Exercise in a pill - thinking science out loud.
Imagine what it would be like if we could prescribe us a pill that would give the benefits of exercise for our cardiovascular and metabolic health without exercising? It sounds crazy, doesn’t it? If you think about it, it might not be such an outrageous idea. Alejandro Marmolejo, a physician and PhD student in mitochondrial biology, shares his thoughts about how “exercise in a pill” could become an important therapy in the future with us.
Exercise in a pill does not sound that crazy after this
We, the human race, have substantially improved our quality of life over the last half-century. We went from a life span of around 46 years in 1950 to living around 71 years in 2015 (world average). This is why the longer we live, the more opportunities for chronic diseases (that we did not even know existed) appear and interfere with our quality of life. By 2050, the world’s population over the age of 60 will double. Based on this fact, the WHO has proposed the “healthy aging” paradigm, where ageing adults do not lose their autonomy due to chronic disease and carry a more fulfilling life.
The COVID-19 pandemic hit the world hard, introducing important changes in our lifestyle. In most countries, measures involved staying at home as much as possible, maintain social distancing and avoiding crowded places. As a result, I have many friends that have shared with me some pre- and post-lockdown photos where they gained considerable weight. This shows that staying at home is a dangerous brew for sedentarism and the reason why maintaining our fitness status is a constant concern. Given that sedentarism is the main cause of major chronic diseases, it would be revolutionary if a medicine was engineered to experience the beneficial effects of exercise!
Why is exercise so important?
When we exercise, our mitochondria (a component of all of our living cells in charge of producing energy for us to survive) gets mildly stressed to meet the demands of our activity. Mild stressors, such as exercise or caloric restriction (fasting), are known stimuli to improve metabolic fitness. Because of their overall beneficial effects, exercise has been widely prescribed against cardiovascular disease, cancer and dementia. Now, if you think about it, prescribing exercise could help a person with obesity mitigate heart attacks, a cancer patient on strong chemotherapies regain strength and individuals suffering from dementia. However, they may be physically or mentally incapable of performing adequate physical activity. These are the cases for whom the idea of exercise in a pill has been proposed.
I worked as a physician (GP) in México before coming to the Netherlands to pursue a research career. In general, the role of the GP is to promote health more than to “cure disease”. In my clinic, the regular 60-70 year old patients had at least one of the following illnesses:
Diabetes Mellitus
High Blood Pressure
Obesity
Mild Cognitive Impairment
Chronic Kidney Disease
On top of prescribing their monthly meds to control their blood pressure or blood sugar, I recommended them to exercise, for example, by going out for walks. To promote this, we had an exercise program in the clinic, where they could join and we could help them to perform basic exercises. Still, their capability was significantly reduced. Imagine if these patients could lower their risk of dying by taking the “exercise pill”?
How can we prescribe exercise in a pill?
Current research focusing on the so-called “exercise-mimetics” (mimetic refers to the verb “to imitate”) is in the field of mitochondria and metabolism. Some drugs that are known to mildly stress mitochondria, such as metformin (an antidiabetic drug), resveratrol (a natural compound found in the skin of grapes), and other compounds are being tested. Metformin, for example, has already been shown to improve the healthspan and lifespan in animal experiments. The problem with current approved drugs is that they are not specific enough to obtain only the exercise effect, and may activate or inhibit other processes in our cells. Recent studies have deciphered the key players that drive the beneficial effects inside mitochondria, and it is just now a matter of time before specifically-designed compounds can reach clinical trials.
So, what’s the catch?
Nevertheless, there are still a lot of unanswered questions, like:
What could be the side-effects of a medicine like this?
What experiments or clinical trials have to be performed to demonstrate that such a medicine would work? Would it be against a specific disease or just give it to people and let them age and follow them through time?
Who would get this medicine? The rich and wealthy? Released worldwide? The healthy population, to increase healthspan? Or the aged population, to increase life-span?
When will this pill happen?
Personal opinion: I think that whoever discovers/designs the medicine that is capable of inducing the beneficial effects of exercise will be a visionary and will be highly regarded in our future society. Who knows, maybe deserving of a Nobel prize. What do you think of exercise in a pill? Please leave a comment, they are always appreciated!
Tot later,
Alejandro