Thoughts on Physical Activity as Healthcare

christophernetley
May 29, 2024
13 min read

Updated: Jun 6, 2024

The Benefits of Physical Activity

At this point, I think it’s common knowledge that exercise and general physical activity are good for our health and wellbeing. The American College of Sports Medicine (ACSM) recommends that you:

“Start where you are. Use what you have. Do what you can.”

These statements suggest that physical activity does not need to be complicated, or expensive, or exclusive. Exercise is free and it can have a positive impact on almost every aspect of your health. The benefits of physical activity are well documented and supported by scientific evidence. Moving your body is safe and does not pose the side effects associated with many other types of healthcare. But is it misleading to claim that general physical activity and exercise are actually forms of healthcare? I don’t think so.

According to the ACSM, moving more often:

“Improves your mood and sleep;
Slows the effects of aging;
Lowers your risk for heart problems, high blood pressure, Type 2 diabetes and many kinds of cancer;
Helps maintain your immune system, which may help to lower the risk of infection, lessen symptoms and speed recovery from various illnesses;
Helps keep your mind sharp as you get older and lowers your risk of dementia and Alzheimer’s;
Increases your energy and simply makes life better!”

Can you think of any other therapy, treatment, medication, supplement, or superfood that can offer even a fraction of these benefits?

There is a book titled, Spark the revolutionary new science of exercise and the brain, in which the author, Dr. John Ratey, discusses the effects of physical activity on mental health, cognitive function, and our ability to learn. Chapter 5, on Depression, is particularly interesting.

“We still don’t know what causes depression, but we’ve made great strides in describing the brain activity underlying emotions.”

“In fact, it’s largely through depression research that we know as much as we do about what exercise does for the brain. It counteracts at almost every level.”

“According to the World Health Organization, depression is the leading cause of disability in the US and Canada. About 17% of American adults experience depression at some point in their lives, to the tune of $26.1 billion in healthcare costs each year.”

“Seventy four percent of depression patients experience some other disorder - including anxiety, substance abuse, and dementia - it’s an urgent problem.”

Of Note: This book was published in 2013, so these stats may be different today.

“One of the hurdles to conquering depression is that the disorder encompasses such a broad array of symptoms, most of which all of us experience at some point. Who doesn’t feel grouchy, irritable, pessimistic, lethargic, apathetic, self-critical, or melancholy on occasion? Sadness, for instance, is a normal aspect of the human condition. But being sad isn’t the same as being depressed.”

How and why do we treat depression with exercise?

“Candace Pert had recently discovered that there were opiate receptors in the brain, meaning the body had a built-in way of killing pain with molecules that worked like morphine. Endorphins, as they became known, dulled the pain in the body and produced euphoria in the mind.”

“The theory that exercise fills your brain with this morphine-like substance matched the good feeling everyone got. It gave us the expression ‘runner’s high,’ an extreme version of the effect.”

“Endorphins are considered stress hormones - and there are 40 types of them, with receptors throughout the brain and body.”

“Aside from elevating endorphins, exercise regulates all the neurotransmitters targeted by antidepressants. For starters, exercise immediately elevates levels of norepinephrine, in certain areas of the brain. It wakes up the brain and gets it going and improves self-esteem, which is one component of depression.”

“Exercise also boosts dopamine, which improves mood and feelings of wellness and jump-starts the attention system. Dopamine is all about motivation and attention.”

Serotonin is equally affected by exercise, and it’s important for mood, impulse control and self-esteem. It also helps stave off stress by counteracting cortisol [“stress hormone”], and it primes the cellular connections in the cortex and hippocampus that are important for learning.”

Let me summarize all the benefits: Moving your body is free, you don’t need a healthcare provider, and it can have a positive impact on physical, metabolic, and mental health. From a medical economy standpoint, it would be difficult to find another type of healthcare that offers more bang for your buck.

So why aren’t the majority of Americans partaking in this miraculous form of healthcare? According to the CDC, data from a national health survey in 2020 indicates that only 24% of adults meet the physical activity guidelines for both cardio and muscle-strengthening activities. As a comparison, in another report the CDC claims that over 57% of US adults have used a dietary supplement in the past 30 days. Dietary supplements are barely regulated and most have limited evidence of any impact on health outcomes. And, supplements cost money. According to the NIH, Americans spend about $60 billion per year on dietary supplements.

