Do You NEED To Exercise To Be Healthy?

Kids Exercise

Integrative Osteopathy is situated within a gym.

Our treatment process will often include exercise or exercise advice for many patients, who are often already gym goers or exercising in another way.

Exercise has many benefits to almost all aspects of health and well being. Does this mean everybody should exercise?

Often, patients will talk about how they “should” be exercising, despite not enjoying exercise in the past.

Part of the challenge of practice is finding exercise that people enjoy doing, as this is often the biggest factor in whether someone sustains the habit for the long term.

However, for some people, exercise is not an option, either because of physical limitation, time restrictions or lack of enjoyment.

For these people, and everyone else, this post explores whether you need exercise to be healthy.

The short answer is no, but it’s a lot more complicated than that.

What is exercise?

Exercise is any activity performed with a specific physical/health outcome in mind.

This is in comparison to activity that is incidental, or part of your normal daily life (including work).

Example: going for a walk for no other reason than to move your body and maintain your health (specific physical outcome) compared to walking to the local shop to buy something you need.

Whilst both are the same activity, it is the intention that defines whether something becomes exercise.

We have developed exercise to compensate for our ever decreasing activity levels in daily life, as well as for enjoyment and to derive specific.

To add to the mix, sport is a form of physical activity, but it is not necessarily exercise.

Sport is a competitive activity played with the objective of winning. Sport can be healthy and a form of exercise, particularly when pursued recreationally, with little/no care to the outcome, but as soon as the outcome is the driving factor, it is no longer exercise, as health is often sacrificed for increased performance.

To recap:

  • Exercise is an activity performed for a physical/health outcome.
  • Sport is a competitive activity performed with the objective of winning.
  • Incidental physical activity is that which occurs when performing your normal activities of daily living, researchers call this NEAT (Non Exercise Activity Thermogenesis).

What is health and fitness?

A discussion about health and fitness is useless if everyone has their own definition of what each is. The following are commonly used definitions, found via google dictionary.

Health = “the state of being free from illness or injury.”

Fitness = “the quality of being suitable to fulfil a particular role or task.”

Using these definitions, you can see that you don’t necessarily need to be healthy to be fit for a particular task.

It’s easier to understand with an example:

In 2003, Cameroon footballer Marc-Vivien Foe died in the middle of a competitive international fixture. It was later found, via autopsy, that he suffered from a genetic condition called hypertrophic cardiomyopathy (1), which made him susceptible to sudden death during exercise. Here was a highly fit man who had a serious health issue that ultimately lead to his premature death.

There are numerous other examples of extremely fit people suffering from serious health issues, enough so, that it is fair to say that fitness does not equal health.

The Effects of Exercise on Health and Fitness

We know that exercise can improve your fitness as measured by a number of different metrics.

We also know that exercise can improve your health, also measured by a number of different metrics.

What isn’t talked about as much, is that exercise can decrease your fitness and harm your health. 

Because exercise is such a broad term, it is very difficult to be specific with claims. What is important to understand, that how you exercise is almost as important as whether you exercise, or don’t.

When we look at the harmful effects of exercise, they generally stem from two issues:

  1. Poor quality (poor technique, leading to an increased injury risk)
  2. Too much (over training, causing systemic stress leading to a multitude of issues like increased injury risk, hormone dysregulation, immune suppression and chronic fatigue)

If you address these two issues, then there are definitely health benefits to be had, but it must always be remembered that when exercising for both health and fitness gains, there is a point of diminishing returns. That is, you have to work ever harder, doing more, for ever diminishing gains.

Additionally, the are also other reasons to exercise. Most of these involve quality of life – looking better, feeling stronger or more capable etc. These factors can indirectly improve your health and help you enjoy life more.

Done properly, exercise can improve your health and wellbeing. Done poorly, at best, exercise is a waste of time, at worst, it is leading to injuries or other health issues.

“Exercise as medicine”

Much recent research has focused on exercise interventions as medicine. This is because exercise, when properly controlled and administered, tends to have numerous positive effects, crossing multiple body systems, with minimal side effects.

