James H. Rimmer, Ph.D., Director

For the past few months, Congressional leaders have been battling on Capitol Hill to pass an unprecedented and historic drug relief reform bill. It has been known for some time now that older Americans are spending a significant portion of their disposable income on prescription drugs, and the President and Congress have finally decided to do something about it. In a recent article in The Washington Post, one woman said that she spends $5,000 a year on medications to manage her high blood cholesterol, diabetes, and high blood pressure. This amount is only the portion that she pays; Medicare picks up the rest of the tab. Under the proposed Senate version of the bill, the government would subsidize up to $4,500 of the annual prescription costs and the consumer would be left with a maximum out-of-pocket expense of up to $5,800. That amounts to more than $10,000 a year.

What is so mind-boggling about this new plan is how no one is talking about a more critical piece of legislation that should be added to drug prescription relief; that is, exercise prescription relief. In most YMCAs and park districts across the country, you can obtain a superb exercise "prescription" for about $50 to $80 a month, depending on where you live and what your income is. The active ingredients in this prescription include aerobics classes, yoga, state-of-the-art weight training equipment, warm-water pool classes, relaxation exercises, socialization, and many more activities. Sadly, subsidizing the cost of medicine that doesn't include an exercise pill may be sending the wrong message that the only alternative for treating a health condition is to take more drugs. The thousands of newspaper and magazine articles that have inundated the media on this important and timely topic are devoid of two words that have been mysteriously left out of the lexicon of health care reform exercise relief. Would anyone argue that exercise isn't one of the best "medicines" for treating obesity, heart disease, high blood pressure, high cholesterol, diabetes, insulin sensitivity, depression, sleep disturbances, pain, fatigue, and so on? Isn't it shortsighted to subsidize medicine but not fitness?

When you read and understand the exercise and dietary literature, you quickly realize that the billions of dollars we are spending on thousands of different medications to treat a variety of modern-day chronic illnesses can be drastically reduced by getting a little more exercise and consuming a little less of the wrong types of foods. The woman spending $5,000 a year of her own money and another $5,000 a year of the government's money to control her high blood pressure, high cholesterol, and diabetes would likely be able to reduce these costs by a significant amount if there was some incentive to join an exercise program and obtain some dietary counseling. Along with this new "prescription" of physical activity, the change in her environment has the potential to add immense benefits to her psychological health, by reducing social isolation and redeploying her back into the mainstream of her community.

It is human nature to want to feel better, and exercise can often do that for many people with disabilities and chronic health conditions. The conundrum, of course, is that most people are not aware of the immense benefits that exercise could have on their health and their pocketbook, and therefore elect to continue medicating themselves with drugs rather than some combination of the two. It becomes a vicious cycle drugs make the person more complacent, they become less active, and need more drugs to manage their health problems.

We must begin a New World Order in health care. Any new drug benefit plan must be inextricably linked to an exercise prescription plan. Throwing another pill at an obesity-induced problem such as type 2 diabetes, hypertension, or joint pain is not the answer. What Congress must offer people who need to improve their health is an alternative to taking more medicine. A subsidized fitness membership or waiver to purchase home exercise equipment should be part of any new health care reform. As Dr. Robert Butler, first director of the National Institute on Aging, once said, "If exercise could be put into a pill, it would be the single most prescribed medication in the world."

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