Healthy obsession

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      Research shows that physical activity reduces the chances of heart disease, cancer, and osteoporosis.

      Like many middle-aged Canadians, Craig de Gruchy has made a New Year's resolution to reduce his waistline. The 41-year-old Vancouver businessman recently told the Georgia Straight that his goal is to lose 16 pounds in 2008. That would bring his weight down to 190 pounds. For de Gruchy, a self-described "thicker guy", there's much more at stake than his vanity. Six years ago, his father died of an aortic aneurysm, and de Gruchy doesn't want to follow his dad into the grave.

      De Gruchy vividly recalled his father telling him shortly before his death that he wasn't feeling well but he also had a lot of work to do. His dad wasn't grossly obese, but like many men of his generation, he rarely visited a doctor. His decision to delay getting treatment is probably what killed him two weeks later, de Gruchy said regretfully.

      "So that really caused me to step up and visit my doctor," he added. "I was definitely overweight. Blood pressure was on the high side. Terrible cholesterol. That was really the start of what I call my program."

      At the start of the new year, millions of North Americans make personal pledges to improve some aspect of their lives, and often these resolutions are health-related. De Gruchy managed to lose 20 pounds in the first year after his father's death and another 10 pounds the following year. He has kept a stable weight since then by exercising four times a week, playing ice hockey, jogging, and cutting fast food from his diet.

      This year, he plans to increase his exercise regimen and make further improvements to his diet. "Portion size," he said. "That's really what I'm going to work on this year”¦smaller portions and a little bit more of them."

      Numerous studies have demonstrated the link between exercise and a longer life expectancy. In a paper in the Canadian Medical Association Journal in March 2006, UBC researchers Darren Warburton, Crystal Whitney Nicol, and Shannon Bredin cited research detailing a multitude of health benefits from physical activity. "There is incontrovertible evidence that regular physical activity contributes to the primary and secondary prevention of several chronic diseases and is associated with a reduced risk of premature death," they concluded. "There appears to be a graded linear relation between the volume of physical activity and health status, such that the most physically active people are at the lowest risk. However, the greatest improvements in health status are seen when people who are least fit become physically active."

      The UBC researchers reported that men and women who increased their levels of physical activity and fitness reduced their overall risk of premature death by about 20 percent to 35 percent. However, their chances became even better with cardiovascular-caused deaths, where being fit or active was associated with a drop in mortality of more than 50 percent.

      This is no surprise to fitness-centre operator Ron Zalko, a pioneer in bringing aerobic exercise to Vancouverites. In recent years, he has observed an increase in demand for cardiovascular workouts, including classes in spinning, which is a form of indoor group cycling. Zalko told the Straight that this is the time of year when many people decide it's time to turn their lives around. "You really find sincere people that want to change their lifestyle from being unhealthy to being healthy," he said. "It's kind of a countdown to do something for the new year."

      Zalko said that prior to entering the fitness business he was overweight. Now, his New Year's resolution is to get more teenagers thinking about the benefits of exercise and looking good. He said he worries that young people don't eat properly and spend far too much time hunched over computer screens. He contrasted this with the early 1980s, when there were role models–such as Jane Fonda, Arnold Schwarzenegger, and Sylvester Stallone–who demonstrated to the masses the value of fitness. A hit movie of the era, Flashdance, demonstrated that women could become more toned by lifting weights.

      "The new generation, what do they have? Britney Spears?" Zalko asked. "They should know that fitness is fun. They think it's work."

      He also emphasized that regular workouts can save a person's life. "They're showing now that being overweight can lead directly to cancer," Zalko said.

      The CMAJ paper cited more than 100 epidemiological studies linking routine physical activity with a reduction in certain types of cancers. Cancer-related mortality rates were 29 percent higher for inactive middle-aged women than for their peers who were physically active. For men and women who were active, the relative risk of colon cancer fell 30 to 40 percent, and for women who were physically active, there was a 20- to 30-percent reduction in the relative risk of breast cancer.

      A large study published last October in the Archives of Internal Medicine carried grim news for women who gain weight as adults. The researchers examined data from almost 100,000 postmenopausal women. Those who were not obese at the age of 18 but who were obese between the ages of 35 and 50 were 1.4 times more likely to develop breast cancer than those who maintained their weight. The good news was that for those women who lost weight, their risk of breast cancer was the same as for those who maintained a stable weight.

