Chapter 4: Obesity - More Physical Activity

Lack of physical activity is one of the nation’s most pressing health problems. An active lifestyle and successful weight management go hand-in-hand.

We are far less active as a nation than we were at the turn of the century. The modern conveniences and change in occupations (from farming and manufacturing to communication and technology) have led to a dramatic decrease in activities that expend calories. It has been estimated that we exercise 75% less than our relatives of 1900. Back then, wash day was an all day affair. Now it is 20 minutes on a Maytag.
Cooking was difficult. You needed to chop the wood for the wood burning stove, buy the ingredient from several different stores, walking to each of them. Even the preparation of the food, chopping, grinding, etc was a lot of work. Now, we buy prepackaged dinners and pop them in the microwave. Everything you need can be found in one giant super-store. In the house, we have remote controls, telephones in every room. It has been estimated that Americans would lose 5-6 pounds in a year if we took away the remote controls and had just one phone in the house. People might get out of the chair and move!

Think about you life and all the ways the modern lifestyle has helped reduce the need for physical activity. I have three jobs and 4 offices at the present time and consider myself a very busy man. Yet, I don’t expend much energy moving around during the course of the day. The parking spots are close to the office door. The exam rooms I use to examine patients are right adjacent to my office so I’m not walking very far to the next appointment. We use intercoms and phones to communicate with other staff in the office. My goodness, I wouldn’t want to get up and walk down the hall to talk to someone face to face. When I leave one office to go to another, it is a car ride and not a walk. One of my jobs is quite sedentary, mostly meetings, phone calls, and consultative work. Yet I sometimes come home feeling exhausted after a long day and comment to the wife, “I’m beat. Think I’ll talk it easy tonight and go to bed early.” That usually means the news or sports on TV or good book.

We have it pretty good in America. As a country, we are considered rich. Incomes are high compared to the world average and food prices are low. Rich countries tend to have more sedentary jobs than do poorer countries and are fatter on average. For years, economists have pointed out the decline in agricultural and manufacturing related jobs in America. We have moved to a more technology and communication focus in our job market, jobs that are typically more sedentary. It is interesting to note that studies have shown that being in a sedentary occupation for a year leads to a small increase in weight. Continuing in that occupation for greater than 10 years is associated with a significant increase in weight.

Exercise is not just about burning calories and helping people keep their weight under control. Everybody knows that regular exercise is good for your overall health. People who exercise on a regular basis outlive those who do not.

Benefits of regular physical activity
Heart benefits
Improved conditioning – better stamina
Improved strength and balance
Improved blood cholesterol levels (lipid values)
Improved sense of well-being
Increase self-confident
May help relieve symptoms of depression
Associated with a greater likelihood that any weight loss achieved will be a maintained weight loss

I remember a discussion I had with a friend about one of the many articles that described this phenomenon of greater longevity in active individuals. I had just read a New England Journal of Medicine article that concluded that “taking up vigorous exercise adds about 10 months” to your life. My friend jogs regularly, spending up to 10 hours per week on the activity. The 10 hours includes the time to change, job, shower, and dress again. We then did the calculations. Ten hours a week for a year is 520 hours or 21 and 2/3 days a year. So in 20 years, he’ll spend 14 months worth of time to gain the 10 months. The joke was that if you jog enough, you will live long enough to make up for the time you spent jogging.

That, of course, is a cynical way of evaluating the benefits of exericse. That same study showed that those who engaged in moderately vigorous activity had a substantial reduction in mortality from all cause (23% reduction) and far less heart disease (41% reduction). So you can’t just focus on the time it takes to exercise or longivity alone. Think of what it is like to live with heart disease for several years. It is severely limiting to people and nothing spoils those “golden years” like poor health. Many other studies demonstate that regular exercise can lower blood pressure, improve blood sugar control in patients with diabetes, help prevent bone loss in people prone to osteoporosis, help relieve constipation, raise the good HDL-cholesterol, and greatly assist people in managing their weight. People who are fit are less likely to fall and less prone to accidents.

