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If exercise were a drug, it would be a miracle pill

For twenty years, the medical profession has wholeheartedly embraced evidence-based medicine. This means using the results of scientific studies published in medical journals to decide how to promote health and to diagnose and treat illness. The alternative is doing things the way "experts" say to do them, or because we've always done things this way. Years of experience have proved that expert opinion and past practice are wrong nearly as often as they're right.

Many of my patients want to know what to do to lose weight, maximize their health, improve their sleep, or lower their risk of cancer and heart disease. The scientific evidence of the past fifteen years is clear: nothing beats exercise.

Many people consider "exercise" a 4-letter word you spell with eight letters. But only exercise can help you live longer -- with less illness, less pain, more energy, and better function. The science is overwhelming: nothing else comes close.

Regular exercise reduces your risk of a heart attack, most cancers, and Alzheimer's disease by about half. Exercise alters your metabolism, so you burn fat. It lowers insulin levels, reducing blood sugar and the risk of diabetes. Sufficiently intense exercise helps your brain grow new neurons, improving memory and concentration. You get more done, so the time you spend exercising is repaid during the day with improved productivity. Studies have shown that for many people, exercise works as well as psychiatric medications to reduce anxiety and depression.

Many of my patients have found they could never get around to exercising or didn't like the results. Here are some of the problems they encountered:

Let's take these one at a time.

First, we'll start with the precautions. Just as there is a tiny risk of injury in getting out of bed -- and even greater likelihood of illness if you always stay in bed -- exercise can cause harm. You can almost always mitigate this risk if you plan ahead. But if exercise makes you feel bad, don't do it without a doctor's supervision. In particular, if you develop chest pain/pressure or severe shortness of breath, have a physician check you out.

Don't emulate Jim Fixx, the famous runner. Jim dropped dead in 1984 while on his daily run. He knew he was at risk from heart disease -- his family had a horrible history of premature death -- and he had chest pain whenever he ran. He was so certain running completely prevented heart disease risk, he never consulted an MD. He kept exercising until he dropped. Autopsy showed severe coronary disease.

Thankfully, few of my patients are at any serious risk from exercise. Most of the time, the problem is a little different: people have fixed ideas about exercise they're reluctant to evaluate or give up. To them, exercise means walking, or going to the gym, or riding your exercise bicycle, or doing something else you hate and makes you feel bad. No, no, no, no!

I like to think of an exercise program as a creative act: something from the smartest, most loving, and most wonderful part of you that you do for yourself. Because this is a field with relatively little science and a lot of "experts," you should probably ditch the rules and figure out what works for you. Nevertheless, there are some good basic rules of thumb worth considering.

The basic rules are simple. Figure out what makes you feel good and makes you pant and sweat. Don't do stuff that hurts, aside from the pleasant muscle aching from working out. Plan your exercise schedule and location so it's convenient and no hassle. Be smarter than your limitations. Most importantly, do what you enjoy!

Unless you have a limiting medical or pain problem, it's important to exercise with the right level of intensity. You should feel better after you've worked out. Pant and sweat during your workout. It should take time to cool down afterwards, at least ten minutes after stopping. As you become fit, your metabolic rate increases, and you'll find you like the room a few degrees cooler.

Different kinds of exercise

Traditionally we think of exercise as occurring in four different settings: aerobics, strength training, exercising while playing a sport like tennis, and on-the-job exercise from hard labor or running around all day. Certainly manual laborers get plenty of all kinds of exercise and may not need more, though doing something that improves fitness and feels good may be well worth the effort. (But why are the guys most apt to be out playing sports the ones who are the most physically active at work?)

I think of the kinds of exercise a little differently: aerobics, strength training, and interval training. I discuss these each in more depth separately (I'm still working on the details of strength training), but here's an overview:

Overcoming barriers to exercise

Let's revisit the common objections:


Last updated Fri, Jun 19, 2015

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©2011, James Gagné, MD