Imagine there was a drug that would treat depression, prevent cancer, stroke and heart attack, and reduce the likelihood of diabetes and overweight… and it would be completely and entirely free and available to everyone? Get excited, because this drug has been around as long as humanity has. It is available to everyone at no cost, and even ancient philosophers such as Hippocrates, Socrates and Plato valued it highly.
“Without exercise, a good diet alone is not sufficient and eventually medical treatment will be needed” - Hippocrates
Today, 2480 years after Hippocrates, the scientific evidence and general knowledge about exercise has greatly increased, and it has only confirmed the ancient wisdom. Magazines like Forbes and the New York Times have reported on the scientific evidence on exercise using titles like “The wonder drug that’s free” and “Closest thing to a wonder drug? Try exercise”. Even the editor-in-chief of the peer-reviewed journal of the British Medical Association published her opinion on “The miracle cure”. The miracle-like properties and benefits for our body and mind of physical exercise and conditioning range from acutely improved mood and cognitive function to long-term prevention of cancer, stroke, heart disease, diabetes and other chronic disease that plague every 6 out of 10 Americans! Oh well, we should have listened to the 2480 year old wisdom.
Unfortunately, today we find our society in a global “physical inactivity pandemic”, with at least 40% of Americans not being sufficiently physically active. Check out the physical inactivity map below from the Behavioral Risk Factor Surveillance System published by the Center for Disease Control and Prevention. Americans were asked “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?”, and those who responded “No” were classified as physically inactive. Think about that – one entire month without even going out for a walk. Is it not surprising how the body and heart can even keep the blood flow intact if we spend most of our time stationary, without using our muscles to flush out the glycogen, co2, and toxins, and help our heart to pump the 1.5 gallons of blood through our body every day? It is not surprising that inactivity is linked to heart and cardiovascular disease, and stroke.
Clearly the increased prevalence and need for office and desk-jobs has increased and many of us are bound to the chair for eight hours a day to feed our families. But what about the other 8 waking hours that we have? Turns out that the most popular and loved leisure time activity above all (including active recreation!) is watching TV, according to the Bureau of Labor Statistics. In 2019, American’s watched on average 2.8 hours of TV.
Almost one decade ago, expert researchers published an article in The Lancet called a “Call to Action”. They wrote that “Physical inactivity is the fourth leading cause of death globally” – this is comparable to smoking, which is the leading cause of preventable death! One global analysis including 1.9 million participants showed a 31% increase in physical inactivity in high-income countries between 2001-2016 and put the concerning trajectory into perspective(1). Concerningly, we have had to endure the effects of another pandemic (you know ‘rona?) which led to many of us being sheltered at home. The gym is not only far away now, but also less safe than staying home, and instead of going out we are safer inside… in front of the TV?! Since the outbreak of the coronavirus, the global physical activity pandemic has been exacerbated, and those with chronic diseases have a greater likelihood of suffering severe consequences or death from the coronavirus. Chronic diseases such as chronic obstructive pulmonary disease, heart disease, diabetes, chronic kidney disease and obesity are associated with severe COVID-19-associated illness which increases the risk of these complications for 40.7% of U.S. adults.
If you are like many others you are probably scared and depressed by this point. How did this article that started with promises about a free miracle drug all of a sudden feel like a threat?! The truth is that “Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.” (Plato). Let’s focus on that last part for the rest of this article - good news! In addition to preventing horrible chronic diseases that govern the modern Western society, physical activity also has many benefits and amazing consequences that can make our life much more enjoyable by improving our mood and cognitive function immediately, and improve our ability to do all that we desire such as playing baseball or basketball with our grandchildren, or simply walking up the steps with groceries. Do you want to live without boundaries? Try exercise!
In order to reach the basic level of “protection” against chronic diseases, the last two and a half decades of research in this field have led the experts to recommend for adults to engage in at least 150 minutes of moderate-to-vigorous physical activity per week (i.e., activity when you breathe harder) and do strength training on two days per week. So, you could go on a brisk walk for 25 minutes Monday-Saturday and do some push-ups and squats for 20 minutes on two days and you are done! You can also spread out your activity with one 10 minute walk before work, and one 15 minute walk after dinner. Doesn’t sound too bad, does it? Let’s review the benefits of physical activity in some more detail.
