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exercise is medicine

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As a consequence of the demographically related increase of dementia prevalence, modifiable risk factors are gaining in importance as possible preventative measures. Medical treatment cannot yet heal dementia. The effects of vascular risk factors as well as behaviour and lifestyle changes on cognitive decline are the subject of a wide range of current literature. The role of physical activity has proved to be especially beneficial. Multiple studies with different study designs describe direct or indirect positive effects of physical activity on cognitive abilities. The positive effects of physical activity are particularly notable in cognitive domains such as attention or executive functions, which are often impaired in dementia.
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Regular physical activity (PA) is a cornerstone of good health in the ageing population. Cardiorespiratory fitness is an important surrogate marker for survival. In primary cardiovascular disease prevention, PA is considered an effective mono­therapy with beneficial effects on the cardiovascular risk profile (e.g. lipid profile, blood pressure, diabetes mellitus, body composition) and endothelial function. In secondary prevention, PA is an addition to, rather than a replacement for evidence-based medication.
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Physical inactivity constitutes the fourth leading cause of death globally. Health systems are being called to respond to the epidemic of non-communicable diseases (NCDs) and help deliver on the promise of prevention approaches. Substantial evidence exists in support of multi-prong physical activity counseling, prescription and referral strategies, in particular those linking clinical and community-based resources, to help increase physical activity (PA) levels. In late 2007, the “Exercise is Medicine” (EIM) initiative was established by the American College of Sports Medicine to institutionalize PA promotion into the US healthcare system.
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Health care professionals (HCPs) play an important role promoting healthy habits to patients, yet they lack knowledge, training and self-efficacy to effectively prescribe physical activity (PA). In 2011, the “Exercise is Medicine” Latin American Regional Center developed a one-day (8 hours) in-person course on PA and exercise prescription for HCPs, with theoretical and practical components. Contents include evidence-based health benefits of PA, screening for major risk factors, key behavioral change strategies, basic exercise testing, and prescription and referrals principles.
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Noncommunicable diseases, mainly cardiovascular diseases and cancers, and external causes account for more than 80% of mortality in Russia. The leading causes of death and disability are directly associated with behavioural risk factors, physical inactivity being one of them. Until a few years ago, a clear standard recommendation on physical activity (PA) counselling for general practitioners did not exist in Russia. In 2010, the guidelines on physical activity counselling for primary health care providers were developed. On the basis of these guidelines the national recommendations on PA were developed in 2011.
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In Slovenia, the role of general practitioners in counselling physical activity for prevention of cardiovascular disease (CVD) is well recognized. The role of general practitioners in advising healthy lifestyle for individuals who are at risk of developing CVD is formally defined in the National Program for Primary Prevention of Cardiovascular Disease, which has been running since 2001. Part of the program is counselling on healthy lifestyle including physical activity, performed in all health centres across the country. First a screening and medical examination is performed. In case of higher risk for CVD (>20%) the physician should give advice on the particular risk factor and direct patients to health-education centres, where they can participate in healthy lifestyle workshops lead by health professionals.
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Primary care physicians in Germany are potentially in a pivotal position to provide physical activity counselling and exercise referral for their patients. The preventative prescription scheme dates back to the late 1970s. This scheme called “green prescription” (Grünes Rezept), however, could not be established as exercise referral scheme in primary care on a regular and systematic basis. After the German Medical Association (Bundesärztekammer), the German Association for Sports Medicine and Prevention (Deutsche Gesellschaft für Sportmedizin und Prävention) and the German Olympic Sports Federation (Deutscher Olympischer Sportbund) had developed the standardized national quality criteria of Physical Activity on Prescription in a joint effort, the German Medical Association has adopted them in 2011 and now recommends them to the Medical Associations of the Federal States for implementation.
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In addition to the delivery of primary care services, recent changes to the NHS in the United Kingdom have placed increasing responsibility on GPs for the commissioning of the full range of health services from prevention through to clinical interventions and rehabilitation. Whilst historically there has always been an expectation that primary care professionals were ideally placed to provide support for prevention as well as treatment, their active engagement in the promotion of physical activity has remained largely superficial.
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The role of regular physical activity for population health has been clearly documented. Improvements in population levels of physical activity require long-term implementation of a combination of measures, including the evidence based approaches described in the “seven best investments for physical activity” (www.globalpa.org.uk): whole-of-school programmes, transport, urban planning, integration of physical activity promotion into primary health care systems, public education, community-wide programmes, sport for all. The health care setting has a particular role in this context, particularly in its access to physically inactive individuals.
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Objectives: Growing interest in physical activity has led to the development of a number of organizations, networks and associations, including grass-root, professional and academic institutions. To maximize relevance and effectiveness of work undertaken in this field, we aimed at developing a systematic overview of institutions active in health-enhancing physical activity (HEPA).
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