EXERCISE AND DISEASE

It is time to talk about the health-giving properties of regular exercise and of high levels of cardio-respiratory fitness. Today’s post is an introduction to the idea that your long term health depends upon avoiding the degenerative diseases of later life which are so common in our society. Most people would believe that length of life – longevity – is the bottom line. However the quality of that life may be even more important. Both length of life and quality of life depend upon avoiding degenerative diseases.

Life expectancy

Life expectancy in medieval Britain was about 35 years and did not change much over several centuries. However by the 19th century, thanks to improved public health and reduction in childhood mortality, life expectancy started to rise and has continued to increase ever since, buoyed by such developments as immunisation and antibiotics –  though the increase in lifespan has stalled over the past decade.

Before 1900 the leading causes of death were infections associated with poor living conditions, poor hygiene and poor nutrition.The most frequent were pneumonia and influenza, tuberculosis, and enteritis with diarrhea. Most people did not live long enough to develop the diseases of middle or old age. However today it is the chronic degenerative diseases which cause our society such problems, cost, late life disability and premature mortality. They are not related to infection and so are called non-communicable diseases (NCDs).

Non-communicable diseases (NCDs)

Today the leading causes of death in developed societies are the  non-communicable diseases, chiefly heart disease, dementia, cancer and stroke. NCDs, also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors. They develop later in life and many are linked by common “risk factors”. For instance obesity is a risk factor for heart disease, high blood pressure, diabetes and several different cancers. Diabetes is a risk factor for heart disease, stroke and dementia. High blood pressure is a risk factor for heart disease and stroke … and so on. There is a rich interconnectedness between the NCDs.

Two factors which link to nearly all NCDs are low levels of physical activity and low levels of cardiorespiratory fitness.

The ultimate outcome of NCDs

NCDs lead to frailty and to premature mortality. Although we are living longer than we did a century ago, the potential increase in lifespan should be much greater.

The seeds of NCDs are sown in youth and middle age and are usually related to unhealthy lifestyles. They result in loss of function and loss of the ability of older people to carry out their activities of daily living. This leads to a downwards spiral of decreasing ability and decrepitude – the state known as “frailty”. One sad characteristic of modern society is the large proportion of its citizens who become frail and dependent towards the end of their lives.

Elderly care

The Covid-19 catastrophe has brought home to us the enormous problem of caring for elderly dependent people, particularly the residents of care homes. Those who need care are usually those who have become unnecessarily weak and unfit because they have never taken regular exercise or have failed to keep active in later life. This inactivity has encouraged the development of one or more NCDs which have further contributed to both weakness and unfitness. The vicious circle is clear. Dependency in old age is due to a toxic mix of unfitness, muscular weakness and one or more NCDs.

Frailty and dependence in old age are not inevitable.  Healthier life choices can keep older people active and fit enough to look after themselves until near the end of their lives, and have the potential to reduce greatly the populations of care homes.

The Public Health

This pandemic has stimulated enormous amounts of hot air about caring better for our elderly but I have yet to hear any politician or other commentator talk about prevention – prevention of obesity, diabetes, heart disease, stroke, arthritis of the lower limbs, some cancers, osteoporosis, loss of balance, falls and fractures; prevention of all the conditions which hasten the onset of frailty and dependency. As I reported last week, Private Eye’s MD has pointed up the failure of the Government to use this opportunity to’ create policies for healthier living – to reduce the unhealthy behaviours which lead to frailty – smoking, poor diet, alcohol and lack of exercise.

You may not be surprised to hear that it the latter which I believe to be the most important and probably easiest to correct – so next week I will start on how physical activity is so crucial for the prevention of NCDs and the promotion of a healthy later life.

PS
Running
The BMJ has an interesting opinion piece this week – it features a consultant psychiatrist writing about how he uses running to improve his own mental health.