So how can this be? Physical activity is free and it has proven benefits that span across a broad spectrum of health. It’s common knowledge that exercise is important for health, yet less than one quarter of US adults meet the minimum guidelines. At the same time, well over 50% of US adults pay money for dietary supplements, most of which have limited or no proven impact on health. Not only do we pay billions of dollars for products that may not even work, but we pay billions of dollars for products that may not be safe and may not contain the ingredients listed on the labels.

Under the Dietary Supplement Health and Education Act (DSHEA), “the FDA does not have the authority to approve dietary supplements before they are marketed. Generally, a supplement company does not have to provide the FDA with the evidence it relies on to substantiate safety before or after it markets its products.”

Now, the purpose of this podcast is not to discuss the validity of dietary supplements. I am using supplements as a comparison tool. Based on the evidence I’ve read, at best, most dietary supplements are mildly effective (with a few exceptions). Supplements cost money and the FDA doesn’t really have the authority to regulate them. In comparison, physical activity is free, it’s absolutely safe, and it has scientifically proven health benefits. In my opinion, when you compare exercise and supplements, there is no question that walking and push-ups are more valuable for your health than multivitamins and green drinks. Now, I am not suggesting that anyone stop taking their supplements. What I am saying is that if you are taking supplements and not moving your body, you are stepping over $100 bills to pick up pennies.

The Guidelines

So let’s assume that we are on the same page… Exercise is good. Why don’t more people meet the minimum physical activity guidelines? Perhaps a better question is, what are the guidelines? Do you know them? It’s okay if you don’t. Most people don’t.

Children and adolescents aged 6 through 17 years should do 60 minutes or more of moderate-to-vigorous physical activity daily.
Adults should do at least 150 minutes to 300 minutes a week of moderate-intensity,
or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity.
They should also do muscle-strengthening activities on 2 or more days a week.
Older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities.
Pregnant and postpartum women should do at least 150 minutes of moderate-intensity aerobic activity a week.
Adults with chronic conditions or disabilities, who are able, should follow the key guidelines for adults and do both aerobic and muscle-strengthening activities.
Recommendations emphasize that moving more and sitting less will benefit nearly everyone.
Individuals performing the least physical activity benefit most by even modest increases in moderate-to-vigorous physical activity.
Additional benefits occur with more physical activity. Both aerobic and muscle-strengthening physical activity are beneficial.

These guidelines only mention moderate and vigorous-intensity activity. But how do we account for light-intensity activity, like walking? The Journal of the American Medical Association (JAMA) published a paper in 2020 stating that, “compared with taking 4,000 steps per day, a number considered to be low for adults, taking 8,000 steps per day was associated with a 51% lower risk for all-cause mortality (or death from all causes). Taking 12,000 steps per day was associated with a 65% lower risk compared with taking 4,000 steps.”

So taking between 8,000 to 12,000 steps per day is associated with decreasing your risk of death from all causes by more than 50%. I ask again, can you name any other therapy, treatment, medication, supplement, or superfood that can offer even a fraction of these benefits? If someone tried to sell you a supplement or a medication with these claims, you would think that person was crazy. But even if there was some form of healthcare or a dietary supplement that was as effective as walking, there would definitely be a financial cost? Keep in mind, walking is free. Push-ups are free. Lunges are free.

Safety

Now let’s talk about safety. The Department of Health and Human Services Physical Activity Guidelines for Americans 2nd Edition, Chapter 7 (Active and Safe) discusses the safety concerns with exercise.

