tingilinde: the good of exercise in midlife

Several readers have recommended a paper in the Archives in Internal Medicine

Midlife Fitness and the Development of Chronic Conditions in Later Life?ONLINE?FIRST

Benjamin L. Willis, MD, MPH; Ang Gao, MS; David Leonard, PhD; Laura F. DeFina, MD; Jarett D. Berry, MD, MS

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Background? The association between cardiorespiratory fitness (fitness) and mortality is well described. However, the association between midlife fitness and the development of nonfatal chronic conditions in older age has not been studied.

Methods? To examine the association between midlife fitness and chronic disease outcomes in later life, participant data from the Cooper Center Longitudinal Study were linked with Medicare claims. We studied 18?670 healthy participants (21.1% women; median age, 49 years) who survived to receive Medicare coverage from January 1, 1999, to December 31, 2009. Fitness estimated by Balke treadmill time was analyzed as a continuous variable (in metabolic equivalents [METs]) and according to age- and sex-specific quintiles. Eight common chronic conditions were defined using validated algorithms, and associations between midlife fitness and the number of conditions were assessed using a modified Cox proportional hazards model that stratified the at-risk population by the number of conditions while adjusting for age, body mass index, blood pressure, cholesterol and glucose levels, alcohol use, and smoking.

Results? After 120?780 person-years of Medicare exposure with a median follow-up of 26 years, the highest quintile of fitness (quintile 5) was associated with a lower incidence of chronic conditions compared with the lowest quintile (quintile 1) in men (15.6 [95% CI, 15.0-16.2] vs 28.2 [27.4-29.0] per 100 person-years) and women (11.4 [10.5-12.3] vs 20.1 [18.7 vs 21.6] per 100 person-years). After multivariate adjustment, higher fitness (in METs) was associated with a lower risk of developing chronic conditions in men (hazard ratio, 0.95 [95% CI, 0.94-0.96] per MET) and women (0.94 [0.91-0.96] per MET). Among decedents (2406 [12.9%]), higher fitness was associated with lower risk of developing chronic conditions relative to survival (compression hazard ratio, 0.90 [95% CI, 0.88-0.92] per MET), suggesting morbidity compression.

Conclusions? In this cohort of healthy middle-aged adults, fitness was significantly associated with a lower risk of developing chronic disease outcomes during 26 years of follow-up. These findings suggest that higher midlife fitness may be associated with the compression of morbidity in older age.

Unfortunately it is behind their paywall. ?The short version is regular exercise in midlife has a payoff as you age. ?The awful chronic diseases are of much shorter duration and at the end of life - so your older years can be much better. ?The relationship between midlife fitness and long term health has been suggested, but not carefully studied. ?This study looks at 18,000 adults over 40 years and was able to focus on the final years of life. ?

It isn't much of a surprise that heart disease and heart failure is reduced, but they found lower rates of diabetes, Alzheimer's disease, kidney disease, and a few others.

Modest levels seem to be sufficient - 150 minutes a week of moderate to vigorous physical activity is apparently sufficient - so swimming, jogging, cycling, etc... ?My rowing would certainly qualify as would Sukie's workouts. ?Perhaps this is why countries like Denmark and the Netherlands have lower rates of chronic disease in later life - a large percentage of the population is physically active as bicycles are regularly used for commuting and errands - a very cheap and nearly transparent way to get regular exercise.

As with many of these studies there are some caveats that came out in an interview and are probably in the paper - but it appears the underlying recommendation of getting some exercise is valid.

I find it fascinating that the Netherlands and Denmark both note correlations between cycling and lower healthcare costs. ?I don't think they've performed this sort of study, but are probing the same thing. ?They are able to calculate a cost/benefit ratio for building cycling infrastructure that saves medical expenses - since their governments build the infrastructure and offers universal healthcare (sigh - the civilized world), such justifications are easier to act upon. ?The figure is something like a dollar spent on cycling infrastructure (bike lanes and roads, parking facilities, snow removal, and so on...) saves four dollars in healthcare costs. ?This is one of the reasons why both countries are pushing for greater cycling use - overall fewer than half of their citizens regularly cycle (in the US it is about one percent of adults).

Adopting a regular exercise program can be tough as many of us are pressed for time. ?I mined some of my evening "down" time - times when I would watch TV or listen to the radio. ?Now I time shift with podcasts, audio books and online course lectures. ?If you are selective the quality can be better than one gets sitting in front of the screen. ?I generally do this first thing in the morning before starting into work. ?I also had a period where I needed to lose weight and found it was essential to build my fitness level. ?Now I'm in a weight maintenance mode, but the fitness component is essential. ?This means I needed some coaching and motivation. ?I recommend that approach - talk to someone who knows what they are doing. Some people like gyms as they get focus and equipment. ?I find gyms are a pain to get to and expensive, so we have a home gym and I get coaching elsewhere. ?Experiment and find what works for you. ?Perhaps it is jugging, swimming, cycling a team sport or even serious dancing ... there are many channels and all you need is to find one (perhaps even more than one) that you like and can sustain. ?Here is a short piece on my weight loss and exercise program - different things may work better for you, but it may be a starting point. ?I note that there are many immediate benefits from regular exercise - perhaps most impressive is the good feeling that persists for a few hours afterwards and what seems to be a somewhat greater cognitive capacity. (admittedly anecdotal)

I caught an audio stream with an author interview ?- recommended listening.

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Midlifefitnessinterview

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Source: http://tingilinde.typepad.com/starstuff/2012/09/the-good-of-exercise-in-midlife.html

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