The Elephant in the room

[Trek420]

I agree. Where is the jersey that says "eat right, exercise, die anyway"

Working with the disabled community I'm made aware every day that I am only temporarily able bodied. Often I hear this "I never thought this would happen to me, I was active, working, suddenly I had ________ ".

My feeling is do what I can do, take care of what I have control over. Even with injury/illness focussing on wellness can help.

For years I banged my head on the walls of doctors offices asking why I hurt so much. Finally a diagnosis, severe arthtritis Again I staged a hissy fit. Simply knowing was not enough. I wanted it to hurt less and still be able to stay active.

Several appointments later the orthopedic surgeon for both the 49'ers and the Raiders told me "there's no pill, no surgical option. You have this choice:

change your lifestyle to fit your knee (he meant go sedentary)
change your joints to fit your lifestyle (build the muscles around the knee)"

He suggested cycling ..... here I am For me I don't so much focus on wellness to live to be 116, it's about being able to open the peanut butter jar in my 80's, being able to just keep doing what I want to, need to do as long as I can. It's about quality of life.

[tulip]

I'm happy to live in an economically-disadvantaged part of the city that really has wonderful grass-roots efforts to improve the educational and nutritional outlook for kids. The Neighborhood Resource Center has a community garden and a kitchen, where kids grow their own food and then learn to cook it. They also have chickens for eggs. Kids had no clue where food came from, and they are so into the gardening and cooking.

I agree that Home Ec should be taught in schools again, too. And yes, people taking responsibility for their health will go a long way in improving society in general, and the health care issue as well.

[Reesha]

They should be teaching life skills in general! Basic cooking skills, balancing check books, paying bills on time, understanding basic financial stuff. People stumble out into the real world these days barely equipped to survive.

[roadie gal]

For Jolt: Here's the article. It's from one of my subscribed sites, so I have to post it this way. Sorry it's so long.

BTW, I never meant to imply that exercise is the total answer. Some people have crappy genetics (myself included). Some people need emergent intervention. My point was that they had to stop the study because they couldn't find participants for the exercise group.


September 8, 2009 (Barcelona, Spain) - Investigators for the multicenter PET study were keen to build on the surprising findings from their pilot trial: that 12 months of exercise training was just as good as PCI for myocardial perfusion and symptom relief in patients with stable angina and even better in terms of preventing cardiovascular events. Those hopes, however, were dashed when the multicenter PET study ground to a halt due to a lack of enthusiasm among patients and enrolling centers.

But in new findings presented by Dr Rainer Hambrecht (Klinikum Links der Weser, Bremen, Germany) at the European Congress of Cardiology 2009 Congress, combined data from the PET pilot study and the aborted PET multicenter trial suggest that regular exercise training is superior to PCI at preventing subsequent cardiovascular events.

The original PET study [1] randomized 102 patients to either exercise or PCI and reexamined patients after 12 months using coronary angiography, technetium-99m scintigraphy, and ergospirometry, as well as a range of clinical end points. Results, which were published in Circulation in 2004, showed clear and comparable improvements in symptoms and myocardial perfusion from baseline with both treatment strategies, and a trend toward better event-free survival in the training group at both 12 and 48 months.

"Our expectation was that exercise training would not be inferior to PCI; however, what we saw after 12 months was a clear, significant improvement in exercise over PCI in patients with stable CAD," Hambrecht told heartwire .

Exercise benefits

Inspired by the PET pilot, Hambrecht et al launched the PET multicenter trial at four hospitals in Germany, Austria, Switzerland, and Romania. By design, patients were randomized either to PCI or to two weeks of a supervised exercise training program every day, made up of five short periods of exercise daily. Patients were then given bicycles at home and asked to exercise on them every day, plus attend a supervised exercise program one or two times per week. The bikes, Hambrecht told heartwire , were equipped with sensors that monitored the amount and duration of exercise and ensured that it was actually the study participant--and not another family member--who was using the equipment.

