Moving: The New Exercise Prescription

| January 1, 2015

This column is dedicated to covering a variety of topics relevant to the multidisciplinary care of the bariatric surgical patient.

Column Editor: Christine Bauer, MSN, RN, CBN
University of Maryland Harford Memorial Hospital, Havre de Grace, Maryland; President, American Society for Metabolic and Bariatric Surgery Integrated Health

This month: Moving: The New Exercise Prescription

by Diane E. Weiman, A.C.E. Certified

Bariatric Times. 2015;12(1):24–25.


Abstract
This article reviews the evidence supporting the dangers of daily physical inactivity, separate from time performing cardiovascular or strengthening exercises. Research points to health risks, such as diabetes, heart disease, and obesity, and earlier death associated with physical inactivity.

Introduction
In the fight against the epidemic of obesity and other comorbid diseases, there is considerable research that points to a key component that is missing in most Americans’ lives—the power of consistent daily movement.

There was a time when gyms were not even a thought. Our ancestors had no need for them because they got an adequate amount of exercise through daily chores. Today, the closest example of our ancestors’ way of life is the modern day Amish community.

In a study published in the American College of Sports Medicine Journal,[1] researchers studied the activity levels of an old order of the Amish Community. Ninety-eight adults wore a step counter for seven days. The researchers found that the Amish women did an average of 14,196 steps a day and the Amish men averaged 18,425 steps a day. Additionally, the researchers discovered that four percent of the Amish community had obesity; compared to the nearly 40 percent of our adult population in the United States.[2] Also, 26 percent of the Amish community were overweight, compared to 65 percent in the United States at the time of the study. The Amish do not count calories, weigh and measure food, or monitor proteins, fats, and carbohydrates. In fact, they eat quite liberally from what they produce from their land and their labor.

Of all the Amish subjects studied, 100 percent met the recommendation set forth by the Center for Disease Control and Prevention for moderate physical activity at the time of the study (a minimum of 30 minutes a day).[3] By comparison, approximately 60 percent of Americans met this requirement.1 The researchers concluded that the level of physical activity in the Amish community is what contributed to their lower rate of obesity.

The Silent Killer: Sitting
Our modern day conveniences have lured us into mostly a sedentary nation. For example, with the age of computer-driven businesses, many simply work by sitting at a desk all day. In addition, many individuals spend time driving where they may also sit for long periods of time. More sitting might occur after dinner while enjoying leisure time (e.g., watching television, reading, playing computer or video games). What about the individual who exercises 3, 4, or 5 times a week? Shouldn’t the exercise time erase the detriments of sitting? Unfortunately, the answer is no.

There was a time when a person who performed exercise for 60 minutes a day was considered physically active. If someone were to do only 10 minutes a day of a fitness activity, that person was considered to be sedentary. However, mounting research and evidence[4] point to the fact that health risks, such as diabetes, heart disease, and obesity, and earlier death are related to the total amount of movement done on a daily basis, which is separate from time performing cardiovascular or strengthening exercises.

For example, while one may exercise regularly at a gym, if he or she is sitting mostly throughout the day, he or she would be considered at a high risk for disease and vice versa. If an individual he or she were moving on his or her feet throughout the day and only did 10 minutes of structured exercise every day, that individual would be at a lower risk for disease.

The American Cancer Society took this theory one step further. One study[5] revealed that women who sat more than six hours a day have a 37 percent higher risk of death from a major disease, such as cancer—primarily colon, breast, endometrial cancer, heart disease, respiratory disease, and diabetes. Men have a 17-percent higher risk. Additionally, the study found that those who did not exercise regularly and sat for six hours or more a day had an increased mortality rate from disease of 94 and 48 percent for women and men, respectively.[5]

The Perils of Sitting
There are multiple detrimental effects of inactivity. As soon as we sit down, “the muscles go as silent as those of a dead horse,” says Marc Hamilton, an inactivity researcher for the Pennington Biomedical Research Center in Baton Rouge, Louisiana.[6] The calorie burning rate drops to one calorie per minute. This sets off a cascade of harmful metabolic effects. The enzymes that break down triglycerides and lipids and that are responsible for “vacuuming up fat out of the bloodstream,” as Hamilton indicates, literally plunge. The good cholesterol (HDL) then drops accordingly. Even after one day of being sedentary, insulin effectiveness is compromised; thus the risk of obesity and developing type 2 diabetes mellitus rises. Hamilton proved this theory by taking 14 young, thin, and fit volunteers and making them sedentary for 24 hours. He recorded a reduction of 40 percent in the insulin’s ability to take up glucose.

