Why did we as a species adopt exercise as a treatment and means to avoid disease?What evidence did we have?What evidence do we have now?Why do US citizens reportedly spend 40 billion a year on organised commercial exercise?The US spends the most per capita on ‘health’ and is 40th in 194 nations for recorded life expectancy. No, it has no effect on the prevalence or mortality of OWOB, DM,CHD at a national level. Life expectancy in the US has been quietly falling for two decades and the degenerative diseases are behaving like fertilised spring crops.
Exercise is ‘good’ for you. Exercise lifts your ‘endorphins’. What are they? Can I measure them, buy them?Exercise’ reduces weight’. Exercise improves your ‘health’. Exercise makes you ‘fit’.Exercise makes your ‘live longer’. I always ‘feel’ better after exercise.Its well known, everyone knows that. Yeah,right. What is ‘exercise’? What does ‘fit’ mean. What is ‘activity’? What actually is ‘health’?What’ type’ of exercise?Does it differ from ‘activity’.I believe it is one of those examples of ‘slogan logic’, that ‘popular medicine’ has vacuumed, I discuss in No Mad Physician.Our culture is riddled with them and the power, controlling fraternity, with commerce and finance using them as tools for their ends extensively.Confusion in interpreting is common and meaning ambiguous, which is unsatisfactory for a reported indice of disease.
An elementary view of our evolutionary origins is always useful. The original single cell organism and those that continue to exist like viruses, bacteria and other less well known species, rely on the medium they survive in to move, like water and air.So transfer to another host by body fluids or contact is critical for survival after the primary host perishes. The creation of extrusions of the cell into filaments, fimbria provided sets of ‘oars’for the cell where it could find new hosts and avoid predators. They evolved into ‘limbs’, legs, arms, wings for all the animal kingdom. Some species have many organs for motion like a catipillar. Some limbs are used for motion and others for creative and functional purposes.Movement served a purpose for survival and reproduction.The ‘limbs’ arose, evolved to effect movement to effect survival and reproduction.There was no exercise training, competing, viral or bacterial ‘marathons’. The ‘limbs’ were built for purpose, but observing unicellular organisms under any microscope, shows a ‘background’movement in their medium, which could be interpreted of functional value, keeping the motion parts active.Or are they just social creatures?
I am not aware of any animal species that ‘exercise trains’ other than us. We calculate first animal life arose 3.7 billion years ago, so all species have had ample time to demonstrate ‘training’ exercise. Many species pursuing prey, have to conduct the exercise often to be successful. But they do not train. Many species when required for survival will travel very long distances, thousands of miles, at their pace and they don’t appear to train for it. The Godwit, an estuary feeding ‘sea bird’, flies from different areas of NZ to Alaska to breed, over 12,000 miles non stop. Except for short flights about the estuary, there are no training flights. Evolution adaption has not deemed that necessary. My impression is over 3.7 billion years, evolution adaption for survival, has not expressed anything I can perceive as exercise training. Skill training is innate for survival.As a Cardiologist I am fascinated how that small Godwit heart functions in duress of all weathers, for so long and I understand most make the journey. Then a few years later that remarkable heart fails, stops, why?That long distance flight is hardly training and it does not appear to provide longevity for the Godwit.
The longest living males in Crete and Okinawa in the 1960’s, did not ‘train’,but they were active in all aspects of their lives, to provide the essentials for survival. Hundreds of very long living groups dispersed about the planet do not ‘train’, but again are active in their practices for survival, with the absence of processed CHO and sugar. The hunter gatherers who have been studied with none of our degenerative diseases were active for survival, but did not train.None of the long living patients in my professional career, trained for anything, but they were active physically and mentally through their life.There are over 600 Okinawan’s aged over 100 years and they and all Okinawan’s do not train, or ‘exercise’ but they do stay ‘active’. The ‘standard of living’ was unrecordable in Crete, Okinawa and all groups studied.
