1st Day-4th Talk: “How to Regenerate Physical and Metabolic Function with Exercise” by Vert Mooney, M.D.

Dr. Mooney is the Emeritus Professor of the Department of Orthopedic Surgery at the University of California, San Diego School of Medicine and is currently the Chief Medical Director of Spine and Sport Clinics.

Dr. Mooney discussed the benefits of resistance exercise in cardiovascular health. He began his discussion with a bit of background information on therapeutic exercise. The therapeutic concept was lost until Ling in 1813 with the founding of the Central Gymnastics Institute in Stockholm. This was a key event in the development of exercise with force against a trainer. Dr. G. Zander was licensed in medicine in Sweden in 1864. He developed the Medico-Mechanical Gymnastic Institute in 1865. By 1906, 90 such institutes existed worldwide. Cardiac rehabilitation was only later made possible with the development of the Hoter monitor EKG’s while moving (Bruce 1973).

One issue with therapeutic exercise as a treatment for regeneration of function is that it implies that we know the exact dose. Additionally, our natural inclination is to increase the dose rationally with a therapy that has shown to be effective, analogous to the protocol followed for drug therapy.

There are several reasons why therapeutic exercise is not a widespread form of therapy in medicine today. Rest, as opposed to physical activity, is thought to be therapeutic. Also, sweat is not sterile, equipment is expensive, and massage feels better as a form of therapy. Therapuetic exercise was kept alive primarily as a result of the need for rehabilitation during WWI. Measurements taken using the Holter monitor significantly aided in the medical endorsement of therapeutic exercise.

Modern exercise equipment displays the ability to isolate muscles and strengthen through a full range of motion incrementally. Arthur Jones was the man who invented the Nautilus exercise machine, revolutionized the health club industry, and he forever changed the way every human being exercises. Dr. Mooney believes that turf is the barrier preventing the transfer of health club exercise of the musculoskeletal system to therapeutic exercise in the clinic.

The Denver Experiment tested intense eccentric exercise and although it was not a pragmatic approach to exercise for the average person, it proved that extreme muscle gain could be achieved in only 12 sessions. Dr. Mooney suggests that the studies conducted on the spine prove to be the best evidence that isolated measured resistance exercise can regenerate muscle function. Dr. Mooney presented several studies that showed overwhelming improvements in the patients who were treated with therapeutic exercise and approximately 96% of the patients were satisfied with the treatment and their overall medical care they received.

Dr. Mooney presented recent findings in adolescent scoliosis patients. All adolescent scoliosis patients present with one common finding: the strength of trunk rotation is weaker to one side when compared to the other, whereas normal adolescents of the same age have equal torso rotation strength. These patients are exhibiting an inhibition of paraspinal musculature. The MedX Torso Rotation Unit was used for torso rotational strength training. The patients performed one set of 20 repetitions while alternating sides. 16/25 patients demonstrated curve reduction, and none of the patients got worse. A 20.1% change in degree rotation pre- and post-training (p=0.003). The first study also showed a 26.6% increase in isometric strength.

Dr. Mooney also briefly discussed the importance of exercise in metabolic health. People who maintain regular exercise regimens have been shown to live longer with a reduced rate of cancer and a reduced wound inflammation response.
In conclusion, Dr. Mooney stated that therapeutic exercise is under appreciated in the medical community. It is poorly reimbursed by insurance, and the role of the dose presents a problem because there is no way to measure its benefits versus alternative forms of treatment. Dr. Mooney suggested that exercise equipment is the best tool we have to define a ‘dose’ for therapeutic exercise; however, scientific studies in humans are difficult to conduct without knowing the actual dose. The dose of exercise to form new bone is the key to the advancement of therapeutic exercise.