“Evidence strongly shows that physical activity can be safe for almost everyone. Moreover, the health benefits of physical activity far outweigh the risks.”
“Studies indicate that the risk of injury to bones, muscles, and joints is directly related to the gap between a person’s usual level of activity and a new level of activity.”
“The size of this gap is called the amount of overload.”
“Creating a small overload and waiting for the body to adapt and recover reduces the risk of injury.”
“When amounts of physical activity need to be increased to meet the key guidelines or personal goals, physical activity should be increased gradually over time, no matter what the person’s current level of physical activity.”
“Use relative intensity (intensity of the activity relative to a person’s fitness) to guide the level of effort for aerobic or muscle-strengthening physical activity.”
For example, I use RIR, Borg RPE, sRPE when I work with patients.
“No evidence is available to indicate that people who consult with their health care provider receive more benefits and suffer fewer adverse events than people who do not.”
“Inactive people who gradually progress over time to relatively moderate-intensity activity have no known risk of sudden cardiac events and very low risk of bone, muscle, or joint injuries.”

Now let’s look at some safety data published in 2017 comparing trained athletes (weightlifters and powerlifters).

“The injury incidence in weightlifting (aka “olympic lifting”) was 2.4-3.3 injuries/1000 hours of training and 1.0-4.4 injuries/1000 hours of training for powerlifting.”
“The risk of injury in both sports were similar to other non-contact sports also requiring strength/power, but low compared to contact sports.”

Now let’s look at research published in 2020 investigating injury rates in untrained populations including CrossFit.

“Previously published studies have reported injury rates ranging from 0.74 to 3.3 per 1000 hours of exposure in CrossFit participants.”
“This study showed that the number of injured participants and total exposure time resulted in an injury rate of 9.5 per 1000 hours.”
“An injury was defined when 2 criteria were present: (1) reporting a problem defined as having pain, soreness, stiffness or swelling in 1 or more body regions and (2) being affected by the problem to an extent that resulted in reduced participation in the CrossFit training for at least 7 days.”
Of note, CrossFit is a program that incorporates powerlifting, olympic lifting, body weight training, dumbbells, kettlebells, various forms of cardio, and gymnastics into high intensity interval training. These injury rates are pretty low.

Now let’s look at some research published in 2018 on the benefits of resistance training for injury risk reduction

“A 10% increase in strength training volume reduced the risk of injury by more than four percentage points.”
“Increasing strength training volume and intensity were associated with sports injury risk reduction.”

Now allow me to offer some data from my college students. For the last 2 years I have been teaching a physical wellness course that includes 2 strength and conditioning sessions per week during 15 week semesters. The program follows a classic linear progression with 3 phases. The program is designed for true novices, so we use subjective rating scales like reps in reserve (RIR) and rating of perceived exertion (RPE) for load selection and managing session intensity. In over 2,700 training hours, we have seen zero injuries. During the Novice Training Program, I define an injury as any signs or symptoms related to the training program that result in more than two missed training sessions consecutively. If you are interested in learning more about NTP, I will give the entire program away for free. I’ll add a download link to the show notes. You can also visit buildbeyondhealth.com to download the program.

Why don’t people move more?

Before you started listening to this podcast, had I asked, you probably would have agreed that physical activity is great for health and wellbeing. Common knowledge, right? But you may not have been aware of just how beneficial it is. I would go so far to say that movement is essential for optimal health.

So let’s assume that my sales pitch was successful and that you are willing to perform routine physical activity. If you were not previously aware of the guidelines, now you are more familiar with the recommendations for cardio, strength training, and daily step count. Is that all you need? Is that enough to motivate you and keep you going for decades?

I still haven’t addressed the reasons why people don’t move more. Is it simply because Americans don’t know that physical activity is important for health? I doubt it. Most people know.

Is it because people just don’t know the physical activity guidelines? Well, it is true that most people do not know the guidelines, but I don’t think that is the issue. I can not imagine handing someone a copy of the physical activity guidelines and then witnessing them spontaneously start moving more. We need to acknowledge that humans have never had greater access to information than we do today. Plus, as previously stated, it’s common knowledge that exercise is good for you. So, merely telling someone they should exercise (which they already know) and handing them a summary of the guidelines is probably not enough to change their behavior.

