Monday, December 5, 2016

How long will you live? Exercise plays bigger role than diet, smoking and a lot of other factors.

Finally some clarity.

You aren’t what you eat.

You are what you DO.

A new study suggests you can get away with a fair number of dietary and other lapses, as long as you stay active.

There are Hawai`i data that make sense of this.

We’ve got our health issues in the Islands. Diet alone is an issue. Think fast food burgers, kalua pork and bento lunches with five kinds of meat. 

(People outside Hawai`i will question this, but I recently had a box lunch with rice, pickled vegetables and Korean barbecue ribs, barbecue chicken, teriyaki beef, Goteborg sausage and Vienna sausage.)

Despite such excesses, Hawai`i has the highest life expectancy in the nation. More than 81 years on average. This isn’t news. Here’s just one citation, from the Centers for Disease Control. 

Hawai`i also has one of the highest rates of exercising in the nation. One Gallup survey from 2013 said 62 percent of Island residents said they exercise at least 3 times a week. 

And it’s not just the nice weather. We’re second highest in the nation for exercise after Vermont. And Montana and Alaska are right up there, too. All are also in the top third in longevity

So, is there a connection? 

Sure there is, according to these researchers from the American Heart Association and Queen’s University. They say exercise trumps diet and lots of other risk factors toward living a long life. (Here's the Eureakalert review of the paper we're citing.)

And you don’t have to be a triathlete. 

“Moderate levels of physical activity consistent with current recommendations may be all that is needed to derive a clinically significant benefit for habitually sedentary individuals,” said Dr. Robert Ross, of Queen’s U.


Those are the basics. Let’s get into the details.

The report is called Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign. It was published in the American Heart Association journal, Circulation.

The report says that your level of physical fitness, referred to here as cardiorespiratory fitness (CRF), is a key to mortality. 

It's dead simple. Low fitness, high mortality. Even moderate fitness, lower mortality.

“Mounting evidence has firmly established that low levels of cardiorespiratory fitness are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers,” the paper says.

It goes on: “A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes.”

Any one study gives you a pinpoint view of a very broad subject. This is different. This particular report is not new research, but is a review of the known literature on health and mortality over the past 30 years, and an attempt to get a better handle on risk factors. And it looks at studies with thousands of participants.

One study after another has confirmed the role of exercise in living longer. Here are some of the study results.

A study of nearly 10,000 men: “Survival increased in subjects who improved exercise capacity.”
A study with more than 3800 participants: “Fitness was a strong predictor of outcomes irrespective of weight status.”
A study with more than 15,600 participants: “Moderately fit had 50% lower mortality than those with low CRF.”

The upshot: “A consistent finding in these studies was that after adjustment for age and other risk factors, CRF was a strong and independent marker of risk for cardiovascular and all-cause mortality.”

And as we said earlier, you don't have to go to extremes in exercise.

The report looks at studies of high intensity training compared to continuous moderate intensity training, and does not find a compelling case for one over the other. Both improve cardiorespiratory fitness, it says, but there are concerns about injury and “cardiac complications in selected patients” with higher intensity workouts, it says.

So, what kind of exercise should you consider? Here is the language from the report:

“Exercise that involves major muscle groups (legs, arms, trunk) that is continuous and rhythmic in nature (eg, brisk walking, jogging, running cycling, swimming, rowing, cross-country skiing, climbing stairs, active dancing), in contrast to high-resistance muscle-strengthening activities that produce limited CRF benefits.”

If you’re getting started, depending on your condition, it recommends building up to a regimen of three to five days a week, for 30 to 60 minutes at a time. You should start slow and easy if you’re just beginning an exercise regime, and breaking the initial sessions up into batches of at least 10 minutes is okay.

If you're in poor shape, the study recommends increasing activity in coordination with your medical provider. And it wouldn't hurt to read the whole report. It's free and available as a PDF from the heart association website

© Jan TenBruggencate 2016

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