We live in a time of relativism. We like to use words without meaning, and tear away meaning from words that have it. Academia, the learned gods peering down from their ivory tower seem to be the largest paradoxical perpetrators, as they constantly poke and prod daily life in a perennial push to interfere with those doers who keep society going (you know, the ones we should be thanking daily). Well, in the exercise world, I have seen an endless push to denude the term exercise of any meaning. This has occurred perhaps most egregiously in the cancer world.
Exercise is medicine, just like medicine is medicine. However, much like with the radiation therapy that I prescribe for breast cancer, if the dose is not high enough, we can be assured the benefit will be little. For exercise to become medicine, we must hit a dose that actually provides the benefits we are looking for. And this is where the relativistic check box mentality must be overcome. This is why insurance should not pay for “exercise,” especially when exercise remains a vague and relativistic term.
The Staples of Life on Our Watch
Sleeping, breathing, and moving. These three are the bread and butter of being alive. I almost view them as synonymously with each other. For instance, I tell my patients that walking is like breathing. It is vital all day, everyday. Walking is a must. Walking is amazing. Waling is therapeutic. Walking provides me with insight and my best ideas.
But, walking is not exercise. Should insurance pay us to walk? How about to sleep? How about to breath? And while we are at it, what is exercise? Is 5 minutes of curls with 1lb dumbbells exercise? What about walking on a treadmill for 5 minutes? Or better yet, what about owning a gym membership, and going once a month for a walk on the old treadmill for a couple minutes while reading US Weekly? We do a nightly walk with my family—is this exercise? Should insurance pay for it?
If you were an insurance company, would you pay for any of the above? I sure wouldn’t.
What about goal-oriented activities that stress the body to adapt and provide physiologic and physical changes that improve health, offset the side effects of cancer treatment, and may even help increase the change of cure? What about prescribed exercise with specific metrics that are measured and manged? What if your doc is in the with you during the process to ensure you will be successful in reaching these goals? Now we are getting closer, but now we are also defining what exactly dose-escalated exercise that provides adaption is…
Besides the fact that that is exactly what we are doing at Inspire Exercise Medicine and the AHN Cancer Institute Exercise Oncology and Resiliency Center, the great thing about real deal “exercise” like resistance training and strength and conditioning training, is that it produces an array of measurable benefits like increases in muscle mass, decreases in fat mass, strength (easily measured, especially when we calculate load), more cleanly firing neurons leading to decreases in fall risk measured by balance tests, and of course the lowest hanging fruit that has been shown upwards of a million times, quality of life. However, if you are exercising simply for the last benefit, you are selling yourself short as there are many ways to improve this, but few ways to provide these other benefits besides throwing around some real weights.
*As a side note, while these tests are a great way to quantify an actual “dose” of exercise, removing the relativistic “exercise” term, there are few things more rewarding in life than watching someone who moves poorly and is a massive fall risk, or someone who has neuropathy from prior chemotherapy, go from being barely able to get up and down off the ground, to performing weighted split squats and hex bar dead lifts with upwards of 100bs on the sides. I have experienced few moments in my life where you watch someone reach total empowerment right in front of your eyes over only a few weeks.
This is what happens when we avoid the check box relativistic “exercise” that we see being offered from many medical centers. Insurance will be unlikely to pay for this, and I don’t blame them. Low intensity regimens from home may have their short term benefits, but when we want to start using “exercise as medicine” we need to start prescribing it, and prescribing it in a dose that works.
There is only one way to increase muscle mass, strength, mobility, balance, and quality of life at the same time, and it requires an exercise program that utilizes resistance training to adequately stress the body to adapt and provide these physiologic and physical changes. Perhaps if we approach exercise in this way, insurance just may start paying for it.
No, insurance should not pay for exercise. They should pay for dose-escalated exercise that is properly prescribed to yield results.
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