The Miracle Cure
If a pharmaceutical company were to introduce a pill that could slow down the aging process by ten years, it is a reasonable guess that it would do well on the stock market. If, the following year it introduced an updated version that could also simultaneously reduce the risk of diabetes, heart disease, depression and dementia by a third - without any side effects - it is likely the other drug companies would throw in the towel altogether, shaking their heads in dazed respect. At least the Daily Mail would have a meltdown.
In 2015 the Academy of Medical Royal Colleges in the UK published 'Exercise: the miracle cure and the role of the doctor in promoting it.' The introduction states that regular "...exercise can prevent dementia, type 2 diabetes, some cancers, depression, heart disease and other common serious conditions - reducing the risk of each by at least 30%. This is better than many drugs." For a couple of specific examples; exercise reduces the risk of dying from heart disease by 31% and it is proven to reduce the risk of developing type 2 diabetes by 50-80% (in non-diabetics). For those with type 2 diabetes lifestyle interventions (diet and exercise) are at least as effective as medications, without the side effects.
Osteoarthritis, chronic pain, fibromyalgia, prostate cancer, peripheral vascular disease, chronic obstructive pulmonary disease are also all improved with physical activity, and although exercise may not be as effective as diet in losing weight, being active still protects your health even if you are carrying a little extra.
Of course, the 'exercise pill' is essentially free, requiring 'only' time, space and motivation, so no company is going to make a big-time profit from it. However, for the government that has the foresight to encourage physical activity the savings are big; the cost of physical inactivity to the UK, the health service and other public bodies is in excess of 15 billion pounds each year, according to the report.
The fact that physical activity is so effective at preventing disease remains a curious blind spot in modern medicine. The Tao Te Ching says 'tackle the difficult while it is still easy'. In the West we seem to have taken the approach of tackling the difficult when it becomes difficult. Yes, we have aspirin and statins and so forth which definitely ward off disease, yet the issue is that these are just things that the professional (e.g. doctors) does to or for people. What about that most basic of human drives - movement - that almost anyone can do for themselves?
Only a few decades ago the medical orthodoxy was that exercise was for athletes only, and that for your average chump you exercised at your own risk. Deliberate physical activity was not popular for the post-war generation and if anything was regarded with suspicion (my father still thinks exercise is for 'perverts'). It's worth bearing in mind that a generation or two ago, life and work was physically demanding. That said, people were not necessarily healthier: Poor air, squalid housing, arduous working conditions, no vaccinations and often poor diets led to an early death for many. Yet by the middle of the 20th Century things seemed to be changing. Modern housing, clean air laws, technological advances in agriculture, better working conditions and so forth promised a healthier people.
Somehow it didn't quite work out like that. A revealing statistic from the report gives us some idea why. In 1949 34% of miles travelled using transport were by bicycle. This has dropped to 1-2% today. Moreover, half of all adults spend 5 hours a day sitting down. Partly this is down to where we live - suburbs and cars usually go together. In the U.S. vast distances, not to mention a powerful motor lobby, make driving pretty much compulsory, where in the U.K. it's more a case of being apparently invisible to drivers which puts people off cycling. And then there is how we work: the loss of manufacturing, automation, the information revolution and so on has placed many of us in chairs for much of our working lives.
Whatever the causes, we have fallen out of touch with our natural selves. We basically have the same bodies as our Paleolithic ancestors, the same genetic code, but where as they were active - walking an estimated 7-12 miles a day - we are generally sedentary. Paradoxically, studies seems to suggest that our hunter-gatherer ancestors did not necessarily work harder than we do. It is estimated that they 'worked' - preparing, hunting, gathering, repairing etc. - an average of four hours a day. Yet they were undoubtedly more active. On the other hand we now work at least 8 hours a day (not even counting the commute) yet are relatively physically inactive.
Physical activity puts us back in touch with our stone-age selves. Nature rewards us for exercise, for moving. It works all kinds of magic on the body and mind. For example, by working the heart - the engine of the body - the muscle gets stronger and grows a better blood supply; it beats slower, reducing the overall work it has to do, and it stabilizes the electrophysiology making it less prone to arrhythmias and palpitations.
Another example is blood sugar. Every cell in our body is a factory which needs glucose to work. But glucose doesn't get into the cell without insulin unlocking the door (i.e. receptor). Too much sugar in the diet and those receptors get 'down-regulated' as the cell needs less of them. This can lead to the dreaded 'insulin resistance' causing sugar to build up in the blood, where it seriously damages the blood vessels. However exercise reverses this process. It increases our sensitivity to insulin, up-regulating receptors on the cells, so less insulin goes a long way. Furthermore it reduces plaque build-up in the blood vessels, and makes them springier and stronger, reducing blood pressure in the process. It also makes the blood less prone to clot dangerously.
