Electronic letters to:
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eLetters: Electronic letters published:
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Health benefits of physical activity: There’s probably more to it than just physical activity alone
- Dr. Rajesh Chauhan (19 June 2006)
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Ban School Busses, Elevators And Lazyboys
- Dr. Herbert H. Nehrlich (17 March 2006)
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Barriers for healthy life styles
- Ediriweera Desapriya (15 March 2006)
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High-volume physical activity and related health outcomes.
- Giuseppe Lippi (14 March 2006)
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Dr. Rajesh Chauhan 309/9 A.V. Colony, Sikandra, AGRA - 282007. INDIA.
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drchauhanrajesh{at}yahoo.com Dr. Rajesh Chauhan
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Dear Editor, In impoverished nations, physical activity is more or less an essential prerequisite for a substantial percentage in order to maintain livelihood, rather than being just another activity aimed towards better health. A farmer or a manual laborer, in order to meet both ends meet, has to start early in the morning and continue until late in the evening. Tricycle pedal rickshaw is still a means of transport at places and its peddler burns immense amount of calories throughout the day, probably equaling ten persons treadmill workout for an hour or more daily. At the end of the day, his health too is no better and has not improved despite his ‘unwittingly’ and ‘supposedly’ deriving health benefits from aerobic physical activity [1- 10]. Therefore, there obviously seems to be much more than just physical activity alone for deriving adequate health benefits. It seems to be interplay of various factors, which tend to offer reasonable amount of health benefit. Probably the obvious and overt facts and live examples have inadvertently been ignored and omitted. It would be reasonable to draw inferences that become applicable across the board based on more in-depth analysis taking into consideration certain variables that may otherwise have the tendency to jeopardize health by an excess of physical activity. Possibly a comparative study of an endurance athlete and an impoverished tricycle rickshaw puller, performing as much daily as an endurance athlete does, may be able to lay bare certain overlooked essential facets. Although the study by Warburton et al [1] is quite meticulous, detailed and interesting, the interplay and role of adequate balanced diet, timely replenishment of essential minerals and nutrients, the role of environment, prolonged and incessant endurance, role of adequate rest and recoup, and the interplay of psychological factors, comorbidity, etc, needs to be evaluated and explored. This would enable establishment of comprehensive and conclusive guidelines relating to physical activity with reference to health benefits. Warm regards. Dr. Rajesh Chauhan, MBBS, DFM, ADHA, FCGP, FISCD, FAIMS. Dr. Akhilesh Kumar Singh, MBBS, MD. Dr. Parul Chauhan, MBBS, MISMCD. References: 1. Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: the evidence. CMAJ 2006;174:801-9. 2. Lippi, G, Salvagno, GL, Guidi, GC Other advantages to aerobic exercise. CMAJ 2005;173:1066. 3. Bouchard C, Shephard RJ. Physical activity fitness and health: the model and key concepts. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity fitness and health: International proceedings and consensus statement. Champaign (IL): Human Kinetics; 1994. p. 77-88. 4. Warburton DE, Gledhill N, Quinney A. Musculoskeletal fitness and health. Can J Appl Physiol 2001; 26: 217-37. 5. Warburton DE, Gledhill N, Quinney A. The effects of changes in musculoskeletal fitness on health. Can J Appl Physiol 2001;26:161-216. 6. Morris JN, Heady JA. Mortality in relation to the physical activity of work: a preliminary note on experience in middle age. Br J Ind Med 1953; 10: 245-54. 7. Lee IM, Hsieh CC, Paffenbarger RS Jr. Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA 1995; 273:1179-84. 8. Barengo NC, Hu G, Lakka TA, Pekkarinen H, Nissinen A, Tuomilehto J. Low physical activity as a predictor for total and cardiovascular disease mortality in middle-aged men and women in Finland. Eur Heart J 2004; 25(24): 2204 - 2211. 9. Lee IM, Paffenbarger RS Jr. Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard Alumni Health Study. Am J Epidemiol 2000; 151: 293-9. 10. Erikssen G. Physical fitness and changes in mortality: the survival of the fittest. Sports Med 2001; 31: 571-6. Conflict of Interest:None declared |
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Dr. Herbert H. Nehrlich Private Practice
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drhhnehrlich{at}westnet.com.au Dr. Herbert H. Nehrlich
