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.
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
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.
ReplyDeleteI 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.
ReplyDeleteI'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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