Although the mechanisms of action are not all clear, they are continually being explored, and more is being learnt annually.

However, when viewing exercise as medicine, we have to accept that people needing medicine are already unhealthy in some way.

Thus, in this case, exercise is akin to taking a drug – it has a specific physiological effect. This is why we have seen the emergence of Accredited Exercise Physiologists (AEP) in Australia, to administer exercise to people with various diseases/health conditions.

And, just as we wouldn’t (shouldn’t) take drugs without a prescription, using exercise as medicine can also involve risks.

The other side of the coin is exercise as prophylactic medicine. Does exercising when you are already healthy, make you “more healthy”?

Very possibly. There is a lot of data to support the reduced risk of many conditions amongst those who exercise.

If health is defined as being free from illness and injury, we can use exercise to prolong our good health, by reducing risk factors for specific conditions. This is done by optimising certain physical qualities, based on statistical averages, in essence, becoming “more healthy”.

The confounding factor here, however, is that most data uses controls the reflect the average person. Research shows that the average person does not meet the physical activity guidelines as recommended by the government health authorities.

So the question becomes, do people experience more health benefits from exercise compared to those who are simply physically active, but don’t engage in formal exercise?

All the research we have come across suggests that the most important factor is to be physically active for at least 30 minutes per day, but it doesn’t matter if this is incidental activity like NEAT, formal exercise or anything in between.

Does exercise extend your life?

We have discussed how exercise can improve your health, and as a result of this, the quality of your life.

However, one issue that seems to be misunderstood is exercise’s role in extending (or not) our lifespan. After all, it’s only natural to want to live as well, and as long as possible.

The following factors influence our lifespan (4):

  • Genes
  • Environmental
    • Year of birth
    • Socio-economic status
    • Education
    • Occupation
    • Smoking
    • Alcohol
    • Body-mass index
    • Diet (?)
    • Physical activity (?)
    • Intra-uterine conditions
  • Medicines

Quiet the list.

One accepted view is that lifespan/longevitiy is predominantly predetermined by genetic factors, which are then influenced by our environment and lifestyle.

Thus if we have a healthy genetic base, living a certain lifestyle will help promote longevity.

Perhaps the most interesting work on this topic comes from the “Blue Zone” group, which started when National Geographic commissioned an article on longevity.

Author Dan Buettner came up with 9 different “lessons” that cover the lifestyle of people in the Blue Zones. They are:

  1. Moderate, regular physical activity.
  2. Life purpose.
  3. Stress reduction.
  4. Moderate calories intake.
  5. Plant-based diet.
  6. Moderate alcohol intake, especially wine.
  7. Engagement in spirituality or religion.
  8. Engagement in family life.
  9. Engagement in social life.

Although physical activity is on top of the list, an article in The New York Times covering the Blue Zones expands a little further:

In the United States, when it comes to improving health, people tend to focus on exercise and what we put into our mouths – organic foods, omega-3’s, micronutrients. We spend nearly $30 billion a year on vitamins and supplements alone. Yet in Ikaria and the other places like it, diet only partly explained higher life expectancy. Exercise – at least the way we think of it, as willful, dutiful, physical activity, played a small role at best.

What really matters though, in relation to this post, is whether exercise makes us live longer. A recent study out of Finland sought to answer that.

Without getting too complex, the authors stated:

Based on both our animal and human findings, we propose that genetic pleiotropy might partly explain the frequently observed associations between high baseline physical activity and later reduced mortality in humans.

What this means, is that there is one genetic component that influences physical activity levels, cardiorespiratory fitness and risk of death.

So it is not that exercising makes you live longer, but rather being active and your lifespan share the same genetic link. 

All this suggests, is that there are people who exercise that live both long and short lives, and there are people who don’t exercise who live both long and short lives.

So if you are exercising to live longer, you might want to consider your entire lifestyle, and even then, reconsider.

Decide to exercise because you enjoy it and its effects, not because you want to live longer.

