Exercise: The Case for Counting What Really Counts

Why shirk this vital elixir of life and youth?


Exercise is not onerous. Now I know, not every variety of exercise is for every body. And there is, of course, pain with extreme exertion—although generally a compensatory sense of accomplishment as well.

But I'm referring to garden-variety motion. And the basic notion of motion, of moving our bodies as they are designed to be used, is not sacrifice or penance. Exercise is not onerous. And it is very, very important.

One could argue that we have known of the importance of physical activity to human health for millennia. Hippocrates made explicit note of it.

But if preferences run to scientific opinion of more recent vintage, then we can still go back 20 years to a seminal publication in the Journal of the American Medical Association entitled "Actual Causes of Death in the United States."

In that paper, to which I refer often both on the page and at the podium, McGinnis and Foege revealed that 10 potentially modifiable lifestyle factors accounted for virtually all of the premature deaths in our society, and that by far the most important were the first three: tobacco use, dietary pattern, and physical activity. Or, as I like to say, feet, forks, and fingers. These are the master levers of medical destiny!

That knowledge is not just the product of one study, either. Quite the contrary. There has been a constant drum beat on this theme in the medical literature ever since.

A 2009 paper in the Archives of Internal Medicine, for instance, suggests that avoiding tobacco, eating well, being active, and staying lean, when compared with the exact opposite behavior, can reduce lifetime risk of any and every major chronic disease by 80 percent! Were any prescription medication even a quarter as good, it would be the wonder drug of all time.

We even have evidence that this same short list of behaviors can work its magic within the double helix of our DNA.

In a 2008 study published in Proceedings of the National Academy of Sciences, a group of 30 men with early stage prostate cancer received a dose of "lifestyle," including routine physical activity, as medicine and were followed over a period of months. The lifestyle intervention dramatically reduced the expression of some 500 cancer promoter genes, and dramatically increased the expression of 50 cancer suppressor genes. I'm sure we've all heard of, and many of us buy into, the "nature vs. nurture" debate. But the reality is, the power of lifestyle as medicine can nurture even nature.

On this solid foundation, ever more arguments for the benefits of routine physical activity are being assembled at a brisk and quickening pace.

In recent decades, we have learned that all movement is good movement. While extended bouts of moderate activity may be best, even accumulating physical activity over the course of a day confers considerable benefit.

In recent years, we have learned that while exercise can help immunize us against obesity, it protects our health even when our weight suggests we are out-eating the calories we burn. Fitness is a boon to health in the presence, or absence, of fatness.

In recent months, research has reaffirmed that sitting more on average each day increases our risk of premature death, and that simply sitting less reduces it.

And this very week, a study in the Archives of Internal Medicine indicated that functional ability and vitality in old age owe much to fitness and activity level throughout mid-life.

Physical activity has long been on the short list of the most important influences on both years in life, and life in years. It is one of the "master levers of medical destiny." More is better, but even just sitting less is good.

And all varieties count. Running, swimming, and biking are good. But so too are activities like walking, and dancing. Soccer and tennis are great, but so too are yoga, and tai-chi, and hula-hooping. And even new-age approaches to fitting fitness into the nooks and crannies of the modern day—at school or at work—can enhance our health.

And yet, even those of us who acknowledge the value of exercise often feel obligated to count steps, or calories, or minutes.

Idon't really object to any of this; I track calorie consumption and time in my own daily workouts to make sure I am pushing as hard today as I did yesterday.

But I also know that exercise isn't just good for me years from now. I know it makes me feel better to have done it today. Today is a better day if I fit fitness in.

I know exercise makes me both calmer and more alert. It makes me more energetic and more productive. Some say they don't have time to exercise; I say I don't have time not to. The dividend—in productivity, equanimity, and enthusiasm—is a rich return on the time invested.

Exercise dissipates my stress and raises my mood, even as it lowers my resting heart rate and blood pressure.

Physical activity is not a chore. It is the vital, conditioning work native to our vital, animal bodies. It rewards us right away, as well as over time.

So, maybe we are missing something crucial.

Consider the person who is incapacitated to one degree or another, by a serious illness, or injury, or anatomical anomaly. We refer to this as "disability." The converse, of course, is intact ability, implying a capacity to do the things we want to do.

How can we feel sorry for someone in a wheelchair, but somehow also manage to feel sorry for ourselves about having to exercise—instead of celebrating our ability to do so? There simply isn't cause for self-pity in giving a fully functional body the exercise it craves.

It's fine to count steps, and calories, and minutes. But perhaps we should look to exercise as the vital, conditioning elixir of life and youth it really is.

We are endowed with a native animal vitality, and fortunate to be so. If we have the additional good fortune of opportunity to unleash ours—and in particular, if we are privileged to do so with a full complement of perfectly serviceable body parts—then we have cause our culture seems inclined to overlook…to count our blessings.

Hungry for more? Write to eatandrun@usnews.com with your questions, concerns, and feedback.

David L. Katz, MD, MPH, FACPM, FACP, is a specialist in internal medicine and preventive medicine, with particular expertise in nutrition, weight management, and chronic-disease prevention. He is the founding director of Yale University's Prevention Research Center, and principal inventor of the NuVal nutrition guidance system. Katz was named editor-in-chief of Childhood Obesity in 2011, and is president-elect of the American College of Lifestyle Medicine.