Motion is Medicine

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.

Taking care of yourself – screening.

This  post is one of several on taking care of your health, and in which I’ll be talking about screening and in a future blog, about prevention (this latter one might be several posts).

The concepts of screening and prevention are related, and sometimes overlapping but different concepts and don’t mean the same things. Screening usually means that one is looking for a disease/disease process that is already occurring. For example, at birth babies are screened for hypothyroidism as well as certain inherited disorders such as phenylketonuria.   The disorders screened for may vary a little from state to state but share the traits of having treatments that PREVENT severe disease or complications of the disease (eg, growth retardation and developmental disability in the case of hypothyroidism). As I’m an internist I’ll focus mostly on adult screening. Screening for colon cancer, breast cancer, aortic aneurysm in older people with other risk factors (a history of smoking and/or hypertension, example) can save lives or reduce the burden of disease.

There’s good evidence for screening for cervical cancer with pap smears in women 21 to 65 (early diagnosis can lead to less invasive treatment) every 3-5 years depending on whether it’s done with testing for human papilloma virus testing or not. History is important in the decision as well  – a woman who’s had a hysterectomy and her cervix removed as well for something other than cervical cancer is in a different category than is someone with a cervix.  Screening for chlamydial infection in young women who are sexually active is another test that has some good evidence behind it (it can lead to PID – pelvic inflammatory disease – which can lead to other issues such as infertility)

For people 50-75 there is good evidence for screening colonoscopy. If a polyp is found it can be biopsied  – which if it’s small enough removes the whole thing. In many cases if it turns out to be a pre-cancerous lesion, having removed the polyp removes the chances of it turning into cancer. Often if there is a history of colon cancer in a patient’s family, a screening colonoscopy will be suggested 10 years before the index case occurred. For example if a patient’s mother had colon cancer at age 49, all of her children and siblings should start screening at age 39 not 50. When and what age to start screening is also affected by other familial syndromes as well and to go through all of them is beyond the scope of this particular blog post.

For other screening tests,  such as screening asymptomatic males for chlamydial infection, older men for prostate cancer, the evidence is less good for routine screening.  As time goes by there will likely be better data to make stronger/more definitive recommendations.

Breast cancer is one area that in the past few years has undergone changes in recommendations. but some organizations recommend recommend screening every two years form 40-50 and then yearly after that. When to start screening and how often is best done in conjunction with your primary care physician.

Screening for proteinuria in patients with hypertension or diabetes might not have the press that some of the screening tests I’ve mentioned (and there are others I haven’t), but can help lead to changing treatment to help prevent or delay kidney disease from getting worse.

For more information you can go to the AHRQ website at http://www.ahrq.gov or the U.S. preventative services website at  http://www.uspreventiveservicestaskforce.org