Taking Charge of Your Health

[sound of marker on white board] DR. MIKE EVANS: Hi, I’m Dr.
Mike Evans and welcome to this visual lecture I’m calling,
“23 and a Half Hours”. So I have a big interest in
preventive medicine, you know, which can mean
a lot of things from, you know, cancer screening,
to eating more fibre, to having a good social
network and I — I mean that in the old sense of the word. Weighing less, drinking less,
smoking less, controlling your blood
pressure, cholesterol, and so on and so forth. So all these things are
incredibly important and I wouldn’t want you to
minimize your efforts in any one category. But I — I want to know
what comes first. What has the biggest
impact, what has the biggest
return on investment? [sound of cash register
ringing] What makes the biggest
difference to your health? So I did my research, and
I found an answer, at least for me. And it’s tricky ‘cause,
you know, all these things are sort of overlapping. But I picked out this
intervention and — because of its breadth. It worked for so many
different health problems, and that’s what I found
so cool about it. So just to kind of walk
you through a quick list, so this intervention in
patients with knee arthritis who received one hour of
treatment three times a week reduced their rates of pain and
disability by 47 per cent. In older patients it
reduced progression to dementia and Alzheimer’s
by around 50 per cent. For patients at high risk
of diabetes and coupled with other lifestyle interventions,
it reduced progression to Frank diabetes by 58 per cent. Post-menopausal woman who
had four hours a week of the treatment had a 41per
cent reduction in the risk of hip fracture. It reduced anxiety by 48 per
cent in a big meta-analysis. Patients suffering from
depression — 30 per cent were relieved with low
dose and that bumped to 47 per cent as we
increased the dose. Following over 10,000 Harvard
Alumni for over 12 years, those that had the
intervention had a 23 per cent lower risk of death than those
who didn’t get the treatment. It’s the number one treatment
of fatigue, and, of course, the kind of outcome of
choice or my favourite outcome is quality of life, which is
really all of the above, and really about making
your life better. And this treatment has
been shown over and over again to improve quality of life. So, the question is,
“What’s –- what’s the medicine?” And what is “23 and
a Half Hours”? So the medicine was
exercise, mostly walking. So not triathlons. And let me just put it
a different way. I think what I’m asking
you to do is if you think about your typical day, so
there’s 24 hours, and so you might spend
most of your day, you know, this varies obviously, but,
you know, couch surfing, sitting at work, obviously
sleeping, and what the evidence that I am going to show
you kind of tells me is the best thing you
can do for your health is to spend half an
hour being active, maybe an hour and that if
you can do that you can realize all the benefits I’ve described
in the previous slide. So let’s just take a quick walk
through some of the literature. So Stephen Blair, he is a
professor at the Arnold School of Public
Health at the University of South Carolina,
and he looked at this in what’s called the Aerobic
Centre Longitudinal Study which followed over 50,000
men and women over time. And along the left side of
this graph is something called Attributable Fractions
which is a kind of fancy word, but it’s the estimate of
the number of deaths in a population that
would have been avoided if that specific
risk factor had been erased. So for example, turning a
smoker into a non-smoker, or a couch potato into
a daily walker. And along the bottom is
the typical risk factors. You can see the hypertension’s
incredibly important, and so on and so forth. But the one that was most
–- that kind of applied the most risk was this sort of
mysterious CRF which is Cardio-Respiratory Fitness
which is really low fitness. So low fitness was the
strongest predictor of death. And this is important. Most of the trails we see, to be
honest, are funded by Pharma, or other companies because
they’ve got a drug for hypertension or high
cholesterol or diabetes. And we rarely see fitness
thrown in to the mix. And so it’s nice to see a
trial that’s not so siloed. [sound of bicycle bell] Blair’s work is interesting. He also did another trial
looking at obesity. What he found was, you
know, sort of two things. One is obesity and no exercise –
that’s a very bad combination and that’s where we saw many
of the negative consequences of obesity from a
health point of view. But if the –- if the obese
person was active, even if they didn’t have
the weight loss, but were just active and
obese, that was much, much better and that the
exercise ameliorated much of the negative
consequences of obesity. So if exercise is the
medicine, what’s the dose? So when I think of dose,
I think of how long, how often and how intense? I’m going to give you a
slightly mixed message, but essentially, more
activity is better. But I must say the rate of
return seems to decline after 20 or 30 minutes a
day so if you’re being active less than 150 minutes a
week or more if you’re a kid — an hour a
day if you are a kid, my flag goes up in the clinic. So my personal take on
this is that, you know, the literature draws
a very broad brush and so we see big
differences when somebody goes from not doing
anything to doing something. And after that the return
is more granular. So if we took the nurse’s health
study, women who went from zero activity to just
one hour a week, reduced their heart disease
rates by almost half. So you can break it down
so it can be 10 minutes, 10 minutes, 10 minutes if
you want to do 30 minutes of exercise so it can be
broken into three. Higher intensity — it
looks like it’s equivalent to less time with
lower intensity. But I think obviously the
clinical pearl is mostly of thinking about your style and
habits and your personal cues. So if you’re only going to
do it if it is pre-booked with friends, you know,
I’ve couples who take a half hour walk every
morning or evening to organize their life. A dog is a great walking coach. [sound of dog barking] The data’s showing
67 per cent of dog walkers achieve the 150 minutes a
week just with the dog walking. And finally, of course,
your commute. You know, getting off a
stop early, taking the stairs, and so on and so forth. So thinking about that, I’m
just going to walk you through some quick slices
of the literature. And the first one
comes from Japan. In the 90s, Japan required
all employers to conduct annual health screenings
for their employees. And so a large gas company
in Japan called Osaka used this to answer
a great question. So if people’s walk to
work was longer, did that reduce their chance
of serious health problems? So in this example,
high blood pressure. And what they found is under 10
minute walk, no difference; 11 to 20 minute walk,
12 per cent reduction in rates of high blood
pressure or hypertension; and over 21 minute walk,
a 29 per cent decrease in rates of high blood pressure. So the authors calculated
that for every increase of 10 minutes in your walk to
work there was a 12 per cent reduction in the likelihood of
getting high blood pressure. The second exhibit is
looking at stents. So this is something we
commonly do now in medicine. So you can see on the left
that the artery is blocked; on the right, a vascular surgeon
has gone in and put a balloon, open it up and left
a stent to keep it open, which makes great sense. So a German researcher
named Rainer Hambrecht looked at this with about
100 cardiac patients. He got half the group to
exercise and by that I mean 20 minutes a day on
an exercise bicycle and then a once weekly 60
minute aerobics class. And the other half got the
high tech stent and just sort of normal activity. And after one year, 88 per
cent of the exercisers were event-free compared
to 70 per cent of the people that got a stent. So both worked, but I find it,
you know, sort of incredible that the low tech made a
bigger difference. And you have to remember
that the stent just fixes one part of the heart. The next way to think
about it is the reverse, so what I call
“sitting disease”. We know that being sedentary
is bad for your health but a researcher
named Leonard Veerman wanted to quantify this
and he did so down in Australia in a big study
that he did there. They found comparative
persons who watched no TV; those that spent a lifetime
average of six hours a day watching TV can expect to
live about five years less. I mean that’s incredible. But then I think, “Oh, who
watches 6 hours of TV?” It turns out the average
adult in the USA spends about five hours a day
watching TV or screens. So I find this fascinating
that we never think of the TV as something that’s bad
for our health, but clearly it’s as powerful
as many other risk factors for chronic disease. So I’m just going to
leave you with, well, I guess, two quotes. So one is Jerry Garcia, the
singer who is the lead singer for The Grateful
Dead, and he said, “Somebody has to do something. It’s just incredibly pathetic
that it has to be us”. And I think that’s true, that
in some ways it has to be us. As Hippocrates said, “Walking
is man’s best medicine”. And so I’m going to finish
by asking you a question. And this may have some
personal challenges for you, so you know, you
might be very busy with work or kids or both and
— or you may be in pain or have other priorities,
but my question to you is, “Can you limit your
sitting and sleeping to just 23 and a half hours a day?” So, something to think about. Thank you very much. [sound of marker on white board]

