If we throw the entire US population into a hat, what are the odds that you pick someone who is metabolically healthy and is in otherwise good physical condition? 50% might seem like a reasonable answer given that the United States isn’t exactly the healthiest country right? Incorrect. As of 2018, the real answer is that only 12.2% of Americans meet the acceptable criteria for chronic disease risk factor management (Bwbieltz, 2018). If your jaw isn’t on the floor, it should be because this epidemic shows no signs of slowing down. Today, I will describe the benefits of exercise in relation to disease prevention, uncover how the United States healthcare system is ill-prepared to prevent chronic illness, and go over national statistics on exercise adherence amongst different age groups. Finally, I will offer the reader advice on how they as an individual can take steps towards a healthier more active lifestyle.
Lack of exercise, poor lifestyle choices, and sedentary behavior are important, yet often ignored predictors of many health crises that manifest later in life, forcing treatment to be reactionary as opposed to preventative (Anderson & Durstine, 2019). There are many possible explanations for the underutilization of preventive methods in our society. Most people simply do not exercise as much as they know they should. Unfortunately, our society usually does not place sufficient value on a healthy lifestyle before illness presents itself.
Today in the United States, there are nearly 145 million people suffering from chronic diseases— a physical or mental health condition that lasts more than one year and causes functional restrictions or requires ongoing monitoring or treatment (Raghupathi & Raghupathi, 2018). Heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes are only five of these diseases, yet account for nearly two-thirds of all deaths in America (Raghupathi & Raghupathi, 2018). Furthermore, the prevalence of chronic diseases continues to trend upward each decade. The percentage of Americans with multiple chronic diseases was 21.8% in 2001, 26.0% in 2010, and was estimated to be 30% in 2020 (Boersma et al. 2020).
While disease-specific medications can negate or slow chronic illnesses, simple exercise is effective in preventing almost all chronic diseases (Anderson & Durstine, 2019). For example, physical activity has been shown to increase myocardial function, decrease systolic blood pressure, and lower blood stress related hormone levels (Anderson & Durstine, 2019). All of these adaptations improve systemic health and reduce the risk of developing cardiovascular disease without the potential side effects of conventional medicine (Anderson & Durstine, 2019). Exercise was also found to improve insulin sensitivity for diabetics, decrease mortality rates for cancer patients, and help with symptoms of depression and anxiety. Studies showed that daily exercise supported an 80% reduction in cardiovascular disease, a 90% reduction in type-two diabetes risk, and a 33% reduction in cancer risk (Anderson & Durstine, 2019).
It is now important to understand the lens that the United States has approached this health crisis from. To no one's surprise, the healthcare system the United States has adopted is driven primarily by financial incentives due to a focus on treating diseases rather than preventing them. Hospitals and physicians are often paid to treat because fee-per-service payment structures encourage them to put a greater emphasis on the number of patients served, rather than comprehensive patient care (Kumar 2022). Roughly 75% of United States healthcare spending goes towards purely reactive care, with heart disease and diabetes constituting the majority of those costs (Kumar 2022). These two diseases are largely preventable with proper nutrition and exercise (Anderson & Durstine, 2019). Unfortunately, when one healthcare decision-maker was interviewed about the economic considerations and resource investment in healthcare they stated, “With no margin, there is no mission” (Levine et al., 2019). As a result, there is a gap in current healthcare that emphasizes the overall well-being of the individual. While necessary, it is evident that the United States healthcare system is imperfect in many ways.
Let us now turn to the statistics surrounding the current climate of exercise adherence in the United States. The Physical Activity Guidelines for Americans recommend a minimum of 150 minutes of moderate-intense exercise per week and two days of muscle-strengthening activity. However, a 2020 National Health Institute survey found that only 24.3% of adults aged 18 and over met this requirement (Elgaddal et al., 2022). Men and women aged 18-34 were the most likely to meet this requirement at 41.3% and 28.7% respectively. Notably, as both these groups aged, their likelihood to meet these exercise guidelines decreased significantly. As a result, by age 65 only 15.3% percent of men and 10.8% of women met these guidelines (Elgaddal et al., 2022). It is evident that Americans exercise less and less as they age, but the value of daily exercise throughout one's life cannot be overstated when scientific literature supports that most if not all physiologic systems are positively altered by physical activity (Anderson & Durstine, 2019). There is no doubt that daily exercise is a hard routine to subscribe to, but with so many positive health effects, it should be a habit that every individual tries to develop to some degree. Exercise is the single most powerful, and more accessible, medicine currently available to living a healthy life.
Up until this point we’ve discussed the rise in chronic disease across the United States, why exercise is critical to longevity, and how grim the facts surrounding healthcare and exercise adherence really are. This brings us to the big looming question: how do we fix all of this? To answer this, I won’t propose any broad sweeping theories, but rather use my experience as a coach to speak from the individual's perspective. I imagine that at some point in their life, almost everyone has a thought similar to “I need to exercise more”. Most of us acknowledge this necessity yet, again and again, that fleeting moment of self-reflection gets buried under the mounds of temptation, obligation, and unpredictability within our lives. We hate it when this happens and worst of all, it leaves us feeling frustrated and disappointed in ourselves.
I won’t lie to you. Integrating exercise and good health practices into our daily lives is a monumental challenge. However, like all big endeavors, if we break down the journey into bite-size pieces it becomes a lot easier to achieve such a lofty goal. Start small. Walk for ten minutes a day, work in a small handful of vegetables with a meal two times a week, or have two drinks at a night out instead of three. Depending on where you’re at, these might seem like small wins that could never amount to any real change, but I assure you there is a much larger victory being forged here. You’re reprogramming your mind to be comfortable with adaptation and change. Small habits set the foundation for any lifestyle change and once you’ve got a couple of small wins under your belt, who is to say you can’t add another ten minutes to that walk, eat a vegetable every day, or limit that night out to just one drink? Good things take time, and embarking on a new health and fitness journey is no exception. Trust in the process and be kind to yourself. Nobody is perfect. Good Luck!
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