Part 1 (1/2)

Healing Through Exercise.

Jorg Blech.

To Anke, Hannah, Antonia, and Leo, with love Our nature consists in motion; complete rest is death BLAISE PASCAL.

PREFACE.

Many diseases can be cured with abstinence and rest, the famous physician Hippocrates decreed more than 2000 years ago. Lately, however, his p.r.o.nouncement has been called into question. In study after study, physicians now prescribe physical exercise for a whole range of different illnessesa”and they see much better results than doctors using conventional medicine.

These results are novel, and exercise hasnat yet been granted the attention it deserves. The marvelous therapeutic effects achieved with exercise are described only in scientific papers scattered throughout the medical literaturea”and have thus been hidden from many doctors and most laypeople.

This lack of awareness results in poor and often downright bad treatment because patients and physicians alike far too often try to fix medical problems with drugs, high-technology procedures, and simply resting in bed.

This book aims to change that. Itas my goal to present the new science of healing through exercise for a wide audience. Iave researched and written this account in the United States, but have added material from European researchers whenever it was insightful and important.

The new research presented in the following chapters applies to healthy readers as well as to people who have already fallen sick. It turns out that we profit from physical exercise to a much greater degree than doctors have previously believed. In particular, individuals who are middle-aged or elderly are able to stave off illnesses and ailments with dramatic results as soon as they get in motion.

My first research on this subject dates back to the summer of 2005 when I began to work as the science correspondent in the United States for Europeas largest weekly news magazine, Der Spiegel. The more I learned about the benefits of exercise, the more I felt the urge to get off my chair, go outa”get moving. It became clear to me that it was time to change my life. I started to commute to work using my own muscles. Whether I ride my bicycle or simply walk, I cover eight miles on the local bike path every day. It would be great if the facts and stories I present here moved you in a similar way.

1.

The Healing Power of Exercise.

AT FIRST GLANCE, THE OFFICE OF THE CALIFORNIAN PSYCHIATRIST Wayne Sandler looks just as one might expect: pictures of Sigmund Freud on the wall, tomes on brain anatomy in a gla.s.s cabinet, and of course the requisite couch.

But there is one thing that seems rather out of place: two treadmills.

aPatients were always telling me how well they felt when they took proper exercise,a says Sandler from his practice on the ninth floor of a building in the affluent Century City district in Los Angeles. But they complained that they never found time or just felt too unwell to practice sports. Thatas why Wayne Sandler decided to combine his standard therapy sessions with physical exercise.

Around half of Doctor Sandleras depressive or phobic patients bring their sneakers along to appointments. The wiry psychiatrist, who lifts weights or pedals away on a cycling machine every day himself, changes into his black tracksuit. Sandler has set the treadmills up facing each other so that he can look his patients in the eye. All he has to do is switch them on, and the therapy in motion can begin.

Sandler still prescribes medications, such as the fas.h.i.+onable Prozac antidepressant, for some of his patients. But he is convinced that in many cases exercise can deal with chemical imbalances in the brain better than drugs. His clients-c.u.m-jogging partners are very enthusiastic, he reports, and he now prescribes exercise just like a drug: aMovement will be your medicine nowa”and you need at least 30 minutes of it every day.a1 Carolyn Kaelin is another believer in the healing power of exercise. A mother of two children, she lives in Boston. In the summer of 2003 she fell ill from breast cancer, at the age of just 42. A course of chemotherapy and five operations including a dual mastectomy couldnat stop Kaelin from going to the gym as often as possible and walking to work every day: aItas the one thing I can do for myself that I know is useful.a Kaelin knows what sheas talking about. She is one of Americaas best-known breast cancer surgeons and runs the Comprehensive Breast Health Center at Brigham and Womenas Hospital, part of Harvard Medical School. Seeing her bright smile and sensing her vitality, itas hard to believe the suffering sheas been through. But thatas what nourishes hope now in the audience of women attending her lectures, with headscarves or a new crop of very short hair.

