To demonstrate how fitness does not necessarily equate to health.
2. Intended Audience
The general public.
3. Introduction
It is often assumed that people who are cardiovascularly fit are also healthy. Indeed, those who wish to attain greater health will run, cycle, swim or row, further and further as a gauge of how fit they are and therefore how healthy they feel. In following this logic it would make sense to conclude that endurance athletes are the healthiest people on the planet, almost indestructible. In the 70's for example it was believed by some that marathon running was the antidote to heart disease [1]. However, this would not appear to be the case at all; in fact, what we see are some very unhealthy, injury and illness prone individuals. In the following article I present the evidence to demonstrate that fitness and health do not by default, go hand in hand.
4. What exactly is fitness?
If you look up the definition of fitness on Google you will find various options. One of them directly links fitness to a state of "being healthy". However, I prefer the following definition.
"the quality of being suitable to fulfil a particular role or task"
I use this because fitness is really about being fit for purpose. Fitness is about achieving a goal; a faster run time or lifting a heavier weight. Often improving health is the initial goal for people. However, in order to achieve this they set another goal, like run a half marathon or complete a 100km cycle. This is because over the years we have merged the terms fitness and health to be used interchangeably to mean the same thing. By changing the focus of the training from "health" to "100km cycle" that is what you are now training for, a "100km cycle" not "health". As such we take man made supplements to aid recovery and performance, place ourselves on a machine which uses our bodies in a completely un-natural way, put excessive mileage through our joints to train for the event and so on. Indeed your fitness will improve as you will be better at fulfilling the task of "100km cycle", but not necessarily your health. Your knees are now killing you, your back is aching (as you have stressed your intervertebral discs) and your hamstrings and hip flexors have shortened placing you into faulty postures, increasing risks of future injuries.
5. So what is health then?
The World Health Organisation (WHO) defines it as the following:
"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"[2]
There are many who don't like this definition for various reasons, however, it is still one of the widest and most recognised definitions of health. There are many others but the overarching message from all of them is that the physical aspect is but a component of health as a whole. Further more fitness is but a component of physical health, along with diet and being free from injury. In summary, health is so much more than fitness alone.
6. But how can being fit possibly be bad for my health?
Now that we understand exactly what health and fitness mean we can explore how fitness can be bad for our health. Below are some common conditions afflicting those who are considered to be fit and therefore "healthy" individuals.
a. Over training syndrome (OTS). It has many names; burn out, chronic fatigue, staleness [3], in fact researchers are still deciding exactly what OTS is, the way it comes about and how best to prevent it. What is known, however, is that it is more then just feeling a little run down from training too much. It is an all encompassing condition affecting the psychological (mental), endocrinological (hormonal), neurological (nervous) and immunological (immune) health of the individual often for months or more. In some cases it can lead to the end of sporting careers [4]. It is also known that the condition comes about (as the name suggests) primarily when excessive training is combined with a lack of suitable recovery time [3],[4],[8].
b. Over use injuries and traumatic injuries[12]. The list of different overuse and traumatic injuries brought about by sports and physical pursuits is vast. All types of fractures, tendonopathies, fascial conditions, muscle tears, compartment syndrome, concussions, other head trauma, infections, contusions, lacerations and so on occur on a regular basis (if it didn't I would be out of a job!). As per our definition of health and for that matter fitness, when you are injured you are not healthy ("complete physical...wellbeing") and you are not fit ("suitable to fulfil particular role or task"). In nature we would go out of our way to avoid injury because if we were injured we would be a burden to the rest of our tribe (family) and therefore place the tribe at risk. In short we would decrease our probability of survival. However, because of modern advances in healthcare (penicillin, surgical procedures, prosthetics) and the fact that we no longer physically work to get our food, we think nothing of throwing our bodies around and picking up injuries. We simply get the correct professionals to put us back together again. Even replacing broken body parts with new ones!!
c. The Female Athlete Triad. Menstrual Dysfunction, low energy availability (with or with out an eating disorder) and low Bone Mineral Density (BMD) can occur together in female athletes as a triad [5],[9]. It is not a common condition. However, some sports, especially those promoting leanness or body conformation (ballet, gymnastics, long distance running), the prevalence of these conditions increases significantly; 69%, 47% and 23-50% respectively [5]. This can have serious affects on the individuals cardiovascular health, immune system, increased likelihood of stress fractures and increased mortality rate among other issues [5].
d. Decreased cardiovascular health. It has been shown that excessive cardiovascular training, far from improving you health, can have some very serious detrimental affects. O'Keefe et al, 2012, [6] found that excessive endurance exercise had various negative effects on cardiovascular health.
