Healing Through Exercise: Scientifically Proven Ways to Prevent and Overcome Illness and Lengthen Your Life (3 page)

OUTDATED ADVICE

While part of the medical community is now hailing a new era of “active medicine,” many doctors remain skeptical about exercise, as physician Annette Becker from the University of Marburg remarks with astonishment. There is now “highest evidence for the effectiveness of exercise in the prevention and treatment of chronic diseases, and for the ineffectiveness or even detrimental effects of bed-rest,” she comments. “But many doctors still often advise their patients to stay in bed for long periods, which can—as in the treatment of chronic pain—worsen the patients’ prognosis.”
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Experts at the University of Hamburg also find it “amazing how little many doctors know about these things.”
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Because of this ignorance, patients—possibly in the thousands at any given time—are simply being wrongly treated. Let’s look at patients with back pain. Physicians are all too keen to carry out expensive diagnosis procedures such as computer tomography and MRI scans. These rarely produce pathological findings but do mean high income for the doctors. The patients are sent away with prescription drugs—and often do not receive the physiotherapy they actually need or, more important, any help for changing their lifestyles in the long term. Patients diagnosed with mild high blood pressure are usually prescribed expensive medication; “Doctors seldom think of prescribing a program of moderate stamina training.”
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In defense of the physicians, all this is the exact opposite of what must have been learned at medical school. What we now know is wrong was considered right back when current doctors were students. Sending sick people to bed made everyone happy. The whole way of thinking, the medical practice of the time, was founded on the basic conviction that patients would find salvation in physical rest.

Many of the experienced doctors who now run large practices or hospital departments went to medical school at a time when heart attack patients were still ordered to spend four to six weeks in bed. Some older doctors may remember a time when patients were even strapped down to keep them still. Not that long ago they were of the opinion that our hearts only had a limited number of beats, according to the motto: “Use up those beats by racing your heart with exercise, and you shorten your life span.”
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In his classic book
The Structure of Scientific Revolutions,
the American historian Thomas Kuhn describes why it’s always so hard for new findings to take the place of old ideas in science.
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Fundamental new ideas are initially disdained because they undermine scientists’ previous work and reveal that this work is wrong or even foolish. Eventually some scholars adopt the new theory, whereas others stubbornly refuse to alter their positions. The latter gradually die out until their views are entirely forgotten.

When it comes to exercise as medicine, we have not yet reached that turning point: “The paradigm shift is in flux, but has not yet been realized in this short period of time.”
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There are signs that it might take a while yet until the breakthrough. Even now, medical training barely addresses the links between regular activity, fitness, and disease.

But it’s not just the medical profession that hasn’t caught on to the healing power of exercise. We laypersons have also failed to recognize its benefits. When our grandparents were growing up, most people in industrial societies never reached old age, worn out by dangerous physical labor on the factory floor or relentless household labor. Their grandchildren now live in what we could call sitting societies. We are the first generation to face the opposite challenge: We may grow old before our time and die young if we don’t get enough exercise.

The Dangers of Going to Bed

A
MEDICAL TREATMENT OFTEN BEGINS BY PUTTING A PATIENT TO bed. Many of us have already had this experience: having barely arrived at a hospital, we are asked to remove our street clothes, put on a skimpy gown or pair of pajamas, and go to bed. The size of a hospital is measured by the number of beds it has, and the severity of an illness is determined by the number of days a patient stays in bed. And whether or not we like a physician depends on that doctor’s “bedside manners.” A good doctor sits down by the patient’s bed and listens.

An example of such medical tact is depicted in Pablo Picasso’s painting
Science and Charity
from 1897. A bearded doctor is taking the pulse of an exhausted patient; he represents science. On the other side of the bed, a nun faces the patient; she represents charity. Picasso’s creation shows a vision of how bed rest should be, says the general practitioner Annette Becker, of the University Hospital in Marburg, Germany. She believes that rest means “not only immobilization but also care, gentleness and protection for an individual who is burdened by disease.”
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A DANGEROUS PRESCRIPTION

Over the years, bed rest has been prescribed in far more coercive ways. The American neurologist Silas Weir Mitchell (1829-1914) introduced something he called the “rest cure.” For Mitchell, the best treatment for individuals suffering from neurasthenia as well as hysteria was to confine them to bed for six to eight weeks. During this agonizing period, some patients were not even allowed to turn their bodies without support. This type of immobilization soon was taken up by virtually the entire medical world, especially for individuals said to be hysterical. During their detainment, these poor souls were not allowed to receive visitors and, in order to avoid any distress, they were always cared for by the same nurse. The patients were forbidden to use their own hands for washing, and their nurses fed them a diet consisting of especially fatty dairy products. Mitchell actually reported many recoveries: as soon as he allowed his patients to go back into everyday life, they were usually more than willing to flee this sickbed.

