[sound of marker on white board] dr. mike evans: hi, i’m dr.mike evans and welcome to this visual lecture i’m calling,"23 and a half hours". so i have a big interest inpreventive medicine, you know, which can meana lot of things from, you know, cancer screening,to eating more fibre, to having a good socialnetwork and i -- i mean that in the old sense of the word. weighing less, drinking less,smoking less,
controlling your bloodpressure, cholesterol, and so on and so forth. so all these things areincredibly important and i wouldn’t want you tominimize your efforts in any one category. but i -- i want to knowwhat comes first. what has the biggestimpact, what has the biggestreturn on investment? [sound of cash registerringing]
what makes the biggestdifference to your health? so i did my research, andi found an answer, at least for me. and it's tricky ‘cause,you know, all these things are sort of overlapping. but i picked out thisintervention and -- because of its breadth. it worked for so manydifferent health problems, and that’s what i foundso cool about it.
so just to kind of walkyou through a quick list, so this intervention inpatients with knee arthritis who received one hour oftreatment three times a week reduced their rates of pain anddisability by 47 per cent. in older patients itreduced progression to dementia and alzheimer’sby around 50 per cent. for patients at high riskof diabetes and coupled with other lifestyle interventions,it reduced progression to frank diabetes by 58 per cent.
post-menopausal woman whohad four hours a week of the treatment had a 41percent reduction in the risk of hip fracture. it reduced anxiety by 48 percent in a big meta-analysis. patients suffering fromdepression -- 30 per cent were relieved with lowdose and that bumped to 47 per cent as weincreased the dose. following over 10,000 harvardalumni for over 12 years, those that had theintervention had a 23 per cent
lower risk of death than thosewho didn’t get the treatment. it’s the number one treatmentof fatigue, and, of course, the kind of outcome ofchoice or my favourite outcome is quality of life, which isreally all of the above, and really about makingyour life better. and this treatment hasbeen shown over and over again to improve quality of life. so, the question is,"what’s –- what’s the medicine?" and what is "23 anda half hours"?
so the medicine wasexercise, mostly walking. so not triathlons. and let me just put ita different way. i think what i’m askingyou to do is if you think about your typical day, sothere's 24 hours, and so you might spendmost of your day, you know, this varies obviously, but,you know, couch surfing, sitting at work, obviouslysleeping, and what the evidence that i am going to showyou kind of tells me
is the best thing youcan do for your health is to spend half anhour being active, maybe an hour and that ifyou can do that you can realize all the benefits i’ve describedin the previous slide. so let’s just take a quick walkthrough some of the literature. so stephen blair, he is aprofessor at the arnold school of publichealth at the university of south carolina,and he looked at this in what’s called the aerobiccentre longitudinal study
which followed over 50,000men and women over time. and along the left side ofthis graph is something called attributable fractionswhich is a kind of fancy word, but it’s the estimate ofthe number of deaths in a population thatwould have been avoided if that specificrisk factor had been erased. so for example, turning asmoker into a non-smoker, or a couch potato intoa daily walker. and along the bottom isthe typical risk factors.
you can see the hypertension’sincredibly important, but the one that was most–- that kind of applied the most risk was this sort ofmysterious crf which is cardio-respiratory fitnesswhich is really low fitness. so low fitness was thestrongest predictor of death. and this is important. most of the trails we see, to behonest, are funded by pharma, or other companies becausethey’ve got a drug for hypertension or highcholesterol or diabetes.
and we rarely see fitnessthrown in to the mix. and so it’s nice to see atrial that’s not so siloed. [sound of bicycle bell] blair’s work is interesting. he also did another triallooking at obesity. what he found was, youknow, sort of two things. one is obesity and no exercise –that’s a very bad combination and that’s where we saw manyof the negative consequences of obesity from ahealth point of view.
