Exercise and it Importance

Approximately 70% of US adults either do not undertake physical activity or are under active, and nearly half of America's youth (aged 12-21 years) are not vigorously active on a regular basis.  

Obesity has increased by 57% in US adults from 1991 to 1999.

More than 50% of American adults and nearly 25% of American Youth are overweight or obese.  

Sixty percent of overweight 5 to 10-year-old children already have one biochemical or clinical cardiovascular risk factor (such as elevated cholesterol, elevated blood pressure, or increased insulin levels), and 25% have 2 or more risk factors. 

Have the Physicians and Health educator in the USA failed to adequately prescribe and recommend exercise?   What about the fast food industry that encourages a high fat, high sugar diet?  What about our schools have they failed in encourage exercise to those at risk?  Where are the parents that let the kids vegetate in front of the TV or Internet?  Yes these are all true.  We must do better. 

Many people with chronic health problems have felt that they are not able to exercise.  

I was surprised, as was the investigators, when a recent medical study comparing exercise to rest for patients with severe congestive heart failure found that the exercise group had a better outcome.   

With few if any exceptions, every person with a chronic stable medical condition will benefit from exercise. 

A few notable studies have demonstrated this in the following conditions: 

1. Obesity  - Exercise increases metabolic rate and increase calorie utilization. 1, 2                        

2.  Diabetes mellitus - Increases insulin sensitivity of the exercising skeletal muscle and improved  whole-body glucose tolerance with exercise. 3                                                                         

3.  Hyperlipoprotenemia (a high cholesterol or blood fat condition) - Increases clearance from the blood of triglycerides, chylomicrons, and VLDL by exercising muscle. 1                                               

4.  Arteriosclerosis – Exercise increases the diameter of the coronary arteries by inhibiting vascular smooth muscle cell proliferation, inhibiting platelet aggregation, and inhibiting monocyte (a white blood cell) adherence. 4, 5                                                   

5.  Hypertension -Regular exercise reduces resting blood pressure. (It has a smooth muscle dilatory effect on vascular endothelium mediated by nitric oxide.) 1,5, 6, 7 

6.  Myocardial infarction /MI? ”Heart Attack” –A structure medically prescribed exercise program lowers death risk by 20%-25% after MI.  5, 8, 9 

7. Congestive heart failure – Exercise improves skeletal muscle aerobic metabolism, produces relaxation of adjacent vascular smooth muscle cells. 10                       

8. Ischemic stroke – Exercise reduces the risk of ischemic stroke by lowering blood pressure and less of a tendency to clot. 11, 12                                        

9.  Peripheral vascular disease and Intermittent claudication (Leg pain due to poor circulation) – Regular exercise increased maximal treadmill walking distance by 179 yards due to increased vascular relaxation mediated by nitric oxide in blood vessels and increases collateral blood vessels 7,13                                                                

10.  Asthma - Physical training improves cardio pulmonary fitness without changing lung 
function. 14                                                                     

11.  COPD (Chronic Obstructive Lung Disease) – With exercise shortness of breath can be improved, despite the presence of fixed structural abnormalities in the lung.  The mechanism is: Improved respiratory muscle function, breathing patterns as well as reduction in anxiety. 15                                

12.   Obstructive sleep apnea.  - Weight loss is the key to treatment. 1                                               

13.   Breast, Colon, Pancreatic, Cancers - are all decreased by exercise the mechanism is unknown. 16, 17, 18 ,19      

14.   Physical frailty (Old Age)- Postpones disability and enhances independent living even in the oldest subjects.  Increased muscle strength is the mechanism. 20, 21                       

15.   Osteoporosis – Exercise delays the decrease of bone mineral density.   Weight baring during walking causes bone to be formed. 22          

16.  Increases immune functions- Increases cardiopulmonary fitness, CD4 (a type of White blood cell) count, psychological status, and quality of life. 23           

17. Rheumatoid arthritis - Regular exercise does not exacerbate pain or accelerate disease progression. 24, 25           

18.  Low back pain - Helps chronic low back pain patients return to normal daily activities and work. .26

19.  Alzheimer disease - Women with higher levels of baseline physical activity are less likely to develop cognitive decline. 27

20.  Multiple sclerosis – Exercise improved functional performance, quality of life, and decreases fatigue associated with the disease. 28  

21.  Depression - Antidepressant effect is well known with exercise. 29                     

22.  Gallstones – Exercise decreases the risk of cholecystectomy (gall bladder surgery) independent of other risk factors for gallstone disease, such as obesity.   Exercise improves glucose tolerance, blood lipid levels, and cholecystokinin release while reducing estrogen exposure. 30

Those with chronic medical problems should get an exercise recommendation from their Primary Physician.  

Those who are “healthly” need to start a program.  It will add at least 2 years to your life, and you will feel happier and better. 

Physical activities such as walking or bicycling 10 to 15 minutes twice a day, parking on the far side of the mall parking lot instead of driving around for the closest space, and doing yard work will all be beneficial.  Likewise, playing with children or grandchildren and restricting time watching television are other ways to increase physical activity in those 70% of Americans who perform less than the 30 minutes a day of moderate activities as recommended by the US surgeon general.

 References

1.     Ross R, Janssen.  Physical activity, total and regional obesity: dose-response considerations.  Med Sci Sports Exerc. 2001;33(6, suppl):S521-S527.

