They're baaack!!!

In 1984, a college classmate of mine, a cardiologist named Henry Solomon, MD, published a book called The Exercise Myth (New York: Harcourt Brace Jovanovich). He came down particularly hard on running. Paradoxically, especially since his thesis stated that exercise did not do any good and might do harm, at the end of the book he snuck in the thought that walking regularly might not be such a bad idea. Solomon received a lot of publicity and sold some books. Fortunately, since even back then the scientific evidence showed that just about everything he had to say about exercise was wrong, the media eventually caught on and the book drifted out of mind and off the bookstores' shelves.

Although The Exercise Myth is long since gone, the anti-exercise myth is still with us and periodically rears its head. In the April 17, 2005 issue of The New York Times News of the Week in Review, Gina Kolata, usually sound and science-based when she writes about medical and scientific matters, published an article entitled "The Body Heretic: It scorns Our Efforts." Based on interviews with Dr. Daniel Haber, director of the Cancer Center at the Massachusetts General Hospital; Dr. Barnett Kramer, associate director for disease prevention at NIH; Dr. Barry Glassner, a sociologist; and Dr. Shelley Taylor, a psychologist; Kolata concluded that "there are real limits to what can be done to reverse the damage caused by a lifetime of unhealthy living." Interestingly enough, she interviewed none of the legion of scientists who believe the massive amount of scientific evidence that one can affect one's own health in many positive ways, at any time of one's life.

Of course, the term "real limits" does apply. But the gist of the article, as many of my lay friends who know that my work now centers on personal health promotion told me when they called to say "have you seen this?" is that there is not much one can do about one's own health, especially when one reaches middle age. And so, having seen the article, many a patient might well say, "So why exercise?"

Why indeed? First, there is the matter of "risk," a concept that many physicians who were never exposed to epidemiology in medical school themselves have trouble with, much less the general public. For years I have told our residents in preventive medicine that health promotion/disease prevention carries only one guarantee: if one engages in it wisely and well, one will reduce one's risk of coming down with a, b, or c. As a physician, if one understands the concept of risk and can communicate it effectively to patients, one can certainly get beyond the "there's nothing you can do ethic." They can also help people to understand that yes, Virginia, there is science behind all of this pro-health information and you can help yourself to become healthier. (See Blumenthal for a recent reference on the effectiveness of regular exercise in reducing the risk of heart attack, even in patients who already have ischemic heart disease. Also see Steve Blair's two year-old Journal of Physical Activity & Health for an ongoing exploration of the benefits of regular exercise and how to help patients engage in it.)

Second, and perhaps more importantly both for helping people to learn how to lead healthy lives and to counter the position taken by the authorities that Kolata interviewed, I think that it is very helpful to talk about the non-medical benefits of regular exercise and the other forms of health promoting behavior change. About 20 years ago, Dr. Ken Cooper asked a room full of public-healthers who exercised regularly if they did it because of the evidence showing that it was good for their physical health (available even back then). "No, that's not it," was the general consensus. "We do it because it makes us feel good." Moreover, it makes us feel good about ourselves too, does it not? Furthermore, if one can find an activity that one enjoys, the exercise itself can be fun, not a chore. Regular exercise has made me into an athlete, something I never was as a child. How is that for promoting a positive self-image? Finally, just the act of taking control of one part of one's life, of deciding to do something for oneself, of setting goals and then setting out to achieve them can be so beneficial to one's health.

Bodies scorning efforts, as in the title of the Kolata article? Once again, as in the case of Henry Solomon, it is a few voices in the minority who happen to gain the attention of the media for a time who are scorning science.

I welcome any comments you may have on this topic, or any other presented in the AMAA Journal. Send your comments to [e-mail].

Respectfully yours,

Steven Jonas

REFERENCE

Blumenthal JA, et al. Effects of Exercise and Stress Management Training on Markers of Cardiovascular Risk in Patients with Ischemic Heart Disease. JAMA. 2005;293:1626.