So where did the link between exercise and disease and or OWOB arise? In a large reputable US study in 1900, OWOB was found to be I%(look at old photos) and now it is 65-75%, in a nation that has arguably the planet’s highest standard of living and ‘exercise’ bill! So much for the political, economical, financial, social philosophies of the last few centuries. Neo-liberal economic capitalism, Marxism have been responsible and fertilised the degenerative and infectious diseases!Do assets and wealth make you happy while you endure your diseases of affluence, where chronic disability and dysthesia predominate with premature mortality and exorbitant cost? No you are not going to ‘live longer’!
We have known in medicine for a long time, most deaths occur from 12 midnight to 12 midday but the deaths are predominantly from arousal time to midday. In this period our cardiovascular response has been well studied as well as the endocrine behaviour. Very simply our main pumping chamber has to increase its work output as the systolic pressure rises independent of exercise when we wake and rise. The graph of the systolic pressure is independent largely of what activity is undertaken, except intentional exercise. By 12 midday the systolic pressure has returned to near normal.If you lie prone in bed awake, this response is modified or aborted. The systolic pressure graph is shadowed by the release of sympathomimetic hormones and cortisol, that shadow the systolic pressure until midday. I suspect the adrenalin and cortisol response impacts the CV features and why the use of beta blocker drugs may have influenced early morning mortality. I have demonstrated in a study that the early morning morphology of beta blocker treated patients, is characterised by a lower and delayed morning systolic peak.In the same study of near 400 treated patients, for all hypotensive drug groups, the peak and morphology was modified, which could suggest this is the prime mechanism, sources of these groups of drugs impact on mortality.
Nearly three decades ago my failure to swim very far at 7. am compared with 7. pm, prompted my 24 hour study of patients CV indices. An Olympic committee ten years ago, recognised finally that endurance races held in the morning, were slower than when held in the pm! For a very long time I have advised my patients to avoid early morning exercise activity and postpone to the pm. Yes, exercise can be dangerous also.
There is physiological evidence that exercise of various types and extent, can act in what appear to be beneficial ways amongst risk factors. Glucose uptake in muscle of diabetic, pre-diabetics or those with elevated HbA1c improves. Is this a change in insulin receptor sensitivity or resistance?Levels of TG/HDL may fall in this context as does CRP levels, from chronic inflammation. Levels of nitrous oxide, a potent vasodilator in the epithelium lining of medium size arteries rises. These are desirable changes in these diseases, but they do not at this stage, translate into significant improvement in morbidity and mortality we can detect. There is no point in running or riding a cycle for a 100 miles a week, if you are only getting the advantage of the person who gardens daily, walks the dog daily and plays bowls three times a week! I am unaware of any study of value that has demonstrated a reduction in size or elimination of atheroma lesions with exercise.It would be hard to do.
I suspect that exercise, based on energy expenditure, became tangled in weight reduction. I will deal with this in a post on fat accumulation. Pure physics was applied using Newton’s Third Law of Thermodynamics, calculating energy consumed, used and excreted must be balanced. That might be relevant if all sources of energy did the same thing in our species, but in this biological case they do not. Fat, protein and CHO are metabolised quite differently in the animal species. No, physical exercise independently will not reduce weight. You must reduce processed CHO with sugar, best eliminate them, we have lived 99% of our existence without them!In my experience ‘exercisers’ implement nutrition change too, not always satisfactory types though.
So does exercise make you ‘healthier’, live longer, avoid degenerative diseases especially CHD?To me as a professional trained and experienced to diagnose, treat and help avoid the degenerative diseases, in my case CHD, the scene is looking like the animal fat and cholesterol scene in the 1960’s- 90’s. Historically observing populations without disease and with disease gave us clear evidence. Interest groups and non-medical fraternities created a fog of uncertainty, poor science and interpretation, which is happening with exercise. The history in this instance tells us regular activity associated with survival nutrition, is the biologic template for disease avoidance and management. I advise my patients to exercise with activities they enjoy and can manage, but their nutrition must be attended to primarily, because what I consider satisfactory evidence for the nature, extent or duration of ‘exercise’ is not available.
Dr.Lindsay A. Green. FRACP. FCSANZ.