Taking the pulse–do exercise programs get kids in shape?

New York Times blogger Gretchen Reynolds, in her Oct. 3, 2012, piece, Do Exercise Programs Help Children Stay Fit?, profiled a recent British journal article that shows such weight-reducing and health-promoting efforts from the past two decades have flopped. (Scroll below to take a quick one-question pool on this very question.)

Citing the study published by Brad Metcalf and colleagues in the August 2012 edition of the journal BMJ (a journal accessible to all users), Reynolds reports that the authors found that “programs almost never increase overall daily physical activity. The youngsters run around during the intervention period, then remain stubbornly sedentary during the rest of the day.”

Two decades of interventions to help kids move more and weigh less may be failing.

Two decades of interventions to help kids move more and weigh less may be failing.

The British team of researchers from the Peninsula College of Medicine and Dentistry in England found 30 acceptable studies that met their criteria for examining if exercise interventions for kids work. The articles reviewed were published between January 1990 and March 2012. According to Reynolds, the programs simply failed to do what they were supposed to do: get young people to move more.

The article said their data covered 14,326 participants–6,153 with accelerometers that measured physical activity. The authors concluded that interventions “had only a small effect (approximately 4 minutes more walking or running per day) on children’s overall activity levels. This finding may explain, in part, why such interventions have had limited success in reducing the body mass index or body fat of children.”

An accompanying editorial  by Sally and Richard Greenhill notes that current United Kingdom guidelines state that all children and adolescents should have 60 minutes of moderate to vigorous exercise a day. And in the United Kingdom, only a third of boys and a fifth of boys are meeting those guidelines. In the United States matters are worse, and kids’ levels of inactivity now ranks as harried parents’ No. 1 concern, according to an August 22, 2012, USA Today story. Yet, parents appear to be a big part of the problem, too, along with ubiquitous and highly, highly, highly addictive technology. Nearly six out of 10 children spend less than four days a week playing outside because “parents find it more convenient to spend time in front of a television or computer.”

Times writer/blogger Reynolds quoted Frank Booth, a professor of physiology at the University of Missouri-Columbia, who worked on the meta-analsysis in the BMJ: “So if structured classes and programs are not getting children to move more, what, if anything, can be done to increase physical activity in the young? It’s a really difficult problem.”

Such a finding begs the question: Do interventions to promote physical activity work, or are they a waste of time and resources?

Maine’s Efforts: Cutting Edge or a Good Idea Needing a Makeover?

The Let's Go program in Maine is one of many in the United States trying to get kids to exercise for an hour daily.

The Let’s Go program in Maine is one of many in the United States trying to get kids to exercise for an hour daily.

One influential program, that combines exercise with nutrition and is being duplicated across the country, is the Let’s Go! 5-2-1-0 program from Maine. This stands for:

5 – fruits and veggies,
2 – hours or less of recreational screen time,
1 – hour or more of physical activity, and
0 – sugary drinks, more water, and low-fat milk [editorial note, I find the promotion of milk as a drink for kids questionable, given the inordinate influence of big agri-business on the U.S. Department of Agriculture and the availability of other fortified, non-dairy drinks].

Let’s Go! founders claim the program is successful and is grounded in three principles: 1) changing environments and policies; 2) consistent messaging across sectors–like “5-2-1-0”; and 3) approaches that use science and are recommended by the medical community.

Places as diverse as Kentucky and Hawaii are attempting to duplicate this program, despite apparently non-conclusive evidence of its efficacy.

Maine launched the program in response to the obesity epidemic (as of 2005, more than 60% of all adults in Maine reported being either overweight and 36% of kindergarten students, 26% of 6th-8th graders, and 29% of 9th-12th grade youth were reported being overweight or at-risk for overweight).

According to the program’s own evaluation of its efficacy tackling issues such as weight, the prevalence of overweight and obesity among children decreased from 33% in 2006 to just 31% in 2009 and was not statistically significant. However, among females, between 3 and 5 years, a smaller proportion were overweight and obese in 2009 compared to 2006 (25% vs. 31%). In short, this confirmed the findings from the BMJ study.

But what do you think?

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Come a rain storm, put those running shoes on your feet

The dark and extremely gloomy days of Seattle are now settling in. For runners in this region who work normal day shifts, this signals the dark days of running that last up to five to six months, depending on what time of day one runs and how much free time one has. I find it more gloomy than Anchorage, where I lived and ran six years. I never minded running in the dark there, because the snow and clouds created very powerful ambient light that made running at night very pleasurable. But here, it is dark as a coal mine, and damp. People’s vitamin D levels are unhealthily low, and there seems to be widespread manifestations of seasonal affective disorder (SAD).

