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James L. Holly, M.D. |
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| James L. Holly,M.D. |
| October 15, 2009 |
| Your Life Your Health - The Examiner |
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Our series entitled, "You can get there but you have to walk," has attracted a significant amount of attention. How do you avoid Alzheimer's? You can't know for sure that you will but staying physically active will help a great deal. How do you deal with your genetic potential for all diseases? You can't be sure that you will avoid all of them but staying physically active will help a great deal. How will you avoid the same chronic, debilitating illnesses which affected your parents or siblings? You can't be sure that you will avoid all of them but staying physically active will help a great deal.
Exercise versus Cardiac Stent
And if avoiding genetically-linked, potential illnesses is not enough motivation to exercise, in September the 2009 European Congress of Cardiology heard a report asking the question, "What If Regular Exercise Were as Good as a Stent for Stable Angina?" Here is the situation. A patient has chest pain because they have heart disease; this is called "angina". There are different types of angina, the two most common are:
- "Chronic Stable angina" is the most common form of chest pain caused by decreased blood supply to the heart. Usually a person can predict what activity will cause angina and the pain is relieved by rest or with angina medication.
- "Unstable angina, unalike stable angina, does not follow a predictable pattern. It can occur with strenuous activity or at rest and it is not always relieved with medication. It is a serious condition and may indicate an impending heart attack.
The congress heard a report on a study which documented that twelve months of exercise training was just as good as cardiac stenting for increasing the blood supply to the heart and for symptom relief in patients with chronic stable angina. Exercise was even better than stenting in preventing cardiovascular events, such as heart attacks. The initial study was stopped because of lack of patient participation.
Forces work against exercise - Implications for Healthcare Reform
The researchers told the Congress that there are multiple forces working against a scenario in which regular exercise is prescribed instead of stenting. For one, patients are not motivated to take responsibility for improving their own cardiovascular health--even if it means better event-free survival. For another, encouraging exercising is financially less appealing to institutions who derive revenue from PCI procedures.
As an aside, in the great "healthcare reform debate" taking place in the United States today, this is a key element. There are cost effective means and methods for restoring health but they require patience, participation and persistence by patients. Often patients prefer expensive and potentially hazardous procedures or surgeries to their taking responsibility for their own health. Ultimately, this is fact alone will be the causative factor in the government taking control for healthcare in America.
If you have heart disease, do you want to avoid dying from a heart attack? You can! You can get to where you want to be, but you'll have to walk.
Nothing New
Five years ago, we saw a new advertisement presented by McDonald's. It was not only politically correct, but was commercially necessary. What was it? Exercise!!! McDonald's, that paradigm of fast, fatty food which contributes to people being fat and sedentary, got the message. Their d started with a lady telling her dog to go get the paper. The dog dashed through the pet entrance in the door and grabbed the newspaper. He then took it to the end of the drive. The master then walked out to the end of the drive and with a big smile picks up the newspaper and checked her pedometer given to her in an adult happy meal at MacDonald's. The extra steps were part of the MacDonald's health sensitive initiative to sell salads and low fat, low calorie fare on its menu. The ad concludes with the command, "Go get the mail."
Artificial Exercise - Exercise not Generated by Lifestyle - Creates a Need
If you never, go to the gym? Never lift weights? Never jog around a track? You may be among the healthiest people in the world. The reason is that the healthiest people in the world as a result of physical activity are people who have never and would never go to a gym but who because of their life style are very active. My father was a great example. In his entire life, he never "exercised." He never went to a gym or lifted weights, but his job had him walking long distances, lifting heavy objects and staying active. And, then when he finished his work day, he continued gardening or working in the yard or doing other tasks which required physical exertion. As a result, he was never overweight, never modified his diet, never had diabetes, hypertension or other diseases associated with a sedentary lifestyle.
Gyms and tracks and weights and structure exercise are not a part of nature's design. They are the result of our distortion of nature's design. They are a result of the change in our life styles which we associate with progress but which often result in the deterioration of our health.
The Amish
Americans now realize that all of our conveniences, which were intended to make us enjoy life more, are in fact squeezing the very breath of life out of us. In 2004, a case study was published on how to correct this problem. There is a group of people whose life styles give insight into what has been lost by most Americans. It is the Amish.
The Amish reject modern conveniences. They don't use telephones or computers and they don't use automobiles; they walk. And, how they walk! They don't go to the track, or to the gym. They don't log their miles, or pace. They don't use heart rate monitors. They don't exercise as a discipline. But, boy, do they walk!
A study of Amish men and women was published in the journal Medicine and Science and Exercise in January, 2004. The result of a project at the University of Tennessee, the study documented that Amish men are six times more active than the average American. While the average American takes 2-3,000 steps a day; Amish men take an average of 18,425 steps a day and Amish women take an average of 14,196 steps a day. One Amish man took over 51,000 steps in a day, which is equivalent to walking 25 miles.