When I ask people about barriers to routine physical activity I hear some common responses. The most common initial reason is a perceived lack of time. “I just don’t have time.” I say a “perceived” lack of time, because it usually does not take much effort to find time in the day for movement. For example, many people would benefit from drinking more water, which would force them to urinate more. Adding additional restroom breaks increases step count. It’s a win-win: better hydration and more steps. Someone could increase their step count even more by not using the closest restroom or taking the stairs. Many people can also find time to do a few lunges or push-ups or squats by pairing calisthenics with other routine activities. For example, squats after brushing your teeth each day. If you brush your teeth routinely twice per day, and perform 10 squats after each trip to the sink, and you repeat this consistently for one year, you would rack up 7,300 squats. No equipment and no extra time required. If you have not done a push-up or a lunge or a squat in years and you tell yourself that it’s because you do not have time, you are either lying to yourself or you have an incredibly tight schedule. And you may be the type of person who literally doesn’t have much time for exercise. A single parent working multiple jobs is an appropriate example of someone who lacks time and energy. But even for those with limited time and energy, it does not take long to find creative ways to increase step count and incorporate body weight exercises into a daily routine. Busy people may just need extra help finding their motivation, making a plan, and then sticking to that plan.

Once we clear the “I don’t have time” hurdle, the second most common reason for not exercising is the claim that someone doesn't know what to do. There is a perceived lack of knowledge. If you believe that you don’t have time and that you don’t know what to do, then you may feel like any time spent exercising would be wasted. So why would you earmark time for physical activity if you don't know how to exercise?

As I said before, we have never had greater access to information than we do now. If anything, there is too much information to filter. But if you are sedentary, anything is better than nothing. I promise you. You don’t need to be picky. Get on YouTube and copy something that looks interesting. Then just keep doing that. Not all programming is created equal, and there is certainly a lot of garbage on the internet. But any movement is better than no movement. If you are moving more, you are winning. Remember the guidance provided by ACSM: “Start where you are. Use what you have. Do what you can.”

At this point in the conversation, many people feel excited and empowered. Discussion and planning can be motivating and tend to liberate people from a psychological movement jail. When you realize that you don’t necessarily need to dedicate a lot of time to exercise and that movement does not need to be complicated to be effective, it should make you smile.

But for some people, the discussion must continue. At the core of many sedentary lifestyles is one of the hardest things to admit. And this may be a factor for most people (to some extent). Many are not physically active because they are embarrassed and they lack confidence. For various reasons, circumstances result in sedentary lifestyles. It happens. One thing leads to another, then you blink and a decade has passed you by. You may feel trapped in a body you don’t like with health conditions that you don’t want. Changing your situation seems impossible. And even if you can contemplate the obvious changes that need to be made, the thought of stepping out of your comfort zone and failing can be terrifying, especially if you feel like people are watching you and judging you. It’s easier to tell ourselves that we do not have time and that we do not know what to do. But for most people, those are not real barriers. Fear of failure and fear of being judged can be paralyzing. After enough time, hopelessness sets in. If these words speak to you, you are not alone. It’s more common than you think. And this is where fitness professionals and healthcare providers can be useful. Sometimes you need a guide to walk with you even if the path is obvious. Sometimes you need teammates and a community. If you want to hear more about the topic of motivation, listen to episode #6 of the Build Beyond Podcast.

Summary

In summary, exercise is good for you. Routine physical activity may even be vital for health and wellbeing (physical, metabolic, and mental). Exercise is safe and free. It does not need to be complicated or formalized to affect your health. From a medical economy standpoint, physical activity may be the best healthcare out there. Most of the barriers to routine physical activity are not real and with some thought and creativity, these barriers are simple to bypass. If you lack confidence, are embarrassed, or feel hopeless, you are not alone. You may need help and there is no shame in seeking guidance. If you make the choice to move your body (even by just doing one push-up or intentionally walking to a distant restroom), you are winning. Keep moving.

References

American College of Sports Medicine: Exercise is Medicine

NCHS Data Brief No. 443, August 2022

NCHS Data Brief No. 399, February 2021

NIH Office of Dietary Supplements: Advancing Research on Botanicals and Other Natural Products, April 2024

US Food & Drug Administration: Questions & Answers on Dietary Supplements

PMID: 30418471

PMID: 32207799

Ratey, J. J., & Hagerman, E. (2013). Spark: The revolutionary new science of exercise and the brain. Little, Brown.

US Department of Health and Human Services: Physical Activity Guidelines for Americans

PMID: 27707741

PMID: 32069804