Archeologists now believe our very active ancestors helped speed the extinction of the giant sloth in the American Southwest. Is our new state of sloth going to lead us down the sloth track?/Science

Exercise, the medicine most Americans refuse

Nearly 1.17 million Americans are now reported dead of Covid-19, and yet most of those still living seem to have missed what should have been the main message of the now-fading pandemic: Exercise is medicine.

Motor-vehicle traffic counts are up all across the country, indicating people are back to being moved almost everywhere by machinery instead of moving themselves with their muscles.

And if the urban trails of Alaska’s largest city are any indication, it would appear an increasing number of Americans are getting their “exercise” by riding some sort of new motorized device – Onewheels, Nextboards, e-dirt bikes, electric scooters. Outriders and, of course, e-bikes, which started life as electric-motor-assisted bicycles but some of which now come with throttles like those on motorcycles to enable them to as one company puts it, “bring you more of what’s out there without breaking a sweat.”

Unfortunately, exercise is pretty much all about breaking a sweat, and the pandemic should only have underlined the importance of doing so.

Homo sapiens spent a couple hundred thousand years or more evolving as highly active mammals, not sedentary ones.

Ten thousand to 15,000 years ago, archeologists now believe, our ancestors were chasing down giant sloths capable of walking upright across the American Southwest.

We ran them down and killed them with our primitive, early technology and the sloths eventually went extinct. Then we let the increasingly sophisticated technologies that followed turn us into the new sloths.

It is more than a little ironic that at a time when some thought leaders are worrying about how artificial intelligence (AI) might be the ongoing of our species, no one seems to have noticed how we decades ago turned our backs on our long evolutionary history and let machines dictate how we would build our cities and spend our time as if there would be no consequences to a sudden change from active creature to sedentary one.

Cardiovascular disease (CVD) – the nation’s number one pre-pandemic killer and the country’s leading cause of death since 1950 – should have been the wake-up call. It was linked to a lack of exercise long before the pandemic, but CVD was easy to ignore because of the slowly progressive onset of the disease.

Many of its victims spent years thinking “I’m happy and comfortable sitting on my ass watching the TV now, and I’ll worry about CVD when I have to worry about it.”

Covid-19, an infectious viral disease, was different in that people could catch it one day, find themselves seriously sick days later, and sometimes be dead within a couple of weeks if they were among the old, the already immune compromised, or the seriously unfit. 

One would have thought this frighteningly new pattern of death might have awoken the masses to the realization that the disease driven by the newly evolved  SARS-CoV-2 virus that spread out of China in early 2020 was no equal opportunity killer.

It mainly killed the unfit and the old – some of whom could at least blame immunosenescence, the decay of the immune system with age.

Lessons unlearned

If nothing else, the pandemic should have taught Americans a lot about immunosenescence and so-called “T-cells”.

T-cells evolved over the millennium as the natural defense against new infectious diseases in homo sapiens. Immunosesnesene evolved alongside them to rid the human population of the old to make room for the young, and of the sloth-like because in the subsistence world of yesteryear, anyone who wasn’t working hard all the time to keep the tribe alive was a liability.

The leaders of the world’s late-arriving Christian religion would later come to think of “sloth,” a synonym for laziness, as one of the “deadly sins.”

Little could they know that most of us were destined to become sinners. Many of the most sloth-like in this country are now, of course, dead. They paid the ultimate price during the pandemic by lounging around and letting their evolutionarily sophisticated immune system decay.

What was learned early on in the pandemic was that the physically fit were able to put up a robust, natural T-cell defense against SARS-CoV-2. These were the people who either never appeared to be infected – the so-called “asymptomatic” cases – or suffered only a minor form of the disease.

The vaccines which were eventually developed to help more of the unfit avoid severe Covid-19 were little more than crutches for weak T-cells.

“Current COVID-19 vaccines elicit robust T-cell responses that likely contribute to remarkable protection against hospitalization or death, and novel or heterologous regimens offer the potential to further enhance cellular responses,” a peer-reviewed study in Nature Immunology reported more than a year ago. “T-cell immunity plays a central role in the control of SARS-CoV-2 and its importance may have been relatively underestimated thus far.”

T-cell importance is no longer underestimated, and there is among the knowledgable a new respect for the connections between T-cells, immunosenescence and exercise and their importance.

Immunoseensescne starts almost as soon as one enters adult life, but researchers years ago discovered that the rate at which it progresses is tied to exercise and diet, as a peer-reviewed study published in  “Seminars in Immunopathology”  in 2020 notes.