The study documented that in a week Amish men perform:
- 10 hours of vigorous physical activity (tossing bales of hay, shoveling, digging and plowing)
- 43 hours of moderate activity (gardening, feeding animals)
- 12 hours of walking
Amish women weekly perform:
1. - 3.5 hours of vigorous physical activity
2. - 39 hours of moderate activity
3. - 6 hours of walking
What is the result? The Amish have a 4% incidence of obesity and 26% were overweight as opposed to a 31% obesity and 64% overweight in the general American population. And, this is in spite of the very high-calorie, high-fat-content diet which the Amish typically consume.
The Amish finding falls in line with a theory espoused by University of Wisconsin professor William Morgan who stresses the need for purposeful activity in exercise. Mr. Morgan calls for a shift in physical activity, criticizing the current trend of peddling treadmills to nowhere. He says that when people exercise for a purpose, there is higher adherence to an exercise program. Purposeful activity includes mowing the lawn, cleaning the house, or even walking the dog. The Amish have that skill down pat. The cows have to be milked. You can't say, It's rainy; I'm going to skip today.
Activities of Daily Living and Exercise
Can something as simply as walking further to get the mail or the newspaper make a difference in your health? Absolutely! In another study published in the May, 2004 issue of Medicine & Science and Exercise, the official journal of the American College of Sports Medicine, it was reported that middle-aged women who took at least 10,000 steps per day on average were much more likely to fall into recommended ranges for measures of body composition such as total body weight and body fat percentage. Conversely, inactive women those taking fewer than 6,000 steps per day were more likely to be overweight or obese and have higher waist circumferences, a strong predictor of increased risk of cardiovascular disease.
In the study, eighty women between the ages of 40 and 66 were first weighed and measured, then instructed to wear pedometers for one week and log the number of steps taken each day. They were asked to follow their typical work and leisure routines during the one-week period.
Researchers classified the participants into groups of:
- Inactive (6,000 or fewer average daily steps),
- Somewhat active (6,000 to 9,999) and
- Active (10,000 or more)
They then analyzed body mass index (BMI), body fat, and waist and hip circumference. The study showed a significant inverse correlation between average steps and each of these measurements. On average, those in the active category had only 26 percent body fat and were within the recommended BMI range while those in the inactive group had a body fat percentage of 44 percent and fell well into the overweight category for BMI.
Researchers point out the public health implications of the evidence, particularly the apparent benefit of accumulating steps throughout the day. Although dietary intake is of equal importance, the investigators suggest that this evidence may eventually lead to the establishment of a standard volume of daily walking for middle-aged women that may help to prevent unhealthy weight gain.
How much exercise is enough
Current physical activity guidelines from the ACSM and the Centers for Disease Control and Prevention call for adults to accumulate 30 minutes of moderate intensity activity on all or most days of the week. Walking is frequently recommended as a key strategy to help achieve that goal. "Considering that middle-aged and older women are much more likely to choose walking as their leisure-time activity, the results of this study tell us that increases in walking and steps per day may be an effective strategy to help achieve proper weight and good health, said Thompson. These step recommendations are not complicated by heart rate monitors or by stop watches or distance measurements. They are simply a means of documenting that you are moving.
Active Living Partners Program
One major effort at helping people incorporate an active lifestyle into their future health plans is the Active Living Partners (ALP) program developed by Human Kinetics and The Cooper Institute. ALP's mission is to help sedentary adults adopt and maintain physically active lifestyles. The program is based on research showing that moderate physical activity improves health; the program also shows that people can be successful in becoming and staying physically active if taught appropriate lifestyle skills such as addressing and overcoming barriers to physical activity, setting realistic goals, and developing social support systems.
ALP pursues its mission by pursuing the two goals:
- Create and disseminate a realistic, practical, and research-proven program that teaches people the skills they need to successfully adopt and maintain a physically active lifestyle.
- Develop and support a network of outstanding health and fitness professionals to implement Active Living programs in their communities and maintain physically active lifestyles.
ALP's philosophy is based on three principles:
- Moderate amounts and intensities of physical activity result in significant health benefits.
- Lifestyle physical activity provides an important alternative for people who cannot fit traditional fitness center-based exercise into their daily lives.
- People are more likely to become and stay physically active when taught appropriate lifestyle skills that are based on their individual readiness to change their behavior.
Another program which is coming to Southeast Texas in January is entitled Nifty after Fifty. It is associated with Select Care of Texas' Texan Plus HMO and will provide exercise training - without cost - to Texas Plus members. Research indicates that the only thing which consistently lowers healthcare cost and increases both health and quality of life is consistent exercise.
Treatment of every disease known to man
The treatment for virtually every treatment known to man, including diabetes, heart disease, respiratory disease, cholesterol, etc., begins with activity. The reality is that the causes of all of these diseases can be traced directly or indirectly to sedentary life styles.
Do you recall the introduction to the February 26, 2004, Your Life Your Health column entitled, "The Consequences of being a couch potato?" No? Here it is:
Question: Which will do more for the improvement of your health? Visiting the doctor or visiting the gym?
Question: Which will do more for the improvement of your health? Taking a pill or taking a walk?
Question: What can medicines do to help you avoid the consequences of your inactive lifestyle? The answer: nothing!
You can get to better health no matter how poor your health is at present, but you'll have to walk to get there
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