So do you need to exercise?

So far it has taken almost two thousand words to get to the point where we can answer the original question.

You should now have an understanding that such a question does not have a clear cut answer.

It really comes down to the reasoning, i.e. why you want to exercise, and the execution, i.e. how you exercise.

Only you can decide if you need to exercise, but our recommendations are:

You should exercise if:

  • You enjoy exercising
  • You lead a relatively sedentary life, so exercise is your main form of activity
  • You have certain health conditions that would benefit from exercise
  • You are looking to improve certain fitness qualities
  • Your quality of life improves with exercise, be it for physical, psychological or social reasons

You do not need to exercise if:

  • You do not enjoy exercising
  • You lead an active life, i.e. you incur lots of incidental activity (walking, lifting etc) in your occupation and/or activities of daily living
  • You are already healthy, and happy with your current fitness levels

You should not exercise if:

  • You have underlying health risks that may be affected by exercise (if in doubt see you doctor and ask about a referral to an exercise physiologist).

Conclusions

At Integrative Osteopathy, we believe in leading a healthy and happy life.

The definition of health is universal, and the code to healthy living has generally been cracked. Physical activity is a big part of that. What isn’t universal is the need for formal exercise, if you are already very active in your day to day life. In fact, exercise can play a part in increasing physical activity, but it doesn’t substitute for regular physical activity in an otherwise sedentary individual.

The often overlooked factor in much heath research is happiness, which is a very individual thing.

Happiness and satisfaction in life are gained from engaging in meaningful pursuits – whether it be working to create things, grow or support a family, hobbies that express your creative side, physical pursuits that challenge your body and mind or whatever else.

We know the benefits of physical activity, but the recommendations from health bodies only talk about the type and amount. They don’t mention intangibles like enjoyment and meaning, and that’s fine, they’re not meant to, they’re public health recommendations, not personal health recommendations.

Whilst your doctor might suggest otherwise, the only person who can really say if you need to exercise, is you.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

 

References

(1) Wikipedia:https://en.wikipedia.org/wiki/Marc-Vivien_Fo%C3%A9

(2) Exercise as medicine: http://www.ncbi.nlm.nih.gov/pubmed/26606383

(3) Exercise is medicine, at any dose?: http://jama.jamanetwork.com/article.aspx?articleid=2468899

(4) Determinants of longevitiy: http://user.demogr.mpg.de/jwv/pdf/Vaupel-JIM-240-1996-6.pdf

(5) Blue Zones: https://www.bluezones.com/

(6) The Island Where People Forget To Die – http://www.nytimes.com/2012/10/28/magazine/the-island-where-people-forget-to-die.html

Rethink Pain: Moving Beyond Muscles and Bones

Classical Anatomy

This is the first post in what will be a series about “re-thinking pain”, or rather, re-conceptualising it.

The aim of the series is to help you move from a tissue based understanding of pain to one based in neuroscience, which is more accurate and more correct (although a better term would probably be “less wrong”, as there is still so much to learn).

Why is this necessary?

  • The language we use around pain shapes the way we think about, and experience pain. Using tissue based descriptors of pain reinforces the idea of a “bottoms up” model of pain, which is wrong, and can often make things worse in the long term. Moving towards a neuroscience approach helps move away from this model.
  • Chronic pain is a massive problem in Australia (and around the world), affecting millions, costing billions and growing worse every year. Chronic pain often starts as poorly managed acute pain. One of the most important management strategies of any painful condition is education.

The Problem

To begin to understand how we have ended up with such a problem regarding pain requires tracing back through the centuries of medical and philosophical history.

In short, we used to describe pain as “coming from the tissues” up to our brains, where we felt it.

What is now understood, is that pain is a brain output, with many different “filters”, that are unique to each and every one of us, being applied before we are consciously aware of it.

Despite having this knowledge, we can see that even within the official definition of pain, the problem exists.

