Live Long, Die Short (17 page)

Stroke

Type 2 diabetes
⁵

Booth estimates that physical inactivity accounts for approximately 15 percent of the entire healthcare costs of the United States.
⁶
His solution? The same as the recommendation of the Expert Panel of the Centers for Disease Control and of the American College of Sports Medicine: “Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, and preferably all, days of the week.… Adults who engage in moderate-intensity physical activity—i.e., enough to expend 200 calories per day—can expect many of the health benefits described [in this report].”
⁷

So why are so many of us sedentary, and why is being sedentary so bad for us? Let’s start with the last question. Sure, we all know that exercise is good for us. But let’s not even use the “E” word. Moving is astoundingly good for us. Ken Cooper, the “father of aerobics” and founder of the Cooper Institute and the Cooper Clinic in Dallas, Texas, recently said in an interview that walking just two miles three or four times a week “would reduce deaths from heart attacks, strokes, diabetes, and cancer by 58 percent, and could potentially prolong life up to six years.” Cooper, so long the advocate of running, is clear in his appreciation for the fine pastime most of us can do without instruction, special clothes, dedicated facilities, or even good weather. That pastime? Walking. Again, why is it that being sedentary is deadly?

Let’s go back to our ancestors again, back before elevators, escalators, cars, and even horses. This is when our human physiology was coming of age. Our ancestors had to move to survive. Not unlike most other mammals, humans had to expend much energy in order to acquire food and water. These early humans, with whom we share most of our physiology, were nomadic, and therefore moving was an essential part of their lives. As descendants of these nomadic people, our physiology is based on abundant
movement and a diet of vegetables, fruits, nuts, fish, and infrequent, small portions of meat (see
Tip Five
). To the extent we have that, we are more likely to be healthy. To the extent we don’t, problems arise.

If you look at photos of crowds just over half a century ago, before
exercise
was a word, before the term
jogging
had meaning, before fitness centers, and before the hundreds of diet plans, you’ll see that the people in these photos are lean. Almost every person—lean. Movement was an inherent part of daily life—walking, biking, work, play—and obesity was rare. Not exactly like our distant ancestors, but closer than we are today.

But today, we have virtually programmed physical movement out of daily life. We drive to work, drive through for our coffee, take an elevator or escalator to our office, sit at a computer or in meetings for the day, order out for lunch. Even laborers, although still moving more, are assisted with power tools instead of hand tools, crane baskets instead of ladders, and backhoes instead of shovels, and therefore move a little less. Most jobs involve sitting, lots of sitting.

Our children catch the school bus, which, as anyone who gets stuck behind one will tell you, stops every hundred feet to pick up a child who has been waiting in the family car parked at the bus stop with Mom. In school, physical education is deemphasized. After hours, we drive our kids where they need to be, and watch helpless as they spend countless hours sitting with computers, phones, and video players, or in front of the television.

How did all this happen? Those of us who lived through the fifties remember that “progress” and “success” usually meant easier (i.e., less physical) work. To the extent you were successful, you were able to obtain things that made it less necessary to walk, or open a garage door, or grow your own vegetables, or open a can. Leisure became inextricably attached to progress and success. Add to that the explosion of automobiles and then the age of technology, which changed workplaces and created huge industries where workers sat while at work.

Six decades later, movement, if it occurs at all, is scheduled. It’s “working out.” This concept of movement as an event rather than a lifestyle is, I believe, precisely why so few of us do it. Who has the time to work out? What more can I put into an already fully scheduled day? David Gobble, my good friend and colleague and the former director of the Fisher Institute for Wellness and Gerontology at Ball State University, shared with me a photo that he thought symbolized this removal of movement from our daily lives. Picture the front of a fitness center—with an escalator taking you up one flight of stairs!

This concept of movement as working out has resulted in a billion-dollar industry offering equipment, clothing, workout facilities, food, drinks, travel, and more, all geared to meeting our body’s innate requirement for movement, and all distancing us, particularly those of us who are older, from the idea that movement is a natural state for us humans. And of course, what has further distanced us is the virtual explosion of fitness experts, programs, and approaches to fitness. This is an area lending itself to zealots, who usually offer a very prescriptive program with often unrealistic expectations, offering abundant opportunity for disillusionment.

Last, and probably most disruptive to a lifestyle of movement as way of life, is, ironically, the fact that movement, now tied to a fitness industry, is even more tightly tied to weight loss. Outside of training for athletic events or perhaps the military, weight loss and vanity are clearly the major reasons for attempting anything physical at all. If we lose the weight, we frequently lose the motivation to continue moving, and weight returns. If we don’t lose the weight, we give up trying and the more frequent movement with it.

Now, before you cry foul, I am absolutely supportive of efforts to maintain a lean body, of the benefits of workouts, and of the culture of health and activity that is attached to our collective approach to movement. I believe the rehabilitative and fitness industries are filled with highly motivated professionals who work virtual miracles every day for injured, challenged, or otherwise impaired people. My criticism has to do with the fact that this technology-based, highly prescriptive approach leads one to believe that movement
must
be managed by science,
must
involve specific machines or approaches, and
must
result in weight loss to be of value.

