The Scientific Case for Living Healthier

Exercise: Just 15 minutes a day makes a difference

The outward benefits of exercise are obvious – trimmer figure, stronger muscles, improved cardiovascular fitness. However, recent research has shown the benefits of exercise extend far beyond what we can see physically:

• Improved brain function, sharpening memory, speeding up learning, and improving mood
• Delaying Alzheimer’s onset, even in older adults
• Lessening depression, often as well as or better than drug-based therapies without the side effects

The mechanisms of how this happens are still being worked out, but exercise improves blood flow to the brain and triggers the formation of substances like BDNF (brain derived neurotrophic factor) a protein that helps stimulate the growth of new neurons and repair and protect brain cells from degeneration, all of which help with brain function.  It also has been shown to increase the size of a part of the brain called the hippocampus (also called “the gateway to memory”), an area that typically shrinks with age. Interestingly, both aerobic exercise and resistance training seem to help improve symptoms of depression equally.

Aside from the brain, exercise also:

• Channels blood flow to the skin which promotes wound healing and skin health
• Increases muscle endurance and strength
• Lessens perceived pain in those with chronic pain
• Causes bones to become denser and stronger with weight-bearing activity causes bones, lessening fracture risk
• Protects against many diseases including diabetes, heart disease, hypertension and cancer
• Slows the aging process and lengthens life spans by as much as 5 years by producing a molecule that protects the telomeres (the protective DNA sequences on the ends of our chromosomes that get shorter and shorter as we age, ultimately resulting in cell death)

As many have postulated, if the benefits of exercise could ever be synthesized in pill form, it would be the most valuable drug ever invented.

So, how much exercise is enough?

The World Health Organization (WHO) has recommended at least 150 minutes of moderate or 75 minutes of vigorous physical activity per week for healthy adults age 18-64.

Aerobic exercise should be performed for at least 10 minutes at a time. In addition, 2 episodes of resistance training for 30 minutes each is also recommended. This, of course, is a guideline. For people with specific health conditions that preclude this level of activity, adjustments can be made to these recommendations to accommodate their limitations.

Let’s dive into some specifics.

What constitutes moderate versus vigorous exercise? The great thing here is that much of what we do a part of our daily life counts as moderate exercise – activities like cleaning the house, gardening, raking leaves. Simple choices like taking the stairs rather than the elevator or walking rather than driving short distances add up over time. More vigorous exercise might include brisk walking, cycling, swimming, dancing, hiking or playing sports.

What about resistance training, do I have to join a gym? Health clubs do offer benefits over working out at home, including a larger selection of exercise equipment as well as a social network to make working out more fun. However, resistance training can be performed using just body weight, through movements such as squats, lunges or push-ups. Activities such as yoga and tai-chi combine body weight resistance training with movements that improve flexibility and balance and have been shown in orthopedic literature to prevent falls. There is a term called “sarcopenia” which is used to describe the age-related loss of muscle mass over time. We lose 3-8% of our muscle mass per decade after age 30 and about 1% per year after age 40. Sarcopenia is reversible through resistance training.

Key Takeaway: Exercise has far reaching value, even small steps add up, and finding time is easier than you think

Exercise has value far beyond the benefits we traditionally have attributed to it and that virtually any effort we make to increase our fitness through exercise will have far-reaching benefits to us. The goal of improved fitness is achievable. The WHO guidelines are a good place to start but each of us has unique needs and abilities. Resources exist to help you to figure out the best way to begin your exercise program including your family doctor or friendly orthopedic surgeon. Physical therapists can also help to turn a negative situation, such as a musculoskeletal injury, into a positive by helping to create a customized home exercise and fitness program for you. Personal trainers are also a valuable way to begin to exercise by providing structure, knowledge and accountability.

Once you have identified your preferred workout and created your regimen, you then have to figure out how to fit it into your schedule. Many of us take care of others – parents, children, spouses – before taking care of ourselves. It’s easy to set aside our own needs in order to serve others. I think you have to take care of yourself first, in order to be able to care for others effectively. There are many ways to fit exercise into your life – do it first thing in the morning, create time during your work day, walk the dog in the evening, find an exercise buddy – whatever gets you out there moving regularly that is not subject to the capricious demands of a busy life. Also, remember the little things count too. It doesn’t all have to be gym shoes and spandex. Clean out that garage, wash your car (or better yet, wash my car), weed the garden, give the dog a bath … it’s all exercise and it’s all good.

Diet and Nutrition: Eating a rainbow a day, keeps the doctor away

The dreaded “D” word. I don’t need to go into all the things that are wrong with the typical American diet. Our obesity statistics speak for themselves. In orthopedics, it has long been recognized that obese patients are more prone to complications following surgery, with increased rates of surgical wound infections, blood clots and other adverse surgical outcomes. There is a general measure of obesity called “body mass index”, which is a simple formula incorporating height and weight (weight in kg divided by height squared in cm). A BMI north of 35 has been shown to lead to higher surgical risk.

