Exercise: It’s even better than you think

Most people know that exercise is good for them. However, only half of adults get the physical activity they need to help reduce and prevent chronic diseases, and about 1 in 2 adults live with a chronic disease, according to the U.S. Centers for Disease Control and Prevention.

“People know exercise is good for them, but I do believe that most people don’t truly understand all the different benefits that can come from it,” said Jordan Cummings, a certified health and wellness coach at Mercy Medical Center in Cedar Rapids. “And the connection between exercise and mental health is huge. I think that is a huge reason why it can help us in so many different ways, even more than nutrition can.”

The CDC estimates that if every American got enough physical activity – the federally recommended amount is 150 minutes each week of moderate intensity exercise, such as a brisk walk, or 75 minutes of strenuous exercise – it would prevent 1 in 10 premature deaths, 1 in 12 cases of diabetes and 1 in 15 cases of heart disease.

Physically active people also have an improved immune system, taking fewer sick days on average.

“For people who have COVID, for example, if you’re more active, your likelihood of having more severe symptoms and hospitalizations goes down,” said Dr. Lucas Carr, director of the Behavioral Medicine Lab at the University of Iowa and leader of the Exercise is Medicine program there.

The Exercise is Medicine program was started by the American College of Sports Medicine as a way to integrate physical activity and health care. The UI program began in 2018 with a gift from the Stead Family Children’s Hospital.

Doctors at the UI’s Family Medicine Clinic ask patients about their physical activity levels at each visit, then refer patients who they think would benefit from increased physical activity to the program. Those who meet the program’s criteria are connected with students trained as health coaches, who work with them one-on-one for 10 weeks.

“We teach them what to do, how to do it, how to build this into their lifestyle. With the goal of, hopefully, they can internalize this and stick with it for a lifetime,” Carr said.

The UI program has served close to 100 patients so far. Carr’s team is hoping to expand to more clinics at the hospital.

“A lot of times it’s a matter of convincing hospital administrators that this is an important thing that we should be doing for every patient at every visit,” Carr said. “Your physical activity predicts your overall health and well-being probably better than some of the vital signs that we measure currently, like body mass index.”

Dr. Cheryl True owns the True Lifestyle Medicine Clinic in Davenport, which aims to educate people in the community, including other health care workers, about how to help patients set and maintain healthy goals.

She said that typical doctor’s office measurements “don’t give you the whole picture of the person.” Lifestyle medicine focuses on six core pillars of health that all affect each other: nutrition, physical activity, sleep, stress management, social connections and avoidance of risky substances. In addition to taking blood pressure and weight measurements, physicians should also ask about these topics and help patients set goals that are “SMART”: simple, measurable, attainable, realistic and time-based.

“It can be labor-intensive and time-intensive, and not every physician has time for that, so sometimes that’s using your ancillary staff and team members to help do that,” True said.

True estimates that around 80 percent of chronic, noncummunicable diseases have a root in our lifestyle choices.

While we are born with a predisposition toward some diseases – for example, high blood pressure can run in families – “our DNA isn’t always our destiny,” True said. “We can flip those epigenetic switches by controlling those behaviors in our environment so that maybe those diseases don’t become our destiny.

“It isn’t just what’s in our genes that affects our health, either, but also what is in our refrigerators, and those contents often run in the family too,” True said.

Resistance training provides protection

A recent study at the UI examined the effectiveness of resistance training on cardiovascular disease factors in post-menopausal women and found it to be even more cardio-protective than aerobic training.

One reason for this could be that the resistance training group lost significantly more body fat – including visceral adipose tissue, or fat around organs, which increases your risk for cardiovascular disease.

“Where that body fat is matters. If you’re carrying that around your viscera, or your gut, that is more indicative of risk,” said Dr. Nathaniel Jenkins, assistant professor of health and human physiology at the UI and leader of the study.

While women have lower rates of cardiovascular disease compared to an age-matched man before menopause, once menopause occurs they lose that protection.

Jenkins said that while social stigmas and apprehension about going to the gym currently prevent many women from participating in resistance training, he had an overwhelming response to participation in his study.

“They just needed to be shown what to do,” Jenkins said.

The study also measured patients’ cardiorespiratory fitness—the body’s ability to supply oxygen to muscles during sustained physical activity. The greater your aerobic capacity, the greater your fitness level and the lower your chance for disease and death.

A study of 122,000 patients undergoing exercise treadmill testing at the Cleveland Clinic that was published in the Journal of the American Medical Association found cardiorespiratory fitness to be as strong or stronger of a predictor of morbidity and mortality than blood pressure or smoking, and suggested that health care professionals should encourage patients to achieve and maintain high levels of fitness.

“You go to the doctor and you get your blood pressure checked, and the doctor asks if you smoke, but they don’t typically ask, ‘are you physically active,’ or ‘what is your fitness level,’” Jenkins said. “But they probably should.”

While the UI study’s method of measuring cardiorespiratory fitness would be difficult to perform at a yearly physical, Jenkins said fitness-tracking devices like Fitbit, Garmin and Apple’s iWatch can predict your fitness level based on your heart rate responses at sub-maximal exercise workloads.

While most people start exercise programs to control weight, Jenkins said exercise is beneficial whether a person is overweight or not.

“I think focusing on weight is a problem, because we don’t realize the multitude of benefits that exercise has for us apart from weight,” Jenkins said. “The weight is like the tip of the iceberg, and in my opinion it’s the least important thing we should be focused on.”

Exercise and nutrition as treatment

In addition to keeping you healthy, exercise and good nutrition can also be beneficial if you already suffer from a chronic disease.

Beth Beckett was the first dedicated dietician at the Helen G. Nassif Community Cancer Center in Cedar Rapids. She started in 2012, working with diagnosed cancer patients on lifestyle and diet changes that help them during treatment and after to prevent recurrence.

“People who have more lean body mass, more muscle, are usually going to have less fatigue and a stronger immune system throughout their treatment,” she said.

When patients move into the survivorship role, she recommends either a low-fat or Mediterranean diet, which includes more fats but from healthy sources like olive oil and avocados. She offers cooking demonstrations at the center and also posts recipes on the center’s website.

She said most people are very receptive to working on their exercise and nutrition habits.

“Nutrition and exercise, those are things that people have some control over when they may feel like they’re not having control over everything,” Beckett said. “A cancer diagnosis creates a lot of anxiety and stress. So patients being able to do things at home when they’re not here having treatments – it creates a sense of empowerment.”

Matt Schmitz, the program manager for physical and integrative wellness at the cancer center, uses exercise to help cancer patients with treatment and surgery side effects.

Schmitz said the benefits of exercise are the same for cancer patients as they are for someone who has not been diagnosed: increased strength; less fatigue; improved endurance, flexibility and range of motion; decreased anxiety and better sleep; and increased cognitive function.

“Science has proven how exercise and our lifestyle can have both a positive and negative effect on our health and lives,” Schmitz said. “Exercise helps with any chronic illness, but it also allows us to age well.”

When he first meets with a patient, Schmitz asks them what they enjoy doing physically. While most people give exercise answers, he is searching for lifestyle goals, like traveling, sports, or playing with grandchildren. He bases his exercise “prescriptions” on these goals.

“I want people to be able to do all that they want and enjoy for as long as possible,” Schmitz said. “Exercise is not the goal; the exercise should allow you to get to and maintain that goal.”

Benefits of physical activity:

Tips for achieving your physical activity goals: