MIA — All sides of “healthy” physical activity
The benefits of enjoying activities we love have a compelling body of supportive clinical evidence, as discussed here. The problem is, the message most people are getting is that this means we all have to “exercise.” And with today’s frenzied fixation on health and youth, it’s also believed that if a little is good, then more must be better, and that age needn’t slow us down or moderate our activities.
A flurry of stories in the news the past week barely made a blip on our screens, but have especially valuable cautionary information — the same warnings as those echoed time and again by the Cooper Institute researchers: The risks of exercise increase the more we go over the moderate amounts and intensity shown to be beneficial to our health.
The Times UK reported: The exercise craze that crippled a generation They were promised the body beautiful and their mantra was “No pain no gain.” Two decades later they are feeling it again — in their knees, hips and lower backs. They are the casualties of the aerobics boom. The craze began in the late 1970s but it was the actress Jane Fonda who really got people moving. Following her lead, thousands climbed into Spandex, donned headbands and twisted and punched the air in church halls across Britain. Now they are more likely to be seen in physiotherapy. Nicki de Lyon, of Sports and Spinal Clinics, London, said: “They have knee and hip and lower back problems.... Disciples were told that pain was good for them. “It’s positive pain, just like childbirth,” devotees in America shouted. As the craze took off in Britain, Geri Livingston bought a cat-suit and joined an energetic group in a church hall in Cheshire. All through the 1980s she sought out the toughest classes, attending up to four a week. “My knees just kill me now,” said Mrs Livingston, now 44. “I can’t jog any more, and I have lower back problems.” ...Aerobics is now in decline. In Britain it has been supplanted by a bewildering array of low-impact routines and “conditioning” programmes aimed at people in their mid50s. There, in softly lit studios, next to Japanese fountains and no longer wearing Spandex, the walking wounded of the aerobics boom may seek to soothe their battered bones. In Australia, a report in the Brisbane Sunday Mail said: Hip woes hit under-50s — High-impact exercise blamed More middle-aged people are having hip replacements because high-impact exercise has wrecked their joints. While osteoarthritis used to be a disease of the elderly, it is increasingly common in the under 50s. Road jogging, strenuous aerobics and skiing are just some of the activities that take a toll on joints, leading to knee and hip replacements. Bill Donnelly, a surgeon at Brisbane Orthopaedic Specialist Services, estimates 90 per cent of the 30,000 joint replacement operations in Australia every year are because of osteoarthritis. "There is an increase of people under 50 having the operations because of an increase in competitive and contact sports and also high- impact activity," he said. Twenty years ago, patients under 55 were told they were too young for surgery, but increased demand and improved technology has changed that...."There are restrictions, however, and if people go back to jogging, and playing contact sports, the joint will become loose. We tell patients to switch their activities to cycling, walking, swimming and golf."... The Herald Times in Wisconsin reported Last September, Ron Seizert often was in pain while walking and sometimes while sitting....Seizert's artificial hip had withstood a major test. His surgery in November and dedicated rehabilitation program have been successful in restoring his quality of life.... Dr. Craig Olson of Orthopaedic Associates is one of several surgeons in Manitowoc County who perform joint replacement surgeries...Olson said the need for joint replacements is not just an older person's problem. "There have been individuals who were highly active athletes when younger, and now they're paying for it," he said. Indeed, Seizert was an active runner, not just on his own, but with track and field and cross country athletes he has coached at Roncalli for the past decade. "I need to switch my activities from those that are high-impact, like running, to something like bike riding that puts less stress on the prosthesis," Seizert said. "I'm also looking into the possibility of getting a kayak." In the Los Angeles Downtown News: Body Shop — The 'Hip' Generation Orthopedics once brought to mind bad backs, weak knees, faulty hips, arthritis and decreased mobility - all pointing to old age. Osteoarthritis, the condition that covers all of the above, is now being diagnosed in younger patients than in previous generations. The American Academy of Orthopedic Surgeons reports that total knee replacements among patients aged 38 to 56 has doubled in the past 10 years. Many of these younger patients are athletic types who sustained injuries in their 20s, or are people who continue to indulge in high impact sports. Every year, more than 250,000 Americans replace painful and crippling knee and hip joints. Wear and tear, especially in knees and hips, can result in painful bone-on-bone friction. In the past, patients suffered discomfort and had to accept an outcome of limited movement. In short, the prospect of a normal routine almost always went downhill from the time of surgery. Today, with advanced procedures, more and more patients undergo joint replacement