Fall 2025 - Vol. 20, No. 3 In July, President Donald Trump issued an executive order to emphasize fitness in U.S. schools.¹ He and Secretary of Health and Human Services Robert F. Kennedy, Jr. have suggested we bring back the Presidential Fitness Test. This program was originally created by President Dwight D. Eisenhower in the 1950s, and in fact, this continued emphasis on physical education should be lauded, as multicomponent goal-directed interventions to increase exercise likely improve participation and lead to positive, measurable long-term health outcomes.²

To be clear, our leaders should extend their vision to support adequate and quality nutrition interventions as well, rather than, for example, reducing SNAP-funded free and reduced-price lunches. Yet, few would argue that continued emphasis on physical education is negative. We are in the midst of an obesity epidemic with well-known adverse implications, and the prohibitive costs and risks associated with weight-loss medications reassure us that lifestyle interventions are still necessary, even vital.

At the same time, advice regarding diet alone to improve health is not sufficient. A literature review reveals that an emphasis by physicians to improve fruit and vegetable consumption has only marginal effect on actual intake and probably no meaningful impact on overall health.³

How valuable is exercise? Let’s set aside the obvious benefit that a physically active lifestyle can have on almost every chronic orthopedic and rheumatologic disorder. Cardiac rehabilitation is recommended for almost every patient who has had a cardiac event or intervention.⁴ In addition, exercise improves atrial fibrillation recurrence, symptom burden and severity, as well as the mental components of quality of life.⁵

In people with pulmonary hypertension, exercise programs increase exercise capacity, pulmonary arterial pressure, and quality of life.⁶ Exercise prescriptions for older individuals can reduce the rate of falls and the number of people who fall.⁷ Exercise improves walking distance and pain in people living with claudication.⁸ It significantly improves sugar control, visceral adipose tissue, and plasma triglycerides in people with type 2 diabetes, even if they do not lose weight.⁹ Pulmonary rehabilitation results in meaningful improvements in functional exercise capacity and quality of life in adults with asthma and improves exercise capacity and quality of life in people with COPD.^10,11

In the realm of mental health and neurology, study results indicate that exercise has positive short-term effects on self-esteem in children and mental health scores among pediatric patients with anxiety and depression.^12,13 In addition, exercise is moderately more effective than control for reducing symptoms of depression in adults.¹⁴ Physical exercise improves functional capacity and reduces pain scores in all comers with chronic pain, and improves many parameters of health in cancer survivors, including fatigue and depression.^15-17

Study results further indicate that regular exercise programs have positive effects on both the physical and mental health of individuals with schizophrenia.¹⁸ Additionally, physical activity likely has beneficial effects on the severity of motor signs as well as quality of life for people living with Parkinson’s disease, although, as in most studies, it is not clear what, if any, is the best type of exercise to achieve these benefits.¹⁹

Exercise, performed for about 45 to 60 minutes each time, three times per week or more, regardless of intensity, may also provide a clinically significant reduction in menstrual pain intensity,²⁰ and it helps avert bone loss in postmenopausal women.²¹ Further, exercise reduces the risks of developing gestational diabetes and having a caesarean section when combined with diet interventions during pregnancy.²²

Being physically active reduces the severity of symptoms and the number of symptom days among patients with acute respiratory infections,²³ and it improves symptoms in people diagnosed with irritable bowel syndrome.²⁴ Finally, prehabilitation may result in improved symptoms preoperatively and postoperatively in patients who will undergo colorectal procedures, and physical interventions and multidisciplinary interventions increase the likelihood that people with cancer can return to work.^25,26

The American College of Sports Medicine offers recommendations about how to write exercise prescriptions,²⁷ but based on the results of much of the literature, recommendations do not need to be terribly specific. In truth, people exercise for different reasons. Part of good history-taking reveals whether patients are competitive, exercise to be social, or because their body tells them that it needs to move. Understanding this aspect of one’s character may help us advise on how to engage. We as clinicians should embrace this moment of national attention to help our patients make positive change.

Studies reveal that the more frequently patients hear advice to exercise, the more likely they are to participate.²⁸ Thus, at the very least, Americans should be encouraged to exercise 150 minutes per week,²⁹ and medical education and continuing education should emphasize ways to accomplish this. In addition, physical activity level should be measured like a vital sign at every clinical encounter, and clinicians should find ways to advise regarding activity during nearly every patient encounter.

Time should be set aside for exercise every day, just as it is for sleeping, hygiene, and spiritual introspection. Thus, I applaud Mr. Trump and Mr. Kennedy for their attention to this subject and would encourage more public emphasis be placed on making environments safe and accessible for exercise. Let’s continue to fund the nation’s parks and even incentivize physical activity — for example, OSHA standards could stipulate space and 30-minute breaks to exercise just as we are already given the opportunity to eat.

