Research Review By Kevin Neeld©

Date Posted:

October 2009

Study Title:

Evidence of the effects of exercise therapy in the treatment of chronic disease


Kujala UM

Author's Affiliations:

Department of Health Sciences, University of Jyvaskyla

Publication Information:

British Journal of Sports Medicine 2009; 43: 550-555.

Background Information:

It is almost indisputable that physical activity has positive health implications for people of all ages. Evidence continues to grow that physical activity is beneficial for individuals with essentially all disease states. Exercise – planned and purposeful physical activity, remains the cheapest, most effective form of health preservation/enhancement (and often treatment) available to everyone.

In general, exercise can be categorized as either aerobic exercise or resistance training, both of which have differential effects on the body. The purpose of this paper was to conglomerate the evidence on the effects of exercise on several disease states.

Pertinent Results:

  • Land-based and aquatic exercises had similar benefits in reducing pain and increasing function in patients with knee osteoarthritis. Improvements were more significant following at least 12 supervised sessions than lower numbers of sessions.
  • Aerobic capacity and muscle strength were increased following exercise in patients with rheumatoid arthritis; functional capacity improved in patients with juvenile idiopathic arthritis.
  • Exercise resulted in an increase in spinal mobility and function in patients with ankylosing spondylolitis.
  • Exercise therapy was found to be more specific than non-exercise therapy for acute low back pain. Similar results were found in individuals with chronic low back pain, with more training supervision resulting in greater reductions in pain.
  • Aerobic exercise was found to improve function and pain in patients with fibromyalgia.
  • Exercise therapy results in a 27% and 31% reduction in all-cause mortality and total cardiac mortality, respectively.
  • Exercise therapy was found to be beneficial in individuals with a number of cardiovascular diseases, including patients with heart failure, intermittent claudication, stroke, and hypertension. More specifically, exercise improved quality of life, maximal oxygen uptake, work capacity, exercise duration, and HDL cholesterol count, and reduces pain, triglycerides, vascular resistance, and plasma norepinephrine and rennin levels.
  • Exercise was found to reduce LDL cholesterol and improve glycemic control in patients with Type II Diabetes.
  • Exercise therapy results in improvements in cardiorespiratory fitness in patients with asthma. Lower body training resulted in better scores on a walking test and less shortness of breath in individuals with chronic obstructive pulmonary disease.
  • Exercise therapy was shown to have beneficial effects on patients with Neurological diseases such as Parkinson’s and multiple sclerosis. Benefits included increased quality of life, physical function, muscle power, and exercise tolerance. There was also mild evidence that exercise therapy improved mood in individuals with multiple sclerosis.
  • Lastly, exercise therapy was shown to reduce symptoms in individuals with depression and chronic fatigue syndrome, and improve function in patients suffering from cancer-related fatigue.

Clinical Application & Conclusions:

The prevailing outcome of this review paper was that exercise therapy is effective in reducing symptoms, reducing event risk, and improving quality of life in all reported disease states. While few individuals refute the benefits of exercise, even fewer maintain consistently healthy exercise habits. In the cases of individuals with chronic diseases, following a well-structured, supervised training program could mean the difference between a higher quality of life and premature death. As fitness professionals, it is our job to help educate these individuals on the risks and rewards of following a training program.

Fitness professionals could also benefit by networking with physicians and therapists. Speaking with these individuals will provide valuable insight into physical and psychological approaches to getting better results from clients with chronic diseases. From a business stand point, networking with these professionals will also create a referral network, which will help you to reach and influence a larger number of people.

Further communication between educated fitness professionals and other professionals within the healthcare field may also help break the stigma that personal trainers and strength and conditioning coaches lack the knowledge to prevent and train around various disease states or musculoskeletal conditions.

Study Methods:

The authors took the conglomerate of evidence from at least three randomized controlled trials documenting the effect of exercise on individuals with the same chronic disease. Only studies and systematic reviews on chronic diseases (e.g. not acute injuries) after the year 2000 were included for analysis.

Study Strengths / Weaknesses:

The study provided a comprehensive, yet succinct summary of the benefits of exercise on various disease states and disease state corollaries. However, the study failed to provide aerobic or resistance training recommendations, general or specific to a disease state.

Future research should emphasize the dose-response relationship between various exercise protocols and the identified physiological response of interest for a particular disease. This will better allow fitness professionals to make research-based recommendations to a large range of clients.

Additional References:

  1. Fransen M et al. Exercise for osteoarthritis of the hip or knee. Cochrane Database Syst Rev 2008; 4: CD004376.
  2. Cornelissen VA, & Fagard RH. Effect of resistance training on resting blood pressure: A meta-analysis of randomized controlled trials. J Hypertens 2005; 23: 251-159.
  3. Thomas D et al. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev 2006; 3: CD002968.
  4. Ram FSF et al. Physical training for asthma. Cochrane Database Syst Rev 2005; 4: CD001116.
  5. Edmonds M et al. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev 2004; 3: CD003200.