A growing number of studies, Kaelin tells her fascinated audience, shows that physical exercise can prolong the lives of breast cancer patients and reduce the likelihood of relapses. If diagnosed with breast cancer, the professor recommends women should start a fitness program as soon as possible: aI know it may be the last thing you feel like doing, but I believe it can honestly save your life.a2 EXERCISE AS MEDICINE.

Until now, doctors have usually recommended physical activity and sport as a preventive measure to avoid the outbreak of disease and disorders. But recently, exercise has found its way into the heart of medicine. Psychiatrists and oncologists, orthopedics specialists, dementia researchers, and cardiologists are realizing that physical activity can help people even after they fall ill. In many cases, carefully administered exercise accompanies standard therapies. According to a growing body of evidence, exercise often works better than these therapies. It can make health-promoting cells grow in diseased tissuea”and literally turn a disease around.

It is the mind itself, according to the poet Friedrich Schiller, that builds the body. For many years, the medical community thought the opposite was not possible. Neurology textbooks stated that muscle activity could not influence the brain in any way: A mysterious organ, called automatism center, kept the brainas circulation and metabolism at a constant level, the books said, regardless of whether the body was climbing a mountain or dozing in a shady orchard.3 Compounding this error was the belief that an adult brain could never rejuvenate itself; no new nerve cells were thought to grow after birth. The medical profession held that the brain could only stand still or decline.

Todayas brain researchers are correcting that devastating view. The body builds the mind as well as itself. If you exercise your muscles, you practically flood your gray cells with fresh nutrients and growth factors. These make new nerve cells grow. The new cells are easily stimulated and particularly capable of learning. But if we donat make use of them, they die after a few weeks.4 aExercise is the strongest known stimulus to grow new nerve cells,a says Henriette van Praag, an expert on neurogenesis at the Neuroplasticity and Behavior Unit of the National Inst.i.tute on Aging in Baltimore.5 Once nerve cells are produced, mental activity is needed for these newcomers to survive. When used, the neurons are permanently integrated into the brain and able to increase its ability to learn.

That means we can train the brain just like a muscle, at any age. aFitness training improves neuronal efficiency and performance,a says the psychologist Arthur Kramer at the University of Illinois in Urbana-Champaign. aOlder brains are a lot more flexible and plastic than we have been led to believe.a6 No one has to work up much of a sweat to benefit from the healthy effects: People who exert themselves physically for half an hour three times a week, as researchers at Duke University discovered in a comparative study, protect themselves just as effectively against bad moods and attacks of depression as those who take mood enhancers every day.7 A study led by the University of Melbourne showed that walking for two and a half hours per week improves memory for older people and may stave off dementia.8 These encouraging findings are being made because doctors around the world are starting to study and measure the actual effects of physical exercise and evaluate its benefits. Many of these studies show that moderate training can be seen as a form of medicine in its own right, which can be confidently prescribed like a tried and tested drug. Medicine has reached a turning point, say researchers at the University of Copenhagen: The acc.u.mulated knowledge on the blessings of exercise ais now so extensive that it has to be implemented.a9 This paradigm s.h.i.+ft to advising activity rather than rest involves the major diseases in particular. Osteoporosis, asthma, osteoarthritis, chronic back pain, and type 2 diabetes, for example, can all be improved and even overcome by exercise. In addition, hyperactive schoolchildren are being prescribed physical activity at playtime instead of pills. Tablets like v.i.a.g.r.a can be replaceda”by moderate exercise. A long-term study carried out on more than 500 men led researchers to conclude the only behavior that helps impotence patients is regular physical activity.10 Exercise also has a therapeutic effect on heart patients. If you raise the number of calories you burn, you reduce the probability of blockages in your coronary arteries. The cardiologist Rainer Hambrecht from the Bremen Heart Centre is studying this phenomenon at the level of single cells. aPatients with stable coronary heart disease,a he sums up his findings, acan increase their life expectancy by taking up a sport.a Yet many doctors still recommend rest for various illnesses or even advise patients against any kind of physical activity. Especially for metabolic diseases such as diabetes and osteoarthritis, doing nothing can worsen the patientsa quality of life. The more researchers are finding out about these effects, the louder theyare calling for a change to the traditional advice for sick people to stay in bed.

