Exercise as Medicine

Longer life within walking distance
facebook
tweet
google

Physical inactivity has been called the biggest public health problem of the 21st century. Of course, just because someone calls it that doesn’t mean it’s true; in fact, physical inactivity ranks down at #5 in terms of risk factors for death, and #6 in terms of risk factors for disability. Diet is by far our greatest killer, followed by smoking.

But, there is irrefutable evidence of the “effectiveness of regular physical activity in the prevention of several chronic diseases—cardiovascular disease, diabetes, cancer, hypertension, obesity, depression, osteoporosis, and premature death”—helping to add years to our life, and above all, “life to our years.” It truly may be survival of the fittest.

How much exercise do we need? In general, the answer is the more the better. Currently, “most health and fitness organizations advocate a minimum of a thousand calories of exercise a week,” which is equivalent to walking an hour a day five days a week. Seven days a week, though, may be even better in terms of extending one’s lifespan.

Exercise is so important that not walking an hour a day is considered a high risk behavior, alongside smoking, excess drinking, and being obese. Having any one of these effectively ages us three to five years in terms of risk of dying prematurely, though interestingly those who ate green vegetables on a daily basis did not appear to have that same bump in risk. Even if broccoli-eating couch potatoes live as long as walkers, there are a multitude of ancillary health benefits to physical activity such that doctors are encouraged to prescribe it, to signal to the patient that “exercise is medicine.”

Researchers at the London School (of Economics and Political Science), Harvard, and Stanford compared exercise to drug interventions in a study highlighted in my video, Longer Life Within Walking Distance, and found that exercise often worked just as well as drugs for the treatment of heart disease, stroke, and diabetes. There’s not a lot of money to fund exercise studies.  So, one option would be to require drug companies to compare any new drug to exercise. In cases where drug options provide only modest benefit, patients deserve to understand the relative impact that physical activity might have on their condition.

Exercise is just one of four lifestyle behaviors found to significantly extend our lifespan. See my video, Turning the Clock Back 14 Years.

Other longevity videos include:

More videos on exercise:

What about the stress it can put on our bodies? See:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Dominic Alves / Flickr

  • cgins

    I am wondering if you have followed any of the research on endurance runners that purports a decline in longevity after training rates of about 1 to 2 1/2 hours a week. As a marathoner, this interests me, and I am getting generally comments from doctors to cut back, not specific to my own health. One study I saw on this only included 12 distance runners, unlikely to be statistically significant. Another was done on rats, and we all know the flaws in predicting from animals to people, let alone the cruelty.

    • Will

      Not sure if you’ve seen this but I thought it interesting. I’m 51 and used to run quite a bit, I just walk more now with some light jogging. I’m erring on side on caution but, like you, I’d like to see more research.

      https://www.youtube.com/watch?v=Y6U728AZnV0

      • David Johnson

        I found this very interesting. In particular the chart at 18:10 comparing reduction in mortality vs duration of exercise for vigorous vs moderate/light exercise was quite enlightening. For those who don’t want to look at the video, the chart shows vigorous exercise provides the greatest reduction in mortality but peaks about about 40 minutes of daily exercise, whereas moderate/light exercise (walking, housework) showed no signs of peaking even at 90 minutes per day. Looks like, as Dr. Mirkin and others recommend, shorter duration vigorous exercise is the way to go in terms of efficiency.

    • siriusfarm

      This is a really interesting subject to me as well. In the last couple of years, I have replaced 75% of my running with cycling and surprisingly have become a faster and better distance runner with faster recovery and little to no injuries. I am doing about 10-15 hours a week of cycling and 3-4 hours a week of running. I wonder if there have been any longevity studies based on different types of endurance exercise.

    • Veganrunner

      Here is the theory. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538475/
      Do you have something on the 1-1.5 hours per week. Or did you mean day?

      • siriusfarm

        Thanks @Veganrunner for that link!

        • Veganrunner

          You are welcome!

          • Daniel Wagle

            I skimmed that link and would like to know your take on it. Someone I know said he was concerned about running too much, but the doctor said it was mostly a concern for persons with existing heart disease.

          • Veganrunner

            Hi Daniel,
            How have you been? I will steal their conclusion as my “take on it.”

          • Daniel Wagle

            I think this friend had read reports such as these. I bicycle close to 150 miles a week. Mind you, it is MUCH easier to bicycle this distance than it is to run this distance. So far, I haven’t had any health issues from this, except much lower weight and much higher HDL. My doctor is the one who suggested I exercise so much. He also said that if someone has heart disease, they might have to be careful with how much exercise they do. My guess is that perhaps there is some limit for *high intensity* exercise to be healthful, but probably the upper limit for more moderately paced exercise is much higher. Of course, people who exercise for a living are going to do a LOT of high intensity exercise. I usually ride my bicycle at a moderate pace. I do usually ride up a very steep hill everyday, but this is only for 1 minute. Thanks

          • Daniel Wagle

            Also, I have been fine. How have you been?

