Train for life: exercise is medicine

By Nash Anderson B.Sc M.Chiro and James Steele, PhD, Lecturer in Applied Sport Sciences at SSU.

Recently, in private practice, Nash heard a fantastic statement from a patient – they said, “People ask me why I go to the gym all the time. They ask me what I am training for. I am training for life!”. The conclusion of that conversation was that although aches can slow us down, we must keep momentum and stay active to feel great.

It is always great to see a patient who understands that exercise is for life. To reap exercise’s benefits you do not need to be a professional athlete or train for a specific event. If only this attitude was more common.

This article was inspired by this experience in clinical practice and by attending the Royal Society of Medicine’s, “Exercise is Medicine” symposium in London June 2015. Conversations with @BJSM_BMJ on Twitter spurred me on to write this and share the messages about the significant benefits of exercise.

exercise is medicineShifting emphasis from aesthetic to health benefits of exercise

Unfortunately, many see physical activity and exercise as a tool to reach potentially shortsighted goals related to external outcomes such as performance improvement or aesthetic improvements in body composition. All who participate in physical activity and exercise will achieve at least one of these outcomes to some degree. It may not however, be the outcome that they expect. This can be disheartening and make people question why they are training. It must be frustrating to work out for 2 months 4-5 times per week with the goal of losing weight when they may in fact be heavier at the end of it due to concomitant reduction in fat mass and increase in lean mass.

Another common disappointment is to not be as muscular as desired at the end of a muscle-building program despite having vivid visions of becoming the next Arnold Schwarzenegger. The harsh reality is that not everyone will reach their original goals and that many of these goals are inappropriately based upon the survivorship bias fallacy – the ones who succeed in reaching these goals are the ones who are best known. Was their success due to the specifics of their training or did they just have the genetics to respond as they did in that particular outcome?

We are all subject to the inter-individual variation in response to physical activity and exercise determined primarily by genetics (Hubal et al., 2005; Timmons, 2011). However, physical activity and exercise is now known to produce such a wide array of potential benefits that almost everyone has something to gain from participation. Sadly though, improvement in health and longevity related risk factors just isn’t as sexy as looking ‘ripped’ or ‘swole’ or hitting a high particular level of competitive performance.

We need a way to tackle the issue that exercise is primarily for external aesthetic outcomes in the eyes of the public. The message needs to be spread that even if people do not reach their original exercise goals, they shouldn’t give up on exercise. They need to train for life. Exercise and physical activity is known to reduce all-cause mortality risk (Paffenbarger et al., 1986; Nocon et al., 2008) in a dose response fashion (Lee & Skerret, 2001; Byberg et al., 2009). Train with a bit more vigorously and with a bit more effort and the benefits to longevity become even greater (Lee et al., 2003; Wisloff et al., 2006; Laukkanen et al., 2010). Getting yourself fitter through physical activity and exercise seems to be one of primary factors that influences longevity. Increased cardiorespiratory fitness (Kokkinos et al., 2008; Lee et al., 2011; Wen et al., 2011), strength (Newman et al., 2006; Ruiz et al., 2008; Leong et al., 2015), muscle mass (Srikanthan & Karlamangla, 2014), or these combined (Artero et al., 2011) all reduce all-cause mortality risk resulting in potentially longer life. We’re not talking huge improvements in fitness measures here the likes of which we see in professional athletes, just achieving your own genetically determined potential through engagement in physical activity and exercise.

It’s not just about training for a longer life but also a more functional and healthier quality of life. Evidence is abundant that exercise offers a wide range of benefits to a variety of health markers including some of those listed below. What’s more, with such a range of possible beneficial outcomes, even if people aren’t achieving the aesthetic goals or performance outcomes that are easily observed or measured it’s highly likely that they are least doing some good. In fact a recent study has brazenly concluded that “There are no non-responders to resistance-type exercise training…” (Churchward-Venne et al., 2015). The following is a small selection of possible improvements achievable through physical activity and exercise whether aerobic or resistance based which were mentioned in the June RSM Exercise is Medicine Symposium.

Mind

  • Improved cognition such as sustained attention, short term memory etc. in older adults AND brain health
  • Decreased cognitive decline.

Mood

  • Reduced depression
  • Reduced anxiety
  • Team sports promote involvement in the community to improve overall health and happiness
  • Improved self-esteem

Musculoskeletal

  • Moderate exercise beneficial for cartilage
  • Often weight control
  • Often strength, endurance and power,
  • Often flexibility and coordination
  • Increased bone mineral density
  • Reduced pain and discomfort from arthritis. Exercise is important in reducing symptoms of osteoarthritis.
  •    Reduces pain and discomfort from fibromyalgia
  • Reduced back pain
  • Enhanced flexibility
  • Increased physical function
  • Favourable changes in genes associated with aging
  • Hip fracture risk decreased by 30-60%
  • Benefits of exercise outweigh risk for osteoporosis

Visceral

Heart:

  • Decreased risk of cardiovascular disease
  • Exercise is better than primary coronary intervention for cardiac event free survival.
  • Improved resting blood pressure
  • Every 200 step/day increase in physical activity is associated with an 8-10% reduction in CVD risk
  • Regular exercise is more effective than heart stents

Colon

  • Decreased gastrointestinal transit time
  • Improved outcomes from colorectal surgery
  • Reduced side effects from chemotherapy
  • Lower 1 year mortality rate

Breast cancer

  • Regular exercise can reduce breast cancer risk by 20%.