aWe are getting better, but there is still a long way to go,a says Robert Sallis, a family doctor in California and a past president of the American College of Sports Medicine. aPhysicians increasingly acknowledge that exercise is good, but I do not think they are trained to think about it as a remedy. They much more quickly pull out their pad and write prescriptions for drugs, and they donat have the training to help their patients to get more active.a11 Cancer patients in particular are still often advised against physical activitya”because doctors believe that that helps them to cope better with the strenuous treatment. But it appears that the opposite is the case.12 Some physicians are now placing stationary bicycles next to the sickbeds of even seriously ill patientsa”and they find exercise cheers patients up and gives them back the energy they thought they had lost forever. Physical activity can strengthen the bodyas own defenses against cancera”and even prolong the life of cancer patients.13 Strangely, these exciting findings have hardly made the rounds. The therapeutic value of sport in aftercare for cancer patients appears comparatively unknown and is often rather neglected. Melinda Irwin, a researcher at the Department of Epidemiology and Public Health at Yale School of Medicine in New Haven, says: aThe leap has not been made that physicians recommend exercise for cancer patients.a14 Unfortunately, doctorsa advice for patients to rest is often likely to shorten many of the patientsa lives. Take heart failure, for example: The physiological processes that cause the problem of weak heart muscles are only made worse if the patient stops taking exercise, on their doctoras advice. Well-informed physicians are now recommending the opposite: According to recent studies, sport can reduce the likelihood of dying from stable chronic heart failure by about 35 percent.15 KEEP MOVING TO LIVE LONGER.

Researchers have also taken a new look at the effects of inactivity on healthy people. They have shown that office workers who make only minimal use of their muscles put themselves at almost as much risk as smokers. The mortality rate of inactive people is up to one-third higher than that of people who take regular exercise. A 65-year-old who walks less than one mile per day might die seven years earlier than a neighbor of the same age and the same risks otherwise who walks more than two miles per day.16 The rule is the same for everyone on the planet: If you engage in regular physical activity and push your muscles, you trigger adaptive processes that have a positive effect on your health. That doesnat just go for sports that revolve around top performance, winning, and losing. Itas true for any way we bestir ourselves, including walking and such everyday activities as climbing stairs, cycling, weeding the garden, and cleaning the house. Itas this kind of healthy exercise that keeps us young and lengthens our lives, if we keep doing it in later life. The reward for burning an extra 500 to 2000 kilocalories a week is living longer; the mortality risk is 28 percent lower for 60- to 69-year-olds, and 37 percent for 70- to 84-year-olds.17 Evolutionary physiologists like Frank Booth from the University of Missouri in Columbia say itas a fallacy to believe that physical inactivity does no further harm, as long as you keep a steady weight and eat sensibly. Modern human beings are still genetically programmed for life as hunters and gatherers because our genetic composition has hardly changed in the 10,000 years since the Stone Age. Back then, our ancestors were in top athletic form every day, looking for food, hunting wild animals, and building shelters. Those who werenat able to keep up simply died out. Those who survived pa.s.sed down the biological equipment needed under these conditions over the millennia. That means we all have perfectly functioning bodiesa”but only as long as we take exercise on a daily basis.

Presently, however, a large part of the worldas population makes a living in ways for which their genetic inheritance was never designed: Billions of people spend most of their lives sitting, at work and after.

