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	James L. Holly, M.D.

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Your Life Your Health - Being Healthy and never exercising? It is possible!

James L. Holly,M.D.

March 06, 2008

Your Life Your Health - The Examiner

Never, go to the gym? Never lift weights? Never jog around a track? You may be among the healthiest people in he world. 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. By 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.

In previous Your Life Your Health articles, we have established that:

Two weeks of total bed rest will deteriorate your physical conditioning more than thirty ears of aging - and we have demonstrated that it is easier to regain your conditioning after thirty years of age than it is to regain it after two weeks of bed rest.
A sedentary life style evidenced by watching more than 10 hours of television a week and/or by walking less than 10,000 steps a day, is a greater risk factor for the development of heart failure than diabetes mellitus which is by itself and independent risk factor for heart disease.
An extremely active lifestyle such as that of the Amish in Pennsylvania or the Masai in East Africa can overcome the side effects of a diet high in saturated animal fat and a high calorie diet.
However, even the beneficial effects of an active lifestyle can be overcome by smoking, excessive alcohol use, stress

The problem for most of us is that our jobs do not require physical exertion Therefore, we spend most of our day accumulating "inactive hours" which requires us to pack our physician exertion into a short period of time at gyms, on tracks, or in other structured exercise programs in order to be healthy.

Total Energy Expenditure (TEE)

If you want to understand why you gain weight or how you can lose weight, you must have an approximation of your TEE. Your daily "Total Energy Expenditure" (TEE) is a combination of three things:

Digestion of Food (Thermogenic Rate) 10% -- this is the energy required to process the food which you eat.
Physical Activity (Active Metabolic Rate) 20% -- this is the energy which is consumed by the activities in which you engage each day. We will look at some of the common activities and their contribution to your TEE later in this article.
Energy for basic body processes (Basal Metabolic Rate) 70% -- this is the energy which you consult just by living and breathing. This is what you would consume if you just sat all day.

Thermogenic Rate

Your thermogenic rate is a fairly fixed number based on the amount of food you eat each day. Because the figures we use in clinical practice to estimate your caloric needs are a rough approximation, it is not unwise simply to ignore the thermogenic rate and let that "make up" for our usual underestimation of how much we eat and for our usual over estimation of how much exercise or work we do. There is, however, one absolute way of knowing whether you are exceeding your total energy expenditure in what you eat. If you are gaining weight, you are eating too much. If you are losing weight, you are eating less than your TEE. There is no magic here; you can know for sure.

BMR

The 60-70% of energy which is used each day with your BMR is the surprising number for most of us because we burn that much energy every day by doing absolutely nothing. SETMA’s electronic medical record uses the Harris-Benedict Equation to calculate the BMR (Basal or Resting Metabolic Rate) which is he way it has been done since 1919. Researchers today say that this equation is not entirely accurate. Every person has so many variables to consider, such as ratio of fat to lean muscle mass, genetics, activity level, menopause and many other things. Although it isn’t perfect, it is a good tool in helping to understand how much energy we need to consume and burn.

Calculating Your BMR:

Women: BMR = 655 + ( 4.35 x weight in pounds ) + ( 4.7 x height in inches) - ( 4.7 x age in years)
Men: BMR = 66 + ( 6.23 x weight in pounds ) + ( 12.7 x height in inches ) - ( 6.8 x age in year )

As you can see the variables which are directly used to calculate your BMR are weight, height, gender and age. If you have calculated this number, you now know approximately how much your energy your body requires just for basic life processes. These are the functioning of your organs such as brain, kidneys, liver etc.

Some of the factors which affect your BMR are:

Age: In youth, the BMR is higher; age brings less lean body mass and slows the BMR.
Height: Tall, thin people have higher BMR's.
Growth: Children and pregnant women have higher BMR's.
Body Composition: The more lean tissue, the higher the BMR. The more fat tissue, the lower the BMR.
Fever: Fevers can raise the BMR.
Stress: Stress hormones can raise the BMR.
Environmental Temperature: Both the heat and cold raise the BMR.
Fasting/Starvation: Fasting/starvation hormones lower the BMR.
Malnutrition: Malnutrition lowers the BMR.
Thyroxin: The thyroid hormone thyroxin is a key BMR regulator; the more thyroxin produced, the higher the BMR. Some weight loss clinics will give a patient extra thyroid in order to boast their BMR. This is not safe and can cause long-term health problems. You should never take more thyroid than you need; even our thyroid function is low.

