01.06.2008

Fit for Life

Just because the scales won't budge, at least in the right direction, don't give up on your exercise regime. The evidence is mounting that daily physical activity is crucial for good health. Story by Margaret Evans.

Justbecause the scales won't budge, at least in theright direction, don't give up on your exerciseregime. The evidence is mounting that daily physicalactivity is crucial for good health. Story by MargaretEvans.

It's better to be fat and fit than thin and unfit.Yes, you read it correctly and that's the maximthat's now being promoted – energetically– by public health authorities increasingly concernedat our descent into a nation of far-too-comfortablecouch potatoes.

The popular wisdom that lean and hungry is both themost desirable and healthiest life choice option isnot that simple, we are now being told. It may be themost desirable – any number of magazine imageswill prove that point for us, over and over again. Butthat reed-thin teenage body that can barely manage awalk to the corner convenience store for a packet ofcigarettes, let alone muster up the energy for the stairsrather than the lift, may not be the paragon of healththe glossies and video clips would have us believe.

And, paradoxically, it's that same fixation withthe "slim at all costs" image we are madeto feel we must conform to that is contributing to ourlack of fitness. Dr Adrian Bauman, Professor of PublicHealth at the University of Sydney, suggests it'swhen people don't lose the weight they were seekingto shed in taking up an exercise program that they giveup in frustration. And doesn't that sound familiar?All that effort spent squeezing into a leotard thatwas better not to have been squeezed into in the firstplace!

But don't despair! Professor Bauman tells usthat even though the kilos may stubbornly resist fallingoff our well padded frames, the exercise is still doingus good. A great deal of good, in fact.

"From epidemiological studies of various kinds,we know it's very important and healthy for overweightand obese people to be physically active, even if theydon't lose weight. Physical activity is of immenseimportance. So, it's a very important idea forpopulation health that we don't tell people tobe active just to lose weight, but to be active in itsown right to be healthier," he says.

The epidemiological evidence is there, says ProfessorBauman, that exercise is beneficial for a whole hostof medical reasons – improving metabolic healththrough boosting glucose uptake and lowering insulinresistance, reducing the risk of diabetes and coronaryheart disease, reducing the risk of certain cancers,sometimes dramatically, improving bone health and evenpsychosocial wellbeing. "So it acts across multiplefronts and exerts multiple benefits."

While he is by no means dismissive of the health effectsof obesity – "obesity is still a healthissue and we'd like obese people to be less overweight"– its importance in our society has been skewedby undue preoccupation with image.

The reality, as Professor Bauman explains, is thatthe recommended 30 minutes of moderate intensity physicalactivity each day is simply not enough to lose weight."If this is your goal, it's more like 60to 90 minutes a day of vigorous exercise", togetherwith dietary and other changes. "And that amountof exercise is extremely difficult for people to fitinto their lives, unlike moderate exercise."

But if you feel tempted to indulge in that slice ofchocolate cake after you've power walked aroundthe block, think again. "The worst situation"– and Professor Bauman has a way of leaving hislistener in no doubt – "is being overweightor obese, and inactive. You're putting yourselfat double risk. It's best to be lean and fit,but being overweight and active, while not quite ashealthy, is much, much better than being overweightand sedentary."
According to Professor Bauman, who is director of theCentre for Physical Activity and Health at Sydney Universityand a keen exerciser himself, with daily walks withhis dogs and regular swimming, cycling and bushwalking,this awareness is still new globally and only slowlyfiltering its way through the lens of public awareness.A lens firmly focused on the lithe beauty of the catwalkand the super sexy marketing appeal of youthful bodyshapes to a cashed up youthful market.

So why exactly is physical activity so good for us?The answer, it seems, is that exercise is holistic inthe way it promotes multiple beneficial health outcomes.As the professor sums up, " Just like tobaccosmoking is a very bad thing, exercise is a very goodthing."

It's holistic in two ways – the first isthat physical activity produces health across a rangeof outcomes and, secondly, the kinds of physical activitynow being recommended "are not just leisure timeactivities, jogging and getting into lycra". Instead,we are being urged to accumulate and increase activitiesacross our day – by walking or cycling to work,using public transport, having kids cycling to school,walking for short errands, taking the stairs, walkinginto the next office to deliver an "email",anything that gets us up out of our office chair orcomfy lounge and gets us moving, just as earlier generationsdid as a matter of course. "So the framework forthinking about increasing physical activity is alsovery consistent with a holistic mindset," saysProfessor Bauman.

And the use of the term "physical activity"rather than the more conventional "exercise"underlines this changing focus towards building movementinto our everyday activities, rather than relying ona gym workout or even a 30 minute jog. Even better,the 30 minutes of moderate intensity exercise recommendedunder the Australian National Physical Activity Guidelinescan be done in several shorter bursts rather than allat once, again making it more accessible for time-pressedyou and me. That can be walking to and from the busevery weekday, walking to the papershop, climbing thestairs a few times and, ideally, a regular walk or cyclearound the streets so that "you are just gettinga sense of breathlessness".