We do of course live much longer lives than the cavemen, thanks to improved hygiene, obstetrics, and antibiotics. But athe average office worker would be much more healthy,a according to the American evolutionary biologists Randolph Nesse and George Williams, aif he or she spent the day digging clams or harvesting fruit in scattered tall trees.a18 Because the biochemical cycles get sluggish in inactive bodies, fats in the blood tend to form gallstones more often, for example. People who donat take exercise have their gall bladders removed more often than the rest of the population. And because digestion slows down in bodies that donat move much, the period of contact with carcinogenic substances in our food is lengthened; inactive people have a 50 percent higher risk of contracting bowel cancer. Even the genes became affected because being lazy appears to make us genetically old before our time. Researchers in Newark, New Jersey, and London found that pieces of DNA called telomeres shorten faster in physically inactive people, making them p.r.o.ne to quicker cellular aging.19 Frank Booth puts most diseases of modern life down to the fact that our metabolisms are going off course because of chronic lack of activity. He and other scientists recommend a minimum of 30 minutes of moderate exercise a daya”walking or swimming, for example. Everything below that is defined as inactive. aWithout that threshold of physical activity expected by our genomes,a says Booth, aphysiological dysfunction is likely to occur from pathological gene expression, eventually leading to chronic health conditions.a20 If this sounds gradual, and not that threatening, put it this way: The body of anyone who doesnat take at least half an hour of exercise every day is in a state of emergency. Pathological processes are constantly taking place in the cells and tissues, and itas only a matter of time until irritations and complaints break out.

According to the evolutionary biologists, we have to rethink the old view of exercise: movement is by no means just a useful added way to improve our health. In fact, it is absolutely necessary for the human body to work normally. That goes for all ages: Children can develop their mental abilities properly only if they do enough running, jumping, and physical playing as well. Motor and cognitive skills develop in unison and stimulate each other within the brain. Researchers in the field of neuroanatomy at the University of Bielefeld sum up what that means for parents, children, and teachers: aLearning needs movement.a The new findings suddenly put what we think of the aging process in a different light: many of the changes are to a great extent the result of inactivity.21 We spend vast amounts of money on the products of the antiaging industry, but so far all the pills, hormones, live cell injections, vitamin cures, and orth.o.m.olecular procedures have been an abject failure. But donat despair: A fountain of youth is at handa”but it just takes a little effort. Only regular physical activity can slow up the biological aging process. In other words, being active is the only way not to look old.

We donat age chronologically but biologically. If we keep our bodily functions vital, we can slow down or stop the biological aging processa”over decades. Thatas practically a law of nature, and you and I can make it work for us.

Of course, physical exercise can never guarantee that an individual wonat get sick. The author James Fixx remodeled long-distance running as ajogginga and popularized it around the worlda”only to collapse and die at the age of 52 while out on a jog on a lonely country road. However, atherosclerosis was running in his family, and he might have died earlier without picking up the habit of exercising.

No one is claiming we can literally run away from sickness. The Norwegian Grete Waitz won the New York City Marathon nine times and has recently been battling cancer. The cyclist Lance Armstrong contracted testicular cancer after becoming the world road race champion. These stories ill.u.s.trate that fate and bad luck also play a role in disease, especially tumors.

We all know the feeling: whenever we come down with an illness, we always look for explanations, for reasons why it got so far. But doctors have long since found evidence that the course of health disorders is influenced by not only genetic and environmental factors, but also by pure coincidence.22 By the time Lance Armstrong was diagnosed with cancer, he had metastases in the whole of his body and brain. The doctors estimated his chance of survival at below 50 percent. Armstrong himself puts the fact that he was still healed and made a spectacular recovery down to aa lucky coincidence.a But at the same time, the likelihood of many healthy decades of life can be improved by living an active lifestyle. Epidemiological studies indicate one factor again and again: Daily physical activity is linked with a lower risk of cardiovascular diseases, strokes, loss of memory, depression, type 2 diabetes, obesitya”and with a longer life. It also reduces the risk of breast and bowel cancer. There is no doubt: If we could put the positive effects of moderate exercise in a bottle, wead all take a good swig from it every morning. Canadian doctors reported that the elixir is even stronger and more effective than previously a.s.sumed. aRecent investigations have revealed even greater reductions in the risk of death from any cause and from cardiovascular disease. For example, being fit or active was a.s.sociated with a greater than 50 percent reduction in risk.a23 Ninety percent of over-50s would benefit from regular traininga”and the good news is, it works just as well if we take it slowly. It doesnat always have to be jogginga”even brisk walking has proven effective.

