Sunday, August 7, 2016

Reading This May Be Hazardous to Your Health

You better sit down for this.  No, on second thought, you better not.  Unless you are reading this while walking on a treadmill, the time it takes you to read this may shorten your life, at least a little.

It's not the contents of the post, which hopefully will be somewhat provocative but not actually dangerous.  No, it's the sitting part that poses the risk.

Several new studies help illustrate the risk of being inactive.  One study in The Lancet found that at least an hour of moderate intensity exercise is needed to offset sitting eight hours a day -- e.g., about the amount of the time that many office workers spend at their desk (and that others spend in front of the TV or gaming console).

Sitting without the offsetting exercise increased mortality risk by close to 60%.  Indeed, the risk of this inactivity is on par with smoking.  The lead author acknowledged that many people may have a hard time finding an hour a day to exercise, but pointed out that: "if this is unmanageable, then at least doing some exercise each day can help reduce the risk."

A second study, also in The Lancet, tried to quantify the cost of physical inactivity.  It "conservatively estimated" its worldwide economic impact at $53.8b, plus $13.7b in productivity losses.  In addition, it accounted for 13.4 million disability-adjusted life years, which take into account the true personal cost -- years lost due to premature deaths and to disability while alive.

If anything, these numbers seems low given the order of magnitude that such inactivity appears to have on mortality and morbidity.

The authors noted their various assumptions that make these results conservative, but conclude nonetheless that: "Physical inactivity is a global pandemic that causes not only morbidity and mortality, but also a major economic burden worldwide."  One suspects "pandemic" was chosen lightly.

The third study, from researchers at the University of Gothenberg (Sweden), echoed the Lancet results in that they found that having a low aerobic capacity (which is highly correlated with physical activity) had almost as much effect on health as smoking.  They followed a cohort of men born for some fifty years, giving them an extremely powerful set of data.

The men with the lowest aerobic capacity had a 42% greater chance of dying than the most fit segment, and a 21% greater mortality than those of average capacity.  Aerobic capacity was more important than high blood pressure or high cholesterol.  Again, only smoking had a greater impact on mortality.

As the lead researcher said, "We have come a long way in reducing smoking. The next major challenge is to keep us physically active and also to reduce physical inactivity, such as prolonged sitting."

None of this should be news.  Numerous studies have validated the positive impact exercise has on our health and well-being.  These impacts include not just the expected impacts on cardiovascular health but also reducing the risk of cancerhot flashes, depression diabetic retinopathy, and dementia, to name a few.

If exercise was a pill, some drug company would tout it as a miracle cure and make a fortune.

In fact, researchers are working on such a pill, which just illustrates that we'd rather take short-cuts to health.  New research confirms that our love/hate relationship with prescription drugs continues, with almost 60% of adults now taking at least one prescription annually and 15% taking at least 5 -- double the percentage just 12 years ago.

Meanwhile, the CDC reports that we weigh 15 pounds more than we did 20 years ago (alas, not because we're any taller).  About half of us get a gentleman's C on our aerobic exercise, but only 21% meet the federal physical activity recommendations,  Truth be told, about three-quarters of us don't exercise regularly.

Perhaps we need our doctors to prescribe exercise, like they would a prescription.  A study in the Canadian Medical Journal Association (CMAJ) proposed exactly that, specifically for several chronic conditions, including osteoarthritis, low back pain, Type 2 diabetes, COPD, and coronary heart disease.  The lead author noted: "Many doctors and their patients aren't aware that exercise is a treatment for these chronic conditions and can provide as much benefit as drugs or surgery, and typically with fewer harms."

One would expect that the impact would be even more powerful on those who have not yet acquired a chronic condition.

There is even an Exercise in Medicine initiative, managed by the American College of Sports Medicine, that encourages doctors to include physical activity in their treatment plans (and to use credentialed EIM programs and exercise professionals).

Leave it to our health care system to medicalize even exercise.

The analogy of physical inactivity to smoking may be illustrative.  Smoking prevalence peaked in the 1940's, with close to half the adult population smoking.  It took Surgeon General reports, "voluntary" bans on television ads, warnings on labels, and successful lawsuits to drop the rate to around 20% today.  However, we're still seeing the tail end of those earlier smoking rates, through the incidence of lung cancer, emphysema, and other disorders in those earlier generations.

We may need a similar campaign for more exercise (hmm, maybe a moonshot).

Look, we shouldn't need our doctors to tell us we need more exercise.  We know it.  We shouldn't need our employers to incent us to get it, through wellness programs.  We know it (and those programs have not proved particularly effective anyway).  We shouldn't need to go to an EIM "exercise professional" to get an EIM program.  We know how to exercise.  

This is not a failure of our health care system (or, as I prefer to call it, our medical care system).  This is our failure.  Certainly health care professionals should be encouraging us, and advising any of us with specific health issues how to exercise safely.  Certainly our friends and family need to be supporting us, and we them.  But it starts with us, for ourselves.

After all, we pay for it when we don't exercise.  We pay in higher costs for deductibles and coinsurance.  We pay in higher health insurance premiums.  We pay in higher taxes for social insurance programs.  Most of all, we pay in how we feel.  

Technology can help.  We have so many options about how we can track our activity, measure exactly how far we go, even socialize our efforts.  Games like Pokomon Go or Geocaching has shown we can even make it fun.

Now stop reading and go take a walk.

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