“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” - Hippocrates
Many years ago, one of my clients gave me a book published in 1929 about the benefits of exercise. Written by C. Ward Crampton, M.D., Physical Exercise for Daily Use was written for practicing physicians with the goal of encouraging people to exercise regularly. In the Foreword, the author calls upon his fellow physicians to take on the “new field” of exercise, becoming “Health Doctors” for the new era of “Constructive Health”. His book sets forth exercise guidelines designed to help “men be capable of living 100% lives”. He tasks practitioners with prescribing exercise for all patients, teaching “…men, women, and children how to live so that they will get the better things into their lives and possess Good Health in Great Abundance.”
From the tone of this book, it seems that even in 1929 the American public needed inspiration to get moving. Fast forward almost 100 years and you’ll find that, even though most of us know that exercise is good for our health, only one fourth of the population gets the bare minimum—150 minutes per week. As a nation we remain sedentary, even though, in the past century, studies in exercise physiology continue to outline in detail exactly how certain types of movements support the healthy functioning of our body. Even with all this knowledge, as a nation, we sit, still far from the reach of the “Good Health in Great Abundance” proposed by Dr. Crampton in 1929.
Much of the research related to exercise over the past 20 years has shown that, not only is it good for us, but it can also be prescribed as a treatment modality for many diseases. That exercise can be medicine has significantly elevated its importance in health care. In 2007, based on a growing body of evidence that showed that exercise reversed or significantly reduced symptoms of many chronic conditions, the American College of Sports Medicine started an initiative to make exercise prescription part of the treatment protocol for several chronic conditions. The list of chronic conditions that improve with a consistent dose of exercise is expansive and growing with long term studies. Just a small sampling of these conditions treated by exercise includes cardiovascular disease, Type 2 diabetes, metabolic syndrome, osteoporosis, arthritis, depression, several autoimmune disorders, and age-related cognitive disorders. It even significantly reduces the risk of developing seven different types of cancer. Exercise, the studies tell us, is more than just a “feel-good” elixir. It is one of the cheapest and most accessible treatment modalities available to all of us. Still, as a nation, we sit.
Much is written about how good exercise is for our health but rarely do physicians prescribe it when a medical condition is diagnosed. Most likely we are told to “start exercising” but the actual dose--type, frequency, intensity, etc.--are left hanging in the ether, with the details left to the patient to sort out. Given the time constraints facing physicians, such a lack of communication is understandable. Although most physicians strongly support the use of exercise as medicine, they are reluctant to prescribe it. Why the hesitation? Seems that patients are not interested in exercise and, when suggested, is met with resistance. When given the option between exercise—a natural drug with numerous benefits--and medicines that come with plenty of negative side effects, most patients choose the pill.
Discussions about exercise, both in the medical field and public arena, can be confusing. The difficulty starts with jumbled and confusing terminology. The terms movement, physical activity, and exercise are frequently used interchangeably but they each describe different processes. Movement refers to any action we take that changes our location or position. A movement can be random, spontaneous, or planned. Physical activity is a broad category which describes all the movements we make that require increased energy expenditure. Much of what we consider as physical activity is associated with the completion of a specific task or activity—gardening, housework, walking the dog, etc. Exercise is a special subset of physical activity. It is a planned activity, designed to meet a particular goal, and is characterized by a specific type of movement that is performed for a scheduled length of time at a particular intensity. Whereas movement and physical activity are good for our health and can encompass a wide range of activities, it is the specificity and intentionality of exercise that give it the power to transform and heal.
Another source of confusion about exercise comes from the perceived role it plays in our weight. Unless one grows up an athlete, many will come to exercise through the door of weight loss, using it as a tool to shed pounds or attain the perfect body. Our desire to exercise is frequently sparked by an attempt to create a calorie deficit, whether it be through the effort we expend in cardio or the muscle strength gained from weightlifting. We select exercises based on their “fat burning” potential or their ability to “boost metabolism”. Our language reflects our beliefs about exercise: we start a program to “get in shape”, “burn calories”, and get “more energy”. The use of wearables that track calories expended with each activity reinforce our focus on exercise as a form of weight loss.