      De Gruchy said the key to keeping weight off is making and keeping a commitment to regular exercise. "You have to make the mental choice to do it," he said. "As soon as you see that you've lost two pounds, it becomes almost an addiction."

      For celebrity personal trainer Anna Wong, fitness became a lifeline after she was seriously injured in a Vancouver car accident in 1991. In a phone interview with the Straight, Wong said that she was a passenger in a car that hydroplaned in the rain and wound up wrapped around a telephone pole. She was freed with the Jaws of Life but her legs were crushed. During a lengthy stay in hospital, she feared she would spend the rest of her life in a wheelchair.

      "It took almost a year and a half before I could actually walk okay," Wong recalled.

      Through this experience, she learned how to listen to her body. Her doctors and physiotherapists recommended that she avoid training with weights, but she decided to ignore this advice. "I believe your body tells you what you can and cannot do," she said.

      Wong promotes a holistic approach to her clients, who have included actor Keenen Ivory Wayans, Maxim cover girl Emmanuelle Vaugier, and hip-hop artist Maestro Fresh Wes. She emphasizes the importance of exercises that develop the body's muscles in unison rather than in isolation. Wong also believes that everyone should work up a sweat for at least 30 minutes every day. She advocates "clean foods" such as fresh fruits and vegetables, proper breathing, and recognizing what the body requires at different times of the year.

      "It goes back to the eastern way, the yin and yang of healing," Wong noted. "Whether your body is hot or cold, you should feed it what it needs. During the winter, we crave more warm food; in the summer, we crave more cold food. Your body will tell you what you need."

      She said that more old people are getting interested in exercise because they understand the consequences of doing nothing. "I just think that being sedentary is a health risk," Wong commented. "Your body is made to move. If you don't move, you become stiff. That's when illness tends to arise in the future."

      The CMAJ study reinforced Wong's advice in this area. It reported that "modest enhancements" in fitness levels in people who were sedentary have been linked to "large improvements" in health: "For instance, in another study, people who went from unfit to fit over a 5-year period had a reduction of 44% in the relative risk of death compared with people who remained unfit."

      As little as one hour of walking per week could reduce the risk of cardiovascular-related death in women, the study reported. Aerobic and resistance exercise have also been associated with lower risk of developing Type 2 diabetes, which is characterized by a shortage of insulin to regulate blood sugars. Sustained high blood-sugar levels can lead to diabetic complications, including limb amputations, cardiovascular disease, blindness, and kidney failure. The UBC researchers reported that "moderately intense levels of exercise" can prevent Type 2 diabetes, and moderate physical activity for about 30 to 60 minutes per day will have the "greatest protective effect" against colon and breast cancer.

      Even if you're suffering from a chronic disease or an injury, it's possible to remain active and enjoy the benefits of exercise, according to Alfred Ball, chair of continuing education with the British Columbia Association of Kinesiologists. Ball's company, Life Moves Health and Fitness, specializes in creating programs for people with chronic conditions, including clients with claims against the Insurance Corporation of British Columbia.

      "The first step is to do a consultation and get a basic history and see what other treatments they have sought, and what they have done for exercise in the past," Ball said. "From there, I'll usually do some movement-screening to see how well they move, and some strength-testing, depending on the area of injury”¦and develop a plan from there."

      He said that for those with chronic diseases, the biggest error is either doing too much exercise or doing none at all. He noted that the body often tightens up around an injured area to protect itself, and more problems arise when the person makes adjustments to compensate. "The body is a connected piece," Ball said. "When you have injuries in one place, there will be reactions in other places as well."

      Ball, who operates out of the North Shore Fitness World, sometimes recommends one-on-one Pilates to ensure clients don't overdo it at first. He said that the next step is to focus on strengthening the client's basic core muscles. One of the biggest challenges for paraplegics or quadriplegics is ensuring they do enough cardiovascular exercises, he added, noting that there are rowing machines and bicycles that can help.

      "It really depends on the level of mobility they have and whether or not they can transfer from their chairs," he said. "If they have upper-arm movement, they can do their cardio wheeling around."

      One of Ball's clients, Maureen Gales, told the Straight in a phone interview that she has several chronic conditions. She said she has dealt with a rotator-cuff injury for 21 years and a chronic nerve impingement in her shoulder since she was a teenager. Gales, 47, said that since giving birth to her kids, she has also had a problem in her pelvis, which doesn't remain in place. Then there are the bad knees and sciatic pain in her lower back.