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Darren E.R. Warburton, Crystal Whitney Nicol, and Shannon S.D. Bredin have done a thorough and credible job in presenting the evidence for health benefits through physical exercise. And it is irrefutable evidence widely accepted by all but a few couch potatoes and recliner pumpkins. While we should not fall into the trap of equating fitness with health, the two are close cousins. Looking back at the early work of Cooper, father of aerobics, one can follow the health benefits this "craze" produced, but, as Cooper himself pointed out in his book Antioxidant Revolution 1, things weren't all that simple and clear cut as first thought. It seems that in our effort to get and stay fit, we tend to forget that the increased demands on the system leads to a requirement for extra nutrients, especially the so-called anti- oxidants. Free radicals are unstable oxygen molecules. When produced in excess, as during heavy exercise, they will cause damage similar to the damage caused by smoking, air pollution and other factors .Overtraining sometimes called "distress exercise" (watch the facial expression of some joggers) may very well increase the risk of developing medical problems. Every book I have seen on exercise carries the disclaimer and caveat to see your physician first, before you start your fitness program. Yet your family doctor may lack the qualifications and make the decision on the basis of his belief that all exercise is great and will only improve health. He is likely to assume that the natural laziness of his patients will keep them safe enough. I take issue with a couple points in this, one, the mention of the truly dead horse hypercholesterolemia and, secondly, the mention of exercise being able to bring established disease (here CVD) to a standstill and even reverse it. This is rather speculative, although some evidence exists. Even Pritikin proposed this and presented apparent proof. However, thinking of people like Jim Fixx and physicians like Thomas Bassler is eye-opening. Fixx had established heart disease and he believed that running a marathon (at least once) would confer immunity from heart attacks. This was preached by Bassler et al. Another firmly held belief was that drinking copious amounts of beer would counteract dehydration and thus kidney stones if one ran in hot climates. Bassler stated that beer went "more directly to the kidneys". 2 As we all know, Fixx died of a massive heart attack while on a 10 mile run. He was convinced (as many were and too many still are) that one needed to overcome the inner resistance which was expressed as chest pain and "hitting the wall", absolute loss of energy. Fixx found that this worked and seemed totally unconcerned about the possibility of his heart condition ever becoming a problem. All in all, the physician or other person involved in a candidate's fitness efforts needs to be aware of his grave responsibility, he cannot assume that the patient's new found enthusiasm to get fit (and healthy) will be tempered by sufficient common sense. I believe that short bursts of maximum exertion (run from the lion)as well as aerobic exercise like long distance endurance running (chase the deer)can both be instrumental in improving the health of a population. It remains for the policymakers to ensure that the opportunities are not only there but that they seem irresistible. References: 1 Dr. Kenneth Cooper The Antioxidant Revolution, 1994 2 James Fixx The Complete Book Of Running 1977 Conflict of Interest:None declared |
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Ediriweera Desapriya Department of Pediatrics
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edesap{at}cw.bc.ca Ediriweera Desapriya
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Epidemiologic and clinical trial evidence supports the view that dietary and lifestyle factors play predominant roles in the development of major chronic diseases. Whereas cigarette smoking, obesity, and physical inactivity have long been established as major causes of chronic disease, the role of specific dietary factors had not been clearly defined until more recently. (1) Regular physical activity or exercise is known to provide health and fitness benefits (muscular strength, cardiorespiratory and muscular endurance, flexibility, reduced body fat, improved physical function, and decreased depression and anxiety), decrease the risk of chronic conditions (coronary heart disease, diabetes, obesity, hypertension, stroke, colorectal cancer, breast cancer, and osteoporosis), and contribute to general well-being and quality of life. (2, 3) Therefore physical activity is essential for health and psychologic well-being. Because physical activity is fundamental to health, CVD risk reduction, and weight maintenance/reduction, children and adults must be encouraged to make time for themselves and their health. Importantly, high prevalence of childhood overweight has become a national health issue. Frequently reported barriers to exercise include lack of time, lack of access, and lack of safe environments in which to work out. Increased availability of affordable secure environments for physical activities combined with acceptable choices for exercise, such as walking, swimming, biking, or fitness classes, may increase activity levels. Education alone does not motivate changes in behavior nor will changes be made before the person is ready to make any recommended change. (4, 5) Researchers and providers have implemented health-promoting interventions for diverse groups of people for many years and have reported mixed degrees of success. They have also been reported that unequal distributions of disease and disability disproportionately affect racial