Introduction
The growing global population of older adults, defined as those aged 60 years or more, presents complex challenges for healthcare systems worldwide. Older adults typically have multimorbidity and are frequently prescribed multiple medications, known as polypharmacy, elevating the risk of adverse drug reactions, drug interactions, and medication nonadherence. Recently published insights emphasize integrating exercise prescriptions into medication management as an innovative, holistic approach to optimize health outcomes in geriatric care. This article critically examines the rationale, evidence, and practical considerations underpinning this strategy to enhance therapeutic efficacy, minimize the harms of polypharmacy, and improve functional status among older adults.
Background: Burden of Multimorbidity and Polypharmacy in Older Adults
Multimorbidity—the coexistence of multiple chronic conditions—is exceedingly common in the aging population. Conditions such as coronary artery disease, diabetes, chronic obstructive pulmonary disease (COPD), osteoporosis, osteoarthritis, depression, anxiety, and cognitive decline frequently co-occur. Consequently, medication regimens often become complex. Polypharmacy is defined commonly as the use of five or more medications and is associated with increased risks of falls, hospitalization, cognitive impairment, and mortality. Moreover, sedentarism and age-associated physiological decline contribute to worsening chronic disease expression and functional deterioration. Hence, addressing lifestyle factors such as physical activity alongside pharmacotherapy offers a promising therapeutic avenue.
Rationale for Integrating Exercise into Medication Management
Exercise exerts multifaceted benefits across physical, mental, and cognitive domains. Notably, exercise acts as both a preventive and therapeutic modality for many conditions prevalent among geriatric patients. It is underutilized as a formal “treatment” yet holds potential to serve as an alternative or adjunct to pharmacologic agents, many of which carry risks of adverse effects in older adults.
Clinical conditions where exercise has therapeutic or adjunctive value include:
– Mental health disorders: Exercise reduces symptoms in depression, anxiety, and insomnia.
– Musculoskeletal conditions: Improves osteoarthritis-related pain and mobility.
– Cognitive impairment: Protective and cognitive-enhancing effects in dementia.
– Cardiovascular diseases: Improves cardiac function in coronary artery disease and heart failure.
– Metabolic diseases: Enhances glycemic control in diabetes.
– Osteoporosis: Stimulates bone density via mechanical loading.
– Cancer: Reduces fatigue and improves physical function.
– COPD: Improves aerobic capacity and dyspnea.
Besides these, exercise can ameliorate medication-induced side effects such as anorexia, sarcopenia, orthostatic hypotension, balance impairment, and falls, which further complicate geriatric care. By incorporating exercise, clinicians can optimize medication effectiveness, reduce doses or eliminate unnecessary drugs, and potentially decrease polypharmacy and its attendant risks.
Evidence and Key Findings
Recent literature, including the comprehensive review by Izquierdo et al. (2025), synthesizes evidence demonstrating the benefits of combining exercise with medication management:
1. Improved Clinical Outcomes: Structured exercise programs improve functional status, cognitive function, and quality of life among older adults with multimorbidity.
2. Medication Optimization: Exercise allows reduction or substitution of pharmacotherapy for conditions like depression and osteoarthritis, decreasing polypharmacy burden.
3. Reduction of Adverse Drug Reactions: By mitigating side effects such as muscle weakness, orthostatic hypotension, and falls, exercise reduces hospitalization and disability.
4. Enhanced Medication Adherence: Exercise promotes psychological well-being and physical capability, leading to better compliance with complex regimens.
5. Addressing Sedentary Behavior: Exercise counters the adverse effects of inactivity and aging by improving aerobic fitness, muscle strength, balance, and bone health.
Randomized controlled trials have affirmed the efficacy of tailored exercise interventions in improving outcomes in cardiac rehabilitation, diabetes management, osteoporosis prevention, and COPD care. Furthermore, mechanistic studies show exercise modulates inflammatory pathways, neuroplasticity, and metabolic function, enhancing drug action and reducing disease progression.
Challenges and Implementation Strategies
Despite compelling evidence, exercise remains underprescribed in clinical practice for older adults. Critical barriers include:
– Limited clinician training on exercise prescription and integration with pharmacotherapy.
– Time constraints and lack of standardized protocols.
– Patient factors such as fear of injury, mobility limitations, or lack of motivation.
– Healthcare system issues including inadequate reimbursement and fragmented care.
To address these, a pragmatic, patient-centered approach is recommended:
– Comprehensive Geriatric Assessment (CGA) incorporating lifestyle evaluation, medication review, and functional status.
– Prescribing tailored exercise programs considering individual preferences, comorbidities, and safety.
– Multidisciplinary collaboration among geriatricians, physiotherapists, pharmacists, and nurses.
– Education and training of healthcare professionals in integrated care models.
– Utilizing technology such as tele-exercise and digital monitoring to enhance adherence and supervision.
Such integrated models have the potential to transform geriatric care by promoting health span and reducing disability.
Expert Commentary
Leading experts advocate that exercise should be considered a “polypill” in geriatric medicine—effective across multiple domains with minimal risk. Clinical guidelines increasingly endorse physical activity as part of the treatment paradigm for chronic diseases but call for embedding it systematically into medication management workflows. While more high-quality longitudinal studies are required to define optimal exercise dosing and modalities tailored to specific conditions and medication profiles, current evidence supports initiating integration promptly.
Limitations remain, including heterogeneity in study populations and exercise protocols, and challenges in measuring adherence and long-term outcomes. Nevertheless, the biological plausibility and accumulating clinical data provide strong justification.
Conclusion
Integrating exercise prescription with medication management in geriatric care represents a transformative, holistic strategy to enhance health outcomes, reduce polypharmacy, and minimize adverse drug reactions. Exercise serves both as an alternative and an adjunct to pharmacotherapy for a broad spectrum of chronic conditions typical in older adults. Implementation requires comprehensive assessments, multidisciplinary collaboration, clinician training, and patient engagement. This model promises to extend health span, improve quality of life, and reduce healthcare costs related to polypharmacy complications and disability. Future research should focus on practical guidelines for exercise integration and long-term effectiveness in diverse geriatric populations.
References
1. Izquierdo M, Ramírez-Vélez R, Fiatarone Singh MA. Integrating exercise and medication management in geriatric care: a holistic strategy to enhance health outcomes and reduce polypharmacy. Lancet Healthy Longev. 2025 Sep;6(9):100763. doi: 10.1016/j.lanhl.2025.100763.
2. Beers MH et al. Polypharmacy and older adults: principles and controversies. Journal of the American Geriatrics Society. 2016.
3. Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian Journal of Medicine & Science in Sports. 2015.
4. World Health Organization. Guidelines on physical activity and sedentary behaviour. 2020.