Show Notes
In 2014, clinical pharmacist and exercise medicine champion Ann Gates spoke to Jack Chew on The Physio Matters Podcast about the need to reposition physical activity at the centre of healthcare. She described physical inactivity as a public health crisis, advocated for integrating exercise into every patient consultation, and encouraged us to view exercise as a therapeutic agent as legitimate as drugs or surgery. Nearly 12 years later, the evidence base for exercise medicine has grown substantially and many health systems are increasingly prioritising physical activity in policy and clinical practice. In our first Core Memories feature, we assess how Ann’s insights align with current evidence and thinking in 2026, exploring where her 2014 perspectives have been supported, updated, or reframed by the research. Exercise as Medicine: Then and Now 2014 Ann framed exercise as being akin to a pharmacological intervention; something that should be prescribed, monitored, and integrated into treatment regimens. She argued that exercise has cost-effectiveness comparable to many drugs and called for healthcare systems to see exercise as an equal partner to traditional medicine. 2026 Ann’s viewpoint has only strengthened with advancing research. Over the past decade, multiple large-scale meta-analyses and clinical guidelines have solidified what earlier researchers hinted at: exercise has measurable effects on morbidity and mortality across a range of chronic conditions. For example: Cardiometabolic disease: In secondary prevention and some high-risk groups, structured exercise interventions can achieve mortality outcomes comparable to drug therapy in the evidence base, and exercise-based programmes (e.g. cardiac rehabilitation) reduce cardiovascular mortality and recurrent events, though effects on all-cause mortality are more variable in contemporary trials [1,2]. Type 2 diabetes: For type 2 diabetes, physical activity is firmly positioned as a foundational component of management rather than optional advice. Contemporary NICE and American Diabetes Association guidance places structured exercise alongside pharmacotherapy from diagnosis, recognising its role in improving insulin sensitivity, lowering HbA1c (a blood test that measures blood glucose levels over the past three months), and reducing cardiovascular risk [3,4]. Meta-analyses consistently show that aerobic, resistance and combined training meaningfully reduce glycaemic markers, with combined approaches often producing the greatest benefit [5,6]. While exercise does not replace medication for most patients, it can reduce medication burden in some cases and remains one of the most powerful long-term cardiometabolic interventions available [7]. Cancer survivorship: Exercise is now embedded within survivorship care in many oncology pathways, with international guidelines recommending structured aerobic and resistance training following treatment [8,9]. Level-1 evidence, including large randomised trials such as the CHALLENGE study in colon cancer survivors, demonstrates reduced recurrence risk alongside improvements in quality of life and physical function [10]. Across tumour types, systematic reviews consistently confirm exercise as a safe, effective adjunct in post-treatment care [11]. Health organisations and clinical initiatives (e.g. Exercise is Medicine/ACSM and NHS England-aligned programmes) increasingly treat physical activity as a “vital sign” assessed in routine consultations and linked to actionable goals [12–14]. Ann’s view that exercise should be monitored like a drug has gained traction in clinical pathways and electronic medical records, where best practice is for physical activity metrics to be charted alongside markers such as blood pressure and blood glucose, although adoption remains variable. Conclusion The core premise of exercise medicine articulated in 2013 has been reinforced and operationalised. In 2026, it is not just progressive advocacy but a mainstream
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It always struck me as bizarre that sports medicine and musculoskeletal specialties deal with pain and dysfunction from head to toe in the human body, yet offer little health literacy or inclusion of the pelvic floor. Traditionally considered taboo and someone else’s remit, men and women with issues affecting the pelvic floor have largely suffered in silence. Thankfully, change is afoot, and healthcare is finally evolving. There is much more awareness, inclusion, and understanding of this unique body area and the role that it plays. For anyone playing catch up, the pelvic floor is a group of muscles spanning the base of the pelvic outlet in layers. While both men and women have a pelvic floor, the pelvic outlet is wider in females than in males and it also contains an extra orifice – the vagina [1]. That’s right, we went there. We said the ‘V’ word. Because just like vulva, or vestibule, the vagina is simply an anatomical term. It needn’t be embarrassing or taboo. Some of you will be long enough in the tooth to remember when the word ‘breast’ was taboo. However, with healthcare campaigns for breast cancer and breastfeeding, this term became an anatomical norm. We need to do the same for the pelvic floor and its related anatomy and physiology. What does the pelvic floor do? In both men and women, the pelvic floor serves to control the bladder and bowel (maintain continence), empty the bladder and bowel (voiding and defecation) and support sexual function (arousal and climax). In women, the pelvic floor also plays an important role in pelvic organ support. Remember that extra orifice I mentioned earlier…well this area is high risk for connective tissue laxity and defects meaning that the pelvic organs (bladder, uterus, rectum) can descend into the vaginal cavity causing symptoms of heaviness, pressure and a sensation of ‘something in the vagina’. What are the signs and symptoms of pelvic floor dysfunction? If the pelvic floor is not doing its job, any of its roles can become compromised. This may manifest in leaking from the bladder or bowel, inability to fully empty the bladder or bowel, pain ‘down there’, sexual dysfunction (compromised erection, dyspareunia, pain with climax) or heaviness and pressure in the vaginal region (for women) [2]. A full list of sex-specific signs and symptoms of pelvic floor dysfunction can be seen in Table 1. Table 1 - signs and symptoms of pelvic floor dysfunction in men and women Who gets pelvic floor dysfunction? Pelvic floor dysfunction can affect any man, woman or child, however it is particularly problematic for women, especially during transitional life events, such as pregnancy/childbirth and the menopause [1]. One in three women will experience pelvic floor dysfunction [3] and for those that engage in sport, the prevalence of symptoms varies according to the load demands of the activity. For example 61% of netballers leak urine [4], up to 43% of female rugby players leak [5], and 32% of gymnasts experience incontinence [6]. Structural changes associated with vaginal childbirth and aging, as well as lower levels of oestrogen to lubricate and bulk out the tissues can increase the odds of experiencing pelvic floor dysfunction. However, even young adolescent females can leak urine due to the load demands of their sport. For example, in athletics and gymnastics, stress urinary incontinence (the involuntary leakage of urine during activities involving high levels of intra-abdominal pressure) is commonly experienced. Yet no-one is doing anything about it. No one is screening. No one is signposting. No one is educating these younger athletes that pelvic floor symptoms are not to be expected and normalised. Or that they simply indicate that the sporting demands exceed the load capacity at the pelvic floor. If this was any other area of sports or MSK practice, would we settle for a load capacity that does not meet the demands of the sport?! Why is this relevant to every therapist, no matter their di
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This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com