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Exercise or Nutrition??

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Which is more important – Exercise or Nutrition??

I have had a long interest in the topic of “Exercise is Medicine”.  The message of the importance of exercise or just moving cannot be overemphasized.  There is no doubt that our country and most developed countries need to be more physically active.  The promotion of exercise and physical activity on a daily basis should be a prominent part of our daily interactions with our patients.  To avoid counseling our patients daily on the importance of moving is poor medicine and some have suggested unethical. 

In addition, during the last couple decades, I have had more interest in nutrition than the average physician.  This started with sports nutrition and hydration, but over the last few years I really looked at eating for health in a more global sense.  So much of this epidemic of obesity, chronic disease and associated disability has a strong relationship to our diet.  As many others have said, “you can’t outrun a bad diet or your fork”!

What has really piqued my interest recently is the series of back and forth editorials in the British Journal of Sports Medicine.  Drs. Malhotra, Noakes and Phinney started this off with, “It is time to bust the myth of physical activity and obesity: you cannot outrun a bad diet”.  They briefly acknowledge that exercise is important in CV disease, Type 2 Diabetes, Dementia and Cancer but dismiss any significant role in our obesity epidemic.  They cite The Lancet global burden of disease report stating that poor diet generates more disease than physical activity, alcohol and smoking combined. Their main premise seemed to be that sugar and carbohydrates are a main cause of the obesity pandemic and the food industry has been misleading – they want to remove the “health halo” legitimization of nutritionally deficient food products. 

This was followed by Dr. Steve Blair’s editorial who respectfully disagreed with much of the Malhotra editorial.  He cites literature, which he feels, indicates that the decline of energy expenditure is the critical contributor to the obesity epidemic, not what we eat.  That same monthly edition of the BJSM includes another editorial by Dr. Mahtani, et al who reviewed exercise and obesity data even further.  They concluded that yes, diet alone was better than exercise alone in the obese patient, but the most impressive changes with obesity occur when diet and exercise are used together.  In addition, multiple health risk factors improve with our patients who exercise regardless of weight loss.  As an aside, there are accusations and concerns about biases and other influences from both of these groups.  This makes it all the more fascinating to me – I have followed the work/research/writing of both Dr. Blair and Dr. Noakes for years and find it very interesting.

So which is it – “Exercise is Medicine” or “Nutrition is Medicine”?  Interestingly, if we go back to the Father of Medicine more than 2400 years ago, Hippocrates, he had some great Lifestyle Medicine advice for us.  ‘‘Eating alone will not keep a man well; he must also take exercise. For food and exercise work together to produce health”.

This is clearly my bias; we need to encourage and promote both physical activity and healthy nutrition choices in our patients.  This should be done on a personal basis with our patients as well as becoming a major part of our health care systems.   So my take is this – Let’s all look at the big picture and appreciate the importance of both exercise and nutrition in the treatment and prevention of so many chronic diseases that plague our world and move to change that fact!

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References:

1.              Malhotra A, Noakes T, Phinney S. It is time to bust the myth of physical activity and obesity: you cannot outrun a bad diet. Br J Sports Med 2015; 49:967-968

2.              Blair SN. Physical inactivity and obesity is not a myth. Br J Sports Medicine 2015; 49:968-9.

3.              Mahtani KR, McManus J, Nunan D.  Physical activity and obesity editorial: is exercise pointless or was it a pointless exercise? Br J Sports Med 2015; 49:969-970.