THE GLOBAL CHALLENGE.
Physical inactivity is estimated to cause 2 million deaths worldwide annually, according to the World Health Organization. At least 60 percent of the global population fails to achieve its minimum recommendation of 30 minutes of moderate-intensity physical activity daily, and 17 percent are completely inactive.19 Meanwhile, health-care costs in the United States and many other industrialized countries are escalating. Nations with universal health care have to pay more for coverage. In those without such coverage, as in the United States, millions of Americans cannot afford insurance, and there is no end of this cost explosion in sight. Dealing with the consequences of physical inactivity is a major part of health costs. In the United States, about $400 billion is spent each year to treat heart disease alone. At the same time, epidemiological studies show that at least one-third of all heart attacks would be avoided if people walked briskly 2.5 hours per week.
As for metabolic disorders, the consequences of not moving are even worse: 91 percent of all cases of type 2 diabetes can be traced back to lifestyle issues. People smoke, they overeata"and they let their muscles waste away. If we could magically remove the problem of physical inactivity from the world, the financial crisis we see in our health-care systems would be far easier to resolve.
So, should people asking for health insurance continue to have the right to be sedentary? In the wake of the emerging science of motion, doctors have started posing such questions: aFrom childhood, when unhealthy food habits begin and sedentary lifestyles are copied from parents, people must be educated about the risks of inactivity and overeating. The degree to which unhealthy behavior is regarded as a private issue should be publicly discussed,a state the cardiologists Rainer Hambrecht and Stefan Gielen in an essay in the medical journal The Lancet. aA balance needs to be struck between a reasonable minimum effort on the part of the individual to reduce the health-care costs a.s.sociated with their lifestyle, and intrusion of an investigative health-care system into personal lifestyle.a20 In this vein, one option would be to make physically inactive people pay for their own medication if they are unwilling to change their lifestyles. One example would be high blood pressure, which is a direct consequence of inactivity and can be reversed through exercise. If a patient opts not to use this proven and cheap remedy and prefers to take drugs, why, then, should he not pay for them out of his own pocket?
The precondition for such an approach would be that patients be given professional consultations about the benefits of exercise. Because physical activity has turned out to be one of the most broadly effective therapies known, one without the adverse side effects of some drugs, it is absurd that there are still no real incentives to make doctors prescribe this miracle remedy.
Of course, it would be naive to a.s.sume that people will start exercising solely because they want to help our troubled health-care system. Regulations a.s.serting that exercise is something like a duty of each citizen are unrealistic and undesirable in a free society. But becoming informed about the emerging role of exercise as preventive and curative medicine should be our duty to each other. Each of us can walk along this path. Itas never too late, and every step will be rewarded.
NOTES.
CHAPTER 1: THE HEALING POWER OF EXERCISE.
1 Personal communication; I visited Wayne Sandler in his practice in Los Angeles in the summer of 2005.
2 Personal communication and talk by Carolyn Kaelin in Wellesley, Ma.s.sachusetts, fall 2005; see also Carolyn Kaelin with Francesca Coltrera, Living Through Breast Cancer (New York: McGraw-Hill, 2005).
3 Wildor Hollmann and others, aKrperliche Aktivitt und Gesundheit,a Blickpunkt Der Mann 3 (2006): 11-15.
4 Christoph Schmidt-Hieber, Peter Jonas, and Josef Bischofberger, aEnhanced Synaptic Plasticity in Newly Generated Granule Cells of the Adult Hippocampus,a Nature 429 (2004): 184-187.
5 Personal communication. See also the review paper by Henriette van Praag, aNeurogenesis and Exercise: Past and Future Directions,a Neuromolecular Medicine 10 (2008): 128-140.
6 Jean Marx, aPreventing Alzheimeras: A Lifelong Commitment?a Science 309 (2005): 864-866.
7 Michael Babyak and others, aExercise Treatment for Major Depression: Maintenance of Therapeutic Benefit at 10 Months,a Psychosomatic Medicine 62 (2000): 633-638.
8 Nicola T. Lautenschlager and others, aEffect of Physical Activity on Cognitive Function in Older Adults at Risk for Alzheimer Disease,a Journal of the American Medical a.s.sociation 300 (2008): 1027-1037.
9 B. K. Pedersen and B. Saltin, aEvidence for Prescribing Exercise as Therapy in Chronic Disease,a Scandinavian Journal of Medicine & Science in Sports 16 (Suppl.1, 2006): 3-63.
10 Carol Derby and others, aModifiable Risk Factors and Erectile Dysfunction: Can Lifestyle Changes Modify Risk?a Urology 56 (2000): 302-306.
11 Personal communication, June 6, 2008.
12 Thorsten Schulz, Christiane Peters, and Horst Michna, aBewegungstherapie und Sport in der Krebstherapie und-nachsorge,a Deutsche Zeitschrift fr Onkologie 37, no. 4 (2005): 159-168.
