HCM Issue 4 2021

Page 12

LETTERS

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Prescribing exercise will always be preferential to prescribing painkillers, given the risks associated with their long-term use Sir Muir Gray Chief knowledge officer, EXi I’m very pleased to see that NICE has acknowledged the power of exercise in managing pain (see page 48). The evidence is clear and strong that activity is beneficial in almost every long-term condition, many of which have accompanying chronic pain. Encouragement is vital as well, so whether that’s online, through apps or in person through social prescribing, combining exercise with reassurance is the way forward. This is quite a change of tack for NICE as, traditionally, painkilling drugs have been the first things to be prescribed.

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Fibromyalgia and chronic pain are two specific conditions which prescribed exercise can help

I welcome seeing exercise on prescription being recommended in this way. It’s a great step forward in the industry’s push to have exercise prescribed routinely for all long-term conditions. Strong evidence Both the evidence summarised in the 2015 Report of the Academy of Medical Royal Colleges, called Exercise, the Miracle Cure, and the evidence base since 2015 have been reviewed by the team here at EXi, along with the 963 systematic reviews on pain and exercise published in the last five years. We found that while the NICE guidelines are encouraging, more research needs to be done in this promising field. The EXi app includes fibromyalgia and chronic pain as two specific conditions for which prescribed exercise can help, based on 24 systematic reviews. The app takes people through a very specific and slow graduation at a low intensity, with the programme designed to guide them in regular exercise, even when they’re away from the gym. Chronic pain by definition is ongoing, so prescribing exercise that can be done for a prolonged period of time will always be preferential to prescribing painkillers, given the risks associated with their long-term use.