There have been as many diets described as there are dogs in Seattle. Grapefruit diets, Twinkie diets, McDonald’s diets …you name it, it’s been described and all of these diets seem to have one thing in common – they’re unsustainable. Still, even if they aren’t sustainable, diets can serve a purpose. Embarking on a diet can jump-start weight loss or a fitness program, even if you eventually go off the diet.

There are a couple of diets with some scientific support: the Slow Carb diet and the Ketogenic diet.

The Slow Carb diet consists of eating primarily protein, vegetables and legumes in roughly equal portions 6 days a week, in whatever portion sizes the dieter desires and avoiding “white foods” like sugars, potatoes, and grains. Then one day a week, often Saturday or “Faturday” as Slow Carb dieters lovingly call it, you can eat whatever you want.

The Ketogenic diet consists of eating primarily fat and protein and some studies suggest may prevent diseases such as cancer and diabetes. There are many resources on the internet about both of these diets if you are interested in learning more.

Improving your nutrition and eating habits doesn’t require a specific diet, and small changes can be more sustainable

You can make a measureable difference with simple measures:

• Eating dinner off a salad plate in order to control portion size
• Reducing intake of sugary drinks
• Eating more colorful foods

It’s generally accepted that we are exposed to toxins and pathogens on a daily basis. Our food can contain pesticides, additives, chemicals, pollutants – some of which is unavoidable. However, certain types of foods can help to protect us against these pathogens. A study from Johns Hopkins showed that cruciferous vegetables (broccoli, cauliflower, brussels sprouts) and foods such as onions and mushrooms contain a compound called sulforaphane that helps protect our cellular DNA against these toxic chemicals and escort them out of our cells.

Brightly colored fruits and vegetables contain anti-oxidants and other compounds that scavenge free radicals and may help protect against cancer and other diseases. Along those lines, a study from Harvard suggests certain foods help reduce chronic inflammation, which has been linked to cancer, heart disease, Alzheimer’s, diabetes and depression. “Anti-inflammatory” foods include tomatoes, fruits, nuts, olive oil, leafy greens and wild caught fatty fish like salmon, tuna and sardines. B vitamins and omega 3 fatty acids are critical for neurologic and cardiovascular health. Grass fed meats appear to have health benefits over corn or grain fed meats.

What are foods to avoid?

Clearly sugar and other refined carbohydrates are over-represented in the American diet with profound health consequences. In addition to a genetic component, Alzheimer’s disease is associated with diets containing large amounts of saturated (meat and dairy) and trans fats (baked goods). Iron and copper have also been found to be part of the amyloid deposits found in brains of people with Alzheimer’s. We typically get plenty of iron and copper in our diets already from dietary sources and from environmental sources such as copper pipes, so avoiding vitamins and other supplements containing these minerals is probably advisable for most of us without some form of iron deficiency.

In the previously mentioned Harvard study, certain foods have been linked to causing chronic inflammation such as fried foods, sodas, refined carbohydrates, lards and processed meats. All of these foods are probably best avoided or at least minimized.

Key takeaway: Eat good foods, fad diets are not required, and plants are good for you.

It can all seem a bit overwhelming. However, there are resources to help you here as well. Your family doctor is a reliable source of information, as is a nutritionist. Websites from institutions such as the Mayo Clinic are generally full of useful information. When it comes down to it, though, I think author Michael Pollan may have said it best: “Eat food, not too much, mostly plants.”

Stress and Sleep: Reduce one by increasing the other

Chronic stress has been associated with many of the same diseases that are connected with chronic inflammation. Therefore, reducing stress has direct health benefits.

There are many strategies for reducing stress:

• Mindfulness exercises, like meditation
• Learning how to say “no” when necessary
• Exerting control over the chaos by controlling what can be controlled and making healthy choices, like finding time to exercise
• Getting enough sleep, which recent studies suggest is 7 hours

The best solution combines mindfulness with physical activity, like simply going for a walk.

Life seems to move more quickly with every passing year. I’m convinced one major reason for this is that we spend too much time in front of screens, working or being entertained. Finding opportunities to turn off our electronics is well worth it.

The ability to communicate face-to-face is rapidly becoming a lost art, yet is critical in order to build relationships. A longitudinal study performed at Harvard looked at a group of subjects over a period of 75 years and found that the happiest and healthiest participants were the ones who maintained loving, fulfilling and intimate relationships. Dr. Robert Waldinger, a Harvard psychiatrist who took over the Grant study in 2003, has a TED talk describing the study findings – screen time that’s worth it.

In Summary

In order to live longer, healthier and happier lives, we need to get out and move. An effective exercise program doesn’t require fancy clothes or expensive gym memberships. Eating right doesn’t require suffering or drastic measures, but instead simple choices for healthier alternatives. Reflecting on your life and investing your time developing your close relationships may be the secret to long-term happiness.

So, turn off your cell phone, grab an apple, take the dog for a walk and say hello to someone new. It might be the best thing you do today.