Eliminate Chronic Ailments

By Tom Hafer
Certified Athletic Trainer

CBN.com – Our current American health care costs us about 15.5 percent of our total spending (Gross National Product) (4). Of this, about $200 billion is spent on prescription drugs (5). These numbers have risen astronomically in the last twenty years. Also, in 1993 the average number of prescriptions written per person in a year was seven. In 2004, it was twelve (6). Most of those drugs are taken by senior citizens, and of those drugs, the majority are taken for chronic conditions, like arthritic pain, osteoporosis, heart disease, hypertension, depression, and diabetes. As the baby-boomers age, this expense is expected to become dramatically higher.

As we learned in the food chapter, we are spending roughly 13 percent of all our GNP in America on food and the food industry, or about one trillion dollars. The estimate is that about 3,800 calories are produced daily per person in America with this expense. This is almost twice the number of calories we need! If we add our healthcare costs and our food costs together (15.5 percent and 13 percent respectively), we can see that for every dollar spent in America, more than a quarter goes to food and health care. Knowing what we know regarding the chronic conditions mentioned above (arthritis, osteoporosis, heart disease, hypertension, depression, and diabetes), what role might exercise play in reducing the need for prescription medications? Can exercise prevent premature disability or a shortened life as a result of these ailments that tend to plague senior citizens?

Without question, exercise has a role in slowing the development of almost all early disability or life-threatening ailments. And the single most important step we can take as a nation to secure our healthcare system is to start eating healthier and exercising faithfully today.

Exercise and arthritis: Osteoarthritis (generally called arthritis) is the name for the typical wearing away of the cartilage on the bone surfaces to the point of damage. Eventually, there is bone on bone, and pain receptors are triggered. People with arthritis do not experience smooth movement of the joints, causing creaking or crepitus in those joints. This is the point in typical arthritis when it is tough to move the joint without discomfort. If the knee or hip joint is affected, walking becomes very difficult. When arthritis gets to the stage in which even pain or anti-inflammatory medications no longer help, then a surgeon might opt for a total joint replacement to restore function to the patient.

This is a typical scenario for most senior citizens. Arthritis happens. A joint cannot stay young forever. But it is interesting to see that individuals who have been consistent with exercises for years have remained ambulatory with minimal pain even late into their nineties. Hazel, who lived until the age of 103, walked briskly every day of her adult life. Other seniors, when walking had become difficult, switched to riding a stationary bike to keep their joints moving. Movement helps arthritis.

In the early stages of arthritis pain (let’s say, age sixty) you may start to get a little “catch” or pain in the knee. You notice it most often after a long car ride or first thing in the morning. Instinctively, you start to favor that knee. You stop walking as long as you used to or not push it quite as hard as before in fear that there is something wrong with it. You think that some day you should get it checked. But you don’t and you just live with it. Years go by and one of two things happened: either it cleared up on its own or the pain had made it difficult to walk. Sometimes joint pain does go away—primarily because of the way joint surfaces get nutrition. But cartilage, which is the lining surface of the joint as well as padding between the bones, has a poor blood supply. Because of this, it doesn’t get fed its nutrients as do other tissues of the body that have a good blood supply, like muscles. Cartilage gets its nutrients from fluid (synovial fluid inside the joint) exchange. It is actual joint movement that allows the joint itself to become flexible and compression forces of the joint fluids to rebuild and repair itself. The process can be compared to working taffy. When taffy is cold and dormant, it is hard and brittle, but when you start to pull it or “exercise” it, it becomes moldable or pliable. The pain you first feel might cause you to not move the joint much for fear that something is wrong. But movement is usually precisely what the joint needs for a consistent length of time.

The other thing that could happen after initial knee pain is an ongoing progression of pain. If pain does not go away naturally, the joint cartilage itself could have been significantly damaged and in need of arthroscopic surgery by an orthopedic surgeon.

Or it could just be in need of disciplined exercise. Either way, once pain appears in the knee or any other joint due to normal arthritic changes, exercising the joint to replenish with nutrients should always be the first treatment choice. A good orthopedic surgeon will diagnose the difference between significant cartilage damage that requires surgery and joint pain that could be treated with exercise.

When arthritis becomes significant and there is much difficulty walking, use of a stationary bike will continue to ensure nutrient exchange to the joint, slowing the arthritic process without the painful weight-bearing of walking or running. Movement will help arthritis, especially in the early stages and also as a preventative measure before symptoms even start.

Exercise and osteoporosis: Without fail, exercise will help slow the progression of osteoporosis. The effects of weight-bearing exercises like walking or running cause an increase in the density of bone. The effectiveness is directly proportional to the intensity of the exercises. Weight lifting exercises will also help increase bone density. It has been shown to be as effective—if not more effective—than the use of prescription drugs for osteoporosis. But clinical trials highlight the value of using exercise in conjunction with the prescription medications for the battle against advancing osteoporosis.

