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Exercise: why are we missing a trick?

Wesley Tingey, Unsplash

As I get older and hopefully wiser I am beginning to realise that it is the simple pleasures of life that may be the most beneficial for healthy ageing. Exercise being numero uno.

In this, Women’s Health Initiative, study below light-intensity physical activity improves mobility among older women. It is really a no-brainer. As we unpack the biology of exercise and ageing there are sound biological mechanisms that underpin exercise as a treatment for ageing.

Exercise increases levels of important growth factors such as brain-derived neurotrophic factor (BDNF) and other growth hormones. Exercise enhances neurotransmission and activates signalling pathways in brain cells. Exercise downregulates several inhibitory pathways for CNS regeneration. Exercise increases levels of the so-called nuclear factor erythroid 2–related factor 2 (NRF2) transcription factor and downstream anti-oxidant pathways. NRF2 is likely to be the main antiageing pathway that is common to multiple other biological mechanisms. This is just a shortlist of some of the important biological processes stimulated by exercise.

Saying this why are we not doing more to encourage the general population to exercise? What needs to be done to make exercise programmes sticky and more addictive? This is the challenge for all of us working in preventive medicine and behavioural psychology. Any ideas would be greatly appreciated.


Glass et al. Evaluation of Light Physical Activity Measured by Accelerometry and Mobility Disability During a 6-Year Follow-up in Older Women. JAMA Netw Open. 2021;4(2):e210005. doi:10.1001/jamanetworkopen.2021.0005

Key Points

Question: Is there an association between light-intensity physical activity and incident mobility disability among older women?

Findings: In this cohort study of 5735 postmenopausal, community-dwelling women without mobility limitation, the risk of incident mobility disability over 6 years of follow-up was 22%, 40%, and 40% lower for women in the second, third, and fourth quartiles of daily mean light-intensity physical activity, respectively, compared with the lowest quartile.

Meaning: These results suggest that recommendations to increase light-intensity physical activity have the potential to improve prospects for preserving mobility among older women.

Abstract

Importance: Almost 1 in 4 women older than 65 years is unable to walk 2 to 3 blocks, and mobility disability is a key factor associated with loss of independence. Lack of moderate to vigorous–intensity physical activity is associated with mobility disability, but whether lighter physical activity is associated with mobility disability is unknown.

Objective: To determine the association of light-intensity physical activity and incident mobility disability among older women.

Design, Setting, and Participants: This prospective cohort study included women enrolled in the Objectively Measured Physical Activity and Cardiovascular Health Study, an ancillary study of the Women’s Health Initiative, between March 2012 and April 2014, with follow-up through March 31, 2018. The Women’s Health Initiative was a population-based, multisite study that recruited from 40 clinical sites across the US. Participants in the present analysis included 5735 of 7058 ambulatory, community-dwelling women aged 63 years and older who returned an accelerometer with usable data, were free of mobility disability and had follow-up data on mobility status. Data were analyzed from August 2018 to May 2019.

Exposures: Light-intensity physical activity, defined as movement requiring energy expenditure between 1.6 and 2.9 metabolic equivalents, captured using an accelerometer over 7 days.

Main Outcomes and Measures: Incident mobility disability, defined as the first self-reported inability to walk 1 block or up a flight of stairs at annual follow-up, and persistent incident mobility disability, defined as incident mobility loss that persisted through the end of follow-up.

Results: A total of 5735 participants were included for primary analysis of all incident mobility disability (mean [SD] age, 78.5 [6.6] years [range, 63-97 years]; 2811 [49.0%] White participants). Compared with women in the lowest quartile of light-intensity physical activity, lower risk of incident mobility disability was observed in quartile 2 (multivariable hazard ratio [HR], 0.78; 95% CI, 0.67-0.90), quartile 3 (HR, 0.60; 95% CI, 0.51-0.71), and quartile 4 (HR, 0.60; 95% CI, 0.51-0.71) (P < .001). This beneficial association was stronger for persistent mobility disability in quartile 2 (multivariable HR, 0.72; 95% CI, 0.60-0.85), quartile 3 (HR, 0.55; 95% CI, 0.46-0.67), and quartile 4 (HR, 0.52; 95% CI, 0.42-0.63) (P < .001). Stratified analyses showed the association was stronger among women with a body mass index of less than 30.0 (HR, 0.73; 95% CI, 0.66-0.82) compared with women with a body mass index of 30.0 or higher (HR, 0.91; 95% CI; 0.79-1.04; P = .04 for interaction).

Conclusions and Relevance: In this cohort study, increased time spent in light-intensity physical activity was associated with reduced incident mobility disability. These findings support placing greater emphasis on promoting light-intensity physical activity for preserving mobility in later life.

CoI: multiple

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Comments

  1. Darin31 March 2021 at 06:10

    It's difficult to even consider exercising when you have MS, fatigue, mobility, balance etc. whenever I've been offered help with an exercise program I've taken it, these programs generally have a limited time frame, hey at least it's free in Australia. It's difficult to stay motivated though and to travel to where one can access these services if you only have a mobility scooter.

    So early this year I decided to do something about it, I bought a decent treadmill to help lose weight and to concentrate on getting my walking better, yes I still hold on to the handles and mostly watch my feet, early days but it is helping, I'm losing some weight and slowly my walking is improving as is my mood. So thanks to all you medicos that push the exercise for MS "thing" it really does help, any exercise will help whatever you can safely do, just be regular and stick to it, oh and watch what you eat as well of course.

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  2. Angela8 April 2021 at 05:58

    Had MS for more than 20 years, i’m an internist and have been in love with neuroscience since i was a child, did some research while on med school and I’ve been doing prehab since i figured it out on my own by reading Kandel’s when i was 17. I happen to love exercise physiology and human movement as well. The evidence re exercise and MS is very bad quality. And regular advice is quite bad. Properly programmed strength training is The best single thing One can do for mobility, balance and spasticity. The MS Hug? Gone thanks to heavy bench press. I lost many years doing yoga, stretching, pilates and such. The problem is you either have to study a lot like i did and be able To carry out your n=1... or you have to find a very special physical therapist or strenght coach. Real prehab and rehab is very tough but the benefit since i started training this way i know no fatigue outside relapses (i’m a doctor, walk more than 15,000 steps pet day, strength train 4-5 Days per week, love dancing and rollerblading) . Also heat intolerance? Mostly gone. It hasnt always been like this way. And nope, DMT was not the cause unfortunately.

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