13 The life-prolonging effect was just confirmed by two new studies among women with breast cancer: Crystal N. Holick, et al., aPhysical Activity and Survival After Diagnosis of Invasive Breast Cancer,a Cancer Epidemiology Biomarkers & Prevention 17 (2008): 379-386; and Melinda Irwin, et al., aInfluence of Pre-and Postdiagnosis Physical Activity on Mortality in Breast Cancer Survivors: The Health, Eating, Activity and Lifestyle Study,a Journal of Clinical Oncology 26 (2008): 3958-3964.
14 Personal communication, July 1, 2008.
15 Rainer Hambrecht, aSport als Therapie,a (Physical Exercise as Treatment Strategy) Herz 29 (2004): 381-390.
16 Amy A. Hakim and others, aEffects of Walking on Mortality Among Nonsmoking Retired Men,a New England Journal of Medicine 338 (1998): 94-99.
17 Heinz Mechling, aKrperlich-sportliche Aktivitt und erfolgreiches Altern,a Bundesgesundheitsbl-Gesundheitsforsch-Gesundheitsschutz 48 (2005): 899-905.
18 Randolph Nesse and George Williams, Why We Get Sick (New York: Vintage Books, 1995).
19 Lynn Cherkas and others, aThe a.s.sociation Between Physical Activity in Leisure Time and Leukocyte Telomere Length,a Archives of Internal Medicine 168 (2008): 154-158.
20 Frank Booth and others, aWaging War on Physical Inactivity: Using Modern Molecular Ammunition Against an Ancient Enemy,a Journal of Applied Physiology 93 (2002): 3-30.
21 Heinz Mechling, aKrperlich-sportliche Aktivitt und erfolgreiches Altern,a Bundesgesundheitsbl-Gesundheitsforsch-Gesundheitsschutz 48 (2005): 899-905.
22 The physician Barron H. Lerner published an essay on the role of coincidence in medicine: New York Times, September 19, 2006.
23 Allen Warburton and others, aHealth Benefits of Physical Activity: The Evidence,a Canadian Medical a.s.sociation Journal 174, no.6 (2006): 801-809.
24 Annette Becker, aActivating Medicinea"A New Approach to Illnessa (Schonungslose Medizin-Der neue Umgang mit dem Kranksein), Zeitschrift fr Allgemeinmedizin 82 (2006): 338-342.
25 Rdiger Reer, et al., aBewegungstherapie als therapeutisches Prinzip,a Bundesgesundheitsbl-Gesundheitsforsch Gesundheitsschutz 48 (2005): 841-847.
26 Ibid.
27 Linn Goldberg and Diane Elliot, The Healing Power of Exercise (New York: John Wiley, 2000).
28 Thomas S. Kuhn, The Structure of Scientific Revolutions, 3rd ed. (Chicago: University of Chicago Press, 1996).
29 Reer and others.
CHAPTER 2: THE DANGERS OF GOING TO BED.
1 Annette Becker, aActivating Medicinea"A New Approach to Illnessa (Schonungslose Medizina"Der neue Umgang mit dem Kranksein), Zeitschrift fr Allgemeinmedizin 82 (2006): 338-342.
2 It was Sir Richard Asheras intention ato justify placing beds and graves in the same category.a He concluded his report about the adangers of going to beda with the following poem: aTeach us to live that we may dread Unnecessary time in bed.
Get people up and we may save Our patients from an early grave.a Richard Asher, aThe Dangers of Going to Bed,a British Medical Journal 2 (1947): 967-968.
3 Thomas Mann, The Magic Mountain, trans. H. T. Lowe-Porter (New York: The Modern Library, 1992).
4 Jules Romains, Knock, trans. James B. Gidney (New York: Barronas Educational Series, 1962).
5 Chris Allen and others, aBed Rest: A Potentially Harmful Treatment Needing More Careful Evaluation,a The Lancet 354 (1999): 1229-1233.
6 Ibid.
7 Thomas Gill and others, aHospitalization, Restricted Activity, and the Development of Disability Among Older Persons,a Journal of the American Medical a.s.sociation 292 (2004): 2115-2124.
8 Angelika Abt-Zegelin, aPrvention von Bettlgerigkeit,a Die Schwester Der Pfleger 3 (2006): 210-213.
9 Almut Schmid and others, aNhrstoff-und Bewegungsmangel im Altenheim weitverbreitet,a Geriatrie Journal 1-2 (2001): 31-34.
10 Abt-Zegelin, 210-213.
11 Almut Schmid and others, 31-34.
12 Paul Corcoran, aUse It or Lose Ita"The Hazards of Bed Rest and Inactivity,a Rehabilitation Medicinea"Adding Life to Years, Special Issue of The Western Journal of Medicine 154 (1991): 536-538.
13 B. Saltin, G. Blomqvist, J. H. Mitch.e.l.l, and others, aResponse to Exercise After Bed Rest and After Training: A Longitudinal Study of Adaptive Changes in Oxygen Transport and Body Composition,a Circulation 37/38, suppl. VII (1968): VII-1-VII-78.