Diabetes reduction

  • Improved glucose/insulin metabolism

Overall

  • 30% reduction in all causes of mortality and increased life expectancy
  • Reduced body fat mass
  • Reduced abdominal fat
  • Improved blood lipids
  • Increased resting metabolic rate
  •  Improved sleep quality

We need to dispel short sighted exercise perceptions. Exercise is a lot more than just losing weight or gaining muscle mass. The public needs to adopt a broader understanding of the benefits of exercise. If questions are asked such as –

  1. If you’re going to the gym to gain muscle and you aren’t, why are you still going? What are you training for?
  2. Or, if you’re going to the gym to lose weight and you aren’t, why are you still going? What are you training for?

Then the public can answer: “I am training for life”.

I highly recommend that we share inspiring infographics about the benefits of exercise like this one in the recent BJSM blog by Andrew Murray et. al on our social media pages and distribute these to a global audience.

I’ll leave you with some fantastic exercise quotes from the Exercise is Medicine symposium.

“One if never too old to start something new” – Dr Charles Eugster (95 years young!)

Exercise medicine needs to escape the medical model. Prevention is better than cure”. – Prof John Buckley.

Take home messages and quotes from the Royal Society of Medicine’s, “Exercise is Medicine: symposium in London June 2015 as well as conversations with @BJSM_BMJ on Twitter inspired me to write this and share the messages.

You can read these tweets and more information here: http://www.sportmednews.com/blog/category/exercise

References.

  1. Artero, E.G., et al., 2011. A prospective study of muscular strength and all-cause mortality in men with hypertension. J Am Coll Cardiol. 57(18), pp 1831-1837
  2. Byberg, L., et al., 2009. Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort. Br J Sports Med. 43(7), pp 482
  3. Churchward-Venne, T.A., et al., 2015. There are no nonresponders to resistance-type exercise training in older men and women. J Am Med Dir Assoc. 16(5), pp 400-411
  4. Hubal, M.J., et al., 2005. Variability in muscle size and strength gain after unilateral resistance training. Med Sci Sports Exerc. 37(6), pp 964-972
  5. Kokkinos, P., et al., 2008. Exercise capacity and mortality in black and white men. Circulation. 117(5), pp 614-622
  6. Laukkanen, J.A., et al., 2010. Cardiorespiratory fitness, lifestyle factors and cancer risk and mortality in Finnish men. Eur J Cancer. 46(2), pp 355-363
  7. Lee, I., and P. J. Skerrett, 2001. Physical activity and all-cause mortality: what is the dose-response relation? Med Sci Sports Exerc. 33(6), S459 – S471
  8. Lee, I., et al., 2003. Relative intensity of physical activity and risk of coronary heart disease. Circulation. 107(8), pp 1110 – 1116
  9. Lee, D. C., et al., 2011. Comparisons of leisure-time physical activity and cardiorespiratory fitness as predictors of all-cause mortality in men and women. Brit J Sports Med. 45, pp 504 – 510
  10. Lee, D.C., et al., 2011. Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study. Circulation. 124(23), pp 2483-2490
  11. Leong, D. P., et al., 2015. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology Study. Lancet. 386(9990), pp 266-273
  12. Newman, A. B., et al., 2006. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol. 61A(1), pp 72 – 77
  13. Nocon, M., et al., 2008. Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil. 15(3), pp 239 – 246
  14. Paffenbarger, R.S. et al., 1986. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med. 314(10), pp 605-613
  15. Ruiz, J.R., et al., 2008. Association between muscular strength and mortality in men: prospective cohort study. BMJ. 337, pp a439
  16. Srikanthan, P., & Karlamangla, A.S., 2014. Muscle mass index as a predictor of longevity in older adults. Am J Med. 127(6), 547-553
  17. Timmons, J.A., 2011. Variability in training-induced skeletal muscle adaptation. J Appl Physiol. 110(3), pp 846-853
  18. Wen, C. P, et al., 2011. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. The Lancet. 378, pp 1244 – 1253
  19. Wisloff, U., et al., 2006. . A single weekly bout of exercise may reduce cardiovascular mortality: how little pain for cardiac gain? ‘The HUNT study, Norway’. Eur J Cardiovasc Prev Rehabil. 13(5), pp 798 – 804

 

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