In the repertoire of the physiotherapist, exercise looms large as one of the cornerstones of the profession, be it for rehabilitation, improvement of strength or general well being. It is this last area I want to consider today as some very interesting studies are emerging to change how we view exercise.
Not in a way that takes it off the table, because it is always going to be good, but to reveal that its effects may have been misunderstood, and in fact used to support some questionable practices.
Being a keen walker, I am wearing my physiotherapists goggles every time I set out for work from my home on a hill. I have noticed a population of exercise subscribers who are using it for a particular motive: weight loss. We have been told again and again over the years that to lose weight we must eat less and exercise more. Our size is supposedly determined completely by the equation: less energy in than energy out equals weight loss. This is common knowledge right? Everybody knows this truth. Unfortunately, it seems to be wrong.
The energy in/out hypothesis is popular because it validates the manufacturers of junk food. They can sell their trash to us because it all comes down to personal responsibility. "You're fat because you ate too much and watched too much TV". If you can lobby the powers that be to legislate pseudo science, you have total freedom to sell bubbly tidings to the unsuspecting public. Take for example the government's approach to childhood obesity. Under a proposal, 95 per cent of children identified as obese in the B4 School Check will be referred to a health professional for clinical assessment and their families will be given advice on diet and exercise. Sounds reasonable, surely?
British cardiologist Aseem Malhotra in a recent editorial in the British Journal of Sports Medicine outlined the misunderstanding of exercise's value in weight loss. In the 30 years since the explosion of obesity, there has been no change in exercise levels, and yet obesity is on the rise. This clearly implicates the quality of calories being consumed.
Calories from fat produce fullness or satiety whereas calories from sugar or carbs cause fat storage and hunger.
You are not fat because you are lazy and slothful. It is what you are eating. Malhotra, along with sports professor Tim Noakes and Stephen Phinney have clearly shown the literature does not find satisfactory evidence to endorse exercise for weight loss. Malhotra, speaking in Cape Town this year, stated of exercise: "Its link to obesity is so weak, I would say that we shouldn't even use it in the same sentence. We are misleading the public. It is a lie. Physical inactivity and obesity should not be associated with each other at all. This plays into the hand of the food industry and they've done it very effectively."
Watching the pavement pounders this morning I felt sad for all the effort going in; they will yield very little apart from damaged knee cartilage. Yes the body will be healthier, and the mitochondria will be positively buzzing, but buzzing mitochondria do not grant you access into that summer swim suit. Robert Lustig in his excellent book Fat Chance states of exercise: "It is the single best thing you can do for yourself. It's way more important than dieting and easier to do. Exercise works at so many levels - except one: your weight."
In a study in 2011 published in the prestigious Lancet journal, the researchers found that increasing energy expenditure to promote weight loss was a fallacy and they found as the subjects lost weight, they had to eat less and less to maintain the weight loss. The energy required to burn a pound according to Lustig rose over time, so exercise alone is ineffective.
The wisdom of the day is to eat less and exercise more. Gary Taubes points out an interesting paradox to this factoid: imagine you are invited to a feast, the likes of which you have never eaten. You will eat like a king. What should you do so that you have a raging appetite? What might you do today so that you won't miss out on a single bite? Well perhaps you might exercise vigorously and skip lunch, so that you work up an appetite. So to give yourself a ravenous hunger, EAT LESS, EXERCISE MORE.
So it's clear that out here in the world, the advice and strategies are a little clouded. It's easy to come across the wrong advice, because it's inherently tied to marketing and media. To actually get above all of the bollocks, half truths and myths, you actually have to care about your body. You have to step out of the invincible mode you are in, and look at the evidence. You have to question the common knowledge and what better day are we in to access good evidence than this very day?
By all and every means do exercise. If you are obese, don't run. Get the weight down first then your joints will appreciate it, just much later. Weight will evaporate if you cut out the sugars. Find out where they hide in your food. You may be very surprised. And if you pump iron, you will put on weight, because bigger muscle weighs more than fat and bigger muscle burns fat better at rest! At rest! (see Resting Energy Expenditure).
"Man is the only species on earth clever enough to make his own food ... And stupid enough to eat it." (Barry Groves).