The most effective prevention of osteoporosis is early rigorous exercise that includes weight-bearing and some sort of weight lifting (free weights, exercise bands, or weight machines). For women, exercise battles osteoporosis best if they are pre-menopausal, but post-menopausal women find benefit from exercise and osteoporosis prevention as well.

Exercise and heart disease: The heart and lungs are strengthened with exercise. Typically, aerobic type exercise (walking, running, bicycling) works best to improve the condition of the cardiovascular and respiratory systems (heart, lungs, blood vessels, and blood). Aerobic activity stimulates the oxygen exchange of all the organs and encourages healing in any part of the body. What is considered aerobic activity? An easy rule of thumb when you are exercising is, if you can talk in a short sentence without gasping, that is considered aerobic. If you can talk in long-sentence conversation without breathing heavily, the exercise level might not be challenging enough. Pick up the pace in order to get a maximum benefit of your aerobic efforts. If you gasp for breath at every word, you might be going too hard; slowing down in order to exercise for a longer time or distance would be more beneficial.

Destructive habits, like smoking, not only compromise breathing and make exercise difficult, but they can also negatively affect healing and increase pain following an injury. The more you improve your cardiovascular system through disciplined exercises and non-destructive habits, the better the rest of your body systems work because of the key role your heart and lungs have on bringing oxygenated blood to all parts of the body.

Exercise and hypertension: Hypertension or high blood pressure often can be managed with exercise. As you exercise over time, the heart becomes more efficient at pumping a larger volume of blood per beat. Since hypertension is excessive pressure against the walls of the blood vessels throughout the body, the more efficiently the heart pumps or forces blood out with each contraction, the less constant tension there will be on the blood vessel walls to move the same amount of blood.

Stress is also a risk factor for hypertension. The sympathetic nervous system is stimulated with stress. We have a heightened sensitivity in times of anxiety. This is helpful when we are in danger, but not when it is self-inflicted or the result of lifestyle choices. When we are stressed, blood flow is constricted to our digestive system to allow more blood for our muscular system—in case we need to fight or flee from danger. Among other things, stress causes an increase in blood pressure and heart rate. If stress is a way of life, one may be at risk for digestive problems, disturbed sleeping patterns, even stroke and heart attack. Long-term effects of disciplined exercise may decrease in the stress of daily life by improving the cardiac output as well as releasing natural chemicals that reduce anxiety.

Excessive body fat also puts more stress on the heart to pump. The less body fat one has, the less stress one has on the heart and blood vessels as they pump the same volume of blood through the body. So exercise not only reduces body fat, but it will directly decrease the tension on the heart and blood vessel walls, therefore moving blood more efficiently through the body. This, in turn, reduces hypertension.

Exercise and stroke: A stroke happens when part of the brain does not have rich oxygenated blood circulating to it. A stroke can be caused by a thrombosis in which plaque (fatty deposit) is built up inside the blood vessel and finally occludes or chokes off the blood to a particular part of the brain. It can also be caused by an embolism in which the blood vessel is blocked off from plaque that has formed elsewhere, broken free, and settled in the small blood vessels of the brain causing a blocking of the blood. Either way, that part of the brain will die. A third way a stroke happens is by a hemorrhage, in which a blood vessel in the brain bursts under pressure or at a weakened spot in the vessel wall causing blood to spill out of the vessel and kill the part of the brain that no longer gets blood delivered to it. In each case, the better the circulation, the more pliable the blood vessels, and the lower the blood pressure, the lower the risk of a stroke. Understand that consistent exercise contributes positively to all of these things. Exercise improves circulation, makes blood vessels more pliable by reducing the buildup of plaque, and lowers blood pressure. Therefore, consistent exercise, especially aerobic exercise, reduces the risk of stroke.

Exercise and diabetes: Diabetes is a condition that affects millions. There are two types of diabetes: Type I and Type II. Type I, formally called juvenile diabetes, is the direct result of the pancreas not producing insulin. Type I usually starts in childhood and may be present at birth, but most often is a result of an autoimmune reaction in which the pancreas is affected by a virus. In Type II diabetes, the pancreas produces too little insulin, or the body has built a resistance to insulin and it is not as effective in using glucose (sugar) for energy from the cells. Type II diabetes represents 90 percent of all diabetes and is the one that has grown to epidemic proportions in the United States. This epidemic has been linked directly to extremely poor diets and sedentary lifestyles.

The bottom line is the following regarding diabetes: damage is done to the body when sugar levels in the blood are too high or last too long. This can lead to cardiac conditions, blindness, kidney failure, stroke, or infection resulting in amputation. Exercise is a natural way to bring blood sugars down.

