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“We have never had greater reason to be hopeful regarding the potential for exercise to become a proven and generalized strategy for promoting successful aging in the expanding population of older adults.” Jeff Williamson, MD, MHS, and Marco Pahor, MD (Archives of Internal Medicine, Commentary, January 25, 2010)

Physical Activity Matters, Fitness Matters More

We have been constantly told to keep moving, but rarely are we urged to move fast and become fit. Until Now.

In 1989, a well-publicized study from the Cooper Institute in Dallas reported that the greatest benefits come when we move from “unfit” (the bottom 20 %) to the medium-fitness group (the next 40%). Those in the high-fitness group were found to be only slightly better off than those in the medium-fitness groups. In other words, high-fitness mattered, but not much.

Exercise is often presented as a “no sweat” proposition. A little effort is said to produce large benefits. That’s a good thing to the extent it gets people off the couch, but it’s only the beginning.

The big picture is starting to come into focus. We are learning that the greatest benefits come from high levels of fitness. We applaud those who are physically active, but they should know that substantially greater benefits are there for the taking. Effort makes a difference. Serious training produces serious rewards

It’s time to stop thinking about the (almost) free lunch, and start thinking about fitness. 

Two new studies highlight the benefits of fast pace and high fitness. The details are enlightening--and inspiring.

Fast Pace—Successful Aging

Dr. Qi Sun and a team of researchers from Harvard and England examined data from 13,535 nurses over 15 years looking for successful survivors—defined as survival to 70 or older with no chronic diseases, impairment in cognitive function, or physical disability. Fewer than 11% (1456) cleared the hurdle. Nurses who were physically active at midlife (age 60 here) were found to have increased odds of exceptional health at age 70. Women with a moderate walking pace had a 90% increase in the odds of successful aging, but a “brisk” or “very brisk” pace increased odds 2.68-fold. (Archives of Internal Medicine, January 25, 2010). 

Let’s look inside this empowering study.  

Now that most of us are living past 70, the goal has shifted to achieving that age in exceptional health.

The team studied nurses who were free of major ailments in 1986 and survived to age 70 or older between 1995 and 2001. Nurses with health problems at the outset were excluded.

In 1986, they started collecting detailed information on physical activity. They inquired about the average time in the past year spent on physical activities—walking, biking, hiking, running, tennis, rowing, dancing and so on. For walkers, they also inquired about usual pace—casual, normal, brisk, and very brisk. Based on this information, they calculated energy expenditure measured in hours per week.

They divided the nurses into categories, based on total physical activity and walking pace. All information was analyzed in relation to successful aging. As noted, physical activity level (amount) and walking pace proved to be good predictors of whether participants were among the 12,079 “Usual Survivors” or the 1,456 “Successful Survivors.”

As expected, successful survivors were more active, as measured by metabolic-equivalent tasks, than usual survivors. Significant increases in successful survival began to appear at the third quintile (fifth) of activity. Odds ratios from the lowest to the highest activity levels were 1 (Reference), 0.98, 1.37, 1.34, and 1.99.  In other words, nurses in the 3rd and 4th quintiles of activity were 34% and 37% more likely to be exceptionally healthy at 70 and beyond. The most active group (top quintile) upped their odds by 99%.

As we’ve already seen, walking pace was the best predictor of successful aging. Odds ratios for casual (<2.0 mph), normal (2.0-2.9 mph), brisk (3.0-3.9 mph), and very brisk (4.0+ mph) were 1 (Reference), 1.90, and 2.68 (brisk/very brisk), respectively.

Physical activity is a good prognosticator of health status, but pace or intensity provides far better odds on successful aging.

(I learned of this study in DukeMedicine HealthNews.)

The other new study, published online June 1, 2010, in Hypertension, draws a bright line between activity and fitness.

Fitness Overrides Activity

Lead author Mercedes R. Carnethon, MD, (Feinberg School on Medicine, Northwestern University, Chicago) and a diverse team from the U.S. and Norway tested whether physical activity and fitness are independent factors in the incidence of hypertension. This is one of the first studies to jointly measure—and distinguish—physical activity and fitness. That’s important, because one is a behavior and other a physiological measure.

They found that high activity was significantly associated with healthy (non-hypertensive) blood-pressure—but only when fitness levels were highest.  

Dr. Carnethon explained the importance of this finding to HeartWire (June 8, 2010): “We know that activity is the principle behavioral determinant of fitness, and we know that being more physically active can improve one’s fitness. But the activity needs to be moderate to vigorous to adequately improve fitness [and] see greater health benefits….We are showing this, for the first time, with objective data.”

As we said earlier, it takes effort to produce real benefits.

Let’s see what they did and what they found.

Carnethon’s team analyzed data from 4618 men and women who were initially tested at ages 18 to 30 years in 1985-86 and re-tested 2, 5, 7, 10, 15, and 20 years later. Fitness was measured using a maximum exertion treadmill test, and physical activity was self-reported.  Participants with hypertension (systolic BP 140 or above or diastolic BP 90 or above) on the initial exam were excluded. The investigation was restricted to initial measures of activity and fitness, while blood pressure was reviewed during 20-year follow-up period.

While acknowledging that using activity and fitness measures in young adulthood only may be considered a limitation, Carnethon explained that physical activity patterns tend to track over time. Moreover, she emphasizes that their study shows the importance of adopting an active lifestyle early on.  

Participants were placed in low, moderate, and high percentile categories for activity and fitness. Men and women were categorized separately. This is where it begins to get interesting.

Over 20 years, 1022 (22%) of participants developed hypertension. For men and women, there was an inverse, graded association between fitness category and the development of hypertension; those high in fitness had a low incidence of hypertension. By contrast, patterns of association between activity and incidents of hypertension were less pronounced.

A previous analysis of the same study showed that young adults who were the most active were less likely to develop high blood pressure. The current study went beyond the previous analysis to take into account fitness. That’s when assessing the benefits of physical activity got tricky.

Listen carefully to what they found: “There was no evidence of statistical interaction between activity and fitness in association with the development of hypertension. When both were included in the same model, fitness remained significant and independently associated with a lower likelihood of developing hypertension, whereas activity attenuated to nonsignificance.” (Emphasis mine)

“Fitness was significantly and inversely associated with the development of hypertension within each [category] of physical activity…Activity was only significantly inversely associated with the development of hypertension in the highest category of fitness.” (Emphasis added)

Physical activity and fitness are independent factors. Activity helps to ward off hypertension—only if fitness level is high. If you are fit, activity level can be low, moderate, or high. Statistically speaking, it doesn’t matter.

Dr. Carnethon and her team say their analysis suggests that a third of hypertension cases (34%) could be prevented if participants had moved into a higher fitness category, low to moderate or moderate to high.

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These remarkable studies lend credibility to short, hard, and infrequent aerobic training. You can train hard or long, but you can’t do both. If you’d like to explore twice-a-week aerobic training (combined with strength training), checkout our books Lean For Life and Great Expectations: http://www.cbass.com/PRODUCTS.HTM

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