But according to Hambrecht, the trial had major problems recruiting and was halted with just over 100 of the original 400 patients it had hoped to enroll. The study had plenty of funding; enrollment problems lay with both the recruiting centers and the patients themselves, he said. "There was some reluctance among the centers to join us in performing this study and also difficulties recruiting patients for the study" and explaining the randomization process. "If you get the stent you are free of symptoms within a few minutes, [whereas] in the training group, you have to work a lot, for several months, to reduce the angina threshold."

As with the pilot study, there were striking improvements with both PCI and exercise training in angina class and improvements in event-free survival that were nonsignificantly better for the training patients.

However, when the patients from both the multicenter and pilot studies were combined for a total of 202 patients with two-year follow-up, investigators achieved the statistical significance not met in the multicenter trial, Hambrecht reported. In a pooled analysis of event-free survival, 21 events occurred in the training group as opposed to 32 events in the PCI group (p=0.039). The differences speak to the direct benefits of exercise on the cardiovascular system globally, as opposed to the palliative, more localized benefits of PCI. Whereas both strategies improve myocardial perfusion, angina threshold, and exercise capacity, only exercise improves endothelial function and slows disease progression, he noted. Moreover, he stressed, improvements in both arms were seen on top of optimal medical therapy.

Forces work against exercise

In an interview with heartwire , Hambrecht acknowledged that there are multiple forces working against a scenario in which regular exercise is prescribed instead of stenting. For one, patients are not motivated to take responsibility for improving their own cardiovascular health--even if it means better event-free survival. For another, encouraging exercising is financially less appealing for hospitals, Hambrecht observed: "That was my feeling, that hospitals were reluctant to participate in this study, because they derive revenue from PCI procedures."

Hambrecht believes his data support calls to take the time between the diagnostic angiogram and the revascularization procedure to discuss the options with the patient, rather than stenting every patient.

"We have enough evidence from several studies, including COURAGE and our PET studies, comparing PCI vs more conservative strategies, and the data are quite convincing that PCI is not superior" in stable angina, he concluded.

[Trek420]

I'm just going to stumble in here and ask "who's they"? Parents? Teachers? Both? The entire village that it takes?

We ask a lot of our teachers: teach the kid to read who's been babysat by the TV and not read to, teach morals, values, calculus, French literature ..... I've been stumbling in the real world for decades, tons of schooling, raised in the wild by a pack of teachers and I've found I have lots to learn still.

So I'll just ask this question for the group: In a society/culture that does not reward or teach a healthy lifestyle or healthier choices how did you learn? Was it in the home, in the kitchen? Classes? Community? A little of both?

[Kris]

Like a previous poster, my aching arthritic knees got me into cycling, and eventually into Weight Watchers and yoga. Between the three, I feel much better and I can walk down hills (which was almost impossible). I'm thinner too. It is definitely worth it, but it is not easy. I have food issues, and there is temptation at every turn. Yes, I belong to a CSA and eat organic a lot of the time, but I still struggle with cravings. David Kessler's book The End of Overeating, shed some light on that for me. Apparently humans are programmed to want sugar, fat and salt, things that were rare for millenia, but all to common now, and the multinational corporations are making Big Bucks from our propensity for those three things. Although I still struggle, I'm proof that it is possible to change a lifestyle and develop a desire to exercise, not just because it's "good for me" but because I really want to get out and ride. And I had quite a few years of bad habits behind me when I started.
There are some things a good health system could do, like make WW-style support groups available for less $$$, and make it possible to ride or walk to places. Our town recently acknowleged that it's impossible to safely get to some places people need to be without a car, due to the car-centered planning they did in the past. It's not just distance. There are places where you cannot cross the 6 lane highway. And healthy food should not be more expensive than sugary, fatty, salty junk.

[DarcyInOregon]

I'm just going to stumble in here and ask "who's they"? Parents? Teachers? Both? The entire village that it takes?