Our focus on exercise and weight loss is well intentioned, but seriously misinformed. If you check the list of chronic conditions listed above that can be treated with exercise, you will not find obesity or overweight in the mix. The science tells us that, while exercise contributes to weight maintenance and can help shed some pounds, there is just not much data that supports its long term efficacy in helping us shed pounds. Even though initially exercise does contribute to weight loss, over time this effect seems to level off. Exercise is incredibly effective in improving a host of conditions, but we are obsessed with using it for the one thing it is not so great at treating.
It is disappointing to learn that exercise plays a small role in weight loss, but we should not ignore the power it has to help us live longer, healthier lives. Studies of overweight and obese people with significant health issues showed improvements in blood pressure, cholesterol levels, and insulin resistance when they started a regular exercise program, regardless of whether they lost any weight. Meta-analyses of studies comparing programs that focused on dieting only with those focused exclusively on exercise found that the exercising group decreased their risk of premature death by as much as 30%, even when their weight did not change. Comparatively, the dieting group saw only a 16%--and sometimes less—reduction in a risk of early death. These meta-analyses showed that fit obese and overweight people are at a lower risk for an early death than normal weight people who are sedentary. Increasingly, studies are finding that exercise, by itself, can create important changes in the body, effectively combating diabetes, lowering blood pressure, and improving cholesterol. Interestingly, it even seems to remake our fat stores in important ways. First, it reduces dangerous visceral fat, which is stored deep within and around the organs and is correlated with lower life expectancy. And regular exercise seems to alter the molecular signaling in fat cells in ways that improve insulin resistance. Exercise provides a range of health benefits that go way beyond simple weight loss, suggesting that it may be more important to be fit than to be thin.
“Sitting is the new smoking” is a phrase you may have heard related to the dangers of a sedentary lifestyle. All movement, from fidgeting in your chair to running a marathon, keeps us healthy. When we move, we are increasing the flow of energy, oxygen, and nutrients to all our body systems. But within the realm of movement, exercise is the crown jewel. It holds this status due to its intentionality and specificity, which are part of its unique ability to treat specific conditions and improve our health. Unlike medicines that have side effects, the only downside to exercise is that we need a spark that will motivate us to stand up from the chair and do it. That spark is hard to generate, which is why we like to associate exercise with weight loss, but also why it gets hard to maintain when the numbers on the scale don’t move. And, whereas physical activity can provide an immediate boost to our energy, exercise is not always a “feel good” activity, and the pay off—a stronger heart, improved breathing, enhanced muscle tone, better balance—comes slowly without much fanfare. It’s hard to get pumped about a high intensity workout simply because it will lower your cholesterol. That’s not much of a spark.
Exercise may indeed be medicine, but it is a treatment many of us find hard to take. But the more we learn about how it changes the body, the larger the role we find it plays in our overall well-being. The body has an intelligence that we are only beginning to understand and appreciate. It uses sophisticated regulatory systems that move energy around the body as well as transform materials from one form to another. Importantly, it uses an elaborate communication system that sends information throughout the matrix of the body, even at the cellular level. Exercise is an essential part of this system, moving energy, stimulating biochemical reactions, and acting as an information superhighway that speeds communication between cells. As we learn more about exercise, we see how it impacts us on a much broader level than just blood pressure, cholesterol, or insulin levels. It can also change us on a deeper level, if we only know how to use it.
Wellness experts tell us that the foundational skills needed, both physically and mentally, for a healthy, balanced life are resiliency, adaptability, and stability. Exercise, when applied in the right dose, helps to build all three. And what we know from studies in health psychology, physiological changes in the body support and sometimes stimulate changes in our mental health. We find, for example, that exercises that help build resilience in cardiac muscle can also reduce a tendency to overreact when faced with a stressor. Increased flexibility reduces blood pressure as well as feelings of hostility. Improved muscle tone, regardless of any change in weight, can bolster self esteem and feelings of confidence.
Throughout July, we’ll take a deep dive into different forms of exercise and how they change the body as well as our mind. Some of what we’ll look at will be the nuts and bolts of exercise physiology, but we’ll connect this to the larger picture of how these changes support the three pillars of wellness: resilience, adaptability, and stability. I hope this exploration helps you view exercise through a wider lens. Whereas it may be more satisfying to pursue exercise for the calories it burns, I invite you to explore the more important role it plays in keeping us healthy. Although I’m not sure if exercise alone can deliver Dr. Crampton’s 100% lives of “Good Health and Great Abundance”, I am certain that it can help us thrive.
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