First, let’s talk about why this is such a depressing time of year and can be such a bummer place to be.

The absence of natural sunlight impacts the body’s production of two key hormones that impact the body’s sleep-wake cycles, energy, and mood: melatonin and serotonin. Research indicates that melatonin is generated in greater quantities because of longer periods of darkness. Increasing the production of melatonin leads to sleepiness and lethargy. Serotonin, whose production rises with more exposure to sunlight, falls during these shorter days. Low amounts of serotonin are also associated with depression.

Another byproduct of the darkness is a decrease in the production of vitamin D, naturally created by the body. Though researchers have not fully determined whether low vitamin D contributes to symptoms of depression or whether depression itself contributes to lower vitamin D levels, higher levels of Vitamin D are associated with decreased risks of depression. But alas, anyone living in  Canada, and the northern tier of the Lower 48 here in North America all require vitamin D supplements too to make up for the absence of sunlight come fall. Vitamin D also is critical in many key functions: enhancing the absorption of minerals in the gastrointestinal tract and kidney and thus into the blood, and it may protect against tuberculosis, gum inflammation, MS, and some cancers—at least according to my handy nutrition textbook: Understanding Normal and Clinical Nutrition. (I really love this tome – nicely written, well illustrated.) My response is to take vitamin supplements, but that is not enough.

So here I am in dark and rainy Seattle, deprived of naturally produced vitamin D, at higher risk of SAD. This is exacerbated by Seattle’s culture that seems to promote the absence of smiles and eye contact with strangers. What is a person to do?

Running is a perfect antidote to the blues that accompany the shorter days of autumn.

Easy, go running. While hitting my local running grounds (Greenlake), I heard some walkers recently comment, “This is when the real runners come out.” The observation was referring to the near absence of mobs of fair-weather walkers and runners whose numbers thin by nearly 80% the moment the rains fall and that stygian Seattle glooms settles around mid-October. Paradoxically, running is the perfect antidote to anything resembling SAD or depression or everyday stress. I have done this since I was 15, and I continue running rain or shine, but particularly when it rains.

One of the earliest blockbuster books on the health benefits of running, the Joy of Running, by Dr. Thaddeus Kostrubala, came out way back in1976. In it, Kostrubala was among the first of the self-improvement health gurus to promote using an aerobic activity, running, to help treat mental illnesses such as depression. More recently, in September 2011, the UK-based Telegraph published a typical story that is the grist for many running magazines, Running outdoors can improve mental health. The story touted how running outdoors “can both raise your spirits and give you a real buzz.” Of course there are all sorts of web sites that list evidence-based findings that point to the health benefits of running–stress relief, blood circulation to the brain, chemical releases, sharpened cognitive functions, getting outdoors, and more.

Running in the dark does not mean you can’t have fun.

There are also numerous, peer-reviewed scientific papers that highlight the mental health benefits of running, particularly in response to depression. I stumbled on one such paper doing a quick keyword search on the database PubMed, by D.I. Galper, et al., in the January 2006 edition of the journal Medicine and Science in Sports and Exercise, called “Inverse association between physical inactivity and mental health in men and women.” That study looked at the associations between measures of physical activity and mental health in a large group of more than 5,400 men and women. Galper and his colleagues found that cardio-respiratory fitness and habitual physical activity were associated with lower depressive symptoms and greater emotional well-being.

Of course I and other dark and rainy weather runners did not need this study to confirm what our bodies are telling us every time we get out of our homes and get wet while splashing outdoors. I realize that not everyone has the time to get out after busy days. They may have classes, second jobs, kids, or all of the above. But even in the rain, in the blackness of a fall day, a run or even a walk is sure to improve one’s mental outlook, boost one’s mood, and stimulate the body’s chemistry. Here’s to the days and months ahead of soggy shoes, headlamps, and hopefully a few hellos from water-logged runners. You’re a fine crew.

Cheap energy poses a threat to Americans’ health

One of the most talked-about initiatives taking place in public health, with funding supports from the Centers for Disease Prevention and Control (CDC), is policy, system, and environmental change to address the rise of chronic disease in the United States, the country’s leading cause of death. According to the CDC, chronic diseases are responsible for seven out of 10 deaths of all Americans annually, and one half of all Americans have at least one chronic illness. Worse, three-quarter of the $2.5 trillion (yes trillion) dollars spent annually on health care in the United States goes to battling chronic diseases. The CDC’s grant funding is being disbursed to health departments to undertake a range of interventions. But none of these interventions is going after what some say is one of major sources for the rise of obesity and chronic disease—the cheap price of energy in the United States.