When you are at rest, your body (muscles and heart) demands only a little sugar (glucose) be used for energy. With exercise, the demand for sugar greatly increases in the muscles and blood-sugar levels come down if they were running high. A sedentary individual who never exercises, sometimes experiences blood-sugar levels that stay higher. When you add to this high-sugar condition an unhealthy diet of excessive carbohydrates like refined sugar and processed flour, the individual’s blood-sugar will start to rise simply because the body becomes resistant to the excessive amounts of sugar in the blood. In other words, the insulin is no longer effective enough to keep up with all those excess carbohydrates and no other way to burn all that sugar in the blood. Exercise works incredibly well to counter this problem. As you increase the demand on the body, the blood-sugar levels come down. Healthy, exercised muscles have the capacity to rapidly select the fuel source they need, sugar or fat, during times of fasting or feeding (7). Untrained muscles or unexercised muscles are more insulin resistant—unable to use sugar efficiently for energy even with insulin present. Think of unexercised muscles as having less ability to use the energy source they have. That is why the more you exercise the better you are at utilizing calories—and the less likely you are to develop Type II diabetes or obesity.

A word of caution regarding exercise for Type I diabetics or Type II diabetics who have a pancreas that is unable to produce enough insulin: vigorous exercise is so efficient at burning off excessive sugar that it is easy to go below your normal, healthy blood-sugar level and produce a low blood-sugar condition while you exercise. For this reason, it is most important to know your sugar levels if you’ve been diagnosed with diabetes. You need to stabilize your sugars by using the right amount of exercise along with the right dosage of insulin and the right amount of food, specifically carbohydrates.

This information should be a wake-up call for those who have very poor diets, who are obese, and don’t exercise. It is this group that is most at risk for developing Type II diabetes. If they consistently exercise and eat healthy they will greatly reduce their risk by giving their pancreas a break from the diet it was never intended by nature to handle.

In addition to chronic conditions requiring medications, exercise addresses other aspects of aging in ways no other medication or activity can.

Exercise and posture and flexibility: Along with strength, flexibility is also compromised with a sedentary lifestyle. Just by adding activity to an inactive lifestyle, general flexibility will improve. But, specific muscle groups should be addressed as well. As we age, our posture typically changes, mostly due to the effects of gravity, sarcopenia, and osteoporosis. We develop rounded shoulders and a forward head posture due to loss of flexibility of the chest and neck muscles, while weakening the muscles that keep the spine and shoulder blades in an erect position. This causes the shoulders and neck to slump forward, changing the posture. Exercises, specifically strengthening exercises, can address these areas to make sure the postural muscles and the chest and neck muscles maintain their strength and flexibility.

Also, muscles of the hips and legs tend to lose flexibility with prolonged sitting or inactivity. It is important to maintain flexibility and strength of these areas to ensure correct posture and function. When you don’t exercise, the muscles in the hips (hip flexors) become shortened because of excessive sitting. With exercise you get to use the muscles’ full available range of motion. The same is true for the muscles in the back of the legs, the hamstrings. Sitting causes this group of muscles to shorten. Standing and exercising, allows these muscles to work through their full range of motion. Aerobic activity improves circulation and this also assists in giving the muscles back their normal flexibility.

Exercise and depression: Exercise also affects depression in a positive way. Addictive substances, such as alcohol, cocaine, and tobacco, stimulate the areas of the brain that cause a craving for more; so does exercise. Exercise, once a routine, becomes a healthy stimulant that can satisfy addictive cravings. Destructive addictive habits are replaced by exercise, the healthy alternative. Exercise stimulates endorphins which functions like an anti-depressant. So, the more you exercise, the more you desire to exercise and the less depressed you feel. Along with improved strength, endurance, flexibility, balance, and reduced risk of osteoporosis and sarcopenia, the benefit of reduced levels of depression is also a benefit with consistent exercise.

Exercise and health care: It is apparent that exercise has positive effects on almost all chronic conditions. Since many of these conditions are worsened with obesity and poor diet, a nation that exercises and eats healthier food will spend less on health care. Remember those healthiest people in the world in Okinawa, Japan, and Sardinia, Italy? Their national health-care systems are not as generous as is the U. S. system, and very little is spent on prescription medications. A healthy, whole-food diet and daily exercise appear to make the difference.

Tom Hafer is a registered physical therapist in Pennsylvania and Florida and a nationally certified athletic trainer.

NOTES

Abrams, John M.D., Overdosed America (New York: HarperCollins, 2005), 76.
In 2002, an estimated $200 billion was spent on prescription drugs in America. Worldwide, American drug companies sold about twice that amount. This number has risen approximately 300 percent between 1980 and 2000. Cited from: Angell, Marcia M.D., The Truth about the Drug Companies (New York: Random House, 2004), xxii.
Critser, Greg, Generation Rx (New York: Houghton Mifflin, 2005), 2.
Goodpaster, Bret H., Brown, Nicholas F., “Skeletal Muscle Lipid and Its Association with Insulin Resistance: What is the Role for Exercise?” Exercise and Sport Sciences Reviews, American College of Sports Medicine Series, July 2005, vol. 33, no. 3.