If there was a medication that you could take that would help reduce weight, reduce the chances of developing disorders such as diabetes, dementia, and  osteoporosis, I think most people would take it. If the side effects of this medication (even in the absence of dementia, depression, fatigue, etc) were a better mood, a better ability to concentrate, less fatigue, even more people would probably clamor to take it.

There is such a medication: exercise. Some medical societies, such as the American College of Sports Medicine state that “exercise is medicine”. The current recommendations for the minimum amount of exercise is 150 minutes a week of moderate exercise. This comes out to 20 minutes 7 days a week or 30 minutes 5 days a week. Walking is an example of moderate exercise often used to give people an idea of what the effort level of moderate exercise is. One should be walking slowly enough that one could talk and not be out of breath, but fast enough that one couldn’t sing. When my patients state they can’t find the time to do 20 minutes a day, I encourage them to find 10 minute periods through the day to walk. Obviously for some forms of exercise (swimming, playing a game of basketball, etc), this would be impractical to do.

Some research indicates that exercise has an anti-inflammatory effect in the body. Other research seems to indicate increased sensitivity to insulin, increases in various other hormones (or decreases in others), it is likely the mechanism for the beneficial effect of exercise is due to more than one pathway. That is to say that rather than, say deceased inflammation is the cause for improved mood or a decreased risk of dementia, it is likely that improved insulin sensitivity, anti inflammatory effects, etc all act in concert to improve health in people who exercise regularly. When talking with my own patients I tend  to avoid talking about why it works  and prefer to talk about the kinds of exercising they could/should be doing.

Though I encourage people to do weight bearing exercises such as walking, jogging, basketball, etc, I also realize that there needs to be some accommodation. For someone who’s morbidly obese or has severe arthritis that limits, at least initially, how much they can walk I might suggest stationary bicycles, water aerobics or something like tai chi (which is a weight bearing exercise, but because one isn’t jumping around as much as with things like basketball) the stress on joints is lower. I also realize that if someone doesn’t like a particular form of exercise, that person’s less likely to do that than a form of exercise they enjoy doing. Prescribing exercise isn’t a “one size fits all” solution to promoting health.

For people who’ve read many of my earlier posts, have probably noticed that I’ve focused less on medication and more on lifestyle issues such as diet. This post is no different. Many of the most common diseases I see in the office are most commonly caused by, for lack of a better word, poor lifestyle choices.By this I mean having a poor (read “western”) diet and not exercising enough. Once one has hypertension, type two diabetes, obesity, etc, lifestyle changes might not be enough to totally reverse  or cure a particular problem in a specific patient. However even if one needs an antihypertensive, diet and exercise don’t become less important.