Active Metabolic Rate (AMR):

Now, you can determine your Active Metabolic Rate (AMR) which is your BMR or resting rate plus the amount of energy you require for the level of physical activity you exert on a typical day. You multiply the BMR number you calculated above times the number below which represents your typical level of activity. In calculating your AMR, you multiple b your BMR according to this formula::

If you are sedentary (little or no exercise): Multiply BMR x 1.2
If you are lightly active (light exercise/work 1-3 days per week): Multiply BMR x 1.375
If you are moderately active (moderate exercise/work 3-5 days per week): Multiply BMR x 1.55
If you are very active (hard exercise/work 6-7 days a week): Multiply BMR x 1.725
If you are extra active (very hard exercise/work 6-7 days a week): Multiply BMR x 1.9

Activities which contribute to your AMR

In 2004, the International Journal of Behavioral Nutrition and Physical Activity published a review article which detailed the activities which contributed to your total daily energy expenditure. This data was developed through the National Human Activity Pattern Survey.

The survey included a 24-hour recall of daily activities for 9386 participants. All activities (or non-activities, including sleeping) over a 24-hour period were reported. This methodology is analogous to 24-hour dietary recalls used by national surveys of dietary intake [5]. Without prompting about the nature of the activities, respondents were asked to start with the time of arising on the previous day, and to describe everything they did and the time spent doing it - for example, "8:00-8:20, getting dressed; 8:20-8:30, eating breakfast." Activities were recorded in the respondents' own words, and recoded later by the authors. In addition to the identification of the specific physical activity, information on location and duration of the activity was obtained.

The study ranked 87 different activities and measured their contribution to a person’s Active Metabolic Rate. In the table below one MET (metabolic equivalent tasks) is the energy expenditure and caloric requirement at rest. Mild exercise such as walking at a leisurely pace increases energy expenditure to perhaps 2.5 METs/hour of walking. Vigorous activity can result in 6 to more than 12 METs/hour of activity.

While it is seen that structured physical activity can contribute more "METs" to your Active Metabolic Rate per hour, the number of hours spent each day in other activities shows why an active life style outstrips structured exercise in contributing to your AMR.

As you can change yur BMR by losing fat and gaining muscle, you can change your AMR by changing your daily habits, i.e., less time sitting and more time being active.