According to Ian Roberts of the London School of Hygiene and Tropical Medicine, the overall obesity rate is highest in the United States among all other nations because the price of gasoline is very low. “So where gasoline is really cheap, we over-consume it, it’s bad for the environment and actually because we should be using food energy for human movement – if we use gasoline for human movement, then we store the food energy and you know where we store it.” And there are other costs associated with being a fat nation, says Roberts. “So there’s obviously an increased demand on food supplies, but also there is an increased demand on everything. You know, bigger people need more energy to move them. Airplanes take more energy to get off the ground. It takes more of the shares that, you know, of the Earth’s resources to actually support all that extra weight.”

In the United States, the U.S. Energy Information Agency estimates we use 317 million BTUs per person a year. In this country, nearly half of all of our energy comes from petroleum and natural gas, and the country ranks seventh globally in terms of per capita energy use, trailing Canada and some smaller nations like Luxembourg and Trinidad and Tobago. However, the United States is  No. 2 (19% of global demand) in terms of global consumption of energy after China (20.3% of global demand), which just took the No. 1 slot.

Feeder pipelines gather crude oil produced at Prudhoe Bay, which is eventually shipped to the lower 48 for consumption on the West Coast.

A significant negative outcome can be seen in the widening waistlines of Americans. Charles Courtemanche of the Department of Economics at the University of North Carolina at Greensboro published a study in 2009  (A Silver Lining? The Connection Between Gasoline Prices and Obesity) that found increases in gas prices were associated with an uptick in walking or bicycling and public transportation use (and more people walking to bus and subway stops) and a drop in the how often people eat at restaurants, all impacting weight. Courtemanche estimates that:

– A $1 rise in the price of gasoline would reduce overweight and obesity by 7% and 10% in the U.S. The reduction in obesity would save approximately 11,000 lives and $11 billion per year, savings that would offset 10% of the increased expenditures on gasoline.

– An 8% of the recent rise in obesity from 1979 to 2004 can be attributed to the decline in real gasoline prices during the period.

According to Dr. Brian Schwartz, professor at the Johns Hopkins Bloomberg School of Public Health’s Department of Environmental Health Sciences and co-director of the School’s Program on Global Sustainability and Health, cheap energy also is responsible for creating our built environment, which is exacerbating our poor health trends. Schwartz argues that since World War II, the United States and other developed countries “have invested in large tracts of low density, non-compact, single use developments, which are highly reliant on the automobile and often lack public transit options.  This type of housing and transportation system is totally reliant on cheap and plentiful oil.”

The built environment of U.S. suburbs has been shaped by the relatively cheap price of petroleum paid by U.S. consumers at the pump.

Schwartz argues the average foodstuff in the United States requires about 10 units of fossil fuel-based energy input for each unit of food energy derived from the food, and that ratio jumps to 100 to 1 for many meats. Less energy would lead to declines in food calories too, as many kinds of food would become too expensive to produce and too expensive for consumers. What’s more, Schwartz suggest that this unsustainable suburban lifestyle would change dramatically after peak oil, that future and historic moment when global production of both oil and natural gas reaches its historic peak and begins to decline, setting off chain reactions impacting every facet of our life to what we eat, how we work, how goods and people move about, and how nations respond on a massive scale. (Go here for a summary of peak oil and its health impacts, as explained by Schwartz.)

Schwartz also notes that our entire health care delivery system, on top of our suburban-sprawl development pattern, food production systems, and supply chains, also is tied to unsustainably cheap energy in the form of cheap fossil fuel. “Large energy-inefficient health care facilities are staffed by health care workers living in distant suburbs who require large quantities of paper, plastic, and electronics to do their work. Systems for provision of care will need to be completely redesigned to adapt to the new reality of more expensive energy.”

Portland, Ore., that oh-so progressive Northwest city that has become a beacon of contemporary planning that tries to vaguely resemble what they do in Netherlands or Denmark, for instance, already has assembled a Peak Oil Task Force, back in 2006. The group prepared a report and drafted a resolution, passed by the City Council in 2007. That resolution sets out an ambitious goal to “reduce oil and natural gas use in Portland by 50 percent in 25 years and take related actions to implement recommendations of the Peak Oil Task Force.” It may be no surprise Portland was recently ranked the No. 1 biking community in the United States.