Research on the benefits of physical activity began in the mid-1950s in London, when Jeremy Morris and colleagues studied heart disease among people with different transport-related occupations, specifically those working in the London buses (the red ones with two floors, remember?).
They found a lower risk of heart disease in the conductors, who would spend
their day running up and down the stairs to collect tickets, compared to bus drivers who spent their day being sedentary. The 1996 Surgeon General’s Report on Physical Activity and Health followed this research and was the first to report that physical activity benefits health and even less-than-vigorous activities have these benefits. In 2008, the Department of Health and Human Services (DHHS) first appointed a group of expert researchers, called the 2008 Physical Activity Guidelines Advisory Committee (PAGAC), to systematically review and summarize the scientific research of the last five decades. The 2008 PAGAC was the first to summarize the existing evidence for physical activity and health in one remarkable report. This report was updated to include the research of the most recent decade in 2018, our most recent guidelines. The 2018 PAGAC laid out guidelines for toddlers, children, adults, older adults, pregnant women, and adults with disabilities, and found (among other benefits) that physical activity is protective against 13 different cancers, and can improve brain health. The experts suggest that adults should get at least 150 minutes of moderate-to-vigorous physical activity per week (i.e., activity when you breathe harder) and do strength training on two days per week. If you follow or exceed these guidelines, you will minimize your risk of chronic diseases, and the more active you are, the lower your risk of disease! Let’s review some areas of your health that you can improve with the miracle drug as described in the most recent PAGAC report.
Brain Health in the context of the PAGAC includes cognition (e.g., memory), quality of life, affect (i.e., emotions), anxiety, depression, and sleep. Specifically, the evidence shows “a consistent association between greater amounts of physical activity and improvements in cognition, including performance on academic achievement tests; performance on neuropsychological tests, such as those involving processing speed, memory, and executive function; and risk of dementia. Such evidence has been demonstrated across numerous populations and individuals representing a gradient of normal to impaired cognitive health status. These effects are found across a variety of forms of physical activity, including aerobic activity (e.g., brisk walking), muscle-strengthening activity, yoga, and play activities (e.g., tag or other simple low organizational games).” In addition, when you engage in moderate-to-vigorous physical activity, you can gain immediate benefits for cognition, including attention, memory, crystalized intelligence, processing speed, and executive control. On the long term, the evidence demonstrates that greater amounts of physical activity are associated with a reduced risk of developing cognitive impairment, including Alzheimer’s disease. Moderate evidence indicates that moderate-to-vigorous physical activity interventions can improve cognition in individuals with dementia.
In addition to improved cognitive function, strong evidence suggests that “or the general population, greater amounts of physical activity are associated with a positive perception of quality of life.” This may be partly due to the immediate benefits on your mood, and the reduction on anxiety and depression. Yes, you read that correctly: There is strong evidence that “physical activity reduces anxiety symptoms in individuals with anxiety disorders and reduces depressive symptoms in individuals with major depression.
Being physically active can also improve sleep, and especially longer workouts and regular activity can help you to fall asleep faster, and improve insomnia or obstructive sleep apnea.
There is strong evidence that physical activity will protect you and your loved ones from bladder, breast, colon, endometrium, esophagus, renal, and gastric cancer, and there is moderate evidence that shows a protective effect against lung cancer.
Strong evidence exists that physical activity reduces blood pressure among adults with and without prehypertension, and the more your exercise and move, the lower your risk of developing high blood pressure. Another piece of great news is that there is moderate evidence that any type of physical activity (e.g., cardio, resistance training, or a mix) will improve blood pressure.
There is strong evidence that being sufficiently active (i.e., meeting the guidelines) can help you to maintain your weight, and there is also evidence to show that the more you exercise, the more likely it is that you will have a healthy weight, or slow down weight gain. Moderate evidence suggests that this benefit does not differ between men and women. So, if you are a man or a woman, get moving to maintain a healthy weight (and avoid the myriad of other conditions that can come with overweight or obesity). If you want to lose weight, being active can be an excellent addition to your diet changes and improve your metabolism.