“Though this phenomenon is often seen in aged individuals, it is also possible in younger adults as it could be ‘accelerated immunosenescence’, especially for T cells, as shown in Cytomegalovirus and HIV seropositive young patients,” researchers wrote there. 

The good news for most people, or what should have been the good news, is that immunosenescence can be slowed and to some degree even reversed with exercise.

Researchers publishing in the peer-reviewed journal “Mechanisms of Aging and Development” in 1999 reported that when a group of sedentary, older Americans with an average age of 65 were put on a monitored exercise program they showed “nominal increases in some measures of immune function….”

The broader picture

The most up-to-date meta-analysis of all the research in this area, published in the peer-reviewed journal of Experimental Gerontology in 2021, concluded that the “newly available data in the field of exercise immunology provides additional evidence for the effect of exercise on immunosenescence-related cellular markers.

“Importantly, this review provides evidence for the effect of long-term exercise on senescent T-lymphocytes in older adults. Additionally, newly retrieved evidence shows an acute exercise-induced mobilization of naïve and memory cells in older adults.

“In general, data regarding long-term exercise-induced effects in older adults remain scarce. (But) noteworthy was the high number of articles describing exercise-induced effects on regulatory T-cells.”

By the time that study was published, the real-world connection between Covid-19 and an exercise had already been made. A full year earlier researchers in the United Kingdom examined”Biobank” data on 400,000 walkers and found big differences in Covid-19 severity linked to walking pace.

Walking pace is a general measure of fitness. The fit walk faster than the unfit, and what the Brits found was that the “slow walkers” were nearly two-and-a-half times more like to be stricken with severe Covid-19 than “brisk walkers” and nearly four times more likely to die.

Subsequent studies have only reinforced this link between Covid-19 and fitness both as to the immediate consequences of being infected by the SARS-CoV-2 – those being severe Covid-19 and death – to the long-term consequences – those being “post–COVID-19 condition” or what most people now just call “long Covid.”

Physical fitness has been clearly shown to be far more protective against severe Covid-19 than the masks Americans were for a time ordered to wear.

Masks may or may not have helped prevent some infections, the jury is still out on that subject. But the only thing that can be definitely said about masks at this time is that they made the believers in masks feel better.

There might be some value to that. Belief has been shown to boost the placebo effect, which has been shown to be powerful in dealing with all sorts of human ailments.

It is likely the placebo effect helped as many people deal with a Covid-19 infection as the nocebo effect, the opposite of the placebo, was shown to cause people to suffer Covid-19-like symptoms even though they weren’t infected. 

These sorts of mind-body connections are something about which we still know little.

Unfortunately, there is no known exercise-related placebo effect. Scientists have yet to find a to way gain the benefits of exercise by just thinking about exercise.

The sloth-like American

“Each week adults need 150 minutes of moderate-intensity physical activity and 2 days of muscle strengthening activity,” according to the Centers for Disease Control, which apparently doesn’t believe the average American is up to this challenge.

“We know 150 minutes of physical activity each week sounds like a lot,” the CDC added, “but you don’t have to do it all at once.”

Let’s be clear here: 150 minutes a week of exercise is not “a lot.”

Do the math. This is a little less than 21 minutes and 26 seconds per day. Some people spend more time in the bathroom every day.

According to the people in the business of selling television advertising, the average American spent more than 10 times longer – 294 minutes per day to be exact – watching TV in the last quarter of 2022.

The website Marketing Charts also notes there were some differences among Americans in average viewing times: “Black adults spent an average of 3 hours and 42 minutes per day watching live TV (in 2021), more than double the amount of time spent by Hispanic adults (1 hour and 42 minutes) and about triple that of Asian-American adults (1 hour and 15 minutes per day).”

These differences are interesting in relation to Covid-19 deaths.

The “Color of Coronavirus” project being run by the APM Research Lab reports that as of June 27 of this year the once varying rates of death among American blacks, whites and Pacific islanders have now balanced out at roughly 380 per 100,000.

The Latino (Hispanic) rate, however, is at 279 per 100,000, and the  Asian rate is even lower at 183 per 100,000.

Could there be a connection between the shorter times spent sitting in front of the tube and the lower death rates?

