Therapeutic Lifestyle Change

Exercise, independent of weight loss, can lead to improved health outcomes

Fitness and healthcare professionals are often dependent on anthropometric measurements (body fat percentage) and laboratory test results when evaluating the effectiveness of interventions such as cholesterol-lowering (statin) drug therapy, or changes in diet or exercise.  The problem with this standard way of measuring success is that small improvements which appear less than spectacular can clinically be quite beneficial.  Modest lifestyle changes reduce cardiometabolic disease risk and, more importantly, improve quality of life well beyond their influence on conventional laboratory measurements. In one of the most important lifestyle trials conducted, after more than three years in the lifestyle stream of the Diabetes Prevention Program (DPP), participants lost just 8.8 pounds on average, or about 4.5 percent of their body weight.  Despite this modest weight loss, new onset diabetes was reduced 58 percent compared with 31 percent among those taking Metformin (a diabetes drug).  Even better, those over age 60 reduced their diabetes risk by more than 70 percent!  These outcomes were achieved with very small dietary interventions and weekly exercise totaling approximately 1000 calories burned.  This was also shown to be the case in a 20-year follow-up analysis of the Da Qing Chinese Diabetes Prevention Study, in which participants also made very modest changes in blood lipids and body weight. Most studies also show improved arterial endothelial function with exercise training.  Endothelial dysfunction (inability of the arteries to sufficiently dilate and contract) contributes to the initiation and progression of atherosclerotic disease – improved endothelial function is thought to be one of the primary mechanisms responsible for reduced cardiovascular disease morbidity and mortality.  Both aerobic and resistance training improve insulin sensitivity and glucose transport mechanisms, which reduces the risk of diabetes and cardiac disease.  Dietary elements such as Omega-3 fatty acids, walnuts, and olive oil have also been shown to significantly improve endothelial function, as well as reduce elevated triglycerides after a fat-rich meal.

In one of the most noted clinical exercise science reviews recently published, Richard Telford, renowned physiologist at the University of Melbourne, revealed that the scientific literature consistently indicates a strong association between low physical activity and mortality and mobidity associated with type 2 diabetes.  This was after controlling for obesity and other potentially confounding variables.  In plain language, this means that it is possible to reduce the risk of dying from diseases of lifestyle (heart disease, diabetes, and so forth) by making healthy changes that do not necessarily lead to weight loss. Reference: La Forge, Ralph (2008).  Therapeutic Lifestyle Changes: New Horizons.  ACE Certified News, October/November. Exercise Specialist Recommendations:

  1. Incorporate weekly exercise that totals 1000 calories burned.  This is equivalent to about 3 hours of walking.  Work up to 1500 calories burned per week (4.5 hours) – this is ideal for disease prevention.
  2. Use a pedometer and try to take 10,000 steps per day.
  3. Adopt as much of the Mediterranean diet as possible – add in nuts, legumes, whole grains, fresh fruit, vegetables, fish and olive oil.  Make small, gradual dietary changes over the course of 6-12 months.
  4. Walk or bike anywhere that will take 45 minutes or less – incorporate physical activity into your daily life and make it utilitarian.  Take the car as a last resort!
  5. Take stairs whenever this is an option.