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Exercise: The Fitness Paradox In America

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Since the only other options are vegetable, mineral, and bacteria-like things, I trust we can all agree that we are animals. We have a tendency to speak about ourselves as if we are something else, apart from nature altogether -- but there is no place for us but the animal kingdom. And along with that comes an innate animal vitality. We are neglecting it to our collective detriment.

That, in essence, was the message conveyed by an article on physical activity in small increments in last Tuesday's New York Times (11/22/10). The article profiled the work of Dr. Toni Yancey, a colleague at the UCLA School of Public Health, whose new book, "Instant Recess," makes the case for brief periods of physical activity in diverse settings throughout the day.

I will return to Dr. Yancey's work before I'm done, but if you'll indulge me, I'll get there via a lament, a harangue, and a proposition.

I lament the loss of animal vitality I have seen over the years in so many of my patients. I believe my most wistful reflection on this particular topic came a few years ago, when my now 71-year-old father and I were hiking together in the winter woods (and lovely they were, though not dark on that occasion, and not quite so deep as we might have liked!).

My father is a cardiologist, and I am an internist -- so we have both cared for lots of people with serious chronic diseases. As we walked up a steep, snow-strewn incline; as our breathing quickened to accommodate the exertion; and as sunlight filtered through tree limbs crisply contrasted against the sky -- we both found ourselves thinking of them, and what they were missing.

We began to discuss it, and the regret we felt on behalf of our patients deepened as we conversed. A common pattern was that a lack of physical activity, increasingly the norm in our society, contributed to weight gain, ill health, and stiff joints. Then, of course, stiff joints, weight gain, and ill health contributed to further declines in physical activity. The end-game here is self evident: people who can no longer be active even if they want to, now wishing they could.

It is, in fact, a paradox of modern living that we probably all feel a pang for those who have lost limbs, or function, or mobility the rest of us enjoy. But those of us with a full inventory of working parts all too often squander the opportunity until disuse leads to dysfunction. I do very much lament that our culture has not yet cultivated the will to revere the use of body parts in good working order. Those of us fortunate enough to have them really should count our blessings along with our steps.

As for the harangue, it's all about the size of the prize. I routinely note that feet (physical activity), forks (dietary pattern), and fingers (cigarette holders) are the master levers of medical destiny, exerting a far greater influence over the course of a lifetime on health, chronic disease risk, and life expectancy than all other factors combined. Generally, my topic is focused on fork use, but feet deserve just as much attention.

Routine physical activity is associated with greater overall quality of life. Being active daily enhances concentration, memory, and productivity. I have heard from patients over the years that they were too busy to find time for exercise; I was always inclined to think I was too busy not to.

Fitness associated with habitual physical exertions reduces the risk of diabetes, heart disease, stroke, cancer, and disabling arthritis. Burning more calories in exercise, and building muscle, both protect against obesity -- but even when fitness does not prevent overweight, it tends to prevent its harmful consequences. Move it, in other words, and you are likely to lose weight, gain health, or both.

Exercise in school generally enhances academic performance as well as health. Exercise in the work place enhances productivity, and the bottom line. Exercise is important enough to enough of what makes life good that it should be a priority for us all. End of harangue.

Which leads back to Dr. Yancey's work, and the proposition. In "Instant Recess," Dr. Yancey suggests that if exercise is a square peg to modern living's round hole, we should find new ways to reconcile the two. Fitting exercise into the daily routine in increments that suit the available time, space, and occasion is the basic proposition. Along with her book, Dr. Yancey offers free access to this kind of exercise routine via her website.

As it happens, we at the Yale-Griffin Prevention Research Center share Dr. Yancey's enthusiasm for this approach. We, too, have a free physical activity program -- for children -- designed in brief bursts throughout the day: ABC (Activity Bursts in the Classroom) for Fitness. With funding from the Turn the Tide Foundation, we are currently developing a video-based program of brief activity bursts adults can use throughout the day, in any setting (Activity Bursts Everywhere for Fitness).

The lure of the couch in modern society is strong. It takes real will to stay in touch with our inner animal vitality. The proposition is that you do your best to muster that will, while Dr. Yancey, we and others do our best to come up with new ways to get to daily exercise and the benefits it confers through the obstacle course of modern living.

With will and creative ways, it should be possible to let the animal in all of us come out and play.

Dr. David L. Katz;

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