The Best (Toughest) Decision
Amidst the swirl of everyone trying to embrace and eternal pandemic while crashing this fumbling health industry into a permanent gargantuan bureaucracy capable of coding minutiae and little else…I stumbled across and interesting headline: Walking Is Good. But Moderate-Vigorous Exercise Boosts Fitness Three Times More. Really?
In an age when the cubicle dwelling and home-bound are bragging to each other about the number of steps daily logged on their FitBit or iWatch, this study supports the intensity of exercise as significant in measuring one’s overall fitness, quantified by VO2 increases. “Findings were largely consistent across categories of age, sex, obesity, and cardiovascular risk … Individuals with high (above-mean) steps or MVPA (moderate-vigorous physical activity) demonstrated above average peak VO2 values regardless of whether they had high or low SED (sedentary time).” The lead author determined that more intense physical activity resulted in higher fitness “regardless of how much time they spent sedentary (his emphasis).” Moreover, the study “found that participants with high activity values at one assessment and low values at another assessment, performed eight years apart, had equivalent levels of fitness, whether or not the high value coincided with the fitness testing. This suggests that there may be a ‘memory effect’ of previous physical activity on current levels of fitness.”
So, working out harder, earlier in life – much like the investment plan that practically none of us started in our twenties – should pay compounded rewards many years later. Likewise, deferring the investment means less payoff later.
Other meta-data is suggesting that improving exercise frequency and intensity has a greater morbidity/mortality relative risk reduction than does mere weight loss (which however, is NOT discouraged).
I think exercise physiology, and improving individual adaptive performance and restorative ventricular remodeling is cool stuff, but I am no expert. This topic is actually one of the 837 reasons I quit primary care. After opening private practice, I saw how many patients in their 40’s and 50’s were coming in feeling sluggish, packing on some obvious pounds, and starting to fight depression, anxiety, and poor sleep. Sometimes they needed the HgBa1c checked, and sometimes they needed to be started on an SSRI, but every single one of them was neglecting physical fitness. I’m no guru, and no evangelist, but the need to routinely shake ‘dem bones has always been bleedingly obvious to me. I had a whole spiel I developed in (really!) positive, encouraging ways for these patients to encourage increased physical activity, which I saw as indispensable to treating the underlying diagnoses. The patient should start at their highest comfortable level – even a nightly 15-minute walk after supper – and steadily increase to the ultimate goal of a vigorous hour of activity 5 days a week. That’s not easy to attain or maintain, but like I said, it’s a goal. I hate running and told my patients so when explaining that they didn’t have to run five miles a day, unless that’s what they were into. Weightlifting, yoga, tennis, kayaking, fast walking…anything to get the heart rate up, make one breathe faster, and break a sweat. More than one lady would giggle and ask if sex counted, and I always said sure, if you can go at it with great intensity for five hours a week. My description was that fitness wouldn’t cure depression or diabetes, but like sand under the tires on an icy road, it would give one some traction on the problem. Patients nodded, promised to add this critical element to their treatment plan…and very few ever did. It was discouraging, and disheartening to have to continue refusing scripts for fat pills after never having any success with them in kick-starting a person into healthier, long-term habits. And don’t even get me started on the ghastly, futile rearrangements of gastric bypassing.
In an increasingly sedentary age, where obesity still reigns as a risk factor for COVID death, it’s gratifying to see more of that science stuff backing up what we have intuitively known. We are all guaranteed to get slower, fatter, achier, and dumber, and the best way to delay these is by working up a sweat. What medicine could be more authentic?
ME TO PATIENT- I know something that will decrease your risk for heart attack, stroke, cancer, diabetes, hypertension, arthritis, and depression. I can improve your sleep and your sex life and your memory. It can reduce your risk for falls. It can increase your energy level while reducing pain levels. It can make you live longer. And it is absolutely FREE.
PATIENT: I want that!!
ME: It’s exercise!!!
PATIENT: Just give me a pill.
In addition, for those that do exercise, they say “I am busy around the house” or “I go to the mailbox every day” or “I go for a walk every day” but when queried it is less than a mile and under 10 minutes. That’s not exercise, that’s just being alive.
Really great article !! Motivational and not preachy. Now 65 and my wife 71, we found ourselves developing the paunch over the past year and a half. Finally decided to do something about it. Joined the YMCA and signed up for a personal trainer. We try to go in for an hour three mornings a week. And a bonus of the YMCA is that as former professional ballroom dancers, they let us use their gym to practice dancing two mornings a week. I was always very skinny when I was teaching dance some 35 years ago before starting a medical career. Doctors used to recommend their post bypass patients to take dance lessons as therapy. So there are fun ways to accomplish what you wrote about. Now that dancing is starting again, it’s a great way to get out and improve your mental health as well as your physical health. Especially if you have a partner. Just be vaccinated and wear a mask if possible. Thanks again for a really great article.