My attention was drawn to a wonderful little youtube video this week, called 23 and a half hours, by Dr Mike Evans, a specialist in preventative medicine.
In it, he summarises the evidence for a wonder drug.
He stresses the importance of not losing sight of the benefits of weight loss, reducing alcohol cholesterol and smoking as well as blood pressure.
But he goes on to look at the intervention that gives the biggest return on investment.
He discusses an intervention that in elderly people with arthritis of the knee, reduced pain by 47%. In older patients, reduced progression to dementia by 50%. In patients at risk of diabetes, when combined with other lifestyle interventions, it reduced progression to diabetes by 58%. In post-menopausal women it reduced hip fracture by 41%.
It reduced anxiety by 40% and depression by up to 47%. In Harvard Alumni it reduced death in a ten year period by 23%. It is the number one treatment for fatigue and improvement in quality of life.
What is the intervention? Exercise, mostly walking. Stephen Blair in the Aerobic Centre Longitudinal study of 50000 men and women, showed the biggest risk factor for death was not high blood pressure or diabetes, but was poor cardio-respiratory fitness. Another study found that, whilst obesity with no exercise had very poor outcomes, obesity with exercise markedly improved risk of ill health.
So, what is the dose? Well, more is better, higher intensity reduces the time required to achieve these benefits. But, increasing from no exercise to one hour a week in one study reduced the risk of heart disease by 50%!
In Japan, in the 1990s they found that whilst a 10 minute walk to work had no benefit on blood pressure, 11-21 minutes reduced the risk of developing blood pressure by 12% and over 21 minutes walking to work reduced it by 29%.
In a German study 100 patients were divided into two groups. One group got a stent in the coronary artery, the other were given daily exercise programmes and a weekly one hour session together. After a year, 70% of the stent group were event free (free of angina or heart attack) but 88% of the exercise group were event free, exercise bettered the technical intervention! The stent fixed one aspect of the heart, the exercise had a broader impact.
In Australia a study compared TV watchers (6 hours or more a day) with non TV watchers. The non TV watchers lived 5 years longer.
So Mike quotes Gerry Garcia of The Grateful Dead, ‘someone has to do something, it is just incredibly pathetic it has to be us’.
Dr Allan Fox
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