Exercise can be a therapeutic tool

Mikel Izquierdo is a Spanish researcher and professor in exercise science, widely recognised for his work in strength training and ageing. He gave the keynote speech at the conference Vöðvaverndardagurinn, held at RU recently and jointly hosted by the Open University and the Department of Sport Science.

Titled: When Pills Meet Physical Activity – Integrating Exercise and Deprescribing to Reduce Polypharmacy and Disability, Mikel says he would not say that medicines are the problem since they save lives. The problem, however, arises when medication becomes the only language of healthcare, especially for older adults with multimorbidity.

Many older people accumulate medications over time. Some are essential, but others may become less appropriate as health status, frailty, falls risk, blood pressure, sleep, pain, mood, or functional capacity change. The key question should not only be: “What drug can we add?” It should also be: “What is this person’s functional problem, and what combination of treatment will restore capacity?”

Mikel says, adding that this is where exercise becomes central. Exercise can improve many of the same clinical domains that medicines aim to influence, such as blood pressure, glucose control, mood, sleep, pain, balance, muscle strength, mobility, and cardiorespiratory reserve. In some patients, structured exercise may support safer deprescribing. In others, it may improve tolerance of necessary medication. In many, it reduces the need to escalate pharmacological treatment.

Exercise can be a therapeutic tool

Mikel is a professor at the University of Navarra and leads international research projects in collaboration with the European Union and the World Health Organisation. He serves as director of the E-FIT research unit at Navarrabiomed and is also a professor of sports biomechanics at the Spanish Olympic Committee’s education centre.

In addition, he has led research and sports medicine initiatives for the Navarra region and worked with Olympic champions and elite international teams, including Liverpool F.C. and FC Barcelona, contributing to the preparation of teams that went on to win European competitions and league titles.

For the past few years, his research has been focused on older adults. His interest in the field, he explains, was sparked by a simple clinical observation: many older adults do not lose independence due to a single disease. They lose independence because they lose strength, power, balance, walking capacity, and confidence.

As an independent researcher, I was fascinated by muscle physiology and human performance. Later, when working with older adults, I realised that the same physiological principles that explain elite performance also underpin independence in later life. The difference is the outcome. For an athlete, improving strength or power may decide whether to win a medal or a match. For an older person, it may determine whether they can rise from a chair, climb stairs, avoid a fall, recover after hospitalisation, or continue living at home.

He says, adding that this changed his view of exercise, seeing it not only as a behaviour or a lifestyle recommendation.

When properly prescribed, it is a therapeutic tool. It can restore capacity, protect autonomy, and build resilience. That is what brought me into this field and what still motivates me today.

He says, adding that, with his talk, he hopes to have shared a practical message with the people of Iceland: that ageing well is not only about living longer. It is about maintaining the physical capacity to continue doing what matters to people

Adding function, independence, and resilience to the later years

Iceland, like many countries, faces the challenge of an ageing population. The question, Mikel says, is not simply how to add years to life, but how to add function, independence, and resilience to those years. That requiring a shift in how we think about exercise for older adults.

My message is that strength and multicomponent exercise should not be seen as optional or secondary. They should be integral to routine prevention and care. We need to measure function, identify risk early, prescribe exercise appropriately, and create pathways so older adults can receive the right programme under the right level of supervision.

He says, adding that he also hopes to challenge a common misconception: that frailty is not an inevitable consequence of ageing. Disability is not always unavoidable. Many losses in strength, balance, and mobility can be delayed, reduced, or even reversed if we intervene early and appropriately.

So, what I hope to bring is optimism, but not vague optimism. Practical optimism grounded in science, implementation, and the belief that older adults deserve interventions that protect their independence.

He concludes.