but if the –- if the obeseperson was active, even if they didn’t havethe weight loss, but were just active andobese, that was much, much better and that theexercise ameliorated much of the negativeconsequences of obesity. so if exercise is themedicine, what’s the dose? so when i think of dose,i think of how long, how often and how intense? i’m going to give you aslightly mixed message,
but essentially, moreactivity is better. but i must say the rate ofreturn seems to decline after 20 or 30 minutes aday so if you’re being active less than 150 minutes aweek or more if you’re a kid -- an hour aday if you are a kid, my flag goes up in the clinic. so my personal take onthis is that, you know, the literature drawsa very broad brush and so we see bigdifferences when somebody
goes from not doinganything to doing something. and after that the returnis more granular. so if we took the nurse’s healthstudy, women who went from zero activity to justone hour a week, reduced their heart diseaserates by almost half. so you can break it downso it can be 10 minutes, 10 minutes, 10 minutes ifyou want to do 30 minutes of exercise so it can bebroken into three. higher intensity -- itlooks like it’s equivalent
to less time withlower intensity. but i think obviously theclinical pearl is mostly of thinking about your style andhabits and your personal cues. so if you’re only going todo it if it is pre-booked with friends, you know,i’ve couples who take a half hour walk everymorning or evening to organize their life. a dog is a great walking coach. [sound of dog barking]
the data’s showing67 per cent of dog walkers achieve the 150 minutes aweek just with the dog walking. and finally, of course,your commute. you know, getting off astop early, taking the stairs, so thinking about that, i’mjust going to walk you through some quick slicesof the literature. and the first onecomes from japan. in the 90s, japan requiredall employers to conduct annual health screeningsfor their employees.
and so a large gas companyin japan called osaka used this to answera great question. so if people’s walk towork was longer, did that reduce their chanceof serious health problems? so in this example,high blood pressure. and what they found is under 10minute walk, no difference; 11 to 20 minute walk,12 per cent reduction in rates of high bloodpressure or hypertension; and over 21 minute walk,a 29 per cent decrease
in rates of high blood pressure. so the authors calculatedthat for every increase of 10 minutes in your walk towork there was a 12 per cent reduction in the likelihood ofgetting high blood pressure. the second exhibit islooking at stents. so this is something wecommonly do now in medicine. so you can see on the leftthat the artery is blocked; on the right, a vascular surgeonhas gone in and put a balloon, open it up and lefta stent to keep it open,
which makes great sense. so a german researchernamed rainer hambrecht looked at this with about100 cardiac patients. he got half the group toexercise and by that i mean 20 minutes a day onan exercise bicycle and then a once weekly 60minute aerobics class. and the other half got thehigh tech stent and just sort of normal activity. and after one year, 88 percent of the exercisers
were event-free comparedto 70 per cent of the people that got a stent. so both worked, but i find it,you know, sort of incredible that the low tech made abigger difference. and you have to rememberthat the stent just fixes one part of the heart. the next way to thinkabout it is the reverse, so what i call“sitting diseaseâ€. we know that being sedentaryis bad for your health
but a researchernamed leonard veerman wanted to quantify thisand he did so down in australia in a big studythat he did there. they found comparativepersons who watched no tv; those that spent a lifetimeaverage of six hours a day watching tv can expect tolive about five years less. i mean that’s incredible. but then i think, “oh, whowatches 6 hours of tv?†it turns out the averageadult in the usa spends about
five hours a daywatching tv or screens. so i find this fascinatingthat we never think of the tv as something that’s badfor our health, but clearly it’s as powerfulas many other risk factors for chronic disease. so i’m just going toleave you with, well, i guess, two quotes. so one is jerry garcia, thesinger who is the lead singer for the gratefuldead, and he said,
“somebody has to do something. it’s just incredibly patheticthat it has to be usâ€. and i think that’s true, thatin some ways it has to be us. as hippocrates said, “walkingis man’s best medicineâ€. and so i’m going to finishby asking you a question. and this may have somepersonal challenges for you, so you know, youmight be very busy with work or kids or both and-- or you may be in pain or have other priorities,but my question to you is,
“can you limit yoursitting and sleeping to just 23 and a half hours a day?†so, something to think about. thank you very much.
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