Lifestyle IS the Pill

Dr George Cho MFSc CEP ND
Clinic Director, Pathways Lifestyle Medicine Clinics / Medical Director, Lifestyle is Medicine / Certified Exercise Physiologist, Cleveland Clinic Canada

“Although exercise is not a pharmacologic agent, in many ways its effects resemble those of a powerful drug.” (1)

Did you know that scientists discovered a pill that can increase your aerobic fitness by over 40%? That’s right, in 2008, researchers discovered that they could elicit fitness-enhancing adaptations in the skeletal muscles of mice (2).  The fascinating part though was that they were able to accomplish this by giving mice a pill without the need for those rodents to exercise. You read that correctly: these mice got fitter without the need for training.  How could a pill possibly accomplish that?  Well, exercise improves fitness via certain physiologically pathways. The drugs given to these mice were targeting those same pathways, resulting in improved fitness (2).

The implications of these results were huge and the researchers knew it. In the conclusion of their paper they wrote:

“In addition to increasing performance in athletes, exercise has beneficial effects in a wide range of pathophysiological conditions, such as respiratory disorders, cardiovascular abnormalities, type 2 diabetes, and cancer risk. Therefore, understanding the effects of exercise on normal physiology and identifying pharmaceutically targetable pathways that can boost these effects is crucial…. We believe that the strategy of reorganizing the present genetic imprint of muscle with exercise mimetic drugs has therapeutic potential in treating certain muscle diseases….” (2)

Notice that the researchers are interested in creating an exercise pill which can impact, not just fitness but also our health. 

An exercise pill? 
Many patients and particularly drug companies would love to create such an exercise pill. It would be easy for the public and hugely profitable for the pharmaceutical industry. But such a pill is not coming any time soon, if at all. Many share this same skepticism. For example, Laurie J Goodyear, PhD, writing in the New England Journal of Medicine and commenting on studies like the one mentioned above, wrote:

“We now know that regular exercise has profound beneficial effects on almost all organs in the body. It is unlikely that a single “exercise pill” will ever supply most of the benefits of regular exercise. Don’t get too comfortable on that couch just yet.” (3)

Dr Steven N Blair and Timothy S Church concur with the opinion that such a pill is likely never to emerge.  Commenting on the above mouse study, they stated:

“Sound too good to be true? It probably is, as mimicking the multitude of health benefits of exercise with a pill would be the equivalent of creating a cancer-free cigarette.” (4)

Exercise just does too much

One reason that a hope for an exercise pill is close to wishful thinking is that exercise just does so much. Exercise is beneficial in the prevention of a whole host of diseases, and therapeutic for many diseases as well, including: (5)

• Schizophrenia

• dementia

• hyperlipidemia

• stress

• obesity

• chronic obstructive pulmonary disease

• depression

• anxiety

• parkinson’s

• polycystic ovarian syndrome

• type 1 diabetes

• type 2 diabetes

• cerebral apoplexy

• hypertension

• coronary heart disease

• heart failure

• intermittent claudication

• multiple sclerosis

• bronchial asthma

• cystic fibrosis

• osteoarthritis

• osteoporosis

• back pain

• rheumatoid arthritis

• cancer

Can anyone name a single drug in existence today that is therapeutic in all of these medical conditions? Probably not. Well, the hope that we will create a single exercise-replacement drug in the future is highly improbable as well.  Exercise just does too much good for a single pill to ever hope of matching. It would be asking too much of a single pill.

Shift our thinking

I think the hope of an exercise pill betrays a certain way of thinking about medicine, and that is this: 

”Medicine must come in the shape of a pill, tablet, injection or surgery, or else it’s not medicine.”

Hence whenever something comes up that seems to be healthful, we rush off to put it into a bottle or needle. Consider vitamin supplements and drugs, how they are often just components of foods and herbs that have been extracted  and put into pill form, and for some reason, it is only once we see it in these forms, that we are willing then to use the label “medicine.” And so the same thinking goes for exercise. Science has come along and convincingly demonstrated how powerful exercise is for our health. So what do we do? We are now hoping for a pill. Why? Because we do not regard healthy behaviors as medicine. 

This way of thinking needs to stop. This limited, narrow understanding of medicine needs to change. Just like how drugs can be used to help in prevention and treatment, so also does healthy lifestyle behaviors like whole-foods plant-based eating, adequate sleeping and exercising. Then why do we consider the former to be medicine and not the latter?  We need to see the health behaviors themselves as medicine as well. Your lifestyle is medicine. 

Conclusion: Lifestyle is medicine

In a recent scientific paper, researchers from the National Institute on Aging in Baltimore and the Institute of Sport Science in Seoul Korea published a paper called: “Exercise in a Pill: The latest on exercise-mimetics.” (6)   In this paper they were seeking to answer the question: “Could a pill be created that would have the same health benefits as exercise?” After 12 pages of exploring this possibility, they ultimately conclude: 

“An active lifestyle, despite the promising compounds currently under study, remains the preferred choice for improving body and brain function. Indeed, the mechanisms of action of exercise-mimetics still require further investigation, and the possibility of a treatment capable of replacing exercise in its entirety is remote.” (6)

This paper was released in 2016/2017, nearly a decade after the mice study we discussed at the beginning of the article, and we are still a “remote” distance from even the “possibility” of an exercise pill. The point is simple: the health benefits of exercise (or any other healthy lifestyle behaviour), cannot be shoved into a pill.  

I like the way Dr Sallis put it: 

“If we had a pill that conferred all the confirmed health benefits of exercise, would we not do everything humanly possible to see it that everyone had access to this wonder drug? Would it not be the most prescribed pill in the history of mankind? I think we know the answer to these questions.” (7)

Dr Sallis is a medical doctor who has advocated for the concept that exercise is medicine, and here he is absolutely spot-on. If an exercise pill was indeed created, everyone would be popping that pill. However, in his paper, he does not argue for us to wait around for the pill he argues that we indeed already have that pill. Exercise itself is the pill. 

In like-manner, this can be said of other lifestyle behaviors. We do not need to wait for the next few decades hoping for a sleep-replacement pill or a pill that can replace the need to eat healthier. Instead, we need to realize that a healthy lifestyle is the “pill” available to us now. The lifestyle “pill” is powerful and only has positive side effects. 

So, think this way: My lifestyle is medicine. When I eat plant-based, I am swallowing medicine. When I go for a jog, I am doing medicine. When I foster a loving relationship with my family, I am practicing medicine. My lifestyle is medicine. 

References

1. Patil, H et al. Cardiovascular damage resulting from chronic excessive endurance exercise. Missouri Medicine, July / August 2012. 109:4

2. Narkar, V et al. AMPK and PPAR agonists are exercise mimetics. Cell. August 2008; 134, 405 – 415

3.  Goodyear, L. The exercise pill – too good to be true? N Eng J Medicine. 2008; 359; 17

4. Church TS, Blair SN. When will we treat physical activity as a legitimate medical therapy … even though it does not come in a pill? B J Sports Med. February 2009; 43 (2) 

5.  Pedersen BK & Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2015: (Suppl. 3) 25: 1 – 72 

6. Guerrieri D et al. Exercise in a pill: The latest on exercise-mimetics. Brain Plasticity. (2016/2017); 2: 153 – 169 

7. Sallis, RE. Exercise is medicine and physicians need to prescribe it! Br J Sports Med. January 2009; 43, (1): 3- 4