14 B. K. Pedersen and B. Saltin, aEvidence for Prescribing Exercise as Therapy in Chronic Disease,a Scandinavian Journal of Medicine & Science in Sports 16, suppl. 1 (2006): 3-63.
15 Saltin, Blomqvist, Mitch.e.l.l, and others, VII-1-VII-78.
16 Walter Bortz, aThe Disuse Syndrome,a The Western Journal of Medicine 141 (1984): 691-694.
17 Angelika Zegelin, aFestgenagelt Seina"Der Prozess des Bettlgerigwerdens durch allmhliche Ortsfixierung,a Pflege 18 (2005): 281-288.
18 Corcoran, 536-538.
19 Becker, 338-342.
20 Irwin Rosenberg granted me an interview in October 2005 when he actually read to me from his 1991 book, saying that its message is still valid and timely. See also William Evans and Irwin Rosenberg with Jacqueline Thompson, Biomarkersa"The 10 Keys to Prolonging Vitality (New York: Fireside Books, 1991).
CHAPTER 3: UNEMPLOYED BODIES, NEW DISEASES.
1 Hans Kraus and Wilhelm Raab, Hypokinetic Diseasea"Disease Produced by Lack of Exercise (Springfield, Illinois: Charles C. Thomas, 1961).
2 H. Mellerowicz, aBewegungsmangel-und seine Folgen,a Zeitschrift fr ffentliches Gesundheitwesen 29.11 (1967): 512-519.
3 Ibid.
4 The figures refer to the year 2000. www.who.int/dietphysicalactivity/ publications/facts/pa/en/.
5 William Haskell, aSport, Bewegung und Gesundheit,a Der Orthopde 29 (2000): 930-935.
6 American Academy of Pediatrics, aChildren, Adolescents, and Television,a Pediatrics 107 (2001): 423-426.
7 Haskell, 930-935.
8 Frank Booth and Darrell Neufer, aExercise Controls Gene Expression,a American Scientist (January 2005).
9 to calculate the BMI you divide your weight (in kilograms) by the square of your height (in meters). Alternatively you can divide your weight (in pounds) by the square of your height (in inches), then multiply with the factor 703.
10 Paul was one of the patients in the rehabilitation facility Insula for obese adolescents in Berchtesgaden, Bavaria. Der Spiegel 51 (2000).
11 Peter Gluckman and Mark Hanson, Mismatcha"Why Our World No Longer Fits Our Bodies (Oxford: Oxford University Press, 2006).
12 The Boston Globe, December 26, 2006.
13 S. Boyd Eaton and Stanley Eaton, aAn Evolutionary Perspective on Human Physical Activity: Implications for Health,a Comparative Biochemistry and Physiology. Part A, Molecular & Integrative Physiology 136.1 (2003): 153-159.
CHAPTER 4: WALKING OFF DIABETES.
1 Diabetes in Indigenous People Forum in Melbourne convened on November 12, 2006.
2 Spiegel Online, November 13, 2006.
3 Manu Chakravarthy and Frank Booth, aEating, Exercise, and athriftya Genotypes: Connecting the Dots Toward an Evolutionary Understanding of Modern Chronic Diseases,a Journal of Applied Physiology 96 (2004): 3-10.
4 S. Jay Olshansky and others, aA Potential Decline in Life Expectancy in the United States in the 21st Century,a New England Journal of Medicine 352 (2007): 1138-1145.
5 Derrick Jackson, aDiabetesa"The Silent Killer Among Us,a The Boston Globe, September 30, 2006.
6 Thea Shavlakadze and Miranda Grounds, aOf Bears, Frogs, Meat, Mice, and Men: Complexity of Factors Affecting Skeletal Muscle Ma.s.s and Fat,a BioEssays 28 (2006): 994-1009.
7 Sally Squires, aFat Cats, Poor Prognosis,a The Washington Post, September 12, 2006.
8 Frank Booth and Darrell Neufer, aExercise Controls Gene Expression,a American Scientist (January 2005).
9 Not only in the United States and in Germany, but all over the world type 2 diabetes is rapidly spreading. In 1985 it is estimated there were 30 million patients worldwide. Now, the number appears to be 230 million, and for 2026 a number of 350 million is expected (unless action is taken). These figures surfaced at the 42nd annual meeting of the European a.s.sociation for the Study of Diabetes in Copenhagen, Denmark.
10 www.nih.gov/about/researchresultsforthepublic/Type2Diabetes.pdf.
11 Christian Roberts and James Barnard, aEffects of Exercise and Diet on Chronic Disease,a Journal of Applied Physiology 98 (2005): 3-30.
12 Press release from the National Inst.i.tute of Diabetes and Digestive and Kidney Diseases, February 6, 2002, www.nih.gov/news/pr/feb2002/hhs-06.htm.
13 Javier Ibaez and others, aTwice-Weekly Progressive Resistance Training Decreases Abdominal Fat and Improves Insulin Sensitivity in Older Men With Type 2 Diabetes,a Diabetes Care 28 (2005): 662-667.