Amazing Remedy for Good Health and Longer Life: Exercise

The next time you see your primary care physician, don't be surprised if he or she asks you whether you exercise regularly. If you don't, you just might leave your appointment with a prescription for a regular dose of exercise.

"That's the recommendation from the American College of Sports Medicine (ACSM) and the American Medical Association (AMA)," says Mark W. Niedfeldt, MD, an Associate Professor of Family and Community Medicine at the Medical College of Wisconsin. It's part of a new national campaign called "Exercise Is Medicine." The campaign was founded by the two organizations, along with National and State Government Councils, the President's Council on Physical Fitness and Sports, and the California Governor's Council on Physical Fitness and Sports.

Dr. Niedfeldt says members of the ACSM and the AMA regard the value of exercise so important to health and longevity, they believe it should be treated as one of the vital signs physicians should routinely monitor in their patients, just like height and weight, blood pressure and body temperature. His practice focuses on Sports Medicine and orthopedic treatment of foot and ankle disorders.

The launch of "Exercise Is Medicine" coincidentally was followed by a number of studies that bolster the principle that regular exercise can prevent some serious cardiovascular conditions. One of the more significant was a 12-year study of 2,603 people over 60, published in December 2007 in the Journal of the American Medical Association.

In that study, researchers at the University of South Carolina found that older adults who stayed fit through regular exercise lived longer than those who didn't exercise routinely. Not surprisingly, perhaps, they found that those who stayed fit were less likely to have risk factors for high blood pressure, diabetes and high cholesterol, and their odds of dying prematurely improved by 50%. What was surprising, however, was that even those regular exercisers who were overweight enjoyed these health benefits.

"But you can't be super-fat and get all those results," Dr. Niedfeldt cautions, although he emphasizes that even obese people will gain some benefits from regular exercise and ideally will begin to incorporate a healthy lifestyle including exercise into their lives, which can lead to even more significant improvements. "Anyone can benefit from regular exercise, regardless of their weight," he says, "although the leaner you are, the better. But at the same time, doing some physical activity is better than none."

Never Too Late to Start
Unfortunately, many Americans are notoriously unfit, Dr. Niedfeldt says. "Research has shown that 23.7% of Americans have no physical activity, and fewer than 50% get the recommended amount of physical activity. Among adults over 65, only 39% get the recommended amount of exercise," he says, adding: "As we age, it's even more important to stay fit."

And it's never too late to start, he says, even for those who've reached middle age or beyond and never exercised, or haven't exercised since their younger days. For them, he recommends walking regularly.

"Walking is the one exercise most people can do throughout their lives. Almost everyone can walk. They just need to do more of it." Walking for exercise doesn't require training, or buying equipment other than good walking shoes. And patients who have difficulty walking can often exercise by swimming or riding stationary bicycles, he added.

Amount and Duration of Exercise Is Critical
In 1995, ACSM and the Centers for Disease Control and Prevention recommended that every US adult spend 30 minutes or more doing moderate-intensity physical activity "on most, preferably all, days of the week." A new study published in the journal Circulation in December 2007 updated and refined that advice. It says "all adults between 18 and 65 need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 minutes five days a week or vigorous-intensity aerobic physical activity for a minimum of 20 minutes three days a week." These activities must noticeably accelerate the heart rate.

To promote and maintain good health and physical independence, the study also recommends "that adults will benefit from performing activities that maintain or increase muscular strength and endurance for a minimum of two days a week. These include such activities as a progressive weight-training program, weight-bearing calisthenics, stair climbing and similar resistance exercises that use the major muscle groups."

"The previous recommendations were too vague," Dr. Niedfeldt says. "People thought that if their total physical activity every day totaled 30 minutes - say, brief periods of a few minutes walking to and from the parking lot, plus some walking while doing activities of daily living - they had met the goal. Not so. Yes, they'd get some benefits from the activity; any little bit helps. But to get the full cardiovascular benefits found in the study, it won't be from short spurts of activity. You really have to spend uninterrupted periods of at least 10 minutes at a time doing moderate-intensity walking to total 30 minutes five times a week, or, if you prefer, at least 20 minutes of vigorous-intensity activity like jogging at least three days a week."

Challenging Physicians
Dr. Niedfeldt thinks "Exercise Is Medicine" is a good initiative for physicians and patients. "It's challenging doctors to live the lifestyle, too," he says. "And surveys have shown that patients believe they would take exercise more seriously if their doctors insisted on it and provided resources to help them get started and keep going." He cited a recent ACSM survey that found that nearly two-thirds of patients said they would be more interested in exercising to stay healthy if advised by their doctor and given additional resources.

"We (doctors) have done a good job asking our patients about smoking, and if they want to quit, giving them information about smoking cessation. Now, 'Exercise Is Medicine' is challenging us to ask our patients about their exercise levels and give them guidelines for getting started and staying with their programs. Yes, it can be hard, but it's crucial to their health. Exercise has to become a habit for everyone."

In addition to improving cardiovascular health and increasing longevity in older Americans, exercise may provide these benefits, according to these 2007 studies:

• Reduced risk of vascular dementia: A four-year Italian study of 749 men and women published in the journal Neurology found that participants who ranked in the top one-third for moderate exercise were 29% less likely to develop vascular dementia, the second most common form of dementia after Alzheimer's.
• Strengthen muscles of heart failure patients: Research presented at the American Heart Association annual meeting found that exercise might repair muscle cells in heart failure patients who exercised on stationary bicycles.
• Reduced Risk of Metabolic Syndrome: A study reported in the American Journal of Cardiology found that walking 11 miles a week - equivalent to about 30 minutes of exercise six times a week - can reduce metabolic syndrome. This syndrome, which affects about 25% of U.S. adults - is defined as having any three of the following conditions that threaten heart health: a large waist, high blood pressure, low HDL cholesterol (the so-called good cholesterol), high blood sugar and high triglycerides.

Regardless of an individual's current fitness level, improvement with exercise is virtually guaranteed. "I've seen people who quit smoking in their 40s and 50s start exercising effectively. People with heart conditions notice their angina pain improving. Patients with peripheral artery disease in their legs find their symptoms decrease when they start walking more. Diabetic patients see favorable changes in their glucose tolerance and insulin sensitivity with regular physical activity. Patients with depression often improve when they increase their activity.

"Anyone can benefit from exercise," Dr. Niedfeldt says. "Just start somewhere."

Barbara Abel
HealthLink Contributing Writer

Mark W. Niedfeldt, MD, practices at the Froedtert & Medical College of Wisconsin Orthopaedic Surgery Clinic, Sports Medicine Center, and Plank Road Clinic.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.