05/30/2014 11:29 am ET Updated Jul 30, 2014

Unfit and Proud of It!

There is little dispute about the health benefits of physical activity. A comprehensive review of 152 articles studying the health benefits of exercise was published in the Canadian Medical Association Journal in 2006, providing evidence that physical fitness decreases vulnerability to a variety of medical problems and improves overall quality of life.

So why isn't everyone exercising? Why aren't we all fit? According to the Centers for Disease Control and Prevention, only 20.6 percent of us meet fitness guidelines for aerobic and muscle-strengthening physical activities. The number is rather shocking, and indeed probably would be even lower were it not for some occupations, such as construction or farm work, that involves sustained physical labor.

There are many in the 80 percent of the population who do not meet physical fitness standards, but would if they could. The reasons for this deficit include that time to exercise is incompatible with their over-loaded life; terrible weather conditions (too hot, too cold); too little money to join gyms; too much travel; too many home obligations; pain and disabilities; shift work; long commutes; caretaking for parents; and probably dozens of other reasons. Until exercise becomes compatible with the constraints of their lifestyle, they are simply unable to do it on a regular basis.

And yet, for many in the 80-percent unfit group, the response to such statistics is: So what? Who needs exercise? An older couple I recently met, let's call them the Smiths, told me, quite proudly, that they never exercised in their lives. They obviously do walk since, unlike some ancient potentate, they are not carried from place to place on a litter. Presumably, they also climb stairs occasionally or bend down to pick up something they drop. But they valet park their car; use elevators rather than stairs; avoid recreational activities like hiking that require physical effort; and overall seek to avoid breaking into a sweat when moving. Assiduous dieting keeps them trim, for their age, and the wife said they try to eat relatively unprocessed, high-fiber foods. "We are healthy," they said to me, "so why do we need to exercise? We have better ways of spending our leisure time."

How does one reach out to and convince the Smiths, and others like them who have the time and economic means to exercise, to do so? Or to turn it around, how does one convince them that by not doing so, they may risk a silent deterioration of their overall health? The loss of bone and muscle, gradual worsening of memory, and the deterioration of balance are just some of the natural changes that come with aging. These changes come slowly, quietly, and often do not reveal themselves until they become symptomatic. Physical activity is known to slow down these processes and maybe even reverse them. Should it be necessary to wait until there is already evidence of bone or muscle loss, for example, or decreased balance, to convince the Smiths and people like them to start on an exercise regimen?

Clearly prevention makes more sense.

The reason the Smiths can believe their well-being is not dependent on exercise is that they have no evidence to the contrary. Changes in weight or blood pressure or blood glucose levels are routinely measured as part of a medical examination, and when the numbers veer into an abnormal range, therapeutic interventions begin. But early stages in muscle, bone and balance loss are not routinely measured. Women are not sent for bone density measurements until a certain number of years past menopause, and few physicians measure muscle strength or balance until their patients become elderly or show signs of weakness and/or dizziness. Even though exercise may improve memory and mood, how many physicians tell their patients to exercise when they complain about normal age-related memory loss, or feeling slightly depressed?

People need to be shown, not told, how their lifestyle is helping or hurting their health. Baseline measurements of physical fitness, including muscle strength and aerobic stamina, should be part of medical examinations every five or 10 years. Everyone accepts the necessity of medical testing to detect the early stages of disease. Shouldn't the early stages of physical decline also be included so that positive interventions can be started before it becomes necessary to order the cane, walker or wheelchair?