Closest Thing to a Wonder Drug? Try Exercise
After
I wrote last year that diet, not exercise, was the key to weight loss, I
was troubled by how some readers took this to mean that exercise
therefore had no value.
Nothing
could be further from the truth. Of all the things we as physicians can
recommend for health, few provide as much benefit as physical activity.
In 2015, the Academy of Medical Royal Colleges put out a report calling exercise a “miracle cure.”
This isn’t a conclusion based simply on some cohort or case-control
studies. There are many, many randomized controlled trials. A huge meta-analysis examined the effect of exercise therapy on outcomes in people with chronic diseases.
Let’s
start with musculoskeletal diseases. Researchers found 32 trials
looking specifically at the effect of exercise on pain and function of
patients with osteoarthritis of the knee alone. That’s incredibly
specific, and it’s impressive that so much research has focused on one
topic.
Exercise
improved those outcomes. Ten more studies showed, over all, that
exercise therapy increases aerobic capacity and muscle strength in
patients with rheumatoid arthritis. Other studies proved its benefits in
other musculoskeletal conditions, like ankylosing spondylitis, and even some types of back pain.
For
people (mostly middle-aged men) who had had a heart attack, exercise
therapy reduced all causes of mortality by 27 percent and cardiac
mortality by 31 percent. Fourteen additional controlled trials showed
physiological benefits in those with heart failure. Exercise has also
been shown to lower blood pressure in patients with hypertension, and
improve cholesterol and triglyceride levels.
People
with diabetes who exercise have lower HbA1c values, which is the marker
of blood sugar control, low enough to probably reduce the risk of
complications from the disease. Twenty randomized controlled trials have
showed that patients with chronic obstructive pulmonary disease can
walk farther and function better if they exercise.
Multiple
studies have found that exercise improves physical function and
health-related quality of life in people who have Parkinson’s disease.
Six more studies showed that exercise improves muscle power and
mobility-related activities in people with multiple sclerosis. It also
appeared to improve those patients’ moods.
The
overall results of 23 randomized controlled trials showed that exercise
most likely improves the symptoms of depression. Five others appear to
show that it improves symptoms in patients with chronic fatigue
syndrome. In trials, exercise even lessened fatigue in patients who were
having therapy for cancer.
What other intervention can claim results like these?
Even studies of older, hospitalized patients
show a beneficial effect from multidisciplinary interventions that
include exercise. Those randomized to such interventions in the hospital
were more likely to be discharged to go home, and to spend less time in
the hospital over all — and at a lower cost.
Although
we don’t think of it this way, you can make a pretty good argument that
exercise is as good as drugs for many conditions. A 2013 meta-analysis of meta-analyses
(that’s how much data we have) combined and analyzed the results from
16 reviews of randomized controlled trials of drug and exercise
interventions in reducing mortality. Collectively, these included 305
trials with almost 340,000 participants.
Diuretic
drugs (but not all drugs) were shown to be superior to exercise in
preventing death from heart failure. But exercise was found to be
equally good as drugs in preventing mortality from coronary heart
disease. Exercise was better than drugs in preventing death among
patients from strokes.
Many
people will be surprised at how little you need to do to achieve these
results. Years ago, in an effort to get in shape, I tried the P90X routine. It proved too hard for me. Later, when I tried the Insanity workout, it beat me so badly that people at work kept asking me if I was ill. Two years ago, I tried P90X3. It was a bit more manageable, but I still couldn’t keep it up.
I
have not been alone in thinking that physical activity to improve
health should be hard. When I hear friends talk about exercising, they
discuss running marathons, participating in CrossFit classes or
sacrificing themselves on the altar of SoulCycle. That misses the point,
unfortunately. All of these are much more than you need to do to get
the benefits I’ve described.
The recommendations for exercise are 150 minutes per week of moderate intensity physical activity for adults, or about 30 minutes each weekday.
Moderate
intensity is probably much less than you think. Walking briskly, at 3
to 4 miles per hour or so, qualifies. So does bicycling slower than 10
miles an hour. Anything that gets your heart rate somewhere between 110
and 140 beats per minute is enough. Even vacuuming, mowing the lawn or walking your dog might qualify.
Today,
my goals are much more modest. Trekking from my office to the clinic
and back again gives me 30 minutes of exercise. Or, I walk to the
supermarket from my office to grab lunch, at a mile each way. In colder
weather, I spend half an hour on the elliptical machine. Doing this five
days a week gets me the activity I need.
Although it feels as if there’s nothing we can do to change people’s behavior, there is evidence to the contrary. A systematic review and meta-analysis of advice and counseling by health professionals found that promotion of physical activity works.
Doctors
and clinics that made efforts to promote exercise to patients needed to
engage 12 adults on the subject to get one additional adult to meet
recommended levels of activity one year later. That might not sound
impressive, but it’s one of the better such results.
After
the Academy of Medical Royal Colleges wrote its report, an editorial in
the BMJ, a prominent medical journal, countered that exercise wasn’t a
“miracle cure.” Instead, the authors argued it was “the best buy for public health.”
If that’s the best “counterpoint,” then physical activity seems like a no-brainer.