and are able to resume normal lifestyles and activities that include bicycling, tennis, golf and even downhill skiing. Advances in technology and surgical techniques contribute greatly to improved outcomes. And the March issue of Cleveland Clinic Arthritis Advisor reported that not only have Americans been needing more joint replacements, but they’re already outliving their first ones and onto revisions. Revision surgeries are more complicated and risks for complications are considerably higher, although improving as technology improves. Joint Replacement The Second Time Around Americans are getting more new hip and knee implants than ever before nearly a half-million a year. This boom in joint replacement has made the procedure somewhat routine and widely available. But when it comes time to have that initial implant replaced, due to wear or failure, the procedure is anything but routine. "Revision surgery is a far longer and more complex procedure than initial surgery," says Kenneth Marks, M.D., an orthopaedic surgeon at Cleveland Clinic. "It requires more time and expertise to remove the old implant and do a customized repair and realignment of the existing bone to ensure that the new implant will be held firmly in place." Though the challenge of revision surgery is higher, the demand is climbing. More and more patients who got their first new hip or knee at age 55 or 60 are outliving the useful life of their implants...."Hip and knee revisions typically last about eight to 10 years, compared to the 20 or more years you can expect with a first-time implant," says Dr. Marks. Encouraging moderation and balance, and old-fashioned common sense, Dr. Dean Edell, M.D., wrote in Eat, Drink & Be Merry: You need less exercise than you think to accrue most of the health benefits...exercise is not a magic cure for all that ails you and it can even have some very negative consequences. Every orthopedist I know drives the latest car, thanks to business. ...I place almost the highest premium on having fun...Over the years I’ve noted a growing belief that all mega-exercise is good for everyone. Science is once again your friend....The real good news is that if you decide to get in shape, you don’t have to go for a 5-mile run every morning. Listen to this, from the Institute: “The greatest reduction in relative risk occurs between the lowest level of fitness and the next-lowest level of fitness.” There is little to support “more is better,” and certainly not for everyone. What may be most surprising is how everyday things we do around the house compare favorably to “real” exercise, he said. Things like gardening, raking leaves, painting the house, washing the car, mobbing the floor, cleaning windows, dancing, playing table tennis, and chopping wood. When men in one study mowed the lawn and felt they were merely lightly exerting themselves, they had actually exceeded maximum peak values obtained on a treadmill. And dispelling popular beliefs that we all can be athletic and equally aerobically and muscularly fit, or that we are all meant, or need, to enjoy the same types of activities, he wrote: ...This research found a strong genetic component to fitness and strength...Heredity accounted for almost all aerobic capacity in girls and only two-thirds of that capacity for boys. Heredity accounted for most upper body strength....The same held true for the ability to jump vertically. Not understanding the genetic aspects to physical abilities and fitness has led to popular condemnations of children and adults who are not athletically-inclined. There is also a popular condemnation in our culture of those not seen as doing "real" exercise. Not only are the benefits of exercise sometimes overstated, but it is also believed even among healthcare providers that other forms of physical activity "don't count." After discussing the effects of too much exercise, Dr. Edell added that the risks of over-exercising are not just among aging babyboomers. Exercise is a potentially constructive activity, but there are loads of ways it can get you into trouble physically and mentally....At some point, being nuts about anything subtly crosses the line into obsession. Dr. Morris Mellion of the University of Nebraska Medical Center has made a strong case that exercise addiction is every bit as real and serious as drug addiction and eating disorders and is very much like them in the way it works. ...Many addicts deny addiction because they insist that exercise is supposed to be good for you. So these addicts are seen by themselves and others as “having a healthy craving and demonstrating a positive commitment to well-being.” We don't see problematic obsessions if they're in the name of "health" and especially if everyone around us is encouraging them. But the effects on our children are especially troubling. He described the growing trends among young athletes engaging in more high-risk behaviors, such as drinking, taking drugs, having more sexual partners and higher rates of sexually-transmitted diseases, using steroids, violence, impaired academic work, and smoking. “Without concluding that sports are necessarily bad for our kids’ behavior, clearly something is going on here. Parents, school administrators and coaches need to get a grip on it.” What is MIA in health recommendations, intent on getting everyone exercising 60-90 minutes a day, is balance and the other side of the story. 
© 2007 Sandy Szwarc
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