23 and 1/2 hours: What is the single best thing we can do for our health?

23 and 1/2 hours: What is the single best thing we can do for our health?

I'm dr. Mike Evans and welcome to this visual lecture I'm calling twenty three and a half hours so I have a big interest in preventive medicine you know which can mean a lot of things from you know cancer screening to eating more fiber to having a good social network and I I mean that in the old sense of the word Wayne last drinking less smoking less controlling your blood pressure cholesterol and so on and so forth so all these things are incredibly important and I wouldn't want you to minimize your efforts in any one category but I I want to know what comes first what what has the biggest impact what is the biggest return on investment what makes the biggest difference to your health so I did my research and I found an answer at least for me and it's tricky because you know all these things are sort of overlapping but I picked up this intervention and because of its breadth it worked for so many different health problems and that's what I found so cool about it so just to kind of walk you through a quick list so this intervention in patients with knee arthritis who received one hour of treatment three times a week reduced their rates of pain and disability by 47% in older patients it reduced progression to dementia and Alzheimer's by around 50% for patients at high risk of diabetes and coupled with other lifestyle interventions it reduce progression to Frank diabetes by 58% postmenopausal woman who had four hours a week of the treatment at a forty one percent reduction in the risk of hip fracture it reduced anxiety by 48 percent in a big meta-analysis patient suffering from depression thirty percent were relieved with low dose and that bump to forty seven percent as we increase the dose following over 10,000 Harvard alumni for over 12 years though that had the intervention had a 23 percent lower risk of death and those who didn't get the treatment it's the number one treatment of fatigue and of course the kind of outcome of choice they're my favorite outcome is quality of life which is really all of the above and really about making your life better and this treatment has been shown over and over again to improve quality of life so the question is what's the what's the medicine and and what is twenty three and a half hours so the medicine was exercised mostly walking so not triathlons and let me just put it a different way I think what I'm asking you to do is if you think about your typical day so there's 24 hours and so you might spend most of your day you know this varies obviously but you know couchsurfing sitting it were obviously sleeping and what the evidence that I'm going to show you kind of tells me is the best thing you can do for your health is to spend half an hour being active maybe an hour and that if you can do that you can realize all the benefits I've described in the previous slide so let's just take a quick walk through some of the literature so Stephen Blair he's a professor at the Arnold School of Public Health at the University of South Carolina and he looked at this in what's called the aerobic Center longitudinal study which followed over 50,000 men and women over time and along the less left side of this graph is something called attributable fractions which is a kind of fancy word but it's yes Touma the number of death in a population that would have been avoided if that specific risk factor had been a race so for example turning a smoker into a non smoker or couch potato into a daily Walker and along the bottom is the typical risk factors you can see the hypertension is incredibly important and so on and so forth but the one that was most that kind of applied the most risk was this sort of mysterious CRF which is cardio respiratory fitness which is really low Fitness so low Fitness was the strongest predictor of death and and this is important that most of the trials we see to be honest are funded by farm oo or other companies because they've got a drug for hypertension or high cholesterol or diabetes and we rarely see Fitness thrown into the mix and so it's nice to see a trial that's not so siloed Blair's work is interesting he also did another trial looking at obesity what he found was you know sort of two things one is obesity and no exercise that's a very bad combination and that's where we saw many of the negative consequences of obesity from a health point of view but if the if the obese person was active even if they didn't have the weight loss but we're just active and obese that was much much better and that the that the exercise ameliorated much of the negative consequences of obesity so if exercise is a medicine what's the dose oh when I think of dose I think of how long how often and how intense I'm going to give you a slightly mixed message but essentially more activity is better but I must say the rate of return seems to decline after 20 or 30 minutes a day so if you're being active less than 150 minutes a week or more if you're a kid an hour a day if your kid my fly goes up in the clinic so my personal take on this is that you know the literature draws a very broad brush and so we see big differences when somebody goes from not doing anything to doing something and after that the return is more granular so if we took the Nurses Health Study woman who went from zero activity to just one hour a week reduce their heart disease rates by almost half so you can break it down so it can be 10 minutes 10 minutes 10 minutes if you want to do 30 minutes of exercise so it can be broken into three higher intensity it looks like it's it's equivalent to less time with lower intensity but I think that obviously the clinical pearl is mostly thinking about your your style and habits and your personal q so if you're only going to do it if it's pre-booked with friends you know i've couples to take a half hour walk every morning or evening to organize their life a dog is a great walking coach the data showing 67% of dog walkers achieved 115 minutes a week just with the dog walking and finally of course your commute you know getting off stop early taking the stairs and so on so forth so thinking about that I'm just going to walk you through some quick slices of the literature the first one comes from Japan in in the in the 90s Japan required all employers to conduct annual health screenings for their employees and so a large gas company in Japan called Osaka a usest answer great question so people's walk to work was longer did that reduce their chance of serious health problems so in this example high blood pressure and what they found is under 10-minute walk no difference 11 to 20 minute walk 12% reduction in rates of high blood pressure or hypertension and over 21 minute walk a 29 percent decrease in rates of high blood pressure so the authors calculated that for every increase of 10 minutes in your walk to work there was a 12% reduction the likelihood of getting high blood pressure the second exhibit is looking at stents so this is something we commonly do down medicine so you can see on the left here the arteries blocked on the right vascular surgeons gone in and put in a balloon open it up and left the stent to keep it open which makes great sense so a German researcher named Reiner hum Brecht looked at this with about 100 cardiac patients you got half the group to exercise and by that I mean 20 minutes a day on exercise bicycle and then once weekly 60 minute aerobics class and the other half got the high-tech stent and just sort of normal activity and after one year 88 percent of the exercises were event free compared to 70 percent of the people that got a stent so both worked but I find it you know sort of incredible that the low-tech made a bigger difference and you have to remember that the stent just fixes one part of the heart the next way to think about it is the reverse so what I call sitting disease we know that being sedentary is bad for your health but I research your name Leonard vermin I wanted to quantify this and he did so down in Australia in a big study they did there they found compared with persons who watched no TV those that spent a lifetime average of 6 hours a day watching TV can expect to live about 5 years left I mean that's incredible but I think oh who watches 6 hours of TV it turns out the average Idol in the USA spends about 5 hours a day watching TV or screens so I find this fascinating that we never think of the TV as something that's bad for our health but clearly it's as powerful as many other risk factors for chronic disease so I'm just going to leave you with that like his two quotes so one is Jerry Garcia the the singer who is the lead singer for the Grateful Dead and he said somebody has to do something it's just incredibly pathetic that has to be us and I think that's true that in some ways it has to be us as Hippocrates said walking is man's best medicine and so I'm going to finish by asking you a question and this may have some personal challenges for you so you know you be very busy with work or kids or both and you may be in pain or have other priorities but my question to you is can you limit your sitting and sleeping to just 23 and a half hours a day so something to think about thank you very much you

