Why should a neurologist ask his patients whether they exercise

In my neurological practice in Frankfurt, I see patients every day with a wide range of neurological and psychiatric conditions.

Which conditions I encounter in my neurological practice in Frankfurt

These include multiple sclerosis, myasthenia gravis, other autoimmune diseases of the central and peripheral nervous system as well as the muscles, stroke, Parkinson’s disease, polyneuropathy, dementia, epilepsy, migraine and other types of headache, depression, and anxiety and panic disorders. Over time, I have developed a habit: after discussing the diagnosis and the appropriate medical treatment, I ask one more question – whether the patient exercises, and if so, what kind of exercise they do.

“Exercise?” – the question that surprises my patients

I often see surprised looks.

“Exercise?”

“Yes, exercise.”

Usually, there is a short pause, followed by various answers:

“Why would I need exercise? I’m already taking medication.”

“I don’t have time for exercise.”

“I can’t exercise because moving is difficult for me.”

“Yes, I do exercise – I walk several thousand steps a day at work, that’s strenuous enough.”

The answers differ, but they all have one thing in common: most patients are genuinely surprised that their neurologist asks them at all whether they exercise – and even more surprised that he takes the time to ask in detail: what kind of exercise, how often, and at what intensity.

Why exercise is important in neurological and psychiatric disorders

In fact, the explanation is quite simple. Regular physical activity has additional positive effects in most neurological and psychiatric conditions. These effects do not replace medication, but rather complement and enhance medical therapy.

It is clear that exercise cannot replace medication when medication is necessary. It is also clear that many patients have neurological impairments that prevent them from engaging in certain types of physical activity. However: exercise affects the nervous system, the muscles, the immune system, and mental health in ways that are independent of medication. For this reason, it should be an essential part of every therapeutic and preventive treatment plan.

Everyone can exercise – even with severe neurological impairments

At moments like these, I always recall one of the most important lessons I have learned from working with sports medicine specialists who focus on patients with neurological disorders: everyone can exercise. Even for severely affected patients, it is possible to design an individual training program that exercises the body safely, in an adapted manner, and effectively.

Even small changes in physical activity can have a big impact

The data are impressive.

Just five minutes of moderate to vigorous physical activity per day can have a significant effect – especially in people who currently do no exercise at all. In this group, mortality is reduced by about 6%.

Spending at least half an hour less per day sitting can reduce mortality:

• by around 3% among the least physically active individuals,

• and by up to 7% in the general population.

These findings come from a recent, high-quality meta-analysis including more than 135,000 participants from multiple studies.

“Even small changes matter,” I often tell my patients.

How exercise affects multiple sclerosis, Parkinson’s disease, and other conditions

The beneficial effects of exercise are well documented in conditions such as multiple sclerosis, Parkinson’s disease, and many other neurological disorders.

But there is also impressive evidence in conditions where exercise might not be the first thing that comes to mind. For example, a recent study showed that patients with colon cancer who followed a structured physical activity program after surgery and chemotherapy experienced a longer disease-free period.

Modern neurology means more than medication

This reflects my vision of modern medicine and modern neurology – including a contemporary neurological practice in Frankfurt.

Patients should be advised not only about the medications required for their condition, but also about lifestyle changes they can implement themselves to improve their health or control their disease to such an extent that they can live a full life despite it.

Combining different types of exercise – such as endurance and strength training – usually produces the best results. Expert opinion is clear: the benefits of physical activity far outweigh the risks, even in people with chronic conditions who may initially hesitate to start exercising.

I also greatly appreciate initiatives such as that of Professor Zimmer at the Technical University of Dortmund, who offers a special online consultation for patients with multiple sclerosis who require individualized advice on exercise and physical activity.

How many hours do you plan to spend sitting today?

And what kind of exercise do you do?