title: Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue.
abstract: BACKGROUND
  The rapidly increasing burden of chronic disease is difficult to reconcile with the large, compelling body of literature that demonstrates the substantial preventive and therapeutic benefits of comprehensive lifestyle intervention, including physical activity, smoking cessation and healthy diet. Physical inactivity is now the fourth leading independent risk factor for death caused by non-communicable chronic disease. Although there have been efforts directed towards research, education and legislation, preventive efforts have been meager relative to the magnitude of the problem. The disparity between our scientific knowledge about chronic disease and practical implementation of preventive approaches now is one of the most urgent concerns in healthcare worldwide and threatens the collapse of our health systems unless extraordinary change takes place.
  
  
  RESULTS
  The authors believe that there are several key factors contributing to the disparity. Reductionism has become the default approach for healthcare delivery, resulting in fragmentation rather than integration of services. This, in turn, has fostered a disease-based rather than a health-based model of care and has produced medical school curricula that no longer accurately reflect the actual burden of disease. Trying to 'fit' prevention into a disease-based approach has been largely unsuccessful because the fundamental tenets of preventive medicine are diametrically opposed to those of disease-based healthcare.
  
  
  CONCLUSIONS
  A clinical discipline within medicine is needed to adopt disease prevention as its own reason for existence. Sport and exercise medicine is well positioned to champion the cause of prevention by promoting physical activity.
  
  
  CONCLUSIONS
  This article puts forward a strong case for the immediate, increased involvement of clinical sport and exercise medicine in the prevention and treatment of chronic disease and offers specific recommendations for how this may begin.
authors.affiliation: Department of Orthopaedic Surgery, Division of Sports Medicine & Human Performance Laboratory, Stanford University School of Medicine, Stanford, California 94304, USA. gord@stanford.edu
authors.forename: Gordon O
authors.initials: GO
authors.lastname: Matheson
authors.forename: Martin
authors.initials: M
authors.lastname: Klügl
authors.forename: Jiri
authors.initials: J
authors.lastname: Dvorak
authors.forename: Lars
authors.initials: L
authors.lastname: Engebretsen
authors.forename: Willem H
authors.initials: WH
authors.lastname: Meeuwisse
authors.forename: Martin
authors.initials: M
authors.lastname: Schwellnus
authors.forename: Steven N
authors.initials: SN
authors.lastname: Blair
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.forename: Wayne
authors.initials: W
authors.lastname: Derman
authors.forename: Mats
authors.initials: M
authors.lastname: Börjesson
authors.forename: Fredrik
authors.initials: F
authors.lastname: Bendiksen
authors.forename: Richard
authors.initials: R
authors.lastname: Weiler
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control*; D003479:Curriculum; D003695:Delivery of Health Care; D004501:Education, Medical; D015444:Exercise / Q000502:physiology*; D006293:Health Promotion; D006801:Humans; D007391:International Cooperation; D007400:Interprofessional Relations; D008490:Medical Informatics; D010358:Patient Participation; D018802:Patient-Centered Care; D011315:Preventive Medicine / Q000193:education; D011364:Professional Practice; D011643:Publishing; D057185:Sedentary Behavior; D012941:Social Responsibility; D012955:Societies, Medical / Q000458:organization & administration; D013178:Sports Medicine / Q000193:education / Q000379:methods*