Exercise as Medicine
Physical activity lowers risk for a wide range of diseases.
August 31, 2009
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In the 19th century, most work involved physical activity; in the 20th century, exercise became a leisure pursuit; today, it's an urgent medical necessity.
Exercise: It's cheap, readily available, and the single most effective step nonsmokers can take to avoid chronic and potentially fatal diseases. If it were being hawked on late-night television, you'd think the phone lines would be tied up for hours.
But regular physical activity remains a hard sell. Despite mounting evidence that it lowers the risk for obesity, heart disease, diabetes, depression, and many forms of cancer, the average citizen is increasingly sedentary. Still, the U.S. Department of Health and Human Services (HHS) isn't giving up on us.
In 2007, the agency convened an expert committee to evaluate a decade of scientific evidence on the benefits of physical activity. Committee member Dr. I-Min Lee, who also serves on the Harvard Women's Health Watch advisory board, said she and her colleagues found an "impressive range of health benefits coming from being physically active." They submitted their findings, and in the fall of 2008, the U.S. government issued a detailed exercise prescription for the nation.
THE GROUND RULES
The "2008 Physical Activity Guidelines for Americans" (www.health.gov/PAGuidelines
) are more extensive than those of most other health organizations, and more extensive than earlier HHS recommendations. While assuring us that a couple of hours a week of moderate activity provides important health benefits, the guidelines also stress that more is indeed more -- finding added benefit from exercising longer and doing so with greater intensity. As Dr. Lee puts it, "Any physical activity one can do is good, but more is better."
The guidelines are also more inclusive. They apply not just to the standard adult audience but to almost everyone age 6 and over -- children, adolescents, pregnant women, seniors, and people with chronic diseases and disabilities
. This time around, no one gets off the hook. Adults, whether 18 or 81, are urged to get no less than 150 minutes (two and a half hours) of moderate activity or 75 minutes (one hour and 15 minutes) of vigorous activity -- or some combination of the two -- each week. Sessions should last at least 10 minutes and be spread evenly through the week.
Adults are advised to fit in two weekly sessions of strength training, as well. The authors urge even people with medical conditions to meet these standards, though they acknowledge this may require a gradual buildup.
EXERCISING WITH HEALTH CONDITIONS
The HHS exercise guidelines emphasize that people with chronic medical conditions and disabilities should get just as much exercise as other adults, if they can. This prescription may be daunting, especially for those with disabilities that sap energy or hamper mobility, like depression, multiple sclerosis, and arthritis. But regular exercise can actually improve mood and energy level, increase muscle and bone strength, and reduce the pain associated with many health problems. So even if a health condition makes it difficult to meet the guidelines, you should participate in any activity as best you can and avoid inactivity.
The HHS guidelines advise patients with disabilities or chronic conditions to speak with their health care providers about appropriate kinds and levels of exercise.
The National Institutes of Health and other organizations like the American Heart Association and the National Multiple Sclerosis Society provide specific, condition-based exercise information.
For example, the National Osteoporosis Foundation suggests low-impact exercises that build bone and minimize the risk of fracture during workouts. If you're not sure where to go, just type "exercise" and the name of a condition into an Internet search engine. The most reliable Web sites are those ending in ".gov," ".org," or ".edu."
The American College of Sports Medicine Web site also has detailed advice for people with certain chronic health conditions. It provides topical paperback guides ("Action Plans") that discuss particular challenges associated with menopause, allergies, arthritis, diabetes, osteoporosis, high cholesterol, and high blood pressure.
The site also offers "Your Prescription for Health" -- concise tip sheets on issues related to physical activity, including Alzheimer's disease, blood clots during exercise, anxiety and depression, heart conditions, cancer, low back pain, and visual impairment. To order or download these materials, go to www.exerciseismedicine.org/public.htm
Children and adolescents should be getting even more than adults: at least an hour a day (420 minutes per week), including both aerobic activity and exercise that builds muscle and bone.
The guidelines also distinguish between different levels of physical activity. For example, for most middle-aged adults, moderate-intensity aerobic exercise is comparable to walking three to five miles an hour; vigorous exercise is anything higher. Or, on a zero-to-10 scale, with zero as the amount of activity involved in sitting, and 10 as the effort of running at top speed, moderate exercise begins at five and vigorous exercise at seven.
Perhaps the simplest way to distinguish moderate from vigorous exercise is by trying to speak as you work out: if you can talk while working out but have a hard time singing, you're exercising moderately; if you find it difficult even to talk, that's vigorous.
Strength training should involve all the major muscle groups of the legs, hips, back, chest, stomach, shoulders, and arms. You should repeat each exercise for each muscle group eight to 12 times. Many aerobic activities also provide strength training: for example, race-walking strengthens legs and hips; rowing builds muscles in the arms, legs, chest, and shoulders.
HOW MUCH IS ENOUGH?
Go beyond the basics if you can, say the guidelines. Once you're routinely logging the recommended levels of aerobic activity, start to add a few minutes a day. (Ramping up slowly reduces the likelihood of injury.) The HHS committee found that you can get even greater health benefits and more effective weight control when you reach twice the recommended weekly amount -- that is, 300 minutes of moderate activity, 150 minutes of vigorous activity, or a combination of the two. More than that may be even better.
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