Don't Consult a Physician Before Exercise

- 5 mins read

The advice to ask your doctor before starting an exercise program has no basis in science, as far as I know. It’s primarily a CYA (cover your ass) disclaimer. Virtually everyone in the fitness industry has adopted it, so it’s stated almost everywhere:

  • Gyms, fitness centers, and health clubs
  • Fitness equipment: weight-lifting machines, treadmills, stationary bikes, elliptical machines, etc.
  • Websites
  • Magazines
  • Fitness books

Apparently, we assume people are too incompetent to exercise without first consulting someone else. Ironically, they’re instructed to ask a physician, a person unlikely to have expertise in exercise unless they’ve pursued it independently. As I mentioned earlier, my medical education included no lectures on exercise. I suspect that hasn’t changed much in most medical schools today.

What exactly is a physician supposed to advise someone who asks if getting off their couch is right for them?

Exercise is universally beneficial for all aspects of health. Increasing evidence highlights its benefits for mental well-being, physical health, and longevity.

I assume the concern about starting exercise is the risk of a heart attack or injury. While there’s a potential risk of adverse outcomes, this risk exists every time anyone exercises. What we fail to consider is that everyone faces risks of adverse outcomes all the time, especially if they’re unhealthy at baseline, particularly with metabolic issues. There’s nothing inherently riskier about exercising compared to everyday activities. There’s a reason we no longer prescribe bed rest after heart attacks or for back pain. We don’t recommend bed rest for anything (except perhaps a few conditions in late pregnancy) because inactivity is unhealthy. Yet, we’re told we must seek permission to exercise?

Consider a sedentary 45-year-old man who weighs 300 pounds and is 5’9” tall. Body Mass Index (BMI), though an imperfect measure, clearly places him in the severely obese category. According to Robert Lustig’s estimates in his Fat Chance: Fructose 2.0 YouTube video, 80% of obese individuals are metabolically unhealthy. Let’s assume this man is metabolically unhealthy.

If he asks me whether he should exercise, should I tell him no?

“No, sir, you should not pursue the health benefits of exercise. You should remain sedentary.”

That sounds absurd, and I’d agree.

Should I subject him to a battery of tests to prove he’s healthy or unhealthy? I’m unaware of any standard “pre-exercise” screening program. I could order blood work to check for metabolic syndrome, measure glucose levels and vitals over several time points to confirm diagnoses like type 2 diabetes or hypertension, or order an exercise stress test or refer him to a cardiologist for an angiogram. All of this delays his ability to start exercising. And if he chooses not to wait and begins exercising on his own, is that against medical advice (AMA)?

What do I do with the results, regardless of what they show?

  • If he’s “healthy,” he should exercise.
  • If he’s unhealthy, he should exercise.

This aligns with an adage from my medical training: if a test result won’t change management, don’t order it.

But perhaps his greatest risk isn’t metabolic health. It might be mechanical—pulling a hamstring, injuring his back, or hyperextending an elbow. Maybe he was a high school or college athlete and recalls proper movement patterns, such as performing bench presses, squats, and deadlifts with decent form, along with some calisthenics. He might be able to resume exercising with some confidence in moving safely. Is that sufficient? Do I, as a physician, need him to prove he can move safely? Should we discuss his high school athletic career or how many issues of Muscle & Fitness he’s read? When was his last gym membership, and can I see those records to verify his attendance? Can he sit and reach past his toes? What exactly is the threshold I’m trying to meet here?

Or perhaps he’s never exercised. Should I refer him to a personal trainer for a movement assessment? I could have someone administer a Functional Movement Screen (FMS) to evaluate his range of motion or identify unusual movement patterns that need correction. Just because he hasn’t been active, should I assume he’ll move poorly? Maybe he’s simply been uninterested but would move fine with motivation. Perhaps the former high school athlete actually needs the FMS.

What about prior injuries? A mild concussion from a skateboarding incident, an ACL tear in high school, a jammed finger from church basketball—do these preclude him from exercising?

What exactly is the standard for allowing someone who doesn’t exercise to start exercising?

And who appointed doctors as the exercise police?

Despite these unanswerable questions, let’s assume our patient doesn’t deliberately exercise. (Let’s also assume he doesn’t literally do nothing but sit at home ordering everything from Amazon, walking only across his house.) Instead, he just lives life with minimal activity unless necessary. He likely squats multiple times daily when sitting on a chair, couch, recliner, or toilet. He encounters stairs, perhaps more than one flight at times. He carries groceries, picks up a child, or hauls bags of dog food from the store shelf to the cart, to the cashier, back to the cart, to the car, and into the garage. He might briefly sprint to catch a bus.

Who gave him permission to do all those things?

My point, which I hope is clear by now, is that there’s no reason to require anyone to consult a doctor before exercising.