So I'll just ask this question for the group: In a society/culture that does not reward or teach a healthy lifestyle or healthier choices how did you learn? Was it in the home, in the kitchen? Classes? Community? A little of both?

I took a nutrition course as a science requirement in college, and that helped me a lot to understand about how the body needs nutrients, how nutritional deficiencies are the cause of many disease, and how nutrition interacts with exercising the body. Then in the 1990s, the community hospitals really got proactive with putting together classes to educate patients and the community at large with respect to cardio health, preventing diabetes, minimizing arthritis, maximizing the fitness level, nutrition for weight loss without dieting, and so on, classes in just about every hospital in North America, either free or low cost. Like other people in this thread have said, it is about education, but you have to seek out the knowledge for yourself, learn what is fact and dismiss the inaccurate fad diet type of books. Mostly though, the person has to come to a realization that their health has to be balanced with the other top priorities in their life and to make time to gain the knowledge, to make the dietary changes, and to embrace exercise as being critically important. Taking classes at the local hospital can be the first step in the right direction.

Ignorance of nutrition and fitness isn't just in the poor neighborhoods. I am appalled at the number of people I encounter who have hypertension, yet know nothing about the Dash Diet, the diet that the USDA Food Pyramid is based on, and thus know nothing about eating the low-fat low-sodium low-sugar fresh portions from each food group every day for maximum health that is proven effective at normalizing the blood pressure without medications, along with daily cardio exercise. I know of people who are educated professionals, who take double or triple medications for blood pressure, and their blood pressure is still high, like 170/100, and they won't give up the high-sodium fast food meals or the highly processed packaged grocery store meals. They rarely eat fresh fruits and vegetables or whole grains, and they don't exercise at all, not even an evening walk around their neighborhood. Meanwhile they are getting hardening of the arteries, kidney damage and the other ailments that high blood pressure brings about, and our health care costs go up as a nation.

With respect to obesity, what is most important is to get rid of the fat that you can't see, that is inside the body cavity, squeezing itself between the organs, invading the liver and heart, pushing up the lungs so that a person can't even take a full breath. The rule is that the waist needs to be 50% or less than your height in inches, and if the waist is over 50%, then the person is at high risk for internal fat that will lead to diabetes, coronary disease, liver disease, kidney disese, and so on. However the rule is not always applicable because a person of normal weight who never exercises can have this internal fat that brings on all of these medical conditions, as cardio exercise is what burns the inside fat.

Just one final thought, and that is a growing number of nutritionists and people in the medical community believe that the gaining of excess body fat is actually brought about by continually eating food that has no nutritional value. The body becomes nutritionally deficient, becomes hungry, and so the person eats more, but more of the same fast food non-nutritional garbage. The hunger really isn't about emotional problems, or being scarred in childhood, or eating to fill a void, but the hunger is caused because there are nutritional deficiencies in the body. The insides of the intestines, where the food is absorbed, might be thickly coated with sludge due to a lack of soluble fiber in the diet and so the person can't absorb the nutrients, or the person is just eating garbage day-after-day, and their diet is devoid of entire food groups that contain essential nutrients to maintain health. When the person cleans up their digestive system and makes it healthy, focuses on eating their portions from each food group every single day, and exercises, the hunger dissipates and the strange cravings disappear entirely. Thus, over time the person will lose body fat without engaging in unhealthy fat diets.

[Jolt]

Thanks, Roadie Gal, for the article. Too bad they had to stop the study because of recruitment problems, hopefully somebody else can do something similar and have better luck. This has a lot of potential in terms of improving outcomes and reducing costs, if the exercise program is confirmed to have equal or better results than angioplasty for stable angina.