100 thoughts on “23 and 1/2 hours: What is the single best thing we can do for our health?

  1. Love this video. The focus of this video is really physical activity: "any bodily movement produced by skeletal muscles that requires energy expenditure" (WHO). Exercise: activity requiring physical effort, carried out especially to sustain or improve health and fitness. I think of exercise as a planned, repetitive activity, where physical activity is just raking leaves or walking the dog, but could include jogging. Perhaps it is just semantics.

  2. "Can you limit your sitting and sleeping to 23 1/2 hours per day?" Nope, physically impossible. Great video and does encourage getting more active, but the walking focus leaves out the millions of people in wheelchairs.

  3. I love videos like this. It really helps people with ADHD (me) pay attention. Really informative and creative. Thanks for the info Doc

  4. WOW an Excellent Common Sense White Board Lecture.  The best part – he's not selling anything.  So its your life, you decide if its worth 10 minutes of your time to change your life expectancy.

  5. This is awesome, not only living longer, but with better quality of life…I am living proof of this with the evidence based practice theory. Long story short, I am physically fit, and four years ago my heart stopped, after resuscitation and a trip to the cath lab and stent placement I live to tell my story.  If I had not been physically fit I would have died that day and not be revivable.

  6. The Japanese are generally much healthier than other people in the world because they walk everywhere, stand during meetings, etc., even though they (as a country) rarely go to the gym.

  7. I found it pretty ironic that we're obviously all watching this from our computers/tablets/phones as well as probably all slouched on our comfortable couches

  8. I train MMA and usually log about 4 hours a day – lifting, circuit training, and technique training. But, I also work from home and sometimes I will have to forgo training from 3 days to a week for really intense deadline pressures that have me sitting at my desk the whole time for up to 12 to 15 hours straight. When this happens, I've found the best thing to do is set a timer for 45 minutes. I work for 45 minutes, then take a 10 minute break where I pound out 20 pushups, 20 pullups, 20 situps, 20 squats, and 1 minute of shadow boxing. 

