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In a world obsessed with finding a silver bullet for health and wellness, there’s been one under our noses this whole time. No, not GLP-1s — it’s exercise.
Doctors have known for centuries how good physical activity is for nearly every aspect of physical and mental health. The problem is, it’s a lot harder to get people to be active than it is to prescribe a pill or get a shot.
Now, that is starting to change. Cindy Lin, MD, clinical professor of sports and spine medicine at the UW School of Medicine and director of the Sports Institute at UW Medicine, has been leading a collaboration between the Sports Institute, the UW Ubicomp Lab in the Paul G. Allen School of Computer Science and Engineering, and UW’s Department of Human Centered Design and Engineering to develop an app called ExerciseRx that allows doctors to give patients exercise goals and track their progress. It’s being researched across a variety of patient populations as a way to recommend exercise at scale.
Why is exercise so important?
Exercise is a crucial way to prevent and manage many of the most common chronic diseases in our society.
“People call physical activity ‘the magic pill,’” says Lin. “We know that it reduces the risk of over a dozen types of cancers; we know that it’s important in preventing and treating diabetes, high blood pressure and obesity.”
Exercise helps you maintain a healthy weight, regulates blood sugar and insulin levels, reduces chronic pain, and strengthens your bones and muscles. It also improves your mood and decreases your risk for depression. And it plays an important role in your brain health, reducing the risk of certain neurological disorders and dementia.
Exercise is indeed medicine for nearly every aspect of human health, but it continues to prove extremely difficult to get people to stay active.
“We know that the average American sits over seven hours a day now; we didn’t evolve to be this sedentary,” says Lin.
But instead of tackling the root cause — inactivity — the U.S. health system spends billions treating diseases caused by inactivity. Lin and her collaborators wanted to flip that.
An app that allows doctors to set exercise goals for patients
Lin herself has had many patients over the years with multiple chronic conditions, like diabetes and arthritis, who knew they needed to be more active but still struggled to get enough exercise. They worked long hours, had family responsibilities or couldn’t afford a gym membership.
“I had a patient come to me once, and she was like, ‘I know I need to get off the sofa after work, can you just message me or call me? I swear I’ll do it then,’” Lin says.
This inspired Lin to come up with an idea for a digital health tool that could do something similar: allow doctors to give patients personalized exercise goals and follow how they do.
As director of the Sports Institute, which translates research into scalable ways to improve safety and participation in sports exercise, she was in the perfect place to make it happen at UW. In 2019, the Sports Institute connected with computer science colleagues at UW’s Ubicomp Lab, and they began working together on what would become the ExerciseRx platform.
The app is free and works on any iPhone or Android, though you currently need to be enrolled in a clinical trial to use it. You don’t need a wearable device, though the app can be synced with one. Once it’s set up on your phone, it provides step-count goals, at-home exercises — like squats and lunges — or both. You can get motivational nudges and messages from your care team, and they can see if you are meeting your goals and adjust them based on your abilities. The ExerciseRx research team is also evaluating using AI to recommend and progress exercises.
The ExerciseRx app interface © UW Medicine
“Because the provider can see their step count, patients are like, ‘Oh geez, now my diabetes doctor or weight management doctor can see how much I’m moving,’” says Lin. “So they’re more motivated to fit in movement. Once it becomes a habit to move regularly, it becomes sticky.”
Now the app is being used in clinical trials for a variety of patient populations, from those going through cancer treatment to people with chronic diseases like multiple sclerosis and axial spondyloarthritis.
An ExerciseRx trial with bladder cancer patients
In October 2023, Larry Dodge visited his primary care doctor after experiencing a burning sensation while urinating. Dodge is a retired architect who lives on Whidbey Island, about two hours north of Seattle. He thought maybe he had an infection and would just need to take some antibiotics to take care of it.
Instead, his doctor detected microscopic amounts of blood in his urine, and further testing found cancer in his bladder.
“That was not good news,” says Dodge. “I went home, told my wife, and we started looking at what our options were.”
He asked for a referral to UW Medicine’s urology department. He had his first appointment on his 72nd birthday with Claire de la Calle, MD, a researcher and surgeon in the Urology Clinic at UW Medical Center – Montlake.
After less invasive treatments didn’t get all the cancer, Dodge decided to get chemotherapy and his bladder removed, the only way to eliminate it 100%.
While he was undergoing chemotherapy, he was contacted by a UW Medicine research team led by Lin; urologist Sarah Psutka, MD; and Hanna Hunter, MD, a physical medicine and rehabilitation physician. They were conducting a trial with the ExerciseRx app for cancer patients undergoing bladder surgery; the goal was to evaluate an approach called “prehabilitation” — getting patients into the best possible physical condition before surgery to speed recovery and reduce the need for “rehab” afterward.
“Our hope is that if we can get patients to a better functional fitness level before a big stressor like surgery, then we can improve overall outcomes,” says Hunter, who specializes in cancer rehabilitation.