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

The definition of pain above has been put together by a group of highly intelligent people (International Association for the Study of Pain), who have spent a large portion of their lives studying pain, it’s effects and how to treat it.

Unfortunately, there is one small problem, and it has nothing to do with the definition itself, but rather, the fact that pain is “described in terms of such damage”.

When we explain all pain in terms of tissue damage we paint a picture in people’s minds. Unfortunately, when it comes to pain, this picture is not only incorrect, but harmful.

One can assume this became part of the definition because of what takes place in the real world:

  • Your back hurts, people say you have strained a ligament/joint.
  • Your knee hurts, people say it must be arthritis.
  • You have a headache, must be wear and tear of the head. No, that last one doesn’t sound quite right.

So how exactly is this harmful?

When pain is described in terms of body tissues alone and combined with the type of language typically used (words like torn, strained, scarred, degenerative) to describe tissue based pain, irreversible damage in the form of nocebo* can be caused.

This can lead you to think that something is wrong with your body that needs to be fixed, when things are in actual fact, completely normal.

Additionally, thinking in terms of body tissues leads to a mechanistic view of the body, one that wears out over time and the association of this “wear” with pain. The body is a biologic organism, one that is always adapting as best it can, it doesn’t “wear out”, but rather fails to adapt. There are lots of reasons for this failed adaptation though, it’s not just the result of “getting older”.

Check out this Facebook post on from September:

"It's probably just WEAR AND TEAR"My oh my, does that saying get tossed about. Usually, it goes something like this:…

Posted by Integrative Osteopathy on Wednesday, 30 September 2015

*Nocebo, is basically the opposite of placebo, ie causing harm when no harm has been done.

The Solution

We need to rethink pain, to conceptualise it as a dynamic process, arising in the nervous system and governed by our brains.

Yes, pain is often a result of tissue damage. However, there are many cases of severe tissue damage with no pain experienced at all and vice versa.

Additionally, the intensity of pain is very poorly correlated with the severity of any tissue damage.

Finally, when tissue damage has occurred, there are three scenarios.

  1. It is quite severe and needs medical intervention at a hospital. Think of compound fractures, 3rd degree burns, deep cuts etc.
  2. It is not severe enough to require medical intervention beyond basic first aid.
  3. It is somewhere in the middle.

In all 3 cases, with time, the body will heal as best it can.

As long as there is adequate rest, nutrition and then re-loading of the tissues in a progressive manner as governed by the condition and individual requirements, you’ll get as full a recovery as possible.

So initially, once the need for medical intervention is ruled out, the important thing to do is treat the pain.

This goes against almost all manual therapy and allied health advertising to “treat the cause of your symptoms”.

Alleviating pain will, in many cases, sort out a lot of associated “findings”, the so called causes of your pain, and then beyond that, allow your body to heal.

If you came to us for treatment, here’s how we might do that:

  • Explain all of this information about pain, in a way that makes sense to you, so that you aren’t as stressed or anxious about it anymore.
  • Have a look at you stand and move and suggest ways that might make standing and moving less painful.
  • Get hands on and apply some really pleasurable manual techniques. There is no need to dig in deep for the sake of it. The goal isn’t to change the tissue, it’s to change the perception and get the brain releasing pain relieving chemicals.
  • Do some breathing techniques to help you relax. You’d be surprised at how poorly most people breathe, even when they are concentrating on doing it properly.

All of these techniques are based on the same principle – once the threat is reduced to an acceptable level, the brain will stop protective behaviours, which include pain and altered movement.

So to summarise a blog post in a sentence:

Pain is all about threat perception, it doesn’t mean damage and body tissues can’t produce pain, only the nervous system can**, so we must focus on the nervous system, including the brain, when describing and treating pain, so as to not cause further complications via nocebo.

 

 

**Yes, the nervous system is a body tissue, but for the sake of the argument we are using simple language.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

Integrative Osteopathy is an osteopathic practice located in the heart of Fitzroy North, within the reputable Healthy Fit gym. For all inquiries, call 0448 052 754, or to make an appointment online, click here.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.