    ANYBODY can do something like that if they have a desk job. Just take 10 minutes, do some jumping jacks, do a few pushups, then back to work. 

  9. Hope you do not mind, but I have taken a few SoundBites from this video, printed them on A4, and plan to post them in the waiting room of the family practice I work in.

  10. I love this video. I am studying Exercise and Disease Prevention and my Prof recommended watching this video in the first lecture. Such a good video.

  11. Anne Brewitt
    2 weeks ago (edited)
    Brilliant, this is so true. Just watched the video and a few others. He certainly does know what he is talking about.

  12. is not the couch or the tv, I work 40 hours a week or more, I go school taking 3 classes, i have to do homework and i have 2 kids, who is going to have time to exercise?

  13. It's statistics. I've always been very active, skinny and healthy eating. But when I hit the 50s I got the high blood pressure.

  14. Oh hai!Did you ever try – Minkunus Acne Recovery Plan (search on google)? Ive heard some awesome things about it and my friend got great clear skin from it. 

  15. Oh my goodness. This really frightened me. I spend hours in front of my laptop. I always mean to go walking and I am never motivated to go. I am overweight. I have hypertension and high cholesterol both kept in check with medication.
    OK I am inspired now. I want to be around for many more years.

  16. The single best video on YouTube, this video must be shared amongst all family and friends regularly and shown in all schools.  I have not seen a video that puts it message across as well as this one, it does it in a low key non-aggressive manner but demands to be taken seriously with the thought that has gone into the presentation style and content.  Just amazing. 

  17. Oddly enough, I got here due to the Mysterious Mr. Enter's Heart of Ice video he did. Still, he does speak the truth here…

  18. Very Good knowledge, thanks You!

    I also don't believe in any unnatural things!

    I reduced 12 lbs by just drinking 8 glasses of normal water/day and with the help of my tracking smartphone app "water meters" by lokesh.

  19. Great video. I prefer telling people to move 2.5 miles everyday. I walk it in about 45 minutes.

    The big thing is that adults have to train every day. We have to get away from the Mon Wed Fri thing. Even with weight lifting adults should lift aerobically … Every day

  20. Walking is too little exercise for me. It just doesn't get my heart rate up and makes little difference to my energy levels. I'd say MOST people easily get 30 minutes a day just by walking to work, lunch, etc but people should run or some shit if they want to make a difference

  21. This is wonderful, thank you! Are there any versions of your work in Spanish?? – in particular related to the benefits of exercise? Would really love to share with a Spanish-speaking group. Thank you.

  22. I think I can definitely limit by sitting and being sedentary to 23 and 1/2 hours a day! Thank you for all of this useful information, Dr. Evans!

  23. very true, the bad thing is that schools aren't doing much to promote this. We need to get the kids started early to enjoy doing it for the rest of their lives. 

  24. Am I the only one that was in awe of the awesome illustration the whole time? Puts a person with suckish drawing and handwriting ability to shame 🙁

  25. Thanks Mike..Trouble is , we dont live in jungles anymore …forget the couch and TV …many of our jobs promote sedentary lifestyle…we just have to take an hour out everyday and walk, swim, bike and run. I am 62 and I swim every summer in our community pool ..Thanks Mike

  26. That's all fine but who is keeping track of the pollution in our water supply or toxins in all our foods and wrappers they come with.  Surely these toxins reduce lifespan and quality of life yet I rarely hear much about them or opportunities to fix them.  Corporations and doctors like to make this huge deal about personal vices and exercise but never talk about reducing their companies pollution or taking responsibility for the consequences. In fact the corporations and government have start fracking inside the United States with toxic chemicals that have already made people sick.

  27. I like the way you said 23 and a half hours of sitting. Instead of walk 30 minutes a day, makes that 1 hour walk seem like a breeze

  28. This is fantastic and greatly appreciated!  I shared it on my facebook page and hope more MDs get on the social media train and help educate our country in preventative health!  Thank you so much!

  29. Anyone have any advice as to how to handle the harassment from people on the street whenever I leave my home for a walk.  Im talking the following your for blocks, yelling at you for a half hour kind of harassment.

  30. Absolutely agree with this 🙂 Said while sitting on my butt infront of youtube, facebook and the television! 😀 
    In saying that was up at 6 this morning and going out at 6pm tonight so nearly 2hrs exercise ftw!

  31. Love this info, and it is so true! I've always loved walking anyways…but now I've been walking even more after reading/viewing this video…thank you so much! Gonna share this one on my Facebook!!!

  32. On the days when I do not want to exercise, I watch this again…. and then I get moving.  Thank you for helping many of us to gradually change our lifestyles.

  33. I found this video very helpful, in the sense that I can use a thirty minute per day exercise regimen to combat any illnesses that I have now. It is also a good way to prevent early death. I have a dog, whom I walk every day in the cooler months of South Texas, but when it is hot, like it is now, I slack. But there are many solutions, some of which are mentioned in this wonderful video. I personally park in a farther parking spot most times so I can get some extra walking in their. Thank you for posting.

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