      She said that prior to visiting Ball, she had 15 percent movement in her right shoulder and her pelvis was popping out two to four times per week. She reported seeing enormous progress in the past year. "I have 100 percent range of motion in my right shoulder, and my pelvis goes out maybe once every two months," Gales said. "That in itself in one year is a tremendous, tremendous improvement. You can't put a price tag on that."

      Ball said that in the past, personal trainers believed that people overcoming heart attacks should only exercise at low to moderate levels. But for fitter clients, some physicians are now recommending "interval training", which includes periods of increased intensity. This can be achieved by going up a flight of stairs. He added that there is a great deal of research delving into the specific amount of exercise that's appropriate for people suffering from chronic diseases such as diabetes, heart disease, arthritis, and cancer.

      Then there is osteoporosis, which is a disease that leads to brittle bones. It's more likely to strike postmenopausal women than men. Weight-bearing exercise appears to have the greatest effects, according to the CMAJ paper. But it has to be done at the correct level or it can be counterproductive. For example, the paper reports, running up to 24 to 32 kilometres per week has been linked to the accrual or maintenance of bone mineral density, but longer distances could be linked to reduced levels.

      Zalko said he is seeing women as young as 22 years old taking up weight training to reduce their risk of developing osteoporosis. However, he noted that lifting weights can shorten muscles, so some women are combining this with yoga, because it stretches muscles. "It's a fantastic combination," Zalko said. "We introduced that. It's doing really, really well."

      He added that many middle-aged women are aware of medical research linking a higher risk of breast cancer to ovarian hormone therapy, which was commonly prescribed to address the effects of menopause and to prevent osteoporosis. Zalko said this has pushed more women into fitness programs, which offer a healthier way to maintain bone density.

      For years, menopausal women took ovarian hormones because the promoters of this treatment claimed that it would reduce the chance of heart attacks. However, Dr. Jerilynn Prior, scientific director of the UBC Centre for Menstrual Cycle and Ovulation Research, pointed out in an article on the centre's Web site that the largest and best-controlled study of this claim was stopped three years early, in July 2002, after some alarming discoveries. "Hormone therapy increased breast cancer significantly (by 26% over placebo) and caused higher rates of heart attacks (29%), strokes (41%) and blood clots (211%)," Prior wrote. "These risks outweighed this therapy's significant benefits in preventing osteoporotic fractures of the hip (decreased by 34%) and colon cancer (decreased by 36%)."

      So what accounted for the belief that a treatment could reduce heart attacks when it had the opposite effect? Prior explained in the article that women who took estrogen were more likely to have a healthy lifestyle. Healthier women have 30 to 50 percent fewer heart attacks, and this wasn't taken into account. She emphasized that the results of the study show that menopausal women should not be considered "estrogen deficient" or in need of "estrogen replacement". She noted that ovarian hormone therapy can be justified scientifically for chronic and disturbing night sweats, for those with early menopause, and for those with osteoporosis at the time of menopause.

      "I will never again prescribe estrogen as a pill," Prior emphasized in her article. "When a pill of estrogen is swallowed it travels through the stomach to the liver and stimulates it to make new proteins. Some of these increase the risks for blood clots, others increase the risks for high blood pressure or migraine headaches."

      Even if you're not at risk of osteoporosis or suffering from a chronic disease, there are still many good reasons to exercise regularly in 2008, according to Wong. "This is not just to look good, but it's also to feel good, feel younger, and be able to have a more clear mind at work," she said. "It does help with being happier. It also removes toxins from the body."

      De Gruchy has a few tips for people who want to start a fitness program in 2008. They include visiting a doctor to ensure their health is good enough to start a program. He also advises starting slowly, possibly by walking first and then moving up to light jogging. He is also a fan of going to exercise classes or working out with a partner, saying this adds a motivating factor.

      He also emphasized the importance of dietary improvements. "Probably the easiest thing for me to stop was fast food," de Gruchy said. "That really made a big difference to me. I was shocked at the impact."

      Filmmaker Morgan Spurlock's 2004 documentary Super Size Me demonstrated the links between fast food and weight gain, poor health, reduced energy, and loss of sexual desire. At times during the film, Spurlock's vegan-chef girlfriend seemed quite troubled by the effect that Spurlock's nonstop diet of burgers and fries was having on his health. One of the documentary's messages was that too much fast food can make you impotent. The CMAJ research, on the other hand, shows that regular exercise can lengthen your life.

      For Craig de Gruchy and many others, the choice is clear: go to the gym more often in 2008 and don't stop at the local burger joint on the way back to the office.