These characteristics have value, but they are obstacles when viewed as absolute necessities for bringing physical activity into our lives. Looking at the endless supply of programs, exercise machines, clothing, diets, and consultants easily pushes most people past the threshold for fear. And fear will never work as a long-term motivator.

So, ironically—and tragically—as movement became detached from our lifestyles, there arose the need for the fitness industry, which, when seen as the only way to be physically active, further distances movement from our basic lifestyles (a self-perpetuating situation). Movement—walking, for instance—can be free and highly effective for keeping us healthy. Cost, complexity, fear, or lack of familiarity with physiology should not be deterrents to beginning a lifestyle of movement.

As we noted previously, the Centers for Disease Control has identified heart disease, cancer, lung disease, strokes, and Alzheimer’s disease as the major chronic-disease killers of Americans.

• But if you ask them what’s
  really
  killing us (wink, wink) they will tell you another story. They will tell you that, overwhelmingly, it is conditions that are related to lifestyle that kill us:
  
• Smoking: 400,000
  
• Diet and activity patterns (sedentary lifestyle, calorie-rich foods): 300,000
  
• Alcohol: 100,000
  ⁸
  

We can see, then, that modifiable behavior—lifestyle—is indeed a major factor in how and why we die, and, as noted by the MacArthur Study, how well we age. Physical inactivity, with its ties to obesity, heart disease, cancer, stress, mood, and our immune system, plays a leading role in this tragedy.

It’s rare indeed that there is one solution to many problems. But it does happen. The problems of heart disease, stroke, many cancers, obesity, diabetes, osteoporosis, depression, and dementia are multifactorial in their causes but
all
are positively affected by physical activity. Unfortunately, as we mentioned above,
physical activity—movement—has been systematically removed from the daily life of most of us
. It has been replaced by excellent alternatives (fitness centers, jogging, classes, home exercise machines), but all of these are add-ons to our already full lives. If I were king, or at least had the ability to change one thing to positively affect the health, aging, and overall quality of life for all, I would bring walking (or biking) back into the fabric of our lives; redevelop cities, workplaces, and neighborhoods to allow all to walk or bicycle as they go about their daily lives, doing errands, going to meetings, going to movies or out to eat.

Movement is, for us as a species, closer to our real selves, our authentic selves. Awareness of the potential for this lifestyle is growing, and more and more planned cities and neighborhoods are designing better alternatives to our too-dangerous-to-walk cities and neighborhoods. Many initiatives, like
the Robert Wood Johnson Foundation’s Active Living by Design (
www.activelivingbydesign.com
), are working with communities to bring about this type of substantial change.

The rest of us cannot afford to wait. We all have a responsibility for our own health. Even the smallest of changes can result in marked reduction in risk and higher quality of life.

OK. You agree that movement is important. Before you rush to the store and to get your Under Armour exercise clothing, let’s be reasonable about this. If this is going to work, it must be a lifestyle change. If it is something that is going to be resilient and outlast the slings and arrows of our crazy frenetic lives (and it must!), then this is not something to take lightly. This is as great a
lifestyle
change as deciding to go back to school, or moving to a new city, or getting divorced (not really that last one, but I wanted to impress on you that it’s big). Remember the concept of kaizen. Then decide what
small
change you’re going to make. Teresa, my no-nonsense colleague, sent me a reminder: “If you change nothing, nothing will change.” Remember, small. If you decide to walk five minutes, or ten, or fifteen, do it with a friend, two legs or four; both will become embedded in your prefrontal cortex and make you want to do the right thing. And perhaps that is the best way to begin. Walking. No equipment, no special facilities, no need for trumpets and fanfare to begin.

Now let me predict what will happen. You will begin. You will feel good about yourself although you will have a tendency to say “I’m only …”
Don’t do that!
No apologies. You’re beginning. You’re better off than perhaps as much as a third of our population. The only failure here is the failure to try. You’ll begin to think either (1)
This is silly, why don’t I start training for a marathon (or something bigger than what I’m doing)?
or (2)
This is silly, it can’t be helping.

Can’t be helping? Really? After all I’ve told you, and in spite of the fact that you
do
feel better? So keep it up. Don’t listen to the critic in your mind. Listen instead to your body. Become aware, as you walk and move, of how that feels. Pay attention to how you’re sleeping, thinking, and feeling. Pay attention to your energy level. Your level of stress and anxiety. All will improve. This will happen. There is a marvelous line from the movie
The Best Exotic Marigold Hotel
: “Everything will be all right in the end. If
it’s not all right, it’s not yet the end.” The more you become aware of your body, and of your inner self, the more you will feel the truly magnificent changes happening to you.

You will persist. You will increase what you are doing. The main challenge will be to resist the impulse to “go Olympic” and try to take on too much. Remember, this is a about lifestyle alteration, not training. Training has an inherent element of time limitation. I’ll train until the event. Then I’m not training anymore. Your change is timeless. Your new self. Your new lifestyle.