OUTDATED ADVICE.

While part of the medical community is now hailing a new era of aactive medicine,a many doctors remain skeptical about exercise, as physician Annette Becker from the University of Marburg remarks with astonishment. There is now ahighest evidence for the effectiveness of exercise in the prevention and treatment of chronic diseases, and for the ineffectiveness or even detrimental effects of bed-rest,a she comments. aBut many doctors still often advise their patients to stay in bed for long periods, which cana”as in the treatment of chronic paina”worsen the patientsa prognosis.a24 Experts at the University of Hamburg also find it aamazing how little many doctors know about these things.a25 Because of this ignorance, patientsa”possibly in the thousands at any given timea”are simply being wrongly treated. Letas look at patients with back pain. Physicians are all too keen to carry out expensive diagnosis procedures such as computer tomography and MRI scans. These rarely produce pathological findings but do mean high income for the doctors. The patients are sent away with prescription drugsa”and often do not receive the physiotherapy they actually need or, more important, any help for changing their lifestyles in the long term. Patients diagnosed with mild high blood pressure are usually prescribed expensive medication; aDoctors seldom think of prescribing a program of moderate stamina training.a26 In defense of the physicians, all this is the exact opposite of what must have been learned at medical school. What we now know is wrong was considered right back when current doctors were students. Sending sick people to bed made everyone happy. The whole way of thinking, the medical practice of the time, was founded on the basic conviction that patients would find salvation in physical rest.

Many of the experienced doctors who now run large practices or hospital departments went to medical school at a time when heart attack patients were still ordered to spend four to six weeks in bed. Some older doctors may remember a time when patients were even strapped down to keep them still. Not that long ago they were of the opinion that our hearts only had a limited number of beats, according to the motto: aUse up those beats by racing your heart with exercise, and you shorten your life span.a27 In his cla.s.sic book The Structure of Scientific Revolutions, the American historian Thomas Kuhn describes why itas always so hard for new findings to take the place of old ideas in science.28 Fundamental new ideas are initially disdained because they undermine scientistsa previous work and reveal that this work is wrong or even foolish. Eventually some scholars adopt the new theory, whereas others stubbornly refuse to alter their positions. The latter gradually die out until their views are entirely forgotten.

When it comes to exercise as medicine, we have not yet reached that turning point: aThe paradigm s.h.i.+ft is in flux, but has not yet been realized in this short period of time.a29 There are signs that it might take a while yet until the breakthrough. Even now, medical training barely addresses the links between regular activity, fitness, and disease.

But itas not just the medical profession that hasnat caught on to the healing power of exercise. We laypersons have also failed to recognize its benefits. When our grandparents were growing up, most people in industrial societies never reached old age, worn out by dangerous physical labor on the factory floor or relentless household labor. Their grandchildren now live in what we could call sitting societies. We are the first generation to face the opposite challenge: We may grow old before our time and die young if we donat get enough exercise.

2.

The Dangers of Going to Bed.

A MEDICAL TREATMENT OFTEN BEGINS BY PUTTING A PATIENT TO bed. Many of us have already had this experience: having barely arrived at a hospital, we are asked to remove our street clothes, put on a skimpy gown or pair of pajamas, and go to bed. The size of a hospital is measured by the number of beds it has, and the severity of an illness is determined by the number of days a patient stays in bed. And whether or not we like a physician depends on that doctoras abedside manners.a A good doctor sits down by the patientas bed and listens.

