Death by effectiveness: exercise as medicine caught in the efficacy trap

Sport and Exercise Medicine (SEM) has had a good run. For a while it was the low-cost magic bullet. With efficacy demonstrated in study after study, the conclusion was clear: ‘Exercise is Medicine’, a potential public health panacea. Sadly, the early promise waned. While we continue to be bombarded by original research and reviews extolling the efficacy of exercise, there is an apparent dearth of evidence of its effectiveness. This fact is highlighted in 2014 reports from the UK Government and Public Health England It is often argued that the major challenge to the effectiveness of exercise is adherence. Adherence to exercise, variously reported at between 40% and 50%3 is no lower than that reported for drugs. However, while there is general confidence that licensed drugs are effective when taken, reports cited above suggest that this confidence does not currently extend to exercise