The perils of bed rest, however, have been known to more enlightened physicians. Richard Asher (1912-1969), who worked at the Central Middlesex Hospital in England, was making his rounds one day when he came across a remarkable case of bed rest. “In a chronic ward of which I once had charge I found a lady who had been in bed for 17 years with a diagnosis of nervous debility and whitlow,” Asher reported in the
British Medical Journal
. “She had survived this remarkable hibernation with little damage, and though she was very upset when I ordered her up she became a different person when she was fully ambulant.”
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There is a long tradition of doctors exercising power over individuals by confining them to bed. In the novel
The Magic Mountain
, soon after the young Hans Castorp arrives at the International Sanatorium Berghof, where he wanted to visit his cousin, he is ordered to bed. “Now, Castorp, we’ll stick you into bed and see if a couple of weeks’ rest will sober you up,” the physician Herr Hofrat Behrens tells him. “As if ‘lie down’ isn’t just as good a word of command as ‘stand up’!”
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The French writer Jules Romains recounts in his satire on medical quackery,
Knock
, the story of a country doctor named Knock who, by inventing outlandish diseases, turns a whole mountain village into a hospital. This disease-monger tells his first patient, a lady in black, “Go to bed when you get home. In a room where you can be alone as much as possible. Close the shutters and draw the curtains so the light won’t bother you. Don’t let anyone talk to you.” The doctor orders a full week of this isolation, after which he will reconsider the case. Knock says: “If you are strong and full of life it will mean that things aren’t as bad as they seem. If, on the other hand, you’re weak and drowsy, have a hard time getting up, then there’s no doubt about it and we’ll have to start the treatment.”
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Over the course of the story, the woman falls sick and confirms Dr. Knock’s case for treatment. Findings from real-life research explain why this outcome is likely. After spending just a few days in bed, our muscles start to waste away and a whole range of undermining effects sets in. Being immobilized can bring more harm to our health than the ailments, which sent us to bed in the first place.

“Bed Rest: A Potentially Harmful Treatment Needing More Careful Evaluation”: this is the title Australian doctors chose for a paper they published in the medical journal
The Lancet
.
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They had carried out a review of the scientific literature on the use of bed rest in treating various illnesses. In 24 trials that looked into bed rest following a medical procedure, the review revealed that none of the outcomes improved significantly. In eight of these trials, bed rest actually worsened the outcome—for example following lumbar puncture, cardiac catherization, and spinal anesthesia.

Fifteen of these trials examined bed rest as a primary remedy, and in these studies the results were even more sobering. While not a single group of patients got better, in nine diagnostic groups the health of the involved patients on average actually got
worse.
This was the case after acute low back pain, childbirth, high blood pressure during pregnancy, heart attack, and acute infectious hepatitis.

The authors of the review article were amazed that so many members of the medical profession were clinging to the ritual of putting patients to bed, even though the bed-rest trials they reviewed had been published for quite some time. “Ideas about bed rest seem so entrenched that medical practice has been slow to change—even when faced with evidence of ineffectiveness.”
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Researchers at the Yale School of Medicine have come to the conclusion that the effect of bed rest is especially detrimental to people age 70 or older. According to their study in the
Journal of the American Medical Association
, the risk of developing a disability within a month of hospitalization was elevated more than 60-fold.
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In many cases, the physical condition of older people staying in a hospital deteriorates so dramatically that they never return home and instead must be transferred directly to a managed-care facility.

There are only a few researchers studying the phenomenon of being bedridden. The nursing scientist Angelika Zegelin at the University Witten/Herdecke in Germany is one of them. In an unusual study, Zegelin went into an elderly care home and conducted interviews with 12 men and 20 women who dwelled there. These residents were of sound mind but had been bedridden for up to four years. Zegelin wanted to find out: Why did they end up in such a sad situation?

According to her findings, the disastrous scenario leading to the state of being bedridden unfolds in five distinct steps.
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It often begins when a person develops what Zegelin calls a “physical instability.” The individual is actually healthy, but at one point in the life refrains, for whatever reason, from physical activity. This voluntary inactivity may not appear harmful but can have such a deep effect that some people will eventually end up in a nursing home. A survey among 50 residents in one such residential home revealed that 75 percent of its occupants never played sports in their adult lives.
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The conversion from being sedentary to being totally immobile, the second stage, is then usually triggered by an accident or a similar event. This incident can be a fall—but it may result solely from the
fear
of falling. In many instances, a stay in a hospital became the starting point for further physical decline. At least, this is what Zegelin heard time and again during her survey interviews. Many of her subjects stated they “just stayed in bed during their hospital stay, and after one week they were already unable to get up.”
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This triggers the third phase, which is the one of continuous immobility. The individual in question walks only a few steps and for most of the day is simply lying in bed or sitting in an armchair. If he or she still lives at home, then he or she is looked after by a nursing service.

At this stage, some exercise would still be very helpful—but typically no one is around to help mobilize the ill person. According to a survey among 70 residents in one nursing home, 66 percent of them had fewer than two hours of physical motion per week, and a third of the residents did not move at all. The situation was partly worsened by an unfortunate misunderstanding. Some of the older persons refrained from leaving their beds because they did not want to cause more work for the nurses who appeared to be overburdened, especially on the weekends. Conversely, many nurses assumed they were being kind to the frail residents by not disturbing their rest. Thus, unsurprisingly, the survey concludes that there is “widespread physical inactivity in nursery homes.”
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Many older people and invalids who are looked after in their own homes are also hardly able to leave their beds. A caregiver from a nursing service might show up two or three times per day, but they usually are in a hurry and leave again after only 20 to 30 minutes. The ailing individuals may ask to be guided to a chair, but once the nurses are gone, they must sit there for hours, until the next nursing shift arrives, at which point a caregiver can help them back to bed. Thus, most people interviewed by Zegelin vowed not to leave their beds in the first place.