TCS Daily

Shape Up, America!

By Sandy Szwarc - January 16, 2004 12:00 AM

Editor's note: Read part one of Sandy Szwarc's two-part series on exercise here.

"Exercise to lose weight" is just one of the misconceptions about exercise.

• Most of us think we have to be thin to be in shape and see health benefits.

• We believe we have to sweat and burn or exercise isn't doing us any good.

• We're convinced fat people aren't exercising.

It's all false.

In the fight against the "obesity epidemic" we are inundated with diet and exercise programs. But when exercise is promoted primarily in terms of weight loss, and being "in shape" as defined solely as being thin, it can discourage people from making activity a life-long habit. For many the weight loss part can be elusive even when working out at the recommended healthful levels, and after a while they don't see the point. Thin people with no interest in losing weight think they're exempt from the need to exercise. It's hard for many of us to separate exercise from the goal of weight loss and to exercise simply for the health of it, but it's an important health message we can all benefit from.

"I think the appearance-based approach [to fitness] almost constitutes a public health threat, in that it inspires exercise resistance in both fat and thin people," said Marilyn Wann, who considers herself a proponent of healthy lifestyles for people of all size and is author of Fat!So? (Ten Speed Press, 1998).

It's important to focus on health, not weight, according to Steven Blair, PED, President and CEO of the Cooper Institute for Aerobic Research in Dallas, where much of the country's landmark research on fitness and preventative health has been done. "We want to help [our clients] develop healthful eating patterns and to be regularly physically active, and to focus on the health benefits of these behaviors. We encourage them to not have unrealistic expectations about weight loss."

"I counsel my personal training clients not to even think about their weight as they are shifting from a sedentary to a more active lifestyle," said Jennifer Portnick, a personal trainer and certified aerobic exercise teacher at Feeling Good Fitness. "Why? Because whether or not they gain, lose, or maintain their current weight, they will benefit...I also find that focusing on weight leads to short term behavioral changes. An exerciser embarking on a new fitness program who has her eye on the scale is likely to become discouraged and stop what she's doing if she doesn't see weight changes. If she is focused on non-weight related benefits... she will be more likely to turn a short term commitment into long term behavioral changes."

We've understandably come to believe that we'll lose weight with exercise because we hear that all the time. But when studies are closely examined, weight loss is more complicated than simply hitting the tread mill. Oftentimes, weight loss is not attributable as much to exercise but to calorie restrictive diets and such weight loss is rarely long-term. But many researchers maintain regular exercise can be an important part of maintaining a stable weight and "tends to reduce risk of the weight gain that often accompanies aging," according to Blair.

More importantly, dieting and weight loss are not required to enjoy health benefits. The benefits of exercise are independent of weight, Dr. Dean Edell told ABC audiences of The View Jan. 5, 2004.

In fact, a just released 17-year study of almost 9,800 Americans found exercise and eating more was a better defense against heart disease deaths than exercise and restricting calories. Focusing on increased activity rather than dieting "may offer the most productive behavioral strategy by which to extend healthy life," said researcher Jing Fang, M.D.

Weight Loss Not Required

In study after study, the health benefits of regular physical activity are consistent -- without any change in body weight being necessary. Exercisers have lower blood pressure and improved insulin regulation, reduced visceral fat (that invisible fat around our organs linked to heart disease and type 2 diabetes, and postmenopausal breast cancer in women), improved glucose and lipid metabolism, lower rates of heart disease in both women and men, and atherosclerosis and heart disease is even reversed in fat children simply with physical activity.

According to the National Institutes of Health, National Center for Chronic Disease and Prevention and Health Promotion, Centers for Disease Control and the American Heart Association other benefits of physical activity include reduced triglyceride and cholesterol levels, lower risks for cancers, better bone mass and less osteoporosis, better mental acuity, and less depression and anxiety.

The importance of physical activity for women appears to be even greater than for men. Heart disease, the leading cause of death among women, accounts for more than half of their deaths. The largest cohort study of women over the longest period of followup, the St. James Women Take Heart Project, confirmed that exercise is an independent predictor of death (in other words unrelated to body weight), reducing mortality risk by 17% (compared to 12% for men) for every metabolic equivalent of activity performed.