          • Veganrunner

            Anecdotally I have never seen what your friend is concerned about in my practice–or life for that matter.

    • David Johnson

      You might be interested in Dr. Mirkin’s take on the Copenhagen Heart Study that ” followed 1,098 healthy joggers and 3,950 non-joggers, ages 20 to 93, for 12 years and found that 28 of the joggers and 128 of the non-joggers died. The authors said that “The dose of running that was most favorable for reducing mortality was jogging 1 to 1.4 hours per week, with no more than three running days per week, at a slow or average pace.”

      http://drmirkin.com/fitness/slow-runners-dont-come-out-ahead.html

      He takes issue with this study. Here’s how Dr. Mirkin, a retired sports doctor who advocates interval training, describes his personal program: “I am 80 years old and plan to continue to do my intense weekly bicycling program:
      • very fast intervals three days a week,
      • race as fast as I can over 25 to 30 miles three days and
      • take one day off. I do not do slow junk miles.”

    • 2abner

      it looks like the ultimate goal of what your physician was trying to protect you from is the immune suppression that’s experienced by long-term high endurance physical activity

    • Michael Orendurff

      You have to do a huge volume to have a negative effect, but the effect is real. Lee DC, Pate RR, Lavie CJ, Sui X, Church TS, Blair SN. Leisure-time running reduces all-cause and cardiovascular mortality risk. J Am Coll Cardiol 2014;64,472-81.

      Try adding an interval day (4 x 4 min at 90% heart rate max) and take a long day off. Intensity matter much more than duration or volume for health…and performance!

  • lwoods

    I love all the videos and articles . There seems to be an emphasis on living longer over that of living with a higher quality of life. It would be helpful to place a little more emphasis on not having to be on multiple medications, having joint replacements, and less deterioration of the brain rather than the fact that one might live a little bit longer.

  • Maria

    There are dime advertisament about: the negative effects of more than 90 minutes a week exercise. Have you listened something about it? Please let us know!

    • David Johnson

      I have never seen this claim but consider it ridiculous. Also, what kind of exercise was referred to? One has to take intensity into account. In general, if you’re in shape, your body can benefit from far more than 90 minutes per week. (If one is not in shape, one should work up slowly. It is essential to give your body sufficient time to recover from exercise, particularly vigorous exercise). Take a look at e.g

      http://drmirkin.com/fitness/slow-runners-dont-come-out-ahead.html

      Among other things, Dr. Mirkin (a well-known sports doctor) states “The majority of studies show that three times week is far less effective in promoting health and longevity than daily exercise.” But various recent studies show that intense/vigorous exercise is overall more beneficial than moderate exercise, and of course, the more intense the exercise e.g. sprinting, interval training of any sort, would require less duration to achieve health benefits. But still 90 minutes per week seems way to low to me,
      .

      • Veganrunner

        Dr Mirkin does a great job of reviewing the study that was highlighted in popular media. It reminds me of the study that lead to the article in the NYTimes that said Butter is now OK!

        • cgins

          Yes, great to see Dr. Mirkin’s explanation. It seems like there are a lot of problems with the conclusion that more running begins to have a negative effect:

          • There are two dimensions to test: intensity and amount of working out.

          • Both of these are continuous variables – nearly infinite potential values, not just a few choices or levels for each.

          • The number of deaths in at least one of the relevant groups is usually very small, making the statistical strength of the analysis questionable.

          More on the later here: http://www.runnersworld.com/sweat-science/will-running-too-much-kill-you

          So I think we have some good questions to consider, but not definitive answers. I enjoyed all the discussion and perspectives. Thanks to everyone who’s participated so far.

  • Ava

    I would like to share this article on Facebook, but I keep getting an error – page not found.

