Saturday, December 1, 2018

Move that body!

Fads come and go in medicine just as they do in fashion. Think back to blood-letting as the cure for most ills. In our own more enlightened era you could think of aspirin. For years, a daily aspirin was widely recommended to prevent heart attacks and even ward off colon cancer. Now we have been taught that unless you have proven coronary disease, daily aspirin is more likely to kill you from bleeding than keep you alive. Digoxin was universally used to treat heart failure until we were told it was pure poison and should never be used, and now we are told that its judicious use in some patients may be helpful. Coffee was bad for us; now it is good.
Is there anything close to a universal truth in medicine? Anything that we will not be told tomorrow is bad for us? There is one: modest or moderate exercise helps just about everyone! Even moderate exercise has been shown to lower blood pressure, ward off heart attacks, improve blood sugar control in diabetics and ward off dementia. It reduces inflammation and improves your immune system.
We are all aware of the obesity epidemic that has swept the world, and evidence shows that obesity contributes to numerous diseases, from diabetes to childhood asthma to breast cancer to osteoarthritis. While dieting in theory should help, very few diets work for long-term weight loss in many people. Weight loss can be induced with surgery, but that is a very dramatic approach to say the least for most of us.
Changing our exercise habits is much more fun than dieting, and it has more sustained benefit. Exercise does not have to mean going to a gym or wearing a leotard. Walking, dancing, gardening or housework all count. The latest advice from the U.S. Public Health Service is that children and adolescents should do 60 minutes of moderate to vigorous exercise daily and that adults should do at least 150 minutes a week of moderate exercise or 75 minutes a week of vigorous exercise. That is NOT that much. Walking the dog for 30 minutes 5 days a week will get you to the moderate goal and if you enjoy the gym, 30 minutes three times a week is all it takes.
How much exercise do we do? Not much. A group of researchers looked at self-reported activities reported in the national Health and Nutrition survey (NHANES) – and fess up, you are more likely to exaggerate your exercise than otherwise, right? They found that 51% of adults were completely inactive and 14% insufficiently active. Only 23% described themselves as highly active.
One of the few controversies around exercise is whether extremes – running marathons or competing in triathlons – is possibly harmful. The evidence is mixed, with an increased risk of atrial fibrillation later in life in endurance athletes. A recently-reported study from the Cleveland Clinic, however, showed that the fitter you are, the longer you live. So, if you are a dedicated runner, go for it!
If we want to live longer and in better health, hide the car keys and walk to the store. Take up ballroom dancing. Dust off that old bike sitting in the garage. Get a dog. Help coach your kid’s soccer team. Also, pressure the local school system to be sure ALL kids get exercise daily and not just the ones who are on a travel team.
News Flash: two articles in the journal Neurology in February 2019 showed that in both younger and older adults, aerobic activity improves cognitive function!

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