Full list ranking activities performed by subjects in the NHAPS study, 1992-1994

Rank		Activity Description	MET			Percent Total Score			Cumulative Percentage (%)		Average Duration (min)		Number of Subjects
(1)		Sleeping, napping	0.9			(19.06)			--		501		7493
1		Driving car	2.3			10.90			10.90		101		6574
2		Job: Office work, typing	1.5			9.24			20.13		415		2094
3		Watching TV/movie, home or theater	1.0			8.65			28.78		216		5919
4		Taking care of child/baby (feeding, bathing, dressing)	3.0			8.38			37.16		60		6545
5		Activities performed while sitting or lying quietly, little movement	1.3			5.78			42.94		158		4086
6			1.5			5.30			48.24		76		6843
7		Cleaning house, general	3.0			3.93			52.18		126		1489
8		Talking/ Visiting, in person or on phone	1.5			3.78			55.96		132		2858
9		Job: Industrial plant/factory (e.g. assembly line)	3.0			3.78			59.73		490		333
10		Food preparation (cooking, baking, setting table, etc.)	2.0			2.93			62.67		53		3996
11		Job: Construction site	5.5			2.76			65.43		500		119
12		Job: Light intensity, stand/walking (e.g. hospital staff, real estate inspector)	3.0			2.67			68.10		464		291
13		Yard work-general: mowing lawn, trimming hedges	4.3			2.63			70.73		147		559
14		Attending event (social) talking while sitting	1.6			2.22			72.95		142		1499
15		Shopping for non-foods (e.g. clothing)	2.3			2.07			75.02		97		1408
16		Job: Store clerk, bartender, hair stylist (light standing)	2.0			1.83			76.85		429		289
17		Job: Farm hand (chores: baling hay, cleaning barn)	8.0			1.55			78.40		417		57
18		Job: Restaurant staff (e.g. waiter, chef)	3.0			1.48			79.87		433		129
19		Job: Teaching class	1.8			1.09			80.96		417		195
20		Laundry	2.2			1.07			82.03		83		863
21		Walking, moderately, doing errands, walking to school)	2.8			1.03			83.06		79		716
22		Fishing and Hunting	3.3			0.93			83.99		294		103
23		Cleaning kitchen (sweeping)	3.3			0.88			84.87		54		689
24		Shopping for food, putting groceries away	2.4			0.86			85.73		47		1125
25		Swimming, exercise	7.0			0.83			86.56		121		96
26		Job: Mechanic	3.0			0.70			87.26		427		56
27		Gardening: Weeding, landscaping, picking vegetables	3.7			0.65			87.91		121		198
28		Remodeling, repairing house, workshop, concrete work	3.6			0.61			88.52		222		123
29	Exercise, aerobics				6.5			0.59		89.11		58		248
30					2.7			0.58		89.69		354		88
31	Dancing/ Heavy Partying				4.0			0.56		90.25		166		122
32	Moving, packing items				3.5			0.53		90.78		73		318
33	Sports: Golf				4.5			0.48		91.26		228		63
34	Playing with children, baby				2.8			0.47		91.73		107		173
35	Household chores, light cleaning				2.3			0.44		92.17		91		330
36	Caring for another person				4.0			0.43		92.59		89		162
37	Home projects (sewing, wrapping presents, arts and crafts)				1.5			0.42		93.01		172		259
38	Exercise at gym (e.g. Stairmaster, bike, treadmill)				7.2			0.40		93.42		85		103
39	Yard work-hard: chopping wood digging, shoveling snow)				6.0			0.39		93.80		120		88
40	Job: Feeding/ Working with livestock				4.0			0.38		94.17		80		131
41	Pet care: Walking, Playing, Cleaning, Feeding				2.7			0.35		94.53		39		576
42	Car maintenance, repair				3.3			0.35		94.88		169		91
43	Washing dishes/loading dishwasher				2.3			0.35		95.22		27		808
44	Game, board or cards, bingo, crosswords				1.5			0.32		95.55		150		223
45	Painting walls				4.5			0.27		95.82		229		36
46	Playing outdoors with others				4.0			0.26		96.08		116		57
47	Working in garage, general maintenance on items				3.0			0.20		96.28		145		52
48	Sports: Basketball				6.0			0.20		96.48		133		37
49	Other moderate recreational sports				6.6			0.18		96.65		118		22
50	Bike riding				8.0			0.17		96.83		95		31
51	Job: Packing, moving boxes				8.0			0.17		96.99		141		18
52	Volunteer work, unspecified				3.0			0.17		97.16		217		29
53	Other light recreational sports				3.5			0.15		97.31		122		54
54	Personal grooming (e.g. shaving, showering, brushing teeth)/ Dressing (sit/stand)				1.7			0.15		97.46		15		851
55	Jogging, exercise				7.0			0.14		97.60		53		57
56	Other heavy sports/exercise				9.7			0.14		97.74		131		14
57	Running, exercise				8.0			0.12		97.86		76		20
58	Sports: Baseball/Softball				5.0			0.12		97.97		133		22
59	Sports: Bowling				3.0			0.11		98.09		139		33
60	Hiking, exercise				6.0			0.11		98.20		214		14
61	Car washing				4.5			0.11		98.31		69		57
62	Waiting, standing				1.2			0.11		98.42		30		465
63	Game, video or computer				1.5			0.10		98.52		138		76

64	Ironing			2.3			0.10			98.63		54		125
65	Playing a musical instrument			2.5			0.10			98.73		106		51
66	Sports: Tennis			7.0			0.10			98.84		122		23
67	Sports: Darts, Billiards/ Pool			2.5			0.10			98.93		165		29
68	Job: Painting			4.5			0.09			99.03		272		13
69	Lawn care: Watering, seeding, fertilizing			2.1			0.09			99.12		64		109
70	Sports: Soccer			7.0			0.09			99.21		115		12
71	Carpentry work			3.0			0.09			99.30		173		30
72	Art and Theater: Directing, Acting, Painting, Drawing, Ceramics			2.2			0.08			99.38		213		34
73	Getting ready to leave (organizing)			3.0			0.07			99.45		29		122
74	Electrical Work			3.0			0.07			99.51		79		32
75	Job: High intensity, implied manual work (e.g. firefighter, oil well work)			10.5			0.06			99.58		83		10
76	Cleaning outside/ basement, heavy			3.0			0.06			99.64		125		29
77	Plumbing			3.0			0.06			99.69		204		18
78	Exercise, weight lifting			6.0			0.05			99.75		72		21
79	Job: Daycare			3.0			0.05			99.80		249		12
80	Walking, exercise			4.0			0.05			99.85		48		38
81	Yoga, Physical therapy			2.5			0.04			99.89		82		23
82	Choir Rehearsal, singing			2.0			0.03			99.92		95		20
83	Moving large items (furniture)			6.0			0.02			99.94		86		10
84	Sexual activity			1.3			0.02			99.96		93		31
85	Pumping gas			2.0			0.02			99.97		11		134
86	Flying airplane			2.0			0.01			99.99		236		5
87	Lighting fire, furnace			2.5			0.01			100.00		24		39

Improving your health will involve losing weight and exercise. Both will involve eating less and being more active. Being active involves much more than going to the gym. Remember, it is your life and it is your health.

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