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Introduction

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A sedentary lifestyle accounts for 250,000 or more premature deaths each year in the United States. About 10% of all deaths are attributed to inactivity, and almost 25% of all deaths are attributed to chronic illnesses. Fewer than 25% of all Americans get the exercise they need.1

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Treating people with chronic disease accounts for approximately 75% of the over $2 trillion Americans spend on health care every year.2 This may be explained by the 75 million adults in the United States age 50 years and older, many of whom have at least one chronic disease, such as arthritis, hypertension, or osteoporosis, that can be favorably affected by exercise. The role of exercise prescription in chronic disease has become a new focus in the shift to "exercise as medicine."3

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Physical Activity for Chronic Disabling Diseases and Conditions

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Exercise has been viewed most often as an activity for healthy people, not for the chronically ill. Physical activity is ranked as the leading health indicator in Healthy People 2010.4,5 Endurance exercise reverses the cycle of deconditioning, weakness, and functional loss associated with many chronic disorders.6

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There is a major research interest in examining the affect of physical activity and exercise on disability and other health outcomes, especially in older people. Studies such as the Established Populations for Epidemiologic Studies of the Elderly (EPESE) report data that show the number of years lived without disability depends on an active lifestyle. Even modest amounts of walking are associated with lower rates of disability onset. The EPESE is ongoing to evaluate the impact of exercise in preventing disability in nondisabled older adults.7

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Supporting evidence continues to accumulate that physical activity and exercise reduce chronic disease risk directly through their impact on hormones and indirectly through their effect on weight control.8 "Chronic disease management" is becoming a new term for rehabilitation in the treatment of chronic and disabling diseases, illnesses, conditions, and injuries.

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Physical inactivity is associated with an increased risk for many chronic illnesses and disability, especially in the aging population. In people with chronic disease, exercise therapy is effective in increasing fitness and correcting some risk factors for the development of disease complications.9,10 The numerous health benefits of regular physical activity have all been well documented. The accumulated knowledge is so extensive that the evidence must be translated into an implemented plan of action.11

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Physical inactivity in an aging population is a major contributing factor to chronic illness and disability. Exercise has been proved to mitigate age-associated changes in the cardiovascular system.12 Regular exercise, or sometimes just a modest increase in physical activity, has been shown to reduce muscle protein wasting associated with chronic diseases or conditions such as cancer, chronic real insufficiency, cachexia, sarcopenia, rheumatoid arthritis, osteoarthritis, and human ...

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