An example of such medical tact is depicted in Pablo Pica.s.soas painting Science and Charity from 1897. A bearded doctor is taking the pulse of an exhausted patient; he represents science. On the other side of the bed, a nun faces the patient; she represents charity. Pica.s.soas creation shows a vision of how bed rest should be, says the general pract.i.tioner Annette Becker, of the University Hospital in Marburg, Germany. She believes that rest means anot only immobilization but also care, gentleness and protection for an individual who is burdened by disease.a1 A DANGEROUS PRESCRIPTION.

Over the years, bed rest has been prescribed in far more coercive ways. The American neurologist Silas Weir Mitch.e.l.l (1829-1914) introduced something he called the arest cure.a For Mitch.e.l.l, the best treatment for individuals suffering from neurasthenia as well as hysteria was to confine them to bed for six to eight weeks. During this agonizing period, some patients were not even allowed to turn their bodies without support. This type of immobilization soon was taken up by virtually the entire medical world, especially for individuals said to be hysterical. During their detainment, these poor souls were not allowed to receive visitors and, in order to avoid any distress, they were always cared for by the same nurse. The patients were forbidden to use their own hands for was.h.i.+ng, and their nurses fed them a diet consisting of especially fatty dairy products. Mitch.e.l.l actually reported many recoveries: as soon as he allowed his patients to go back into everyday life, they were usually more than willing to flee this sickbed.

The perils of bed rest, however, have been known to more enlightened physicians. Richard Asher (1912-1969), who worked at the Central Middles.e.x Hospital in England, was making his rounds one day when he came across a remarkable case of bed rest. aIn a chronic ward of which I once had charge I found a lady who had been in bed for 17 years with a diagnosis of nervous debility and whitlow,a Asher reported in the British Medical Journal. aShe had survived this remarkable hibernation with little damage, and though she was very upset when I ordered her up she became a different person when she was fully ambulant.a2 There is a long tradition of doctors exercising power over individuals by confining them to bed. In the novel The Magic Mountain, soon after the young Hans Castorp arrives at the International Sanatorium Berghof, where he wanted to visit his cousin, he is ordered to bed. aNow, Castorp, weall stick you into bed and see if a couple of weeksa rest will sober you up,a the physician Herr Hofrat Behrens tells him. aAs if alie downa isnat just as good a word of command as astand upa!a3 The French writer Jules Romains recounts in his satire on medical quackery, Knock, the story of a country doctor named Knock who, by inventing outlandish diseases, turns a whole mountain village into a hospital. This disease-monger tells his first patient, a lady in black, aGo to bed when you get home. In a room where you can be alone as much as possible. Close the shutters and draw the curtains so the light wonat bother you. Donat let anyone talk to you.a The doctor orders a full week of this isolation, after which he will reconsider the case. Knock says: aIf you are strong and full of life it will mean that things arenat as bad as they seem. If, on the other hand, youare weak and drowsy, have a hard time getting up, then thereas no doubt about it and weall have to start the treatment.a4 Over the course of the story, the woman falls sick and confirms Dr. Knockas case for treatment. Findings from real-life research explain why this outcome is likely. After spending just a few days in bed, our muscles start to waste away and a whole range of undermining effects sets in. Being immobilized can bring more harm to our health than the ailments, which sent us to bed in the first place.

aBed Rest: A Potentially Harmful Treatment Needing More Careful Evaluationa: this is the t.i.tle Australian doctors chose for a paper they published in the medical journal The Lancet.5 They had carried out a review of the scientific literature on the use of bed rest in treating various illnesses. In 24 trials that looked into bed rest following a medical procedure, the review revealed that none of the outcomes improved significantly. In eight of these trials, bed rest actually worsened the outcomea”for example following lumbar puncture, cardiac catherization, and spinal anesthesia.

Fifteen of these trials examined bed rest as a primary remedy, and in these studies the results were even more sobering. While not a single group of patients got better, in nine diagnostic groups the health of the involved patients on average actually got worse. This was the case after acute low back pain, childbirth, high blood pressure during pregnancy, heart attack, and acute infectious hepat.i.tis.