  • A 2010 literature review indicates that aerobic (runners, mixed sports) endurance athletes enjoy longer, healthier lives than the general population, while anaerobic athletes (power exercises) apparently do not. “long-term vigorous exercise training is associated with increased survival rates of specific groups of athletes” http://www.jsams.org/article/S1440-2440%2809%2900114-5/abstract

    On the other side of the argument, a 2011 study of aging veteran athletes found that, while moderate exercise apparently provided cardiac benefits, endurance exercise seemed to cause possibly deleterious morphological changes in the heart muscle. The article goes on to say that older athletes should be cautious about endurance exercise. http://bjsm.bmj.com/content/33/4/239.short

    Additionally, Dr. Greger provides a video comparing the benefits of plant-based eating to those of endurance running: http://nutritionfacts.org/2014/12/16/comparing-vegans-arteries-to-runners/

  • ron

    As a youngster and early adult I excercised a great deal. I did not eat very healthy, doing fast food for many years and at age 65 I required heart bypass surgery. I did not have other significant medical issues but a little overweight about 175 and 5ft 7in. I did have 2 hip replacements 13+14 years ago. I continued to play golf, take long hikes, and senior softball until age 74..I no longer can walk as long or far or fast as I wish I could. I also have little tolerance for exercise. Perhaps, arthritis and some cervical spondylosis is part of the reason. But About 1 1/2 years ago I started doing healthy morning smoothies, improved my eating choice and habits and feel quite good. My cholesterol is 110, LDL is 51, triglycerides 114, A1c 6.2 abit high. But I am almost 82. I wish I could go back about 20 years or so and change my nutition, food choices. I now weigh 154 and lost a couple inches off my waist. So the bottom line is, focus on your nutrition while young or old, particularly if exercise is very difficult. An article like this is fine for those younger but at my age the choice of nutrition is as or most important.

    • Fred

      I’m more than 10 yrs your junior…and have tended to be a couch potato most of my life. Last few years I’ve developed my own exercise routine involving hand weights and a mat….around 35 mins 2x / week. I also walk some…when I can get my dog to walk in a straight line that is.

      My experience with the exercising is that when I first started I was using heavier weights and exercising 3xs / week…and got pretty buffed out….but eventually it was too much and I got something like a flu and quit. Now I use lighter weights and do it 2x per week…but my INTENTION is to be consistent with it…no excuses. The difference between just walking now and then and this consistent exercise program is night and day as far as getting around more easily and being able do repairs…car…house…etc. Hoping that when I reach your august age I can still do what I’m doing now.

      Do know that aging accelerates as one gets older…I think this is verified. Your numbers are looking better than mine though.

      Check out the internet for info on various exercises with hand weights…start with light weights…but be consistent….. I made a chart that I put up on the wall…and I go thru the various sets…sometimes I might delay a day…but almost never miss a session. Some of these exercises are more like stretching than exercising…but they keep one flexible.

  • Michael Orendurff

    The problems with nearly all studies of “activity” and “exercise” is that they do not quantify the exercise “dose” accurately. Nearly all studies are designed and run by very experienced professionals who lack ANY training in exercise science. They use the terms “exercise” and “activity” to mean the same thing, but they are vastly different stimuli to the human body. The intensity of the exercise has a much larger effect size on human health than any other parameter, but it is poorly measured. High intensity intermittent exercise (4 x 4 min at 90% of HR max or VO2 max) produce much greater gains in VO2 max than 40 min at 70%, the most common jogging workout. Calcium handling adapts much more with high intensity exercise, producing more forceful contractions of the cardiomyocytes (heart muscle cells), but more importantly calcium re-sequestering is faster leading to faster relaxation and lower resistance to fill during diastole. (Wisloff U, Ellingsen O, Kemi OJ. High-intensity interval training to maximize cardiac benefits of exercise training? Exerc Sport Sci Rev 2009;37,139-46.)

    Probably, “exercise” has a much larger effect on health than many of these studies have shown.

    “Exercise” and “Activity” are separate risk factors. (Williams PT. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Medicine and Science in Sports and Exercise 2001;33,754-61.)

    Training causes specific molecular signaling responses that lead to better health. Strangely, quite a bit of this suppresses unhealthy gene expression rather than initiating healthy gene expression. (Stepto NK, Coffey VG, Carey AL, Ponnampalam AP, Canny BJ, Powell D, Hawley JA. Global gene expression in skeletal muscle from well-trained strength and endurance athletes. Medicine and Science in Sports and Exercise 2009;41,546-65.)

    Lower intensity longer duration exercise (marathon training) provides much more local muscle endurance, mitochondrial biogenesis and greater glycogen storage. (Coffey VG, Hawley JA. The molecular bases of training adaptation. Sports Medicine 2007;37,737-63.) Its still good for your cardiovascular system, but better if mixed with a high intensity intermittent exercise workout once a week.

    • ron

      Age is more a factor of what exercise is. As I discussed in my post below. A time comes when activity and nutrition can mean a lot more to comfort and life.

  • MHarris

    My 15 year old daughter is a dancer (about 2 hours per day, 6 days per week). She got her period when she was 12 and it was regular for about 3 years. However, since she became a vegetarian and then a vegan, she has only gotten her period once in the last 10 months. Should I be concerned?