The Evidence

The Science of Exercise Medicine

Exercise medicine is more than fitness advice — it is a clinical discipline built on precise diagnostics, evidence-based therapeutics, and quality-assured laboratory practices spanning health and disease.

9,237

PubMed citations (2015–2023) with search phrase exercise medicine, exercise prescription or cardiopulmonary exercise testing

$117B/yr

in US health care spending linked to inadequate physical activity¹³⁷

19M+

US children with special health care needs¹⁶⁰

~2 hrs

of required physical activity training per year in US medical schools¹⁶⁴

The Discipline

Why EMD&T Is a Distinct Clinical Discipline

Exercise Medicine, Diagnostics, and Therapeutics (EMD&T) encompasses the full spectrum of clinical exercise science: from cardiopulmonary exercise testing (CPET) and performance assessments, to evidence-based exercise prescriptions for patients with complex chronic diseases, to laboratory quality assurance and data interoperability.

EMD&T focuses on the proactive use of exercise as a diagnostic and therapeutic tool across the full range of medical conditions. Its scope spans cardiology, pulmonology, oncology, pediatrics, psychiatry, rheumatology, endocrinology, metabolic disease, and beyond.

The clinical evidence supporting this discipline is both vast and rapidly growing. Below is a summary of the evidence across a sampling of multiple diseases.

Clinical Evidence

Evidence Across Multiple Diseases

The disease states outlined here are examples of the role of exercise as a diagnostic and therapeutic tool. This list is not exhaustive.

Chronic Obstructive Pulmonary Disease

Level 1 evidence demonstrates improved exercise tolerance and enhanced quality of life after pulmonary rehabilitation,¹ and in a nationwide Korean study, average medical costs among patients receiving pulmonary rehabilitation fell from $18,569 to $11,472.¹⁵⁵

Cystic Fibrosis

CPET has been a valuable prognostic tool in cystic fibrosis since a landmark 1992 NEJM study linked aerobic fitness to survival.^165,166 Highly effective CFTR modulators now create new opportunities for exercise therapeutics.^167,168

Heart Failure (HFrEF & HFpEF)

CPET is a cornerstone of risk stratification in heart failure, and peak oxygen uptake measured by CPET is one of the criteria guidelines use for heart transplant listing.^51–53,182 Exercise training consistently improves fitness, function, and quality of life in both HFrEF and HFpEF.^55–57

Congenital Heart Disease

CPET is critical for functional assessment, surgical planning, and the shift from lifespan to health span models. The AHA recommends exercise counseling as core CHD care.⁶⁹

Cancer Care & Survivorship

In patients undergoing cancer surgery, higher preoperative CPET values are associated with better postoperative outcomes.¹⁹⁹ Exercise prescription is now widely recognized as part of contemporary cancer treatment and survivorship models.^{41,46,200,201}

Pediatric Pulmonary Disease

Exercise flow-volume loops, exercise laryngoscopy for EILO identification (7–28% prevalence),^94–97 and exercise challenge testing for EIB are essential diagnostic tools.

Psychiatric & Behavioral Disorders

Exercise is an effective treatment for major depressive disorder,¹⁸⁸ and systematic reviews support it as an addition to care for PTSD¹⁸⁹ and many chronic pain conditions,¹⁹⁰ while early studies in anorexia nervosa find supervised exercise safe.¹⁹¹ A critical tool in the mental health crisis.

Rehabilitation & Prehabilitation

Risk stratification and exercise programming across cardiac, pulmonary, neurological, and surgical rehabilitation. Prehabilitation evidence is growing exponentially.^114–117

Cardio-Metabolic Disease

Aerobic and strengthening exercises are foundational in obesity and diabetes management,^118–120 with diverse modalities conferring different metabolic adaptations.^122,123

Sickle Cell Disease & Health Equity

Addressing research disparities: about 100,000 people in the US have sickle cell disease,¹⁵⁸ yet a search found only 12 pediatric exercise clinical trial publications (1966–2021). Safety evidence for exercise testing is accumulating.^125–128

Pulmonary Arterial Hypertension

Exercise testing is among the strongest prognostic predictors. Supervised exercise-based rehabilitation improves exercise capacity and quality of life, and early trials suggest it may also improve hemodynamics.^197,198

View References

Economic Case

Cost-Effectiveness Evidence

For institutional leaders considering advanced training program investments, the economic data is compelling.

Condition / Intervention	Metric	Value	Source
COPD (Pulmonary Rehab)	Average medical costs, Korea, 2016 → 2019	$18,569 → $11,472	Choi et al., Chest 2024¹⁵⁵
Breast Cancer (Exercise)	Cost per life-year gained	AU $8,894	Gordon et al., Int J Environ Res Public Health 2020²
Type 2 Diabetes (Aerobic + Resistance)	Cost per QALY vs. no exercise	CA $37,872	Coyle et al., DARE trial 2012¹⁵⁶
Heart Failure (Cardiac Rehab)	All-cause hospital admissions, first year	31% fewer	Molloy et al., Cochrane Review 2024¹⁵⁷
Physical Inactivity (Prevention)	Share of US health care spending	11.1% ($117B a year)	Carlson et al., Prog Cardiovasc Dis 2015¹³⁷

Health Equity

Addressing Disparities in Exercise Medicine

Health equity is central to the Academy's mission. Social determinants of health profoundly influence exercise prescriptions, monitoring, and access to rehabilitation services.^8–11

The case of sickle cell disease illustrates this gap: about 100,000 people in the US live with sickle cell disease,^158,159 yet a PubMed search of exercise clinical trials in children and adolescents (1966–2021) found only 12 publications on sickle cell disease, compared with 121 on cystic fibrosis, a far less common condition.

Advanced training in exercise medicine diagnostics and therapeutics can begin to address health care disparities by building a cohort of physicians with the knowledge base to consider the full context of patient exercise behavior as well as address knowledge gaps and advocate for equitable exercise medicine programs at institutional and community levels.

100,000

people in the US with sickle cell disease¹⁵⁸

Only 12 pediatric exercise trial publications (1966–2021)

19M+

US children with special health care needs¹⁶⁰

Growing need for pediatric exercise medicine

8.3%

of US adult deaths linked to inadequate physical activity¹⁶¹

Inactivity is more common in rural areas and in some minority communities^162,163

The Evidence Is Clear

Exercise medicine needs a dedicated workforce. Explore how the Academy of Exercise Medicine (AEM) Advanced Training Program (ATP) translates this evidence into a training pathway.

Explore the Advanced Training Program See Who Supports EMD&T