Diabetes means that there are too many carbohydrates in our blood and muscles and our body cannot keep up metabolizing them. When you exercise and move, our muscles naturally utilize the fuel that is in the blood and stored in the muscles, so that when you go outside for a walk after eating, your blood sugar is more likely to remain stable because the carbohydrates are being used directly. It is not surprising that strong evidence exists to show that more physical activity is related to a lower chance of diabetes, and this counts for people with any weight status (i.e., normal weight, overweight or obesity). So, do what you can! As long as you move today more than you did yesterday, you are already collecting the benefits. Even if it may not be comfortable at first, it will come much easier once you have built a habit (approximately 3 weeks).
It can either be hard to go and be physically active today, or it can be hard to die early, not see your grandchildren grow up, have to manage diabetes, or not being able to move and don’t remember your family member’s names.
It is time to choose your hard.
You are still here? Great! Let’s talk about a few steps that can help you to get in the groove of an active lifestyle.
So, how active are you? Think about how you spend your day. Do you spend
most of your time sitting at work or driving? How do you spend your leisure time during the week and on the weekends? Do you watch TV, or do you go for a walk or play sports? How often are you so active that you are breathing hard? You can use this one-item questionnaire, the Stanford Leisure Time Activity Categorial Item to find out if you are meeting the physical activity guidelines.
“In every real man a child is hidden that wants to play.” - Nitzsche
Find and choose activities that are fun, that make you feel good and that make the time go by fast. What is it that makes you happy? Music, dance, yardwork, running in nature, group fitness classes, cycling, … the list of physically active leisure time activities is endless. Check out this activity planner from the “Move your Way” campaign from the National Institutes of Health. You can pick out activities that you like, add them to your week and find out how much you need to meet the physical activity guidelines. For example, a sufficiently active week could look as follows: Play an active video game on the weekend for 30 minutes, walk briskly for 15 on five days a week, spend 45 minutes gardening and weeding on one day, and take one strength class for about 20 minutes.
Prioritize your movement. Most of us are busy and have little time during the
day. But why is that? Think about what you do make time for that is not part of your career, chores or childcare. Is it your nightly TV watching routine, or maybe the time you spend in online stores? You can make time for exercise and movement by scheduling it into your day at a time that you are most likely to do it. For example, are you a night owl or an early bird? When is your best time? Complete your daily exercise, or at least some of it (e.g., a 10 minute walk!) in the first few hours of the day, or before you watch TV or do other leisure activities.
Actively seek social support. Surround yourself with those who are active, and meet up with a friend for a walk or have your spouse or children move with you. If you ask someone to help you out, they will most likely want to help out and by helping you out they also improve their own health!
Getting outside in the fresh air can be a wonderful way to exercise and strengthen your immune system and overall wellbeing and health. Have you ever come inside after spending time outside in the snow, being active or skying? You feel how the crisp air and sunshine has made your skin fresh and young, and your lungs feel clean and rejuvenated. We should listen to our founding fathers such as Thomas Jefferson:
“Not less than two hours a day should be devoted to exercise, and the weather should be little regarded. A person not sick will not be injured by getting wet. It is but taking a cold bath, which never gives a cold to any one. Brute animals are the most healthy, and they are exposed to all weather, and of men, those are healthiest who are the most exposed. The recipe of those two descriptions of beings is simple diet, exercise and the open air, be it's state what it will; and we may venture to say that this recipe will give health and vigor to every other description.” – Thomas Jefferson
In other words, get out there, get dirty, get cold, be active, and follow a simple diet with whole foods and plenty of water!
“It is a shame for a man to grow old without seeing the beauty and strength of which his body is capable.” – Socrates
Instead of seeing exercise and activity as a punishment or chore, see it as a gift. Exercise is Medicine and it will help you to become healthier and live your life to the fullest, and it is a CELEBRATION of what your body is able to do. No matter your fitness level, the fact that we can get up and do something is a gift and a miracle. Be thankful to the pile of cells that is your body for what it makes possible for you.
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