Exercise as therapy: still great potential in Switzerland

Non­-communicable diseases (NCDs) are steadily on the rise in our soci­ety as a result of increasing life ex­pectancy, but also due to lack of physical activity. This trend is not without its consequences: an estimated 80 percent of health costs in Switzerland are caused by NCDs and mental illness.* Working with partners, the FOPH has therefore drawn up the “National Strategy for the Prevention of Non­-Commu­nicable Diseases” (NCD Strategy). In all three action areas of the stra­tegy, promoting exercise is a key measure, since physical activity is clearly an important prevention factor for the development of NCDs. But exercise also has a the­ rapeutic effect: one aim of the NCD Strategy is to establish exercise as a form of treatment in healthcare provision.

On behalf of the FOPH, re­ searchers at the Zurich University of Applied Sciences (ZHAW) in Switzerland and other selected countries have studied whether, and if so how, exercise can be used as a therapeutic intervention. From their findings, they have derived recommendations for action for Switzerland.

Exercise is considered to be an ef­fective treatment for non-­commu­nicable diseases such as cancer, cardiovascular diseases, diabetes, obesity, mental illness, etc. Since exercise courses often take place in groups, this increases social in­tegration, which has a further positive impact on well­being. Exercise as therapy poses a chal­lenge because – in contrast with drug treatment – it requires active input from the patients. Exercises also need proper instruction, which means that the professionals who conduct exercise pro­ grammes require specific training. Specialist courses already exist, Swimming for mobilisation – therapeutic exercise programmes also increase social integration because they often take place in groups for example those run by the Swiss Association of Professionals in Adapted Physical Activities (ASP­APA) or the Schweizerischer Verband für Gesundheitssport & Sporttherapie (SVGS).

Exercise as a therapeutic inter­vention is not yet widespread in clinical practice in Switzerland, as is apparent from the final report issued by the ZHAW. Although most exercise interventions in NCDs are part of structured reha­bilitation programmes covered by basic health insurance, exercise is still not deliberately prescribed to everyone following such pro­ grammes.

Based on these findings, the ZHAW researchers have drawn up rec­ommendations, including the for­mation of the umbrella organisa­tion “Exercise is Medicine (EIM) Switzerland”, which is designed to prepare the ground for estab­lishing exercise as therapy in healthcare provision. As well as the FOPH, therapeutic and medical professional associations, educa­tional institutions and other stake­ holders are responsible for EIM Switzerland. The umbrella organi­sation aims to bring these stake­ holders together and jointly address the promotion of exercise as therapy. One of the tasks of a joint EIM concept is to produce a list of indications, establish guide­ lines and develop an exercise prescription.

Other recommendations for ac­tion include the establishment of appropriate funding options as part of basic health insurance and the development of guidelines for the professionals concerned.

* Wieser et al. 2014. Die Kosten der nichtübertragbaren Krankheiten in der Schweiz.