"Fitness is a more powerful predictor of mortality than BMI," Blair said. Regular physical activity cuts overall mortality in half for both men and women. The ongoing Aerobics Center Longitudinal Study of 25,389 men at the Cooper Clinic begun in 1970 has found "that low-fit men with a BMI of less than 27 were at a greater risk for death than high-fit men with a BMI of greater than 30," he said. "The percentage of a person's body weight derived from fat does not seem to matter in predicting all-cause mortality after cardiorespiratory fitness is taken into account... As a result of our findings, we believe that no matter how you split up the population, fitness has a strong inverse relationship with mortality."

Fitness Redefined

Further discouraging most people from exercising is the belief in "no pain, no gain," say fitness experts at the University of Southern Maine Center for Wellness and Health Promotion. It's "not a healthy approach to exercise at any age," said Dr. John Egbert, a geriatrician at Palmetto Health Richland in South Carolina.

It's now recognized that the fitness needed to enjoy health benefits means "metabolic fitness," not being an endurance performance athlete with maximum oxygen capacity and muscular strength. Aerobic, flexibility and strength components are valuable parts of every exercise regimen, but it's much easier to reach fitness than most people think.

"To be in better physical condition most people...just need to get out there and engage in the kind of activity that brings a stronger, fitter body," said Portnick. Anything physically active that you enjoy counts -- be it dancing to gardening, walking to skating. It should be fun, not punishing.

According to researchers, as well as the U.S. Preventive Services Task Force, American College of Physicians, American College of Sports Medicine, American Heart Association, and the government's Healthy People 2000, people should aim to exercise at a light to moderate level (like walking) at least 30 minutes at least 5 days per week. And, it can be in little spurts as short as 5 minutes at a time, making it quite doable for fitting into our days.

Yet, according to a recent CDC report over half of all Americans aren't meeting these recommendations.

It's the Fat People

Since over half of all Americans are also considered fat, it's assumed that they're the same folks who are sedentary. The popular belief is that fat people don't exercise and most certainly can't be fit.

Not so, said Blair. "Fat but fit people are not rare... We find that 40 to 50% of obese (BMI >30) adults are fit by our criteria, based on maximal exercise testing." So, while slightly more thin people are active, it's not by much.

"It is a mistake to assume based on a person's body size anything about their health or exercise habits," said Portnick. "I know thin people who do not move at all and fat people who dance and run and jump and just generally get in a good workout several days a week."

Wann is an inspiring example for many large women. For years, her exercise regimen has included a variety of activities that would leave most of us in the dust. Her weekly schedule currently entails: a 1 1/4-hour vigorous aerobics class, 2-hour yoga class, 11/2-hour water aerobics class with weight resistance, brisk walks 2 to 3 mornings, and she's a master gardener. While following a healthful diet, her weight hasn't fluctuated significantly from her 270 pounds (BMI 46), while all her health indices (blood pressure, cholesterol, blood sugar, etc) are fine.

We can help encourage everyone to exercise by making it not just the privvy of jocks. "People don't tend to go where they don't feel welcome," she said. "Most people don't feel welcome in gyms and other fitness venues...mainly, I would imagine, because they fear that they don't sufficiently look the part of athlete."

Portnick started aerobic workouts 17 years ago and today does vigorous aerobic classes at least 5 days a week. Her fight to become an aerobics instructor at Jazzercise, denied her at the time because of their "fit appearance" requirement, is legendary. She now teaches her own classes for people of all sizes. Hers, and other weight-friendly exercise gyms and classes springing up across the country, are inspiring more and more fat people to exercise, many for the first time.

It was at just such a size-friendly yoga class that Aimee Cegelka of New York City discovered exercise. "I always thought I hated exercise because it was always something I did to lose weight," she said.. "But since understanding it's not about losing weight, I've found I LIKE exercising! Now I would never want to give up my weekly swimming, yoga, my bike riding, long walks or dancing."

The National Institutes of Health also offers a guide, Active at Any Size, with tips and resources on active lifestyles that lead to "healthy fit bodies that come in all sizes."

"I have seen many fat people regain a sense of joy in physical activity that also allows them to feel good about themselves for the first time," said Wann. "It's precisely the act of eliminating weight from the equation that allows both a return to physical activity and a return to self-esteem. I know plenty of thin people who would enjoy breaking the connection, too!"

"So how do I encourage other people to enjoy health habits for their own sake...? Well, I suggest that it's simply much more fun. I suggest treating one's body well because we're worth it, not because we seek to make less of ourselves. I suggest that people break the connection between healthy habits around food and physical activity on the one side and weight expectations on the other side. Healthy habits themselves can be such a joy."

© 2003 Sandy Szwarc


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