Monday, April 30, 2012

Guess who is hiding the magic pill to longevity?

Imagine a medicine which protects you against cardiovascular disease, cancers, diabetes, depression and dementia. A medicine which works best when taken regularly and long before any symptoms of any of those diseases appear. A medicine which is cheaper than any supplement or aspirin. Would you take it?

Then why don't you? The name of that medicine is exercise, and ...
...OK, OK, I hear you saying "not again, I have heard that mantra before. Tell me something I don't know!" Which is exactly what I want to do: To tell you something you AND I don't know, because nobody seems to have the answer to the sixty-four-thousand dollar question: Why don't we take this medicine?
Now here is this hot item called swarm intelligence, the phenomenon which, we are being told, makes a horde of blooming idiots come up with solutions worthy of an Einstein's. That should work just fine for us. So, let's put it to the test. I'll tell you first a few facts and my thoughts, after which it is your turn, and then we can look at the results over the next few days, or so.
Now, just so that we all start form the same page, let me recap the effects of exercise. 

Exercise & Heart Disease

Exercise, done right, has been found to reduce the risk of dying from any cause by at least one third with a 9% reduction for every one hour of vigorous exercise performed per week [1]. To be fair, studies which calculate such risks are inherently flawed. They assess exercise through questionnaires, which makes it difficult to reliably judge the amount and intensity of exercise, and whether people stick with a given exercise level and for how long. That's why I like to look at the exercise-health correlation using fitness as the marker. Because fitness is a direct consequence of exercise, and it is something we can objectively measure in the lab.
A fit 45 years old man has only one quarter the lifetime risk of dying from cardiovascular causes compared to his unfit peer [2]. And 20 years later, at the age of 65, being fit means having only half the risk of an unfit 65-year old. So much about exercise and the number one killer of men and women alike, cardiovascular disease. How about the runner-up: cancer?

Exercise & Cancer

The association of fitness with cancer is not as well researched as with cardiovascular disease. But the available data clearly point to a substantial effect. In a study performed in 1300 Finnish men who were followed for 11 years, the physically fit ones, when compared to their least fit peers, had a 60% reduced risk of dying from non-cardiovascular causes, which means mostly cancer [3]. An almost identical value of risk reduction for cancer death had been found in a 16-year study of 9000 Japanese men aged 19-59 [4]. The ones in the highest quartile of physical fitness had a risk of dying from cancer that was 60% lower than the risk of their peers in the lowest quartile.
The fact that fitness correlates so strongly with the risk of dying from cancer might tell us that the intensity of exercise plays a large role. In a study, which followed 2560 men for close to 17 years, the intensity of physical activity was clearly related to cancer mortality. But only in those who were physically active for at least 30 minutes per day did the higher intensity of exercise lower the cancer death risk by close to 50%. Do less than those 30 minutes, and high intensity might not get you away from cancer death. Obviously, low-intensity exercise does neither increase your fitness level nor does it decrease your risk of dying from cancer. The message to all those who play 18 holes on a daily basis: Get a (sports-)life!

Exercise & Dementia

Even less well examined than the exercise-cancer association is the exercise-dementia association. But also here we begin to see a remarkable effect. Results from the first relatively small trials show that physically active elderly have substantially reduced risk of Alzheimer and other forms of dementia, possibly in the range of a 50% risk reduction [5]. 

Why Don't We Exercise?

