How are those New Year’s Resolutions going? Did any involve exercising more? If they did (or didn’t) keep reading. Last week, a patient of mine told me she just took her exercise regiment to a new level – it now involves two resistance training and two Zumba classes per week. I asked why? She said she and her boyfriend had gained nearly 10 pounds over the Christmas holidays and they were now engaged in a “Couples Challenge” to see who could lower their BMI (body mass index) over the next several weeks. She went on to say they are using BMI instead of pounds because “men lose weight more easily than women”.
First, I congratulated them on making a commitment to increase their level of physical activity and let her know they were on the right track. However, I suggested that BMI may not be the best measuring stick. BMI is directly related to changes in weight (it increases if you gain weight and decreases if you lose weight). As such, if her perception that men lose weight more easily than women is true, and they use BMI to measure success, her boyfriend would have the advantage in their “couples challenge”.
Based on the growing evidence, our focus should be on fitness and making regular exercise a part of our lifestyle regardless of what the scale says.
With nearly 1.3 million hits, 23 ½ hours is the most popular education video on youtube (go to YouTube.com and search 23 ½ hours). It’s a nine- minute video which, in a rather simple, creative and clear format, answers the question: “What is the single best thing we can do for our health?”
The answer is – exercise. This video was sent to me a number of weeks ago by a colleague, Richard Phillips, missions specialist with the Heart and Stroke Foundation of Ontario. I watched it and was impressed. It essentially presents the findings of research studies on large populations in Japan, Australia and the United States which looked at the impact of physical activity on the incidence of disease and health.
The video highlights the work of renowned physical activity advocate, Dr. Steven Blair, a professor of exercise science at the Arnold School of Public Health at the University of South Carolina and lead researcher of the Aerobic Centre Longitudinal Study (ACLS). Incidentally, Dr. Blair was in Toronto recently to receive the inaugural $50,000 Canada’s Bloomberg Manulife Prize for the Promotion of Active Health.
The ACLS followed over 50,000 Americans over many years. Each participant received an extensive medical exam which included testing their blood pressure, blood sugar, cholesterol levels, weight and other variables including a maximal exercise treadmill test which is an indicator of cardio respiratory fitness. Researchers were looking for the most prolific predictor of death in the study group. The most common predictors of death were hypertension, smoking, high cholesterol, diabetes and obesity. But the strongest predictor of death was low cardio respiratory fitness.
Coincidentally, I recently heard a CBC Radio interview with Dr. Blair who was commenting on his research. He said that low-fit men and women at the bottom 20 per cent of the fitness scale, “the couch potato”, were more than twice as likely to die during the follow-up period of seven years versus people who were moderately fit. Therefore, being only moderately fit would cut your risk of dying by 50 per cent.
Well, the next question is what do I have to do to be at least moderately fit?
Analysis of the study group indicated that 130-150 minutes per week of moderate exercise produced significant health benefits including reducing your overall risk of death. This level of activity is achievable by walking about 30 minutes, five days a week. If you prefer more intense activity like jogging or running, you only need to accumulate 70 minutes per week. The more intense the exercise, the shorter duration required to achieve health benefits.
Most nations have now adopted the 150-minute physical activity recommendations. In Canada, our Physical Activity Guideline states: “To achieve health benefits, adults aged 18 – 64 should accumulate at least 150 minutes of moderate to vigorous aerobic physical activity per week in bouts of 10 minutes or more”. There are guidelines for children, youth, adults and seniors.
I know what you’re thinking: what about diet? Which is more important, diet or exercise?
Analysis by a researcher at Queen’s University did a detailed study of a sub-population (section of the study group) looking very closely at their diet records, their fitness levels and health outcomes. Those who ate poorly but were moderately active did better than those who ate well but were inactive.
That being said, no one is suggesting diet is not important. Basic sound nutrition that includes eight to 10 servings of fruit and vegetables per day; focus on whole grains versus highly processed grains; decrease fat, especially saturated and trans fats; less alcohol; attention to portion sizes and so on, remains a vital part of a healthy lifestyle.
Let’s get back to the idea of fitness. Here are some hard truths about slim versus fat. There is a general perception that someone who looks overweight or obese cannot be fit whereas someone who looks slim must be in good shape. Looks can be deceiving.
Obesity and physical activity research reveals the truth that when you study people who are of normal weight, overweight and obese and consider their respective fitness levels, those who were obese but fit had a death rate of one half of those who were of normal weight but not fit. Put another way, according to the Harvard Health Policy Review, “a fit man carrying 50 pounds of body fat has a death rate less than one half of an unfit man carrying only 25 pounds of body fat.”
The million-dollar question is, how do we get people to be more physically active? What would an effective public health policy on physical activity look like? What have we been doing wrong and what do we need to do differently?
Urban planning, which considers recreation spaces, optional modes of transportation including walking or cycling, employers who encourage fitness among their employees with lunchtime walking programs or exercise facilities on site, improved physical activity programming in elementary and secondary schools, better education of physicians on how to counsel their patients on exercise, and trained professionals who can help us overcome the challenges associated with changing our behaviour, are good beginnings. We need to further the development of a culture of health and fitness.
Dr. Blair further suggests we need to harness the influence of social media and modern communication to promote physical activity and keep people on track.
The good news is some of these elements are in place, such as the increased use of bikes and bike lanes. I also believe more people from the Black community are becoming more physically active as they join culturally appealing physical activity programs such as Socacize, Reggaesize or Zumba.
We should encourage one another, beep our horn or wave whenever you see someone, (it’s usually a women), going for a brisk walk in the neighbourhood.
So the take-home message is simple – Get moving. It’s good for your health.
Dr. Christopher J. Morgan is the director of Morgan Chiropractic & Wellness, an interdisciplinary health centre in Toronto, and the President of the Black Health Alliance, a network of community organizations, health professionals and community members working in partnership to advance the health and well-being of the Black community. He can be reached at 416-447-7600 or firstname.lastname@example.org
Dr. CHRISTOPHER J. MORGAN