We are finding that exercise also has a range of effects on the nervous system, so called 'neurotrophic effects'. Essentially, exercise develops nerve. Tests show that regularly exercised muscle has more motor-units; by lifting weight you are also building up your nervous system. A striking example of this is Christopher Reeve, the Superman actor who sustained a catastrophic spinal injury after falling from a horse. For years he remained unable to move or feel anything below his neck. He began a regular exercise program anyway - using electrodes to stimulate his muscles in order to resistance train on an exercise bike. Within a few years he was able to walk with assistance in water and reported that sensation had returned in his body to about 75% of what it was. What is more, whereas before he was regularly in hospital with infections and sores, post exercise-regime he stayed out of hospital for three years.
The more subtle play between the body and mind also benefits from activity. Our 'neuro-immuno-endocrine' system releases endorphins - feel-good hormones - as an evolutionary 'reward' for exercise: and the more we release endorphins, the better we get at releasing endorphins. Activity also suppresses inflammatory processes. Exercise increases our pain and fatigue threshold. The more we do, the more we feel we can do. Short, controlled bursts of movement stresses our system, essentially mobilizing the famous flight-fight response, which in turn 'teaches' our body how to handle stress. Only in this case we are choosing the stress and not the other way around, and after we are allowing ourselves to return to a state of rest, often feeling recharged.
It is also worth mentioning the effects of activity on the aging process. After 40 years-old, conventional wisdom had it, you were over the hill. This pernicious myth continues to this day sometimes backed up by old studies which show how 'after 25 your body stops growing muscle/bone' etc. What we now appreciate is that while tissue such as muscle or bone doesn't grow as fast as we age, the main reason it grows weak is through lack of use - 'misuse atrophy' - rather than simply the passing of time.
The fact is, beyond various theories, nobody quite understands why we age. One convincing mechanism of how we age though is due to damage to our DNA. Our DNA could be seen as an impossibly long and sophisticated shoelace of information (bear with me) which unzips, copies, then re-zips. This process repeats itself each time a cell divides. The DNA shoelace is protected at each end by a cap called a telomere. With each division however this telomere get a little shorter until eventually it wears away altogether, leaving the DNA end frayed and basically useless, leading to cell death and, for the human organism, aging.
Yet even this can be protected by exercise. A recent study in Germany comparing the DNA of fit 20-something athletes (with pristine telomeres) and middle-aged subjects (average age 51) found that the sedentary middle-aged had 40% reduced telomeres, yet in active 50-somethings this was only a 10% reduction. Similar studies have shown how - somehow - on a molecular level, activity protects against DNA damage.
So, physical activity benefits almost every part and every 'system' of the body, from the cardiovascular, the musculoskeletal, to the nervous system, to the genes. On another level, movement connects us to our 'natural' selves as we have lived for millennia. It protects from disease and makes us age slower. Crucially, as suggested earlier, the advantage of exercise is that it is something we do for ourselves. Rather than being dependent on certain medications, or diets or other restrictions, we can use activity to maintain balance and wellbeing.
The other advantage is that those who benefit most - those who have the most to gain - are those who are basically sedentary. If you are 'unfit' then by just doing a moderate amount of activity (roughly half an hour a day) you are still getting the protective effects. Nor is age a barrier, as the growing amount of mature athletes will attest.
In the West we have also seen a resurgence of interest in exercise, most recently the 'new frontier fitness' movements such as Crossfit or bootcamp, or with increasing popularity of triathlons and marathons. Yet one doesn't need to be this dedicated in order to be fit. A study in Sweden found that those who used active transport to work (i.e. walking or cycling) lived on average 12 years longer than those who didn't.
Of course, like anything else, exercise can be exploited. It can be 'used' by our restless minds as a distraction, or as a type of detox, or we attach to a goal of physical perfection and try to get 'there', unable to accept our body as it is. Or we simply attach to effort itself, unable to feel normal unless we've punished or pushed ourselves. As attachments go it's at least physically healthy, but there is another way of approaching exercise, more in tune with the 'ways of liberation' mentioned elsewhere. These 'philosophies' often go hand-in-hand with some type of physical practice: yoga asanas with Indian philosophy, tai chi and taoism, buddhism with kung fu, or the axe philosophy of capoeira from Brazil, to give a few examples. In all of these, the movement is inseparable from the deeper meaning, the liberation. With this in mind almost any type of activity can be a liberation practice, a meditation. At the very least you'll feel good after.
Lift by Daniel Kunitz, 2016. A self-professed decadent intellectual turned disciplined crossfitter, Kunitz takes us through the entire history of fitness from Ancient Greece to Asia to Muscle Beach. If you're a bit of an exercise geek, this is the book you always wanted written.
The First Twenty Minutes: surprising science reveals how we can exercise better, train smarter and live longer, Gretchen Reynolds, 2012. Reynolds, a writer for the New York Times, gives a thorough and enjoyable guide to the most recent discoveries in exercise. Guaranteed to make you get up and go out for a spot of fartlek.
Exercise: the miracle cure and the role of the doctor in promoting it, The Academy of Medical Royal Colleges, 2015. A slightly drier read than the above books, but really ought to be on any medical curriculum.