What continues to baffle me is how unengaged or willfully silent the United States’ professional public health system is to the connection between cheap energy and health, notably obesity. I just did a keyword search today (Sept. 3, 2012) on the word “obesity” for the upcoming American Public Health Association (APHA) Annual Meeting and Exposition to be held in San Francisco in October 2012. There were 797 hits for the word–many for papers being presented on the topic. When I typed in the word “oil” I yielded 33 hits, some on the Deep Horizon oil spill and its impacts and others on shale gas development, such as a paper being presented by Dr. Roxana Witter of the University of Colorado called “Comprehending health implications of natural gas development through public health research.” But I saw no papers on any linkage between the so-called “obesygenic environment” and energy prices tagged under the word “oil” in the searchable database of presentations and papers. I did a search for the word “energy” and got 82 hits, but most related to topics like high-energy drinks, not on oil, gas, or energy policy issues impacting human health.

Seattle like other cities is entirely dependent on relatively cheap petroleum, and as a consequence suffers from some of the worst traffic congestion of any metro area in the country, as well as a sprawl development in the city and throughout surrounding King County.

I dream of the day when public health professionals will organize their advocacy less around what kids eat at school and talk more about what our state and national lawmakers are doing to create meaningful tax policy that prices energy–making it more expensive while using revenues to promote renewable energy sources–to create larger downstream impacts. To completely cede this issue to supporters of cheap energy and the status quo and to deny that there are serious public health implications by doing so is to turn one’s back on best available evidence and the duties those in the field have to promote healthy outcomes for the U.S. population.  I did try to raise this issue in one of my classes at the University of Washington School of Public Health, and was met with unusual silence. I hope one day perhaps UW faculty in the economics department, school of business, and schools of public health and public affairs get together one day to pursue research examing negative health impacts of national energy policy.

Walking and why it is the secret to longevity and happiness

This week, a physical education columnist with the New York Times named Gretchen Reynolds was all over the radio. In 48 hours I heard her interviewed by Terry Gross of Fresh Air  and then interviewed by the BBC World Service. She has published a book with a catchy title called The First Twenty Minutes. It appears to be catching fire.

I liked a lot of the things she was saying, and how she communicated. Reynolds is a communicator attempting to take peer-reviewed journal articles, which to nonscientists are impenetrable with graphs and meaningless numbers and confusing P values and unconnected to their lives, and make them fit into the larger problems this country faces with the obesity and overweight epidemic. I applaud her for calling attention to this problem that is bankrupting our medical system and leaving tens of millions of Americans unable to live more productive, happier lives.

I caught most of her interview with Gross, and while upbeat, I found some of the discussion on the health benefits of activities like standing up often while sitting to be out of touch with larger systemic issues causing the health crisis that led to two-thirds of this country to become obese or overweight.  Encouraging people to do minor things is not asking anything resembling sacrifice or commitment, which is what is required both in a personal sense and a larger policy sense. It is as if we have completely dumbed down all of our messaging to the lowest denominator. But then again, Reynolds is someone making a living as a writer and health expert — and selling a popular message as a product is critical to success.

Instead of the media talking to experts about whether 30 minutes of exercise is  good enough to keep us healthy, media should be talking about the primary reasons why people aren’t exercising—the overconsumption of TV and screen use, the built environment that promotes the utter dominance of the internal combustion engine, and the failure of each individual to take ownership for their health from the food they eat to how much they move their bodies. (And, yes, I know it is more complicated than this, especially for many minorities and lower-income Americans, but these factors matter a lot).

I was delighted, however, that Reynolds praised the health benefits of walking. She rightly called walking the single best exercise that exists on the planet and what humans are built for. She is right. It reduces your risk for heart disease and diabetes, and it apparently increases memory capacity in mammals (makes sense, blood flow stimulates oxygen and chemicals produced by the body to be delivered to the brain). As for me, there is no better exercise in the world than walking. A walk anywhere, anytime, in any weather, beats sitting on my butt and not walking at all. I feel healthy, happy, and more level-headed after a walk. I just wish more Americans could embrace walking and voted to support measures that promote walking – sidewalks in neighborhoods, parks and trails – and support politicians who want to change how we deal with public transportation funding in this country. Even one of the biggest promoters of lopsided transportation priorities, the car- and petroleum-friendly federal government, notes that a tiny sliver (0.7%) of federal transportation funds are spent on improving pedestrian facilities.

Maybe we need what Scotland has, the right to roam about in a responsible way (yeah Scotland).

Walking the Coastal Trail in Anchorage on a lovely summer night.

My favorite place to walk in Anchorage Alaska, along Westchester Lagoon.