"on the basis of animal and human data, CV benefits of vigorous aerobic ET (endurance training) appear to accrue in a dose-dependent fashion up to about 1 hour daily, beyond which further exertion produces diminishing returns and may even cause adverse CV (cardiovascular) effects in some individuals."
For example they have found increased troponin levels in the blood during and directly after marathons in up to 50% of the competitors. The reason this is significant is that when troponin is found in the blood stream it only means one thing, damage to the muscle of the heart. This in turn can lead to fibrosis (scarring) in the heart. This scarring also has a positive correlation with Coronary Heart Disease (CHD).
These are but a few of the ways in which exercise can harm us. Drug use, social and psychological factors also have a large effect on those in pursuit of increasing fitness.
6. Training for health rather than fitness.
It could be said that moderation is the key. However, it is not as simple as this. Whether you are excessive in your exercise or not there are many activities we take part in which we are simply not designed to do. The effect is increased risk of injury and therefore decreased health[11], [12].
So how do I train for health and not fitness? O'Keefe, et al, 2011 [7], put forward a basic outline of the kinds of activities and approach, which I have summarised below:
a. Walk and carry loads for 3 - 10miles, daily. Park away from the entrance to the supermarket, use shopping baskets not trolleys, get off the bus one stop early and so on.
b. A day of high intensity exercise should be followed by a day of low intensity exercise.
c. When walking or running it should ideally be done on softer surfaces not on hard tarmac and pavements. It should also be in barefoot or at least in less restrictive minimalist shoes.
d. Interval training once or twice a week. Pushing from low - moderate exercise into moderate - high intensity exercise.
e. Cross train. By this I don't mean cross fit directly or the ski type machines in gyms. This refers to conducting a wide range of activities involving both strength, flexibility and cardio. It is advised that strength training should be done at least twice a week as our ancestors spent a lot of time carrying loads, where as we now have machines to do that for us.
f. Maintain a lean body mass to reduce weight on the joints.
g. GET OUTSIDE!! This will help the body produce vitamin D through exposure to the sun, improve mood and facilitate better compliance with an exercise programme. There is also much data to suggest that outdoor activities are far better at stimulating brain development. See the following link to my blog article - Health Body, Healthy Mind.
h. Train with a partner or group. All of our foraging and hunting would have been conducted as a pair or small group depending on the activity. As such it has been shown that these group activities greatly boost adherence to a program and has far reaching psychosocial benefits for mental health.
i. Exercise with a dog. Sounds slightly strange however, it is known that our two species co-evolved for many years. It is well known that therapy dogs can have dramatic benefits on the health of those recovering in hospitals. It is also hypothesised that we likely hunted in a co-operative manner. Anecdotally I find something very primal about running with one or more dogs and in general they seem to be more responsive when running with you, like they are almost tuning in to you.
j. Dancing. Lose your inhibitions and get on the floor. Our ancestors would regularly dance for extended periods. It promotes social bonds, elevates heart rates and its enjoyable (for most people any way).
k. Sex. Regular sex (twice a week) can be extremely beneficial. Among other things, it has been shown to reduce mortality rates, reduce the risk of cardiovascular disease, increase bone density (no crude jokes please), improve mood and improve psychological wellbeing.
l. Plentiful rest and relaxation especially following physical activity. This is vital for the body to recovery, repair and improve following exercise.
7. Conclusion
In no way is this article trying to say that all exercise and physical activity is bad for you or that you should stop taking part in the sports you love. This is clearly not the case. It is rather a question of intensity[10]. Yes, we are designed to be active every day, however, we are not supposed to be exercising at high intensities every single day. We are evolved to alternate between high intensity days and low intensity days. This way you allow the body time to recover and make the appropriate adaptations.
You also have to ask yourself, "what am I training for and why?" If you want to be an Olympic marathon runner then go for it. The goal of these individuals is to achieve elite performance and will do whatever it takes to achieve it. Often this entails putting their health at risk by way of over training, psychological pressures, injury and drug abuse[13]. If your goal is "health" however, then a global approach focusing on the mental, spiritual and physical activities is far more effective than simply running till you drop!!
All the best
Gregory Hunt
References
1. Bassler T.J. Marathon running and immunity to atherosclerosis. Ann N Y Acad Sci. 1977;301:579-92.
http://www.ncbi.nlm.nih.gov/pubmed/270939
2. Official Records of the World Health Organization, no. 2, p. 100. 22 July 1946.
http://www.who.int/about/definition/en/print.html
3. Brooks K.A., Carter J.G. Overtraining, Exercise, and Adrenal Insufficiency. J Nov Physiother. 2013 February 16; 3(125): 11717.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648788/