And the other major bonus is how it makes you feel. My friend is happier when he jogs. After his workout, he is energized and feels more alert. It gives him self-confidence. For many people, the time to exercise becomes a time to look forward to. When you exercise, you are taking care of yourself. Many find it can relieve stress, allows time to plan and think through problems. Other use the exercise time to relax the mind. This is what is meant when people say that regular exercise can impart a sense of well-being and improve the quality of your life.

Yet most of us get far less exercise than we should and many of us get no exercise at all. Recenlty, the United States Department of Health and Human Services published a report entitled “Healthy People 2010” that outlined health goals for Americans. The report notes that only about 23 percent of adults in the United States report regular, vigorous physical activity that involves large muscle groups in dynamic movement for 20 minutes or longer 3 or more days per week. Only 15 percent of adults report physical activity for 5 or more days per week for 30 minutes or longer. Forty percent do not participate in any regular physical activity. The goal of the report is to reduce this number of inactive Americans by 20%. That shouldn’t be hard to accomplish, right? Wouldn’t seem that way, but Americans are just not that enthusiatic about exercise. Although participation in regular activity did increase from 1960 to the early 1980s, there has been little change in the level of participation over the last several years.

Why don’t people exercise? A lack of time is the most common reason people give when asked. An injury is the main reason people give for stopping. Smokers are slightly less likely to exercise and more likely to drop our of exercise programs. People who are overweight are less likely to exercise. Men are more likely than women to engage in regular activity and in sports. Physical activity declines continuously as age increases. Minority populations are less active than white Americans are and this trend is more pronounced in minority females. Better educated Americans exercise more than people with less education. Lack of role models among families and friends, bad weather, an unsafe neighborhood and lack of appropriate facilities – parks, bicycle, and walking paths, etc – also contribute to an inactive lifestyle.

Can you find yourself in the paragraph? Can you find enough excuses to keep your butt on the couch? Gee, I’m older, belong to a minority group, and don’t have a park within 5 miles. This book is about the truth so you are not getting off this easy. Most people could engage in some increased activity if they wanted to. They choose not to. There is time in the day to choose to be more active.

Some people don’t exercise because they think they have to really work at it to reap any health benefit - the “no pain, no gain” philosophy. It is true that enjoyment of activity is highly correlated with participation. In other words, if you dislike panting, heavy sweating, and sore muscles, you are less likely to pursue any activity that could lead to that physical state. Not too surprising. What some people really want to know when they ask me about exercise but are afraid to ask is - Tell me the minimum I need to do.

Studies have been done that demonstrate the health benefits of moderate-intensity physical activity. People who expend about 200 calories per day engaged in a moderate level of activity can expect most of the same health benefits as those who pursue the “no pain, no gain” approach.

So what is moderate activity? Examples include walking at a pace of 3-4 miles/hour, cycling for pleasure, racket sports, table tennis, golf (when you pull the clubs or carry them), leisurely canoeing, moving the lawn with a power mover, home painting, and home cleaning. Generally, about 30 minutes of these activities will burn about 200 calories. And you don’t have to get the whole 30 minutes all at one time. Intermittent activity has also been shown to confer substantial health benefits. So you can grab 10-15 minutes at a time doing calisthenics, or pedaling a stationary bike and work toward your 30 minute total for the day. If you do pursue lower-intensity activities – “light” exercise – you should do them more often, and for longer than 30 minutes per day.

Since most of us do not currently get the exercise we should, begin by incorporating a few minutes of increased activity into your day. Gradually build up to 30 minutes per day of added moderate-intensity activity. This recommendation is different than some of the advice you might have been given in the past. Physicians or other health professionals may have advised 20-60 minutes of moderate to high intensity aerobic exercise three times a week. The change in emphasize is based on research demonstrating health benefits accrue in approximate proportion to the total amount of activity performed. So you goal can be 60 minutes 3 times a week or 15 minutes 12 times a week. Same time – roughly same health benefit. So frequent smaller doses can reduce your risk of chronic disease and improve quality of life to the same degree.

For most obese folks, start slowly, and gradually increase the intensity of the activity. As I emphasized above, you don’t have to do your 30 minutes all at one time. It can be done intermittently over the day – three 10-minute episodes. Try being less efficient. You read that correctly – less efficient.