Ok, so here we are. Obviously, man is made to move. And whether you call exercise medicine or whether you call the lack of exercise a pathogen - which is clinician speak for something nasty that makes you sick - we already know a lot about how exercise does its work biochemically. That's beyond the scope of this post.
What interests me here is the question which I have asked at the beginning of this story: Why do we not take this "medicine" which is free-of-charge and which has a stronger effect than any of those pills for lowering cholesterol or blood sugar or blood pressure?
As researchers we have made no progress at all in answering this question.
The psychologists outdo each other with the creation of behavioral models, which give their inventors a lot of stature, but which have failed to get us one inch closer to the answer. Just to give you an impression, there is the Health Belief Model, the Theory of Reasoned Action, the Theory of Planned Behavior, the Transtheoretical Model of Behavioral Change, the Social Cognitive Theory, the Protection Motivation Theory, the Health Action Process Approach, and probably a few new ones in the making. Their common denominator: no reliable answer to our question.
That's why I would like to try swarm intelligence. If the "swarm" of readers of this blog post, that is you and me, is large enough, we might just come up with an answer that is worth pursuing in a more methodical way.
So, I'll go ahead and tell you a few suspicions which I have. And then, at the risk of baring my soul to the point where you might not find me a likable person, I will tell you what motivates me to do an early morning 90-minutes exercise session almost every day of the week.
But first the suspicions which I have why so few people get themselves to do even the bare minimum of exercise:
1.     Is it because we can't see, I mean literally see, the effects? Would some sort of visual feedback about the benefits and effects of exercise inside your body motivate you to exercise?
2.     Is it because we rather react than act? That is, we only do something to cure a disease once it's manifest rather than prevent it? But then, why do we have intelligence and one of its nifty byproducts called foresight in the first place?
3.     Is it because we are so focused on a pill or an operation as the only tools, which work against a disease, that we simply can't appreciate the value of something so simple and cheap as exercise?
4.     Why do we use the lousy excuse "no time" when we have several hours to spend in front of the TV EVERY day? Regardless of how busy we are with our work?
These are just a few questions which come to mind. They amount to asking why we don't exercise. 
But it will be equally helpful to ask the question: what is it, that KEEPS YOU exercising? 
Because from those who do, we can learn, how to motivate those who don't. Provided we get an honest answer. My suspicion is, the answers which we get in research, are mostly edited for "political correctness". The couch potatoes hide behind the time constraints, because being busy is not perceived as a character flaw, being lazy is. And what could possibly be a character flaw of the exerciser?
Well, I give you mine. The instinctive gratification with which my inner brute views the overweight person in front of me at the check-out queue or in the waiting room, the gratification that comes from being reminded of his risk for disease and suffering being a lot greater than mine (in German we have that word "Schadenfreude"), the gratification that comes from telling him, in my mind only, of course, "I have that strength of will that you don't". 
That's a gratifying incentive, to be sure. But it's not the only one. The main reason why I run every morning, no matter what the weather or the size of the hangover from Saturday's evening (yeah, it happens to all of us) is, that I have seen enough people who suffered a stroke or a heart attack. And I have seen their remorse of not having done enough while there was still time. I fear that. That's what keeps me running.
And what is it for you? Honestly. Let's hear it, and let's see whether we find a common thread, which research has overlooked so far. Remember, as a swarm we are supposed to be far more intelligent than as individuals.

Samitz G, Egger M, & Zwahlen M (2011). Domains of physical activity and all-cause mortality: systematic review and dose-response meta-analysis of cohort studies. International journal of epidemiology, 40 (5), 1382-400 PMID: 22039197

Berry JD, Willis B, Gupta S, Barlow CE, Lakoski SG, Khera A, Rohatgi A, de Lemos JA, Haskell W, & Lloyd-Jones DM (2011). Lifetime risks for cardiovascular disease mortality by cardiorespiratory fitness levels measured at ages 45, 55, and 65 years in men. The Cooper Center Longitudinal Study. Journal of the American College of Cardiology, 57 (15), 1604-10 PMID: 21474041

Laukkanen, J. (2001). Cardiovascular Fitness as a Predictor of Mortality in Men Archives of Internal Medicine, 161 (6), 825-831 DOI: 10.1001/archinte.161.6.825

SAWADA, S., MUTO, T., TANAKA, H., LEE, I., PAFFENBARGER, R., SHINDO, M., & BLAIR, S. (2003). Cardiorespiratory Fitness and Cancer Mortality in Japanese Men: A Prospective Study Medicine & Science in Sports & Exercise, 35 (9), 1546-1550 DOI: 10.1249/01.MSS.0000084525.06473.8E

Buchman AS, Boyle PA, Yu L, Shah RC, Wilson RS, & Bennett DA (2012). Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology, 78 (17), 1323-9 PMID: 22517108 Print Friendly and PDFPrintPrint Friendly and PDFPDF


  1. Now that you are bringing it up: I have to admit I share that occasional inward sneer at an obese person. Particularly when I see those typical food items in her supermarket trolleys: high in calories and low in nutrients. And it gets at me once a month when my health insurance deducts the monthly premium. Where I live we all pay the same, that is, those who do something for their health pay as much as those who don't. Maybe we should really get our feeling and opinions about this more into the open.

  2. I exercise to flush out the laziness. I can feel myself venting the extra energy into unproductive activities. But that happens only if I hadn't done any exercise for a long time, say over a week. I believe exercise or sports are a much better way of spending the energy. Moreover it is a time when don't talk too much and that gives you time to think.

  3. I've been very fortunate. After many years of being a couch potato and sedentary worker, too wrapped up in my work to notice how things I enjoy have slowly been falling by the wayside, I realised one day that I really, really missed swimming. I was never that great at it when I was younger; I assumed that since I was so unathletic and inept at other sports I would be useless at this as well. Long story short: I started again, hesitantly; could barely manage five lengths or so the first time, but after about 9 months I'm doing between 40 and 80 a day and sitting somewhere close to the median at our local pool. For all that time, I've been concentrating on one single motivation: joy. Getting fitter and losing some pounds has been a great side-benefit. I'm also very partial to the endorphins. These aren't the real reason I keep at it though. I think that if you're lucky enough to find an energetic activity which you actively enjoy for its own sake, you won't have many problems keeping at it.


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