Clearly there’s more to do. Let’s keep moving.

REFERENCES
1. President’s Council on Sports, Fitness, and Nutrition, and the Reestablishment of the Presidential Fitness Test. The White House. July 31, 2025. Accessed August 16, 2025. https://www.whitehouse.gov/presidential-actions/2025/07/presidents-council-on-sports-fitness-and-nutrition-and-the-reesetablishment-of-the-presidential-fitness-test/
2. Virgara R, Phillips A, Lewis LK, et al. Interventions in outside‐school hours childcare settings for promoting physical activity amongst schoolchildren aged 4 to 12 years. Cochrane Database Syst Rev. 2021;9:CD013380.
3. Hodder RK, O’Brien KM, Wyse RJ, et al. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev. 2024;9:CD008552.
4. What is Cardiac Rehabilitation? American Heart Association. Updated April 24, 2024. Accessed August 16, 2025. https://www.heart.org/en/health-topics/cardiac-rehab/what-is-cardiac-rehabilitation/
5. Buckley BJR, Long L, Risom SS, et al. Exercise‐based cardiac rehabilitation for adults with atrial fibrillation. Cochrane Database Syst Rev.2024;9:CD011197.
6. Morris NR, Kermeen FD, Jones AW, Lee JYT, Holland AE. Exercise‐based rehabilitation programmes for pulmonary hypertension. Cochrane Database Syst Rev. 2023;3:CD011285.
7. Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019;1:CD012424.
8. Lane R, Harwood A, Watson L, Leng GC. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2017;12:CD000990.
9. Thomas D, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006;3:CD002968.
10. Osadnik CR, Gleeson C, McDonald VM, Holland AE. Pulmonary rehabilitation versus usual care for adults with asthma. Cochrane Database Syst Rev. 2022;8:CD013485.
11. McNamara RJ, McKeough ZJ, McKenzie DK, Alison JA. Water‐based exercise training for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013;12:CD008290.
12. Larun L, Nordheim LV, Ekeland E, Hagen KB, Heian F. Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database Syst Rev. 2006;3:CD004691.
13. Ekeland E, Heian F, Hagen KB, Abbott JM, Nordheim L. Exercise to improve self‐esteem in children and young people. Cochrane Database Syst Rev. 2004;1:CD003683.
14. Cooney GM, Dwan K, Greig CA, et al. Exercise for depression. Cochrane Database Syst Rev. 2013;9:CD004366.
15. Knips L, Bergenthal N, Streckmann F, Monsef I, Elter T, Skoetz N. Aerobic physical exercise for adult patients with haematological malignancies. Cochrane Database Syst Rev. 2019;1:CD009075.
16. Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;4:CD011279.
17. Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health‐related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev. 2012;8:CD008465.
18. Gorczynski P, Faulkner G. Exercise therapy for schizophrenia. Cochrane Database Syst Rev. 2010;5:CD004412.
19. Ernst M, Folkerts A-K, Gollan R, et al. Physical exercise for people with Parkinson’s disease: a systematic review and network meta‐analysis. Cochrane Database Syst Rev. 2024;4:CD013856.
20. Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011;7:CD000333.
21. Armour M, Ee CC, Naidoo D, et al. Exercise for dysmenorrhoea. Cochrane Database Syst Rev. 2019;9:CD004142.
22. Shepherd E, Gomersall JC, Tieu J, Han S, Crowther CA, Middleton P. Combined diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev. 2017;11:CD010443.
23. Grande AJ, Keogh J, Silva V, Scott AM. Exercise versus no exercise for the occurrence, severity, and duration of acute respiratory infections. Cochrane Database Syst Rev. 2020;4:CD010596.
24. Nunan D, Cai T, Gardener AD, et al. Physical activity for treatment of irritable bowel syndrome. Cochrane Database Syst Rev.2022;6:CD011497.
25. de Boer AGEM, Tamminga SJ, Boschman JS, Hoving JL. Non‐medical interventions to enhance return to work for people with cancer. Cochrane Database Syst Rev. 2024;3:CD007569.
26. Molenaar CJL, van Rooijen SJ, Fokkenrood HJP, Roumen RMH, Janssen L, Slooter GD. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database Syst Rev. 2023;5:CD013259.
27. American College of Sports Medicine, Ozemek C. ACSM’s Guidelines for Exercise Testing and Prescription. 12th ed. Lippincott Connect-ACSM; 2025.
28. Burge AT, Cox NS, Abramson MJ, Holland AE. Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev. 2020;4:CD012626.
29. Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services. Executive summary: physical activity guidelines for Americans, 2nd edition. 2019. Accessed August 16, 2025. https://odphp.health.gov/sites/default/files/2019-10/PAG_ExecutiveSummary.pdf