Aaron: I wrote a piece on exercise and weight for the New York Times a couple months ago, and I'm gonna talk about that next week.  But a lot of people took that column to mean that exercise isn't important or helpful.  That's so wrong that I want to address that first.  Exercise and the good it can do you is the topic of this week's Healthcare Triage.

(Intro)

There has been a lot of research on exercise, and I'm not talking about the usual cohort studies or case control stuff that the media likes to pass off as causal when it's really correlative.  I'm talking about randomized controlled trials. Take the effect of exercise on musculo-skeletal disease.  There have been 32 randomized controlled trials looking at the effect of exercise on pain and function of patients with osteoarthritis of the knee alone.  32 just for that!  And exercise works.  10 RCTs have shown that exercise therapy can increase aerobic capacity and muscle strength in patients with rheumatoid arthritis.  Other studies show its benefits for a host of other conditions, like ankylosing spondylitis, and even some types of back pain. 

A systematic review showed that exercise therapy reduced all-cause mortality by 27% and cardiac mortality by 31% in middle aged men who had suffered a previous heart attack.  14 more randomized controlled trials have shown the physiologic benefits in patients with heart failure.  It even has clear lowering effects on blood pressure in patients with hypertension and can improve cholesterol and triglyceride levels.  People with diabetes who exercise have better HbA1c values, which is the marker of glycemic control.  20 randomized controlled trials show that patients with Chronic Obstructive Pulmonary Disease can walk further and function better if they exercise.  

Exercise improves physical function, seven randomized controlled trials, and health-related quality of life, four randomized controlled trials in people who have Parkinson's disease.  Six RCTs showed that exercise improves muscle power and mobility-related activities in people with multiple sclerosis.  It even appeared to improve those patients' moods.  23 randomized controlled trials showed that exercise can improve the symptoms of depression.  Five randomized controlled trials appear to show that it improves patients with Chronic Fatigue Syndrome.  It even improved fatigue in patients who had fatigue from cancer therapy.

So look, there's almost no other thing around that I could point to that could deliver results like these for such a wide variety of conditions.  Being active and exercising can do a whole lot of people a huge amount of good.  Other than smoking, there are few modifiable risk factors that seem to have the huge impact on health activity does.  It's a big part of cardiovascular disease, hypertension, stroke, diabetes, depression, musculoskeletal disease, and even death.  It's a huge deal.

The basic recommendations for physical activity are 150 minutes per week of moderate intensity, or about a half hour a day, five days a week.  What's moderate intensity?  Walking briskly, say at 3-4 mph or so.  Bicycling, but slower than 10 mph.  Playing doubles tennis, something that will get your heart rate somewhere between 110 and 140 beats per minute for most people.  Even vacuuming or mopping or mowing the lawn might qualify.  That's not that hard.  It's also what you need to do to get most of the benefits I've described here. 

My issue with the way we sell exercise is that sometimes it feels too much like the way we sell organic food.  The people who are doing way more than they need do are panicked that they're not doing enough, when there are far too many people out there who are doing none at all.  Just walking from my office up and back to my clinic gets me the 30 minutes of walking that I need, or walking to the supermarket from my office to grab lunch does the same.  You can get to the mark pretty easily.  

Alternatively, you could choose to do 25 minutes of vigorous aerobic activity three times a week, 75 minutes total, and two days of strength training.  That would also meet the recommendations.  And that's what I tend to shoot for most of the time.  Three days on the elliptical, two days of P90X 3.  And let's talk about the whole P90X thing for a few minutes.  A number of years ago, I committed to doing P90X like you see on those infomercials.  It involved a rotating list of activities, seven days a week for somewhere between 60 to 90 minutes a day.  It worked.  I got in great shape and I definitely added some muscle mass to my body.  Of course, I didn't look like the people in the videos, but still it was better afterwards than beforehand.  And then I tried those Insanity workouts, and they're aptly named.  I barely got out of the first half of them before people started asking me at work if I was ill.  I didn't look good.  I quit them.  I found that for me, those workouts were unsustainable.  I couldn't keep it going past the 90 day commitment, even for P90X.  The P90X Thursday yoga workout was like, 90 minutes and I didn't have the time.  It was just too hard to keep it up.  

This year, I think John did the P90X 2 routine.  I think he finished, but I don't think he's kept that up either.  I happened on the P90X 3 workouts, and those were much better.  They acknowledge that most research shows that 30 minutes a day is all you need, but it was still six days a week of really vigorous training.  Again, they worked, and I liked them more than I did P90X.  But it's still really overkill.  If you're looking to really reshape your body, that's fine.  They're entertaining, and I think they're great.  But they're way more than you need to be healthy.

What do I do now?  The videos, like two times a week.  I do the elliptical a few more times, and I walk a lot at work, and that easily clears the bar for health, and that's what's important.  That's what you're shooting for.  If you want to be a bodybuilder, if you wanna run a marathon, that's a different story.  Go find a YouTube channel that talks about that.  On this one, we're shooting for health and we're shooting for what we can prove.  We'd all be better off if we committed to adequate and sustainable exercise, 30 minutes a day, five times a week.  One thing exercise doesn't appear likely to help you with, though, is weight-loss.  That's the topic of next week's Healthcare Triage.  

Healthcare Triage is supported in part by viewers like you through Patreon.com, a service that allows you to support the show through a monthly donation.  We'd especially like to thank our honorary research associates, Cameron Alexander and Qadeem Salehmohamed.  Thanks, Cameron and Qadeem.  If you'd like to support the show, more information can be found at Patreon.com/HealthcareTriage.