Be less efficient
Park further from the door at work, when you go shopping – force yourself to walk further
Use the stairs instead of the elevator
Quit using the remote
Move the phone across the room
You go out and get the paper instead of the dog.


You may find that it is easier to build the 30 minutes into your daily routine than it is to set aside time for exercise. In other words, walking to the bank when you had to go the bank anyway may be easier for you to do than joining a health club and going their for a 30 minute work-out.

How does all this work into your calorie equation? Remember the 100 calories = 10 to 11 pounds in a year rule. If you add 100 calories of exercise of activity to your day, continue to eat the same, you can lose 10-11 pounds in the next year. 200 calories of new activity per day = 20 to 22 pounds.

Walking is a great initial activity. As a general rule, on a flat surface, a 150-pound person will expend about 100 calories when walking a mile. A bigger person will expend more calories because it takes more energy to move a larger mass. You can calculate how many calories you will expend in walking a mile with the following simple equation:

Your weight x 100 calories = number of calories you will expend per mile
150 lbs.


For example, if you weigh 200 pounds; 200 divided by 150 is 1.33 times 100 = 133 calories. If you walk up hill, you will expend more calories than this amount; down hill – less.

Now remember that 3500 calories = 1 pound rule. To lose one pound at 200 pounds you would need to walk 3500/133 or 26 miles! That is a lot. You can see why it is important to understand calories. You might go out for a 1-mile walk and think you can reward yourself with a sandwich, right? Wrong! You would gain weight if you did that.

Most health professionals working with obese patients recommend that you expend about 2000 calories a week in activities or exercise. This will help you lose an additional ½ to 2/3 of a pound per week. More importantly, it is the level of exercise or activity that has been shown to improve how the heart functions and will contribute to other health benefits.

A simple way to start a walking program is to get in the car and map out a 1 or 2 mile route with the odometer. At a good walking pace, you will eventually be able to walk a mile in about 20 minutes. Start with 5 minutes out and 5 minutes back. After a few days, when this is comfortable for you, add another minute; 6 out, 6 back. Keep doing this until to get to 10 minutes out, 10 minutes back. You should be able to do close to a mile within this time period as your conditioning improves and your weight comes down. Then work up to 20 minutes out, 20 minutes back if you want to.

The use of a pedometer may be motivational and useful for you. A pedometer is a device that counts steps when you walk. They have gotten pretty popular recently with several group, organizations, and even states advocating 10,000 Step Programs. Simply put, these are programs that suggest you strive for 10,000 steps a day. Since 2500 steps is about a mile for most of us, that would be the equivalent of 4 miles of walking per day.

Pedometers are interesting and can teach you a little about your usual level of activity. Leonardo da Vinci invented the pedometer. Thomas Jefferson gave one to James Madison as a gift in the late 1800s. They have changed some since Jefferson’s time. Most of the current models are electronic and some can even be linked to the Global Positioning Service (GPS). If you do link to GPS, you can know exactly where you are in the world to within three feet. I can’t see myself needing that service but I leave that up to you. Some models will even talk back to you or play music while you walk.

The one I use is pretty basic. It tells me steps, converts that to miles, and estimates my calorie expenditure. Remember these devices count steps. The calculations used to convert to miles and calories are just estimates and may be a little off. Don’t get hung up on a different between your car odometer and the pedometer. You place a pedometer at the waist, close to the hip bone for best results. It works best for walking. With running, stride length can vary and the conversion to distance could be off quite a bit.

When I first started wearing the pedometer, I was surprised by the amount of walking I did. Up and down the halls in the office, from room to room to see patients, off to a meeting, etc. The pedometer would often record 4000-5000 steps during a typical office day. However, I have other days when I’m writing, reviewing protocols or other administrative tasks and the device will record less than 3000 steps. This kind of awareness can help you adjust your calorie intake to the kind of day you are having. It also tells me when I need to spend a little more time on the treadmill or some other activity.

I have discussed recommendations and health benefits relating to endurance exercise, but don’t overlook two other important components of fitness, namely flexibility and strength.