The Benefits of Exercise Opportunity

76% of American adults now say that people should take primary responsibility for their own health and not rely so much on doctors. The Yankelovich Monitor May, 1998

When Dr. Luther Terry released the first Surgeon General's Report on smoking in 1964, approximately 49% of American adults were smokers. Today, only 24% of American adults smoke. In that 35-year period, the percentage of smokers in the U.S. declined by just more than 50%

In effect, over the 35 years since the publication of the first Surgeon General's Report on smoking, 75 million Americans have either quit smoking, or have rejected smoking in the first place. America's anti-smoking campaign, which has had worldwide public health implications, ranks among the most successful public health initiatives in recorded history. Its global impact looms larger with each passing year.

That campaign had several distinct features. First, it included a clear-cut, well-entrenched, and politi- cally potent enemy in the tobacco industry. Second, the campaign was fueled by the abundant medical research relating the omnivorous health dangers associated with smoking. With the passage of time, the results of this research became ever more compelling, more comprehensive, and more conclusive. Eventually, no intelligent person in the medical, scientific, business, or media communities could reasonably defend smoking. Gradually, the entire medical community, including flagship spokesgroups, such as the American Medical Association, the American Heart Association, and the American Cancer Society, developed compelling and ongoing campaigns to reduce the number of smokers in the U.S. In their turn, these campaigns engendered policy initiatives in the schools, the workplace, the restaurant industry, and the public domain.

Each of these initiatives further amplified the overriding message that smoking was a threat to the health of every man, woman, and child in the U.S.

But the foundation and centerpiece of the anti-smoking campaign always remained research. It was research-deliberately sifted and tested, and then mined and marketed-that successfully created an anti-smoking constituency. This constituency rapidly evolved into a full-fledged movement, complete with a coalition of interest groups that promoted programs and policies making smoking an increasingly more expensive and culturally unacceptable behavior.

On July 11, 1996, Dr. Audrey F. Manley, the Acting Surgeon General of the United States, released the Report on Physical Activity and Health to a nation in which only 30% of adults were exercising enough to optimally protect themselves against disease. Another 40% of the American people were exercising only on an occasional and irregular basis, and 30% were totally sedentary (Figure 9.2).

When the the first Surgeon General's Report on smoking was released, 49% of American adults were at risk from smoking. When the Surgeon General's Report on Physical Activity was released, 70% of American adults were at risk from insufficient exercise (Figure 9.3).

In short, not only is a greater percentage of the U.S. population at risk, but evidence now shows that the health benefits involved in becoming physically active on a regular basis are greater than those gained from quitting smoking. A report published in 1995 by the Journal of the American Medical Association indicated that low-fit men who became regular exercisers reduced their mortality risk more (65%) than male smokers who stopped smoking (50%).

Today, research relating to the health benefits of regular exercise, and the health dangers of sedentary living, is following the same critical path as did the research relating to smoking. Indeed, with each passing year, that research becomes more compelling, comprehensive, and more conclusive. Nary a month passes without publication, in some major medical journal, of yet another study documenting exercise's protective effects for an ever wider spectrum of chronic illnesses and conditions (Figure 9.4).

To mention but a few recent examples, in the second half of 1998, research reports on exercise and risk reduction (Figure 9.5) published in major medical journals indicated that:

1. The risk of colon cancer is 54% less for regular exercisers than it is for sedentary individuals;

2. The risk of heart attacks is 38% less for frequent exercisers than it is for non-exercisers;

3. Over a five year period, the all-cause mortality rates of non-exercisers, aged 65 to 101, was 67% higher than it was for regular exercisers;

4. A strength training program is a component of any safe and effective weight-loss program;

5. Frequent exercise decreases the incidence of gall bladder disease by more than 40%;

6. Exercise alone is more effective than diet alone in reducing low-density cholesterol measures;

7. Regular exercise reduces the risk of Type II diabetes by over 25%;

8. For women, aged 65 and over, moderate to vigorous exercise reduces the incidence of hip fractures by 45%;

9. For men, aged 65 to 84, the risk of a fatal stroke was 60% less for men who exercised regularly;

10. Weight-loss programs that include both dietary changes and regular exercise programs are twice as effective as programs which focus exclusively on diet.