Participants in the trial’s intervention group are given the app, and Hunter and her team tailor exercises for them to do during the weeks before the surgery to improve strength in their hips, legs and core, without needing a personal trainer or physical therapist. After surgery, they continue the exercises for about three months with the goal of helping them recover their physical function more quickly. Meanwhile, a control group goes through surgery with standard education about activity.
Dodge had been an active person — his several dogs would “take him for walks” on Whidbey Island every day. But chemotherapy was sapping his energy. The app sounded like a good way to motivate him to keep exercising. So the study team created a plan for him that involved different resistance-band and body-weight exercises. The app on his phone would show him how to do the exercises and record his repetitions.
Larry Dodge and his dogs, Sophia, Oakley and Lucy © Courtesy Larry Dodge
“I found the exercises to be fun,” he says. “I didn’t have to do anything but turn my phone on, and knowing I was being monitored gave me incentive to keep doing them.”
A month later, about a year after his diagnosis, he had his bladder surgery — once again right around his birthday.
“Before they put me under, I thanked all the people in the room and told them this is the best birthday present I’ve ever received,” he says.
When he came to the next morning, he found himself in a hospital room with a catheter and other tubes hooked up to him. Later that day, his nurses asked him to try getting up and walking around the floor. To his surprise, he felt no abdominal pain or discomfort as he got out of bed. After two laps supported by a nurse, he had done so well that they told him he could continue going on walks all by himself — something he didn’t expect to be able to do for at least a couple of days.
“I think part of that was because ExerciseRx helped tone the muscles I was going to need to use after surgery, and part of that was because of my physical condition from giving my dogs exercise,” he says. “I highly recommend using the app and also getting a dog from your local shelter.”
Today, he is cancer-free, and while the bladder removal has required some lifestyle adjustments, he has resumed the traveling and dog walking that he thought cancer might take away from him.
The trial is still enrolling patients, and Psutka, Lin, Hunter and the rest of their team also received the Andy Hill Cancer Research Endowment (CARE) Fund grant to use the ExerciseRx platform to study this at-home physical activity intervention with non-muscle invasive bladder cancer survivors after their treatment is done. A major study published last year found that exercise reduced the risk of cancer coming back in colon cancer patients by nearly 30%.
Using ExerciseRx for chronic conditions
Lin and her colleagues are also using the ExerciseRx app to study chronic conditions, including multiple sclerosis, an autoimmune disease that attacks the central nervous system.
“There is just a huge body of work suggesting that physical activity is helpful for a wide variety of the symptoms most prevalent in people with MS, including fatigue and chronic pain,” says Sarah Simmons, MD, PhD, a physical medicine and rehabilitation researcher and doctor at UW Medicine, who specializes in MS.
Simmons is a coinvestigator on another trial using the ExerciseRx platform, this one using it to promote physical activity in MS patients. The trial is funded by the National Multiple Sclerosis Society and led by Dawn Ehde, PhD, a clinical psychologist and professor in UW School of Medicine’s Department of Rehabilitation Medicine. Participants are given step counts through the app and receive the same nudges and gradually increasing goals.
One of Simmons’s patients, who wished not to be named, knew that exercise helped with her MS symptoms, including pain, fatigue and muscle stiffness. When she was first diagnosed, 20 years ago, she lost her ability to walk unaided. She was able to regain her balance and mobility and manage her other symptoms with exercise, as well as medications, acupuncture, massage and physical therapy. But in January 2025, she started a new job with a demanding schedule, making it hard to exercise consistently. She told Simmons she was in a rut, and Simmons suggested considering the ExerciseRx trial.
Having clear daily and weekly step goals helped her get back to walking almost immediately.
“I needed accountability, and as soon as I had someone ‘monitoring’ my progress, I started really caring about my daily step count,” says the patient. “In addition to walking outside and on the treadmill, I tried to find ways to add more steps into my day, like walking around my office building.”
When she started the trial, her daily step count was less than 2,000. By the end of the trial, it was up to 10,000. After the trial, it dipped back down to a more sustainable 8,000 steps, but the increased stamina, as well as better balance and reflexes, persisted. Staying active and feeling like she’s taking charge of her health has also helped with her anxiety.
The future of the ExerciseRx platform
Lin hopes to continue finding ways to expand ExerciseRx platform, so it’s available to more patients.
“I’m a sports medicine doctor, so I’ve always been passionate about getting people active,” she says. “We want to help solve it in healthcare so it’s affordable, accessible, and can get to patients, and it is not something that just lives in the research world.”
Lin hopes that the funding cuts that researchers in the U.S. have experienced in the last year won’t affect progress on this goal. She points out that the work being done at UW Medicine with the ExerciseRx app is already accomplishing what the current Department of Health and Human Services has called for — addressing the environmental and behavioral drivers of chronic disease.
“We have to invest in physical activity research because we know how important it is to health,” she says.