We've all heard, even if too many of us havebeen ignoring the fact, that our heart and cardiovascularsystem health will benefit from a more active life.But it really hits home when Professor Bauman refersto new research that suggests simply being sedentaryis a health risk in itself. And that's irrespectiveof whether we exercise or not. "We're startingto think that there may be adverse effects to our metabolichealth from prolonged sitting; that we do need to buildincidental physical exercise into our day to promoteglucose uptake, to reduce insulin resistance, to getthe glucose into the muscles where it needs to go andnot just hanging around in the bloodstream."
Rather scarily, the metabolic disorder of fatty liverdisease is now the commonest form of chronic liver disease,having overtaken both Hepatitis C and alcohol-relatedliver disease. And its cause, says Professor Bauman,is inactivity. While that other metabolic disease, diabetes,is now centre stage because its incidence, too, is rapidlyincreasing, fatty liver disease has crept up on us largelyunremarked. "Now it's nearly as prevalentas other chronic diseases like diabetes and it'san important cause of morbidity, so we really need totake it seriously, too."

And if that's not enough incentive to get usmoving, "innumerable" epidemiological studiesinto two of the most common cancers, bowel and breast,make an unambiguous link to the benefits of physicalactivity. The risk of bowel cancer declines 30 to 40per cent by being active on most days of the week, saysProfessor Bauman. Physical activity, as well as producingantioxidants, increases blood flow and peristalsis tospeed up the passage of food through the bowel, therebylimiting the development of pre cancerous toxins. Andwhile the protective effect of exercise is less dramaticwith breast cancer, it is, nevertheless, significant.According to Professor Bauman, activity works in thisinstance to regulate and balance hormones and perhapscreate antioxidant pathways. These factors appear tobe independent of dietary intake or obesity, two otherimportant risk factors for breast cancer.

In his role as a passionate champion of public healthin Australia, the worrying state of our young people'shealth is occupying more of Professor Bauman'stime. "While it's difficult to define healthoutcomes in kids directly because they don't getheart disease or diabetes very often, the key issueis that some behaviours will track. Just as kids whostart to smoke become lifelong smokers, those who areused to sedentarism are more difficult to motivate asyoung adults to become active."

It's frightening enough that this new word "sedentarism"has entered our 21st century lexicon, but now there'sevidence emerging that atherosclerosis (the early signsof heart disease in coronary and other arteries) inoccurring even in childhood in developed countries,the result of poor diet and inactivity. It is also nowaccepted, to a degree that should shame us into longoverdue action on behalf of our children, that theyface the real prospect of a shorter life expectancythan us, their parents – and surely that'sa truly damning report card on how we, as a society,live our lives and, through our indifference, allowthem to live their, shorter, ones.

It's people like the inspirational Adrian Baumanwho can help bridge that widening gap – and I'mimpressed by his vision of encouraging a more integrated,harmonious society, simply through becoming more physicallyactive. And maybe young people would benefit most ofall.

The increasing pressure to reduce, sometimes to nothingat all, the time in the school day given over to organisedsport or dance sessions because of the demands of moreacademic pursuits, draws this thoughtful comment: "Thisis an important issue for reframing social norms amongstparents, to think about childhood having its own intrinsicvalue. It's also important to think about thesocial engagement qualities of physical activity forkids. They are becoming more isolated from each other– they are connecting through virtual communities,but it would be nice to have them connect through physicalcommunities as well."

The hovering spectre of osteoporosis in our ageingpopulation is yet another strong incentive to encourageour youngsters to put aside the books and the screengames to take up real games and the sorts of weightbearing activity that help ward off bone frailty inlater life. As the professor points out, most bone depositionis finalised in late adolescence, but the decline inphysical activity in girls starts at about 12, six yearsbefore it tails off in boys.

A traditionalist when it comes to recommending typesof physical activity, Professor Bauman can certainlysee a complementary role for modalities like yoga ortai chi. While they don't expend as much energyas suggested under the moderate activity guidelines,(perhaps followers of some of the more vigorous yogaforms might disagree), they increase flexibility andmuscle strength and their meditative elements may reduceblood pressure. When undertaken together with those30 minutes of moderate intensity activity each day,tai chi and yoga are "a fabulous adjunct".
Whatever our choice of activity, or even better, activities,the message is clear: even if you don't lose weight,and I've yet to meet a woman who doesn'tadmit that is her secret dream, don't give upand flop down on the couch to grudgingly sympathisewith "The Biggest Loser". Keep at it becauseit really is doing you good.

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