Book review: healing benefits of exercise across the lifespan

Mitchell, Ted, Tim Church & Martin Zucker. (2008). Move yourself: The Cooper Clinic medical director's guide to all the healing benefits of exercise (Even a little!). New York: Wiley.

Much has been written about the importance of reforming the American diet. However, there is an equally important aspect of fitness and the maintenance of a healthy weight: exercise. Move yourself: The Cooper Clinic medical director's guide to all the healing benefits of exercise (Even a little!) is a positive, upbeat book that proclaims the value of even small amounts of exercise, as a way of encouraging overweight Americans to change their negative lifestyle behavioral patterns. Given the multiplicity of prescriptions to Americans about the right way to 'move more' as well as to 'eat less' as the way of addressing their weight problems, it is worth considering the question as to if it is enough to do even small amounts of exercise as a way of enhancing general fitness.

The Cooper Clinic is a well-established research institute devoted to accumulating data about physical fitness. The book focuses on what are perhaps the two areas of greatest interest amongst clinicians and patients alike today: how to reduce the risks of lifestyle diseases and how to lose weight. The benefits of fitness, according to the book for the former, are undeniable. A lower rate of chronic diseases like diabetes, heart disease, and arthritis; higher levels of energy, improved productivity in the workforce, and improved mood can all be generated through exercise. But many people struggle to fit exercise in their lives. The book advocates fitting additional activity bursts into the day, by walking rather than driving a car whenever possible, taking the stairs, and making everyday house and yard chores into exercise. It suggests that additional exercise has significant health-promoting potential.

The book does not discount the importance of diet: there is a sample 1500 calorie-a-day weight loss plan. However, its philosophy is to focus on fitness, rather than thinness. It is better to feel motivated by changes such as improved strength, health, and energy levels. The book offers several 'plans' for readers to embark upon healthy life changes, and advocates logging calories and activity to improve accountability. It includes many 'real life' examples to inspire the average reader who is making the shift from the couch to the treadmill.

The overall perspective of the book is on moderate exercise, and there are even scare stores such as 'Chad,' who shifted too quickly into a fitness program, and because of an underlying heart condition, died of a fatal heart attack (Mitchell, Church & Zucker 2008: 102). Better to buy a pedometer, they say, and track the number of steps logged. However, the book also cautions certain groups, such as mothers, who say that they get enough exercise running after their children. It notes that mothers actually become more sedentary after having children, not less, even though they may feel worn out after taking care of children (Mitchell, Church & Zucker 2008: 107). Moderation in all things, from exercise to diet is its advice.

For a person who is already active, simply walking a certain number of steps per day may not seem like 'enough.' In terms of calorie expenditure, it will not add a significant additional weight loss. In fact, the book states that it is healthier to be slightly overweight and exercise than it is to be lean and inactive (Mitchell, Church & Zucker 2008: 18). While this claim is supported by scientific evidence on one hand, on the other hand, few people will adhere to a rigorous diet and exercise program simply on the promise that it will make them healthy, without enjoying some 'results.' Also, there is no denying that regardless of the level of activity, once the BMI of the individual surpasses a certain point, exercise and mobility can become hard on the joints, lead to injury, and make it difficult to fully enjoy the benefits of exercise. "I don't think most people would appreciate that, wow, you only burned 200 or 300 calories, which you're going to neutralize with just half that muffin" eaten after a run (Cloud 2009:3). For many patients, it is virtually impossible to separate the need to lose weight from exercise, and finding an exercise program and eating program that is calorically 'balanced' is essential.

The value of exercise and its relationship to health should not be discounted, of course, but the claims of the book, particularly its Plan A moderate walking campaign, must be viewed with caution in terms of really offering enough physical activity to ensure good health when weight loss is required. At best, it should be viewed as a transitional step to more intensive exercise. Of course, if Plan A is intense for a previously sedentary person, they may see substantial health benefits that are worth noting and praising. But unless a person continually increased the intensity his or her health regime, he or she will not see continued weight loss. The American Heart Association and the American College of Sports Medicine's joint guidelines for physical activity and health stated that "30 minutes of moderate physical activity five days a week is necessary to promote and maintain health...It is reasonable to assume that persons with relatively high daily energy expenditures would be less likely to gain weight over time, compared with those who have low energy expenditures. So far, data to support this hypothesis are not particularly compelling" (Taubes 2007:1). Ensuring that energy expenditure was in balance with caloric intake was essential, not simply adding exercise minutes to the day.