Thursday, December 2, 2010

on exercise and health

I am not well.  The adrenaline from the conference has worn off, and in the bombardment of the holiday season I find myself sinking.

The CT scan of my sinuses revealed an osteoma, which is evidently of no concern because it is not causing obstruction.  Therefore, I continue to mollycoddle my nasal pathways and oblige the constant flow of green mucous.  My ear colony, which is either fungal or an exiled celestial community, has responded to its daily chemical assaults by growing over the last two months.  Touch√©, Ear; I will be taking you to the Derm in a few weeks.

I think that it has been so long since I slept through a night that it doesn't bother me as much anymore.  And by doesn't bother, I mean it doesn't keep me from going to work every day, or shopping or cleaning or getting other things done.  What it does do is keep me from getting to work on time, being any degree of efficient, and enjoying anything that I am doing.  In brief, I pretty much feel like I'm hanging on for dear life until around noon.  For the rest of the time, I am a confused drone.

"Are you exercising?" my doctors ask.  By the way, I've also been to no less than 13 medical appointments over the last 2 months.  In a pleasant twist, none of these appointments were related to abdominal misery.  Hooray?

"Yes," I answer, mentally rolling my eyes, crossing my legs and preparing to explain to whichever physician I am seeing that day what exercise actually does for your health.

The endorphins!  Physicians pedal endorphins like they are the Western version of harmonizing one's Chakra.  Endorphins and metabolism-boosting are the more direct effects of exercise, and why it is the physician's favorite shout-out.  And while I have no arguments with the widespread benefits of physical activity -- it is 50% of my own research, after all -- it is certainly not a therapy without caveats.

In Parkinson's disease (PD) research, in which I am most fluent, it has been the general finding, although uncommonly published, that voluntary exercise has more positive effects on gait and neuropathology than does forced exercise.  Observations lead by Dr. Carl Cotman at UC Irvine have shown that PD patients guided in treadmill exercise received minimal improvement.  In other studies, aging canines taken for walks and given the opportunity to explore and run displayed great improvement in gait, cognitive ability and initiation of neural growth factors (2, 3).

A study was recently published in the British Journal of Psychiatry surveying the effects of "leisure" or "work" exercise (i.e., voluntary versus forced exercise) by Harvey et al.  The implications of the study are very aptly presented by one of my favorite neuroscience bloggers, Neuroskeptic.  What the conclusions amount to is that forced exercise does not have the beneficial effect on depression that voluntary exercise does.  People who got exercise through their labor-intensive jobs did not experience the positive changes seen in people who chose their own exercise on their own time. 

Therefore, the study suggests that it is not just the physical activity that is important to the therapy, but the interest in engaging in it, and the feelings of accomplishment, etc., that help a person achieve positive results.  This has been the case for me my entire adult life: when I enjoy physical activity, it helps me get through the day, it helps my mental state, it makes me feel better about myself; but when I do it out of sheer guilt and obligation I get absolutely nothing out of it.  As a woman who spent the majority of her life in competitive gymnastics and dance, this is not a new subject for me.

So yes, Dearest Physicians, I do exercise.  But I do not do so when I feel like I am dying.

My physician looks at me, puzzled.  "You know, if you make sure that you exercise consistently you will have better results.  I want you to try to exercise more often, even if you're tired in the morning."


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