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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Man to Man Man to Man
 

Exercise -- No Pain, Big Gains


January 24, 2013

By Harvey B. Simon M.D.

Harvard Medical School


Most men know that exercise is good for them. But if exercise means a trip to the gym or a 5-mile run, exercise becomes a "spectator sport" for too many men. Vigorous exercise is great for guys who are so inclined, but for many others, there is a kinder, gentler way to exercise for health.

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The Aerobics Doctrine

The scientific study of exercise blossomed in the 1960's and 1970's. Researchers used a tool called the maximum oxygen uptake test, which measures the amount of oxygen sucked up by the lungs, pumped by the heart and delivered to the muscles during maximal exertion on a treadmill or stationary bicycle. Improvements in the maximum oxygen uptake — also called the VO2max — quickly became the gold standard for judging the benefits of exercise.

Research showed that the biggest improvements in the VO2max depend on exercise that is intense enough to raise the heart rate to 70% to 85% of its maximum heart rate for 20 to 60 minutes continuously, at least three times a week. The aerobics doctrine was born along with the no pain, no gain school of thought.

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Aerobics – A Hard Sell

The aerobics doctrine gained acceptance just as Olympic champion Frank Shorter and marathoner Bill Rodgers proved that Americans could run. Running became the symbol of aerobic exercise and the marathon took over as the icon of success. Despite extraordinary individual achievements, however, the aerobics revolution did not succeed in getting our nation off its collective duff.

The aerobics doctrine inspired the few but discouraged the many. A relatively small number of lucky people discovered the benefits (and pleasures) of aerobic exercise. But by proclaiming that the only way to really benefit from exercise was through aerobic training, doctors discouraged people who found aerobic activities, such as running, too difficult. According to the "gospel of aerobics," golf was the perfect way to ruin a 4-mile walk. But we now know that's wrong.

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The Benefits of Moderation

New studies show that it's possible to attain nearly all the health benefits of exercise without high-intensity activity that leaves you drenched in sweat. That means moderate exercise, such as walking, biking, and gardening can help you get fit. Exercise intensity is less important than the overall amount of time spent exercising, and intermittent exercise is as effective as continuous activity. In fact, golf is beneficial, as long as players walk the course and play two to three times a week.

Research involving more than 320,000 people from around the world proves that regular moderate exercise can reduce risk factors, such as high cholesterol, high blood sugar, blood pressure and body fat, which we expect will improve health and reduce the risk for many chronic diseases.

Although we don't have the advantage of randomized clinical trials that evaluate the effects of exercise on cardiac events and mortality in healthy men and women, doctors have data from 48 trials of patients with proven coronary artery disease. About half of the 8,940 patients studied were randomly assigned to receive the best medical and surgical care available, while the others got the same standard of care and participated in a cardiac rehabilitation program based on moderate exercise. The exercisers came out on top. They enjoyed a 26% reduction in the risk of death from heart disease and a 20% reduction in the overall death rate. It's powerful evidence that exercise protects the heart — and what's good for ailing hearts should be at least as beneficial for healthy ones!

Summary of the Research

Group

Activity

Benefits

10,269 Harvard Alumni ages 35-74
Walking at least 9 miles a week

Climbing at least 55 flights of stairs a week

22% lower death rate

33% lower death rate

73,743 American women ages 50-79
Walking for at least 2.5 hours a week
30% lower risk of cardiovascular
events
44,452 American male health professionals
Walking at least 30 minutes a day
18% lower risk of coronary artery disease
39,372 American female health professionals
Walking at least 1 hour a week
51% lower risk of coronary artery disease
72,488 American female nurses
Walking at least 3 hours a week
35% lower risk of heart attack and cardiac death; 34% lower risk of stroke
30,640 Danish men and women ages 20-93
Spending 2-4 hours a week on light leisure-time activity
32% lower mortality rate

If reducing risk factors for cardiovascular disease were the only benefit of moderate exercise, it would still be vitally important. But moderate exercise also helps:

  • Promote weight loss – Exercise, along with diet, is essential for losing weight.
  • Decrease the risk for stroke (by 21%-34%), diabetes (by 16%-50%), dementia (by 15%-50%), fractures (by 40%), breast cancer (by 20%-30%), and colon cancer (by 30%-40%).
  • Slow the physiologic changes associated with aging
  • Increase life expectancy – A 2005 analysis of data from the famed Framingham Heart Study reports that people who exercise regularly live an additional 3.7 years, compared with sedentary individuals. Walking at a 17-minutes-per-mile pace (about 3.5 miles and hour) was sufficient to produce this extraordinary gain. Another 2005 study showed that moderate exercise (walking 8.6 miles a week at 40% to 55% of maximum) will increase the VO2max, though not to the same degree as aerobic training.

I know what you're thinking: There must be some catch. There isn't. To get the astounding health benefits of exercise merely takes walking at a moderate pace for 30 to 40 minutes a day, with the goal of covering about 2 miles. If you need to lose weight, build up to 4 miles a day. Remember you can divide your walking into 8 to 12-minute segments throughout the day if that's more convenient. And you can substitute other activities, such as climbing stairs, gardening, biking, dancing, swimming, playing racquet sports, or yes, even golfing — as long as you walk the course.

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The Bottom Line

Moderate exercise is the key to exercising for health. But many people will get extra benefits by adding exercises for strength, flexibility, and balance – not necessarily at a gym under the watchful eye of a trainer, but at home in just a few minutes a day. And a prudent diet is an essential part of a healthy lifestyle to prevent many of the chronic illnesses that plague modern societies. Medical science continues to make astounding advances. It has taken the collective effort of many dedicated scientists to bring us back to the wisdom of Hippocrates. Some 2,400 years ago, the Father of Medicine said, "If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health."

Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of the Harvard Men's Health Watch newsletter and author of six consumer health books, including The Harvard Medical School Guide to Men's Health (Simon and Schuster, 2002) and The No Sweat Exercise Plan, Lose Weight, Get Healthy and Live Longer (McGraw-Hill, 2006). Dr. Simon practices at the Massachusetts General Hospital; he received the London Prize for Excellence in Teaching from Harvard and MIT.

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