Lifestyle diseases. We hear a lot about them these days. Indeed, governments, public health agencies and the medical community are very accomplished at telling us how lifestyle choices are doing us damage. And it’s backed up by oodles of evidence. Numbers, charts, tables and infographics. If you’ve been paying attention, you probably know a lot about it already. If you haven’t, here’s a snippet.

Being motivated by the numbers

As lifestyle diseases go, obesity and diabetes (type 2) are chart-toppers. Globally, overweight and obesity are an issue for around 2 billion people, with the problem so bad in the USA that it was classified as a chronic disease in 2013. Then there’s diabetes. After increasing seven-fold between 1975 and 2005, it is now the fastest growing disease in the world. By 2030, an estimated 600 million people will be diabetic.

These numbers really hit home when we consider how obesity and diabetes effect a human life. Some of these effects are plain to see. Obesity makes movement difficult, overloads joints and effects breathing. Diabetes causes swollen feet, slows skin healing and causes excessive thirst. Whilst all make living uncomfortable, they are mere surface markers of much bigger problems.

Obesity and diabetes have profound effects on body function. Accumulations of too much body fat (obesity) and blood sugar (diabetes) throw its processes seriously out of whack. For example, when our fat cells become swollen, white blood cells invade them and can cause chronic inflammation. This damages body tissues. When we consume lots of sugar, insulin binds to cells to allow glucose to be drawn from the bloodstream. If our sugar intake remains high, body cells start resisting insulin and blood sugar levels remain high. This is toxic to the body.

Now that you’re paying attention!

Naturally, all this makes for scary reading. And it could go on. And on. And on. Indeed, flip through any book on health change and you are likely to find pages – if not whole chapters – on the way our lifestyle choices are insulting our bodies in the worst ways. The more the better it seems. Insofar as fear is a powerful motivator, it makes sense to tell that story.

We know that obesity, diabetes and other aliments (like cardiovascular disease) are lifestyle diseases courtesy of two related sciences: anthropology and evolutionary biology. Both track human development over time, albeit from different perspectives. Anthologists study how humans live and organize themselves into communities, whereas evolutionary biologists study biological changes that occur in species (not just humans) as the result of evolution.

Paradoxically, it is a lack of evidence that provides the evidence. That is, studies of pre-industrial hunter-gather societies and fossil records have given little indication these diseases existed prior to 150 years ago. As such, they are considered modern diseases, influenced mainly by environmental factors that have shaped the choices people make regarding how they live.

The need for health promotion

Metabolic dysregulation is the term that describes what happens when lifestyle decisions challenge our finely tuned metabolic processes in ways they are not evolved to cope with. Whilst our bodies are quite resilient, they much prefer to operate within a tight set of limits. These are limits health professionals promote via the health guidelines we know so well. Limits related to what we eat, what we drink, how much we sleep, how much we rest, and how much we exercise.

Of all the healthy practices recommended, exercise is arguably the most widely promoted. Yet, despite this, physical inactivity and sedentary behaviour continue to rise. As a result, health experts keep looking for ways of persuading people to move more. Framing exercise as a form of medicine has been one such way.

Exercise-is-medicine, or is it?

The “exercise-is-medicine” (EIM) initiative began in the USA in 2007 and quickly spread to around 40 countries. On the surface the idea makes a lot of sense. A mountain of scientific evidence confirms that physical activity has a positive role to play in improving quality of life, along with physical and mental health. However, when you think about it, it’s a bit odd to frame exercise in this way.

Consider this. If I have chest congestion, I might take some cough mixture (the medicine) to get rid of it. Obviously, if I didn’t have the cough, I wouldn’t take the medicine. So, it’s only useful to me when my discomfort makes me want to take it. But the situation with exercise is quite different because there’s overwhelming evidence that it’s good for me pretty much all the time. Exercise is only medicinal because the absence of physical activity is unhealthy. So, does it really qualify as medicine?

EIM has some issues

Why play these word games you might wonder? Simple. From a health promotion perspective, there are some problems that come with calling exercise “medicine”. Problems worth pointing out:

The perception problem

The word “exercise” is a loaded term for many people. It can trigger an array of strong reactions, like negative thoughts about being hot and sweaty, or feeling embarrassed at a gym.

One way to avoid these problems is to use the broader term – physical activity – instead, as it includes a wider variety of bodily movements (e.g., walking, gardening, climbing stairs), along with all forms of exercise, which are more planned, formal and structured (e.g., playing soccer or tennis). Doing this can break down psychological barriers for people, give them more options and make those options seem more manageable.

The prescription problem

Medicine is normally something that gets prescribed. So, just as a doctor might prescribe antibiotics for a throat infection, they might prescribe daily walking for high cholesterol. Whilst this is unquestionably sound advice, in effect the doctor is doing what the medical community feels is right for patients.

But are patients persuaded by the same things that persuade medical experts? Quite possibly not. And this becomes more unlikely when we remember that prescriptions are a formal way of telling people what to do. Now, given most people don’t like being told what to do, there’s a dual motivational challenge that comes with prescribing exercise. First, will it be accepted? Second, will it be owned?

A better way is needed

The rationale behind exercise-is-medicine is easy to understand. But the problem of physical inactivity persists, so new ways need to be found to help get people moving more.

I think the answer lies in recognising that human beings are naturally active creatures, right from the beginning. As infants we touch, kick, grip, thrust, roll and explore our surroundings in as many ways as we can. Then, as young children, we get immense pleasure out of using their bodies – we jump, slide, throw and need absolutely no incentive to play. For most children and adolescents, physical activity is intrinsically motivating. Satisfaction and enjoyment are built into the activities. Nothing else is needed.

Sadly, our natural affinity for physical activity tends to diminish with age. Many people fall out of love with it, and by the time we’ve turned 30, 40 or 50 have little interest in exercise. But I don’t think we lose the love.

Rather, I think it gets concealed. Hidden behind life decisions that relegate physical activity and exercise to the status of discretionary effort. Hidden by self-limiting beliefs that develop as we get older, about what we’re NOT capable of doing based on our age, or physical status. Decisions that make physical activity and exercise the collateral damage of a busy life.

Leading with your heart, for your heart

Thinking about living a more active life? Great! My advice is to start by thinking about the things that seem most interesting and exciting to YOU. Whilst you might have some physical restrictions (e.g., injuries) that limit your options, you will still have options. And how you go about exploring those options is vital for your acceptance of whatever health change you try to make, and the amount of ownership you take over it.

But this is more than can be covered in a short blog. So, expect to hear more from me on this in the coming months, with a book that’s almost finished.

But for now, think of it this way. When it comes to physical activity and exercise, I’d say you’re best to lead with your heart because, once you get your blood pumping, it’s your heart that stands to gain the most.

info@drgordonspence.com
(+61) 421 641649

download the pdf