and ethnic minorities and impoverished peoples. Therefore we need to develop and deliver inclusive, culturally appropriate interventions to increase and encourage active life styles and healthy diets of our communities. Highlighting the public health benefits of physical activities and active life styles are important. (6) Discussing barriers to physical activities and suggesting solutions, as well as recommendation of best practices to increase physical activities are equally as important. To slow and reverse the current trends in obesity related health problems, highly effective health promotion interventions and similarly, removal of the barriers to active life styles and healthy diets in our communities are greatly needed. (7) REFERENCES: (1). Willett, W. C., Balancing life-style and genomics research for disease prevention. Science 2002: 296; 695–698. (2). US Surgeon General. Surgeon General's report on physical activity and health. JAMA. 1996; 276(7):522. (3). National Institute of Health (NIH) Consensus Development Panel. Physical activity and cardiovascular health. JAMA. 1996; 276(7):241–246. (4) Sneed NV, Paul SC. Readiness for behavioral changes in patients with heart failure. Am J Crit Care. 2003;12(5):444-453. (5) Paul S, Sneed N. Strategies for behavior change in patients with heart failure. Am J Crit Care. 2004;13:305-313 (6). Warburton, D.E.R., Nicol, C.W., Bredin, S.S.D.,Health benefits of physical activity: the evidence. CMAJ 2006: 174 (6) (7).Desapriya E.B.R., Obesity epidemic. Lancet 2004:364; 1488 Conflict of Interest:None declared |
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Giuseppe Lippi Ist. Chimica e Microscopia Clinica, Dip. Scienze Morfologico-Biomediche, Verona University
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ulippi{at}tin.it Giuseppe Lippi
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Giuseppe Lippi, Federico Schena, Gian Cesare Guidi. In the review article of Warburton and colleagues, recently published in this Journal, it was concluded that there appears to be a linear relation between physical activity and global health status, such that a further increase in physical activity and fitness will lead to additional improvements in health status (1). Although Health Canada physical activity guidelines appears to be sufficient to elicit health benefits, especially in previously sedentary people, there is still open debate regarding intensity and type of physical activity required to achieve most favourable health changes without overwhelming favourable health outcomes or eliciting osteoarthritis and cardiovascular abnormalities not present at rest (2). Warburton and colleagues provided a comprehensive insight into this debate. Nevertheless, in recent investigations on top class endurance athletes (professional road cyclists and members of the Italian Cross-Country ski team, who have won two gold and two bronze medals at the recent Turin Olympics), we further demonstrated that a vigorous and regular endurance aerobic training regimen does not influence markers of hemostatic or endothelial activation (3), nor it induces any persistent phlogistic reaction (4). We also demonstrated that such a demanding physical activity, though able to trigger reversible skeletal muscle sufferance, would not be associated with any biochemical sign of acute or chronic cardiac involvement, as reflected by lower concentrations of the NT-pro-brain natriuretic peptide in athletes (5). The measurement of natriuretic peptides is currently the best minimally invasive surrogate for echocardiography in assessing cardiac dysfunction (6). Therefore, results of our investigations support the conclusion that a substantial intensification in leisure-time physical activity within the population does not produces any increase of the risk of adverse cardiovascular events (3-5) and it is likely to be more effective for eliciting supplemental health gains. We further suggest that higher intensities and amounts of aerobic training may be safely implemented in free-living sedentary individuals as a preventive or therapeutic measure to gain further health advantages, especially in individuals who are most at risk of developing cardiovascular problems, osteoporosis and cancer (1). References. 1. Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: the evidence. CMAJ 2006;174:801-9. 2. Lee, IM, Sesso, HD, Oguma, Y, Paffenbarger, RS Jr Relative intensity of physical activity and risk of coronary heart disease. Circulation 2003; 107: 1110-1116. 3. Lippi, G, Salvagno, GL, Montagna, M, Guidi, GC Chronic influence of vigorous aerobic training on hemostasis. Blood Coagul Fibrinolysis 2005; 16: 533-534 4. Lippi, G, Salvagno, GL, Guidi, GC Other advantages to aerobic exercise. CMAJ 2005;173:1066. 5. Lippi G, Salvagno GL, Montagnana M, Schena F, Ballestrieri F, Guidi GC. Influence of physical exercise and relationship with biochemical variables of NT-pro-brain natriuretic peptide and ischemia modified albumin. Clin Chim Acta 2005 Dec 30 [Epub ahead of print]. 6. Melanson SE, Lewandrowski EL. Laboratory testing for B-type natriuretic peptides (BNP and NT-proBNP): clinical usefulness, utilization, and impact on hospital operations. Am J Clin Pathol 2005;124 Suppl:S122-8. Conflict of Interest:None declared |
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