and communities. By developing a positive relationship with kinesiology, we can inspire others to reach for healthier, happier and richer lives. With principled doctors joining fitness professionals to help lead the reduction of the grave risks of inactivity, there is great hope in the phronesis of medical wellness in action.



Blair, S. (2009). ‘Smokadiabesity’ reaches epidemic proportions. But low fitness still kills more Americans than smoking, diabetes and obesity combined!,

Blair, 2009, British Journal of Sports Medicine, (43) pp 1-2.

Sallis, R. (2010). Editorial, Developing Healthcare Systems to Support Exercise: Exercise as the Fifth Vital Sign. British Journal of Sports Medicine, 45(6), 473.

Schwartz, B. and Sharpe, K. (2010). Practical Wisdom. New York: Penguin Group.

Evening Jogger courtesy of Ernst Vikne
Children need activity courtesy of Norma Desmond
Bicycler courtesy of Paladin27
Human Choreography

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wayne 25 July 2011 - 1:35 pm

Elaine – a couple of points

1. Exercise is a foundation of the good life – perhaps more people in the US are depressed because they don’t exercise – not because they don’t have PP in their lives.
2. There is some reserach suggesting that for basic health light (as opposed to moderate exercise) is ok – see the Baker IDI research in oz

Sherri Fisher 26 July 2011 - 11:41 am

Hi, Elaine–
Agreed! I’d love to see more intentional support of movement in schools as it is an important way to provide what is sometimes called “white space” or the time when the brain is reintegrating experience and memories while not consciously thinking about them. Shared movement, such as dance, can build all sorts of psycap, and that is what positive psychology is all about. I wrote about the positive impact of recess on student achievement here https://positivepsychologynews.com/news/sherri-fisher/2010050510847 and love to see more research that supports the topic.

Thanks for this well-written article on an important topic! (PS: Find out how to attend a dance-fitness class with Elaine, who is a fantastic teacher embodying PEP.)

Elaine O'Brien 26 July 2011 - 7:13 pm

Hey Oz,
In creating positive psychological interventions to help people flourish and thrive in the world,it seems to me one of the best strategies for health and flourishing is around encouraging daily moderate physical activity/moving well via positive exercise practices (PEP), through the life span. I’ll certainly check out the research you described. Thanks so much for the post. Very best, Elaine

Lou Harmon 26 July 2011 - 10:25 pm

Great article Elaine and very impotant message.
I believe in and practice this whole concept in my life.
Hope it catches on more and more… for the sake of every age group.
Keep up the good work, Lou

Dan Tomasulo 27 July 2011 - 4:59 am

Excellent article — particularly since last year WHO focused on the fact that it was the non-communicable diseases listed were the leading causes of death world wide. Low fitness should have been at the top of the list! Thanks, Elaine, for an other illuminating piece.

Dan Henkel 27 July 2011 - 9:03 am


Thanks for an article that ties together some much-needed information. I’m struck by the congruence of several initiatives, such as Exercise is Medicine, the National Physical Activity Plan, the ACSM American Fitness Index, workplace wellness programs, and more. All are pointing to the same, inescapable conclusion: physical activity brings so many benefits to the individual, but also to society.

Recently, the National Prevention Strategy tied this together. Their recommendations, after a long process of discussion, review, comment, town hall meetings, etc., are very much in line with EIM and the Plan. This gives us a clear roadmap for action.

A compelling argument, I think, is health care costs. With PA shown to prevent or treat more than 40 chronic diseases, it’s clear that physical activity is fiscal responsibility.

Virginia Pryga Zientek 27 July 2011 - 9:03 am

Absolutely agree with the importance of exercise to promote one’s health and general well being. Especially poignant was the idea that physicians should include patient’s exercise regimen as part of their health history. Their recommendations may make a difference to bring light, every day in their practices, to how much people can avoid health issues with simple – and enjoyable – exercise. Especially true is the joy of dance! Insightful and helpful article! I will print it -with your permission- to have for client’s to read at my wellness center, SenseAbilities.