48 thoughts on “23 and 1/2 hours: What is the single best thing we can do for our health?”

  1. I found this video very helpful, in the sense that I can use a thirty minute per day exercise regimen to combat any illnesses that I have now. It is also a good way to prevent early death. I have a dog, whom I walk every day in the cooler months of South Texas, but when it is hot, like it is now, I slack. But there are many solutions, some of which are mentioned in this wonderful video. I personally park in a farther parking spot most times so I can get some extra walking in their. Thank you for posting.

  2. Love this info, and it is so true! I've always loved walking anyways…but now I've been walking even more after reading/viewing this video…thank you so much! Gonna share this one on my Facebook!!!

  3. Absolutely agree with this 🙂 Said while sitting on my butt infront of youtube, facebook and the television! 😀 
    In saying that was up at 6 this morning and going out at 6pm tonight so nearly 2hrs exercise ftw!

  4. Anyone have any advice as to how to handle the harassment from people on the street whenever I leave my home for a walk.  Im talking the following your for blocks, yelling at you for a half hour kind of harassment.

  5. This is fantastic and greatly appreciated!  I shared it on my facebook page and hope more MDs get on the social media train and help educate our country in preventative health!  Thank you so much!

  6. That's all fine but who is keeping track of the pollution in our water supply or toxins in all our foods and wrappers they come with.  Surely these toxins reduce lifespan and quality of life yet I rarely hear much about them or opportunities to fix them.  Corporations and doctors like to make this huge deal about personal vices and exercise but never talk about reducing their companies pollution or taking responsibility for the consequences. In fact the corporations and government have start fracking inside the United States with toxic chemicals that have already made people sick.

  7. Thanks Mike..Trouble is , we dont live in jungles anymore …forget the couch and TV …many of our jobs promote sedentary lifestyle…we just have to take an hour out everyday and walk, swim, bike and run. I am 62 and I swim every summer in our community pool ..Thanks Mike

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