ABSTRACT
Chapter 4 briefly introduced the EiM movement, the explicit aim of which is, ‘To make physical activity and exercise a standard part of a disease prevention and treatment medical paradigm in the United States’ (Jonas and Philips 2009: ix). The rationale for EiM is that exercise (sufficient to induce slight breathlessness, enabling one to talk but not sing) is ‘the much needed vaccine to prevent chronic disease and premature death’ (Sallis 2009: 3). Moreover, the ‘exercise pill’ is claimed to have miraculous effects; ‘If we had a pill that conferred all the confirmed health benefits of exercise would we not do everything humanly possible to see to it that everyone had access to this wonder drug?’ (Sallis 2009: 3). While it is conceded that ‘either too much or too little [exercise] can be harmful’ (Phillips et al. 2009a 149) EiM replicates ideas that ‘the more intense the activity, that is the more aerobic it is, the more benefit there is to be gained from it’ (Jonas 2009: 11). For this reason clinicians are exhorted to ‘collectively urge all patients to become more active and stay active throughout their lives’ (Sallis 2009: 4, emphasis added). EiM has been so influential that it is now established in 43 countries, and its inaugural ‘World Congress’ (2010) was attended by delegates from over 60 countries (Neville 2013). EiM embodies the psychologization of PAHP (Horrocks and Johnson 2014) and lifestyle drift (Popay et al. 2010), focusing on ‘change and how to make it, choices to be made and how to make them’ (Jonas 2009: 1). There are expressed desires to create a ‘broad awareness’ of the desirability of exercise (Jonas and Philips 2009: ix), but also an attempt to provide clinicians with the tools and techniques to effectively make these changes. A central aspect of this educational work has been the publication of a book which, in many ways, is an instruction manual for those charged with implementing EiM, the ACSM’s Exercise is Medicine: A Clinician’s Guide to Exercise Prescription (Jonas and Philips 2009). Containing guidance for advising/persuading patients of the benefits of regular physical activity, it draws only briefly on the clinical evidence for the reduction of risk and/or effective management of certain conditions and emphasizes in particular aesthetic and lifestyle factors related to exercise including the claim that
‘Regular exercise can be fun, if you let it be fun!’ (Jonas 2009: 5-6). Similarly, included amongst the seven major benefits of taking regular exercise, is the advice that it ‘can help you feel younger and act that way too’ and ‘can help spark your sex life’; exercise ‘is the only way to “get in shape” ’ (Jonas 2009: 6). The (in)decision to be physically (in)active is projected as an essentially personal and individual (ir)responsibility. Clinicians are advised that their ‘patient . . . knows that he “should” be more active’ (Phillips et al. 2009b: 91). Previously, we saw the multiple senses in which EiM represents a form of medicalization: effectively redefining an everyday social practice under a medical rubric; explicitly expanding and consolidating the jurisdictional influence of medicine over both citizens and the fitness industry; and even refracting medical surveillance back onto the profession itself. As these factors largely operate at the conceptual level, it is necessary to ask what broader impact such policies have on people’s lives. Thus, in this chapter, we seek to explore the literal claim of EiM, and a claim that is implicit in PAHP more generally, that undertaking exercise medicinally contributes to the relief of human suffering (Edwards and McNamee 2006). Specifically, how does the reality of exercise experienced at the interactional level relate to these claims for EiM? The empirical focus of this chapter is the lived experience of health/ illness of a group of 26 people who have been diagnosed with Chronic Obstructive Pulmonary Disease (COPD) (see Appendix). COPD patient’s experiences of, and attitudes toward, physical activity provide an excellent case study of the broader EiM and NPH movements for three reasons. First, given the centrality of exercise to COPD treatment programmes, this cohort had either been explicitly advised or were acutely conscious of the (clinical) desirability of exercise. Second, given the demographic profile of COPD sufferers this cohort illustrates some of the more extreme physical (and to some extent social) disadvantages and thus tests the extent to which all patients can become more active. Third, the role of smoking in the aetiology of COPD centrally locates the illness in lifestyle-centred explanations of health and thus magnifies the potential dual role of selfresponsibility and guilt in the contemporary illness experience. In other words this cohort will both directly medically benefit from exercise and be acutely aware of the health imperative (Lupton 1995). As we will see, while those diagnosed with COPD had largely internalized broader cultural messages that stem from PAHP’s medicalization of sport and exercise, the impact of these conceptual developments was significantly constrained by the problems encountered when trying to implement such messages at the interactional level of behavioural change. The chapter illustrates how PAHP depictions of the choice(s) to exercise are simply unrealistic and fundamentally at odds with the physical and structural barriers individuals face. It therefore concludes that EiM, and PAHP
more generally, is indicative of an imperialistic form of medicalization which, to some extent, creates iatrogenesis as it exacerbates the everyday lived experiences of those diagnosed with COPD.