Elaine O'Brien 27 July 2011 - 6:10 pm

Lou, I appreciate your contributions over the years in helping people move well. You clearly “get it,” particularly around the need for fun and effective physical activity through the life span. Thanks for posting. Cheers, Elaine

Elaine O'Brien 27 July 2011 - 6:17 pm

Dear Virginia, Research from Harvard’s Lifestyle Medicine at U Mass shows that when doctors recommend exercise, there is more inclination towards participating in activity, as well as adherence. It really matters that the medical field prescribes positive exercise, and not just pharmacology. So happy that you are dancing; what fun! Yes, please feel free to share this article with your clients at SenseAbilities. Blessings and thanks for sharing, Elaine

Elaine O'Brien 27 July 2011 - 6:24 pm

Yes, Dan. It’s great to see that congruence from these associations about the importance of physical activity. Thanks for your support, the great information and interview! I love the work you are doing at Exercise is Medicine. I’m happy to hear about the National Prevention Strategy, and will continue to strive to get the word out, as well as lead positive movement programs that are safe, effective and fun. Finally, I agree about the fiscal responsibility around moving well, and hope to further promote sustainable and positive movement through the life span at Temple University this fall. Really appreciate your point of view and leadership! Elaine

Elaine O'Brien 27 July 2011 - 6:33 pm

Dear Dan Tomasulo, It’s fascinating to hear about the World Health Organization information you described. Thanks for sharing! It seems clear that our lifestyle/habits are a major contributor to our health, fitness,or decrements through the life span. It’s unfortunate that physical activity hasn’t necessarily had the “cred” of other interventions/preventative aspects. I think we are on the road to some positive change around the importance and practical wisdom of daily exercise in our lives.
Cheers, Elaine

Elaine O'Brien 27 July 2011 - 6:45 pm

Hey dear Sherri, Yes, I totally agree about supporting movement (and meditation) in schools). There’s just too much sitting, which is unnatural for us, as humans. I also agree with you about people moving together. (My thesis is around moving together for the greater good). Haidt talks about the elevation of communitas through group activity It’s a beautiful thing. I love the neural, biological psycho-social connections that can be achieved through exercising together. It’s powerful stuff – great for our hearts, minds. souls. Thanks for sharing the link to your excellent article, and for your kind words.
Blessings and cheers, Elaine

Galina 27 July 2011 - 6:57 pm

Great article. Yes, how can we get communities exercise more? Great graphic you used to show how low activity kills. We should post that everywhere 🙂

Patty Di Pano 30 July 2011 - 4:11 pm

Elaine O’Brien is truly an inspirational human being. Her move2love program combines physical exercise/movement with an uplifting social experience. Each participant is made to feel special and that their well-being counts. She is highly competent, open and accessible, willing to provide links to local resources and fosters an environment where friendships can be forged. Elaine brings energy, fun and a spiritual component to each session. Her students come away feeling relaxed, refreshed, renewed and stronger. They are now armed with the conviction that they can reach their life goals.

Marie-Josee Shaar 2 August 2011 - 4:30 pm

Great article, Elaine! Thanks so much for sharing all this valuable info! I’d like to add that physical inactivity has been identified as the #4 cause of death worldwide. So Patti, not only does Elaine educate, inspire and stimulate her students, but she also helps save their lives! 😉
Very best,

Elaine O'Brien 2 August 2011 - 8:03 pm

Thank you MJ. Your and Kathryn Britton’s excellent new book demonstrates wonderful support for exercise as a key ingredient in the recipe for well-being. Kudos!

Elaine O'Brien 2 August 2011 - 8:13 pm

Wow, Patty. It’s been my pleasure and honor meeting you this summer! Thanks for being a light in my Water Fitness and Dance/Ex classes. You are strong and flexible. Thank you for those kind word, Patty. That may be the nicest thing anyone has ever said about me. In awe of your care, kindness and understanding, Elaine

Elaine O'Brien 2 August 2011 - 9:21 pm

Thank you Galina! You’ve a great idea – posting Dr. Blair’s powerfully stark “low activity kills” chart “everywhere.” Let’s talk more…

How we can get communities and organizations to exercise more? Glad you asked! Community exercise is an area I’ll be researching with Erica Tibbets, fellow doctoral student, at Temple University, this fall. May we keep you posted? Your thoughts, ideas, dreams to share, are all welcome and appreciated.

