Physical activity, and not necessarily sport, has a role to play in preventing many chronic diseases, but especially in preventing many of them from getting worse. It acts like a drug and can, as such, be prescribed by doctors.
In France, the proportion of people aged 60 and over should increase from a quarter in 2015 to a third of the population in 2040. However, currently, if one in four French people suffers from a chronic disease, c is three out of four after age 65.
Improving the prevention and management of chronic diseases means responding to a major public health emergency. L’Inserm has therefore been mandated by the Ministry of Sports to make recommendations on the integration of physical activity in the program (course) of care for the various chronic diseases.
Prescription of physical activity
In many chronic diseases, rest has long been the rule, but the most recent scientific studies have led to a real paradigm shift: physical activity (and not sport) is now an integral part of the treatment of chronic diseases in order to to prevent its aggravation. Its prescription must be systematic and as early as possible, adapting it of course to the phase of the disease, and even before any drug treatment for mild to moderate depression, type 2 diabetes, obesity and obliterating arteriopathy of the lower limbs.
The issue is not to know if we should recommend a regular practice of physical activity adapted to people with a chronic disease, because there is no longer any doubt about this necessity, but rather to determine the most suitable programs. more efficient according to the chronic diseases, the physical abilities of the patients, their resources and their environment. It is also a question of allowing a perennial physical activity and registered in the way of life of the sick people. It is therefore not necessarily sport (swimming, cycling, walking, etc.) that will be prescribed most often in these patients, but rather physical activity, sometimes more playful and in a group (adapted yoga, Taï Chi, ballroom dancing, Nordic walking, adapted gymnastics, etc.).
Specific recommendations by pathology
If there are variations in the modalities of physical activity according to chronic diseases, on the other hand, everyone agrees on the frequency of the practice of an adapted physical activity: a minimum of 3 sessions per week.
Obesity : these are endurance activity programs (cycling, swimming, Taï Chi, dance… over at least 45 minutes) which are recommended, emphasizing the reduction in waist circumference as a monitoring parameter rather than on weight loss;
Type 2 diabetes : focus on the combination of muscle strengthening (leg, arm and abdominal muscle training, etc.) and endurance activities at moderate to high intensities;
Coronary diseases : continuation of a regular physical activity of endurance to be optimized by varying the intensity of the exercise;
Obliterating arteriopathy of the lower limbs : painless walking is the first-line treatment, gradually gaining in length;
Heart failure : all patients, regardless of the degree of severity of the disease, can benefit from an effort retraining program thanks to regular and progressive training: ideally, 30 minutes of moderate activity 5 times a week in the last phase of the program which must be continued throughout life;
Cerebrovascular accident (CVA) : regular physical activity integrating the practice of gestures of everyday life by improving cardiorespiratory capacities and muscular strength in order to reduce the impact of neuromuscular sequelae on quality of life and prevent recurrences;
Chronic obstructive pulmonary disease (COPD) : regular, long-lasting and varied physical activity (endurance, muscle strengthening, swimming, Taï Chi, etc.) in order to improve quality of life and reduce the functional limitations of complications;
Asthma : endurance activities or sports to reduce the severity and frequency of seizures by improving VO2max, endurance and exercise capacity;
Osteo-articular diseases : physical activity programs adapted to the diseased joint(s) and long-term practice to prevent and/or reduce disability and pain;
Cancer : programs combining endurance and muscle strengthening to improve quality of life and reduce side effects linked to cancer and treatments (muscle deconditioning, fatigue, intolerance to treatment, etc.);
Depression : programs combining endurance and muscle strengthening to prevent recurrences and improve symptoms.
Adapt the physical activity prescription
The main barriers to the practice of physical activity are generally linked to the disease itself (pain, fatigue, side effects of certain treatments, etc.) and to the patient’s habits and lifestyle. The challenge is therefore to adapt the practice to the patient’s state of health, as well as to his treatment, his physical abilities, his medical risks, his psychosocial resources… but also his way of life and his desires.
The approach is based on the initial assessment of the patient’s level of physical activity and their tolerance to exercise through an interview and/or simple tests with the doctor (eg: 6-minute walk test). More complex tests (eg cardiorespiratory stress test) will then be essential to allow adaptation of the prescription in terms of intensity of practice and to secure it in the most vulnerable people.
A national approach
The national “sport health well-being” plan has led to new partnerships in the 22 regions with the development of a physical activity offer aimed at preventing chronic diseases. By developing the prescription by the attending physician of a physical activity adapted to patients with chronic diseases, article 144 of the Public Health Law and the tools that accompany it, aim to generalize this type of prescription.
There remains the question of accessibility to this prevention offer for all people with chronic diseases, regardless of their age, place of residence or resources.
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