Another study[7] examined the correlation between sitting and gaining weight. Researchers at the University of Missouri injected fat containing a radioactive tracer in both laboratory animals and human volunteers. They found that when the test subjects were sitting down for a few hours, the fat was captured in the adipose tissue (where fat is stored) instead of passing through the muscles where it could be burned because the enzyme lipase, which is critical to the body’s ability to break down fat, decreased to only 10 percent of normal levels. The end result was retention of fat.

Outside of the metabolic detriments of sitting, there is musculoskeletal damage as well.8 Abdominal muscles go soft when we slump in chair, which eventually changes the integrity in the spinal cord giving way to conditions such as lordosis (swayback). The poor posture and disc load that can accompany sitting are one of the significant causes of herniated discs. The hip flexors get tight, which affect gait and balance. One condition, called gluteal amnesia, is when the body “forgets” how to activate gluteal muscles due to too much sitting. The gluteal muscles affect stride and hip action. If the gluteals shut off, serious problems with the ankles, knees, hip, and back will occur. In elders, gluteal amnesia is one of the fundamental causes of frailty.[8]

Exercise Prescription: Move More
You can help your patients to literally “stand up” to the dilemma of sitting. If they have a desk job, you might suggest that they try to rearrange their work habits to move more. For example, instead of emailing to a fellow worker, they might just walk over to the person instead. On work breaks, the patient could take a five-minute walk or even longer if its lunch time. Patients with desk jobs might also try changing the keyboard and screen height for part of the day to stand to do work, while shuffling their legs from side to side to keep moving. They also could park the car far away from the building and take the stairs instead of the elevator to encourage an increase in movement in their daily routines. Additionally, patients might consider purchasing an under-the-desk elliptical.

You can also give suggestions for patients to increase activity at home. They could move during a TV program’s commercial breaks or, even better, cut out TV and engage in a more active task. For example, house cleaning or helping someone else clean their house, washing the car by hand, or working in a garden. Simply put, you can encourage them to look for any opportunity just to move and get up after every 30 minutes of sitting.

Conclusion
In summary, traditional workouts are considered both restorative and necessary in our current society to improve physicality and health. Moving often through the day has been demonstrated in research to regulate metabolism, help prevent disease, and protect against musculoskeletal deficiencies. The two make a perfect marriage for patients to achieve not only a changed lifestyle and permanent weight loss, but also a lifetime of enhanced energy and health.

References
1.    Bassett DR, Schneider PL, Huntington GE.Physical activity in an Old Order Amish community. Med Sci Sports Exerc. 2004;36(1):79–85.
2.    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806–814.
3.    US Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Atlanta, Georgia: US DHHS, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.
4.    Sauders T. Sedentary physiology: Part 1—Not just the lack of physical activity. December 2010. http://blogs.plos.org/obesitypanacea/2010/12/06/sedentary-physiology-part-1-not-just-the-lack-of-physical-activity/. Accessed August 20, 2014.
5.    American Cancer Society. Cancer Prevention Study II. http://www.cancer.org/research/researchtopreventcancer/currentcancerpreventionstudies/cancer-prevention-study. Accessed August 20, 2014.
6.    Vlahos J. Is sitting a lethal activity? The New York Times Magazine. April 14, 2011.
7.    Dye L. A new way to control weight?” ABC News. November 28, 2007.
8.    Berkowitz B, Clark P. The health hazards of sitting. The Washington Post. January 20, 2014.


Author Affiliation: Diane Weiman (A.C.E certified) is an exercise specialist for Upper Chesapeake Bariatric Surgery at Harford Memorial Hospital in Havre de Grace, Maryland.

Funding: No funding was provided for this article.

Disclosures: The author reports no conflicts of interest relevant to the content of this article.

Category: Hot Topics in Integrated Health, Past Articles

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