My community exercise practice, as “Group Dance Exercise” is a comprehensive rhythmic cardiovascular, muscular strength and endurance, balance and flexibilty program. The group practice combines positive psychology education and dance/exercise/medicine for improving physical, psychological, social complexity and well-being. Community exercise makes excellent fiscal sense because it builds the above resources and bolsters physical, mental, and social-emotional health for the lifetime.

The benefits of organizational and community exercises, especially outdoor physical activities, are favorable in improving well-being, and for flourishing.

Interestingly, I have found there is potential to reciprocally elevate people en masse, via group dance fitness. To get going with an action plan, one idea might be in planning an outdoor community dance in the park – connect with your community recreation department or local media. You can invite different artists and local musicians to play, perform. For the dance bit, play a variety of ecletic and world dance music to get your heart, mind and soul pumping. Just a thought…Cheers!

Judith Jones Ambrosini 3 August 2011 - 12:04 pm

Elaine, I hope you receive this comment. I wrote one the other day and it didn’t register.

As children we ran, jumped, skipped, bicycled, skated, hopped and played. We didn’t need to use the word “exercise”. We moved all the time and it was always fun. Isn’t this the goal of sports and movement? As people get older and bogged down with the busy-ness of life many stop moving and having fun. Your article is a good explantion of the reasons why people should be active. It gives excellent statistics on the power of physical activity.

As a Type 1 diabetic for nearly 50 years, I have always been an strong advocate of sports and exercise for good health. It really works and really is fun. You are certainly doing a fine job in getting the message out. Thank you for that!

Judith Jones Ambrosini
diabetes writer

Elaine O'Brien 4 August 2011 - 9:40 am

Judith, Thanks for your contributions to the health and fitness community and for your inspiration – thriving with diabetes. Thanks for dancing in my classes for the past 10 years. You rock! I look forward to your new book of stories about ultra-athletes/women with diabetes. Like you, they are flourishing, and role models for all of us. Thanks for posting!

carla capuano 5 August 2011 - 9:31 am

Elaine, as one of your students, I thank you for your incredible classes. For several years I taught aerobic dance and look back on those years as the best years of my life. Coming in to your classes after 20 years of inactivity, I’m remembering how wonderful it feels to MOVE! It is so important to our mental and physical health, and you are truly an inspiration. You take it beyond excercise; you create an invironment of friendship and joy.
You are inspirational!
Carla C.

Francie 7 August 2011 - 9:00 pm


I would love to reach you to discuss an invitation to be part of a national leadership conference for Women. I am chairing a session entitled The Healthy Leader and your work would be a tremendous addition to our session…how can I reach you?



Sara Oliveri 9 August 2011 - 8:39 am

Elaine. This is such an IMPORTANT article. I believe physical activity/ exercise is an absolutely essential ingredient in human flourishing.

We need to continue spreading the research that you shared in this article, and start using the term “lifestyle medicine” more widely in order to inspire massive change in the health status of our nation.

You are absolutely right about getting the physicians on board.

As a Health and Well-being Advisor – I believe the everyone intuitively (as you say practical wisdom) knows now how important movement is. However, since the majority of physicians still do not prescribe exercise as treatment, drive-home the importance of staying active (as much as quitting smoking, etc.), and even exercise THEMSELVES (how many overweight doctors have you had?) people still see exercise as “extra.” THIS is a grave disservice to the general public.

I wonder how we could team-up with medical schools and hospitals to start a much-needed revolution. The Harvard Institute of Lifestyle Medicine seems like a great place to start. Would love to hear more about the conference you attended there.

Viva la revolución!


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