As for "how I learned", that's kind of hard to answer. I was always an active kid (often too much so!), so I think that part came pretty naturally. I enjoyed riding my bike (including on a paper route at one point) and rollerblading as well as other outside activities. My sisters and I were on swim teams for a number of years, which is what really got me into the habit of working out on a daily basis; the running was something I took up in college and found I liked once I learned to pace myself and started to develop endurance. After college, I decided to buy a used bike to ride on errands etc. to save on gas and incorporate some of my exercise into trips I would have to do anyway; besides, being stuck in the car drives me nuts! As far as the healthy eating, I didn't really learn that at home--we did have our share of junk food growing up although my mom did and does cook from scratch the majority of the time and she taught me to know my way around the kitchen. I think that came more from having always had an interest in health, deciding to go into health care, and realizing that it is much better to prevent illness when possible rather than waiting to treat it after it happens. Being out on my own and doing my own grocery shopping helped too, and then I moved into my current apartment (in a three-decker) where there are pear trees and a vegetable garden in the yard that I got involved in helping with.

[Crankin]

I learned most of my cooking skills from my mom, who only cooked from scratch. We did eat things that would be considered unhealthy, but hey, everyone else ate raspberry danish and frosted flakes for breakfast in the 50's and 60's! I was an active kid, always outdoors and spent a considerable time on my bike. That ended when we moved to Florida, I got my license, and never walked anywhere. After college I gained a lot of weight. The sedentary life style caught up with me, along with my love of food. I studied a lot on my own, became a vegetarian, and started exercising (walking, aerobics). Although I started eating meat again after a year or so, I lost the weight and have never gained it back.
The ignorance of people about health and fitness amazes me. I have a very good friend who has been overweight for years. She lost 30 pounds by eating grapes and nothing else until dinner time...

[Medianox]

"How I learned..."
I'm not really sure. I'm the only person in my immediate family that has never smoked. Grew up in a household where both parents smoked heavily (mom still does), drank more than casually and potato chips (and junk food in general) were a food group. In my family, no one has ever intentionally been physically active or worked out or exercized for fun, or been involved in a sport beyond being an observer.
In high school, I would get up very early, pack a light breakfast (granola bar and an apple) and hike in the woods/fields near my house until it was time for school, then I walked to the bus stop. I played tennis (not competively) every summer, swam often and rode my bike everywhere.
About nutrition....to my mom, it had to be store-bought or packaged to be any good. I was a throwback *hippie* kind of kid and was always trying to make stuff from scratch, bake my own bread, etc. Now, at age 70 my mom calls me and tells me about the bread she is baking herself so I guess it finally caught on-lol! I'm still trying to get her to quit smoking though.
Then I went to nursing school, and formally learned about nutrition science and realized I was pretty much on the right path all along.
I was living in a small town and literally walked everywhere (a bike would have been a luxury!) and was in great shape...it never occurred to me to get a car....
Anyway, I was always the oddball and I can't say for sure where I learned positive habits-I just gravitated towards them naturally. Not perfect but...better than my family's habits for sure.

[mayanorange]

And the kicker is that a lot of the stuff being discussed here doesn't even have to (and often shouldn't) be done by the government! Sure, things like changing the infrastructure and agricultural policies will require government intervention, but incentives for healthy habits can be provided by employers and insurance companies.

This is one of the reasons I switched insurance to Fallon- they reimburse $400/yr for my hubby and I to do pretty much any organized fitness- not just gyms. They cover town sports, the Y, even our fave indoor cycling classes! I think it's great. Hopefully people will be encouraged to actually use it and maybe other companies will follow suit.

[Trek420]

This is one of the reasons I switched insurance to Fallon- they reimburse $400/yr for my hubby and I to do pretty much any organized fitness- not just gyms. They cover town sports, the Y, even our fave indoor cycling classes! I think it's great. Hopefully people will be encouraged to actually use it and maybe other companies will follow suit.

Not health insurance but this is one reason I switched from AAA to Better World for roadside assistance which pained me for sentimental reasons.

I've used AAA since I learned to drive . BW gives a public transit discount because we use that most often, they have a bike assistance option (not signed up for that yet) and they lobby FOR cycling.

I get a low mileage discount on my auto insurance. By being car-light (not car free) I drive far less than the national average.