2.     National Task Force on the Prevention and Treatment of Obesity.  Overweight, obesity, and health risk.  Arch Intern Med. 2000;160: 898-904.

3.     Goodyear U, Kahn BB.  Exercise, glucose transport, and insulin sensitivity.  Annu Rev Med. 1998;49:235-261.

4.     Hambrecht R, Wolf A, Gielen S, et al.  Effect of exercise on coronary endothelial function in patients with coronary artery disease.  N Engl J Med. 2000;342:454-460.

5.     Kokkinos PF, Narayan P, Colleran JA, et al.  Effects of regular exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension.  N Engl J Med. 1995;333:1462-1467.

6.     Fagard RH.  Exercise characteristics and the blood pressure response to dynamic physical training.  Med Sci Sports Exerc. 2001; 33(6, suppl):S484-S4927.    

7.    Sessa WC, Pritchard K, Seyedi N, Wang J, Hintze TH.  Chronic exercise in dogs increases coronary vascular nitric oxide production and endothelial cell nitric oxide synthase gene expression.  Circ Res. 1994;74:349-353.

8.     Miller TD, Balady GJ, Fletcher GF.  Exercise and its role in the prevention and rehabilitation of cardiovascular disease.  Ann Behav Med. 1997;19:220-229.

9.     Muller JM, Myers PR, Laughlin MH.  Vasodilator responses of coronary resistance arteries of exercise-trained pigs.  Circulation. 1994;89:2308-2314.

10.   Hambrecht R, Gielen S, Linke A, et al.  Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: a randomized trial.  JAMA. 2000;283:30953101.

11.     Wannamethee SG, Shaper AG.  Physical activity and the prevention of stroke.  J Cardiovasc Risk. 1999;6:213-216.

12.   Hu FB, Stampfer MJ, Colditz GA, et al.  Physical activity and risk of stroke in women.  JAMA. 2000;283:2961-2967.

13.   Leng GC, Fowler B, Ernst E. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2000;2:CDO0990.

14.   Ram FS, Robinson SM, Black PN.  Effects of physical training in

asthma: a systematic review.  Br J Sports Med. 2000;34:162-167.

15.   Bourjeily G, Rochester CL.  Exercise training in chronic obstructive pulmonary disease.  Clin Chest Med. 2000;21:763-78 1.

16.   Verloop J, Rookus MA, van der Kooy K, van Leeuwen FE.  Physical activity and breast cancer risk in women aged 20-54 years.  J Nati Cancer Inst. 2000;92:128-135.

17.   Tomeo CA, Colditz GA, Willett WC, et al.  Harvard Report on Cancer Prevention: volume 3: prevention of colon cancer in the United States.  Cancer Causes Control. 1999; 10: 167-180.

18.   McTieman A, Ulrich C, Slate S, Potter J. Physical activity and cancer etiology: associations and mechanisms.  Cancer Causes Control. 1998;9:487-509.

19.   Michaud DS, Giovannucci E, Willett WC, Colditz GA, Starnpfer MJ, Fuchs CS.  Physical activity, obesity, height, and the risk of pancreatic cancer.  JAMA. 2001;286:921-929.

20.   Carter ND, Kannus P, Khan KM.  Exercise in the prevention of falls in older people: a systematic literature review examining the rationale and the evidence.  Sports Med. 2001;31:427-438.

21.   Spirduso WW, Cronin DL.  Exercise dose-response effects on quality of life and independent living in older adults.  Med Sci Sports Exerc. 2001;33(6, suppl):S598-S608.

22.   Bonaiuti D, Shea B, lovine R, et al, Cochrane Musculoskeletal Group.  Exercise for preventing and treating osteoporosis in postmenopausal women [protocol].  Cochrane Database Syst Rev. 2001;issue 4.

23.   Nixon S, O'Bfien K, Glazier RH, Wilkins AL.  Aerobic exercise interventions for people with HIV/AIDS (Cochrane Review). Cochrane Database Syst Rev. 2001;1:CDO01796.

24.   O'Grady M, Fletcher J, Ortiz S. Therapeutic and physical fitness exercise prescription for older adults with joint disease: an evidencebased approach.  Rheum Dis Clin North Am. 2000;26:617-64625.   

25.  Van Den Ende CH, Vliet Vlieland TP, Munneke M, Hazes JM.  Dynamic exercise therapy for rheumatoid arthritis.  Cochrane Database Syst Rev. 2000;2:CDO00322.

26.   Van Tulder M, Maimivaara A, Esmail R, Koes B. Exercise therapy for low back pain: a systematic review within the framework of the Cochrane Collaboration back review group.  Spine. 2000;25:27842796.

27.   Yaffe K, Bames D, Nevitt M, Lui LY, Covinsky K. A prospective study of physical activity and cognitive decline in elderly women: women who walk.  Arch Intern Med. 2001; 161:1703-1708.

28.   Petajan JH, Gappmaier E, White AT, Spencer MK, Mino L, Hicks RW. Impact of aerobic training on fitness and quality of life in multiple sclerosis.  Ann Neural. 1996;39:432-441.

29.   Lawlor DA, Hopker SW.  The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials.  BMJ. 2001;322:763-767.

30.   Leitzmann MF, Rimm EB, Willett WC, et al.  Recreational physical activity and the risk of cholecystectomy in women.  N Engi J Med. 1999;341:777-784.