March 29, 2017
Very few physicians talk to patients about exercise other than to say its good for you. I like to put much more focus on exercise with my patients and educate them at the same time. There are health consequences when we don’t exercise.
If health is what we want then exercise definitely plays a role. Looking at health as the opposite of disease means that exercise should be a part of any discussion with your physician. There are many studies that now show the health benefits of a regular routine of exercise.
First let’s look at the negative side. The Grim Reaper Study looked at men as they age and correlated their risk of dying. The risk was significantly increased if a patient could not walk faster than 2 miles per hour. Another way to look at it is this statement: Low fitness is the strongest predictor of death. The highest risk seems to be in patients who are not exercising and who are obese. So we see a new modern age disease developing here in the U.S. and it is called “sitting disease”. So sitting and sleeping with no movement during the day significantly increases your risk for chronic health issues. The best challenge I offer patients is — “can you limit your sitting and sleeping to just 23 and one half hours a day?” A good anecdote for sitting disease is an exercise prescription and here is the dosing formula — for every one hour of sitting, do 3+ minutes of walking.
Watching TV and sitting is now a chronic disease with serious health consequences and some researchers have even tried to quantify the risk by estimating that watching TV 6 plus hours daily will lessen your life span by about 5 years.
I like to recommend we start by just walking. No need to get a gym membership, just get comfortable sneakers on and just get outside and walk. There is great health benefits by just walking. There is a study where the goal in this research was to determine which form of activity would help men decrease abdominal girth — in other words trim up the belly. In this study there were three study groups. One group were runners, another group did sit ups and the third group walked. Guess which group had a trimmer belly? The walkers.
I am not that big of a fan of fitness trackers but do own and use a Fitbit devise and personally have found it interesting that it does somewhat motivate me to meet a goal. I do like to advocate we all get 10,000+ steps in daily and now research is even showing benefits up to 15,000+ per day. This next fact tends to motivate older men. It was found that men had better erections when they moved more — simply walking 21 miles per week improved erectile function.
In another English study, workers on a transit system were studied and they found that the drivers, those men who sat most of their shift, had more risk of cardiovascular disease. The other group were the workers who moved — they walked up and down the aisles collecting tickets, etc — they were less likely to develop serious illnesses.
In order to summarize and quantify the benefits of exercise and activity, I like to say that,”the best medical intervention which will make the biggest difference in your health is activity/ exercise”. There appears to be a broad benefit for so many health issues and here are some examples:
— Knee arthritis pain and disability is decreased 47% (1 hour 3 times weekly)
— Dementia and Alzheimers progression decreased by 50%
— Patients at high risk for diabetes reduced developing full-blown diabetes by 58%
— Menopausal women decrease risk for hip fracture by 41%
— Anxiety decreases by 48%
— Depression decreases by 30% (and maybe even to 40% with more activity)
— Overall risk of death decreases by 23%
— Exercise is without a doubt the number one medical intervention for combatting fatigue and for improving overall quality of life
So, which exercise is best? For health, it looks like any activity that makes you sweat and that gets your heart rate elevated is of great benefit. And making that commitment to doing it 30-40 minutes daily. The general formula for heart rate increase is 220 minus your age and this is your maximum heart rate. It is best to elevate your heart rate to 60-70% of your maximum heart rate.
Some newer studies show that high intensity interval training (HIIT) reverses many age-related issues. Researchers compared resistance training, HIIT aerobic interval training and both combined. All three activities improved a persons lean body mass but at the cellular level, the group participating in HIIT also saw improvements in the exercise capacity of their muscle’s mitochondria (the cells energy producing “factories”). So when researchers looked at the cellular level, the changes they saw in older people’s cells with HIIT made those cells look more like younger people’s cells in terms of how they handled energy.
Any exercise can be done using high intensity. I personally like to swim laps. So to warm up, I swim several laps comfortably. I usually swim 2-3 laps at a “normal” speed” and then every 3rd or 4th lap I swim “all-out” as if being chased by an alligator. If you are walking you would walk 1- 3 minutes at a comfortably brisk rate and then do 30 seconds of a really fast rate. The same would be true if using any gym devise — such as a stairclimber, cycle, treadmill or rower — just use 30 -60 seconds of all out activity in intervals and keep it up for 30- 40 minutes.
Doctors need to educate patients about the disease risk when we are sedentary and offer healthy exercise prescriptions. Remember the saying — “use it or lose it? — or stated differently move it or lose it. Staying fit and active with daily exercise can improve your quality of life and possibly extend your life.
Don Fisher D.O.
Medical Director/ Physician
The BEST Program, Inc.