It is well to remember that all of these findings were published in journals with the highest standing in the worldwide medical community-journals such as The Lancet, The Journal of the National Cancer Institute, The Journal of the American Medical Association, the Journal of the Harvard Center for Cancer Prevention, The New England Journal of Medicine, The Physician and Sports Medicine, etc.

It was precisely this type of research that created the movement against smoking. And it was precisely the same constellation of medical journals (and the organizations that they represent) that formed the foundation for the coalition against smoking. This coalition involved The American Medical Association, the American Heart Association, the National Arthritis Foundation, the American Cancer Society, the Center for Disease Control (CDC), the National Institute on Health (NIH), and others. Today, these same organizations are again coalescing around the issue of physical activity and have already formed a coalition to promote it. This group, aptly named the National Coalition to Promote Physical Activity (NCPPA), already involves hundreds of organizations, both state and national, and both public and private. All are committed to the cause of increasing the frequency and vigor of physical activity among all Americans. (For those wishing to become more familiar with the NCPPA, its website is: www.ncppa.org.

We know that the results of research alone are usually not enough to motivate large segments of society to incorporate more physical activity into their lives. But we also know, thanks to the work of behavioralists such as Dr. James Prochaska, Dr. James Sallis, and Dr. Bess Marcus, that such research contributes significantly to every stage of the process by which a once sedentary person gradually becomes physically active. We know, for instance, that knowledge of medical research plays a vital role in turning "pre-contemplators" (people who have no understanding of the issues involved) into "contemplators" (people who realize that exercise is good for them and have begun to think about doing it). Such information also helps to turn "contemplators" into "preparers" (people who are preparing to begin exercising), and preparers into "starters" (people who have begun regular exercise, but for whom the habit is still weak and fragile). Nor does the power of information slacken in the last stage, when starters finally become people who have firmly incorporated regular exercise into their lives: i.e., "incorporators" (Figure 9.6).

If compelling data relating to the benefits of exercise did nothing else but play an important role in the process of getting people to be more active, it would still be indispensable. But such research also

accomplishes something more. It strengthens the hand of opinion leaders and policy makers who are in positions to develop social, cultural, economic and political incentives for healthy lifestyle initiatives.

Another important parallel that exists between the anti-smoking and benefits of exercise initiatives involves demographics. To state the matter directly: Those with higher education, income, and pro- fessional status are less likely to smoke and more likely to exercise. This is yet another indicator that the process of cultural transformation begins with continuous dissemination of compelling data that gradually infiltrates deeper and deeper into the culture, influencing one opinion leader after another. Ultimately, all major societal establishments-i.e., medicine, education, business, the media, government, the military-begin to develop initiatives that support physically active living.

It is one of the main theses of this report that America's 14,000 commercially operated fitness centers and every other fitness venue have the greatest possible vested interest in the dissemination of data relating to the health benefits of regular exercise and the health risks of sedentary living. Thus, the importance of providing the commercial health club industry with a continual stream of visually attractive and succinct summaries and compilations of the most important and timely research cannot be overstated. Indeed, this process becomes one of the central and abiding membership growth opportunities for the industry as a whole, and for every individual club in its own community.

Such brochures might have the following titles:

Exercise and Aging Exercise and Longevity Exercise and Productivity Exercise and Creativity Exercise and Cancer Exercise and Heart Disease Exercise and Weight Loss Exercise and Energy Exercise and Mental Health Exercise and Attractiveness Exercise and Stress Exercise and Arthritis

These brochures would support the resolve and commitment of millions of current and prospective health club members to stay with their exercise programs. Additionally, they will provide grass roots fitness leaders with an arsenal of information that will help them motivate and energize people in their communities. In the end, such information also serves to position the nation's fitness centers as institutional leaders in community and corporate health education. And it also establishes them as central players in community and corporate initiatives to help people become more physically active.

In this regard, the industry will focus on the whole panoply of research relating to the benefits of exercise. Of course, the focus will include preventive benefits, such as data on how exercise lowers incidence of heart disease, hypertension, arthritis, diabetes, and other maladies. But even more especially, it will relate to exercise that directly affects customers' most deeply-felt needs, including weight loss, stress reduction, and the preservation of youthful vigor and attractiveness.

To sum up, with respect to effectively communicating the myriad benefits of regular exercise, the industry's long-term goals are twofold:

· first, to position regular exercise as a central and essential component of healthy, happy, high- performance living; and,

· second, to position every commercial health facility as a grassroots community leader in health education and health promotion relating to regular exercise.