Such a connection would appear highly likely given a peer-reviewed and widely covered study from 2018 wherein the American Journal of Epidemiology reported that “prolonged leisure-time sitting was associated with higher risk of mortality from all causes, cardiovascular disease (including coronary heart disease and stroke-specific mortality), cancer, diabetes, kidney disease, suicide, chronic obstructive pulmonary disease, pneumonitis due to solids and liquids, liver, peptic ulcer and other digestive disease, Parkinson disease, Alzheimer disease, nervous disorders, and musculoskeletal disorders.”

Covid-19 should now probably be added to that list sitting-related diseases, but you’re unlikely to find those involved in  American “health care” suggesting so because “health care” in this country isn’t about health, it’s about medicine.

And the medical business in this country – which now accounts for almost 18 percent of the nation’s gross national products (GDP) and ranks number one on Investopedia’s list of industries “driving the U.S. economy” – is all about selling services and drugs.

It has no financial incentive to push exercise as medicine given you can exercise for free. In fact, the American “health care system,” as it prefers to brand itself, has a disincentive to push exercise as medicine because this health care system loses money on the healthy.

Better to order people vaccinated, which made nice profits for the big pharma part of the health industry, than to tell people to get off the couch; get out in the clean, open air; and exercise to protect themselves from Covid-19.

Yes, there are individual exceptions. Some physicians do push healthy lifestyles, and the Alaska Department of Health and Social Service, to its credit, ran some TV spots since the pandemic began urging people to exercise.

The federal government, on the other hand, seems to have its head deep in the sand.

When the Government Accountability Office (GAO) earlier this month released its recommendations on how to “Help Federal Agencies Better Prepare for Future Public Health Emergencies,” the word “exercise” was nowhere to be found in the 38-page report though the biggest thing that could be done to prepare for the next pandemic is to create a healthier population of citizens in a country that is now unhealthy.

The CDC says more than half of Americans – 53.1 percent to be exact – fail to meet that minimum, 150-minute requirement for weekly aerobic exercise.

Forget the now documented Covid-protective differences between slow walkers and brisk walkers. America’s problem is that a lot of people aren’t walking at all, let alone engaging in more strenuous forms of exercise.

Failed attempts

Former First Lady Michele Obama did try to do something about this with her “Let’s Move” campaign tied to the National Football League’s (NFL) “Play 60” promotion.

The messaging was misguided in that the issue isn’t about play, it’s about survival.

“Get Moving or Die,” might have been a better pitch.

“Play” is a particularly bad angle.  Play is what children do or once did. There was a time when they didn’t have to be told to play because they ran wild through the neighborhoods around their homes for fun.

Now, parents don’t want to let them out of the yard for fear they’ll be run over by the motor vehicles that have taken over American neighborhoods, and even if they were turned loose all the fences in some neighborhoods would make it impossible for them to run through neighborhoods.

And “play” at the adult level sounds to many like “goofing off.”

As a reporter at the Anchorage Daily News long ago, I tried to talk Alaska Supreme Court Justice Robert Eastaugh, a serious amateur athlete, into letting me profile him as such for the newspaper as an example for others.

He was at the time out-running people half his age in Alaska 10-kilometer foot races and performing equally well in bike races. He, however, refused to participate in a story about his highly active lifestyle because he didn’t think it would look dignified for a judge to be seen so deeply involved in getting sweaty engaging in what some might consider “play.”

I could understand. I was then spending most of my lunch hours in the ADN’s one-room, fitness area either on the stationary bike to boost the endorphins that made tolerable the pain from a badly messed up back or on the treadmill when the back permitted.

And I was regularly razzed by a co-worker or two wanting to know if I was on a “sports scholarship” at the newspaper. It wouldn’t have been quite as irritating if the work output of the biggest smartass of them all had been producing copy at a level at least half that of mine.

Sadly, this idea that exercise is a waste of valuable time has been a common theme in many American workplaces despite a wealth of data showing that physically fit workers are more productive workers.

What the data says appears to be known by many, too.

A 2020 study of attitude to exercise at work found that “benefits were anticipated by managers and employees for both employees themselves and the organization and included improved mental health, productivity and more favorable perceptions of the employer.

But the problem for businesses as for individuals appears to have come in acting on the data.

The same study added that “despite these widely acknowledged benefits, significant barriers were identified and included the structure and nature of the working day, workplace culture and norms (resentment from colleagues, no break culture) and organizational concerns (cost of lost time, public perceptions).”

The study concluded that nothing was likely to change until workplace cultures changed, and the same can now probably be said for American society in general.

It’s easy to talk about – even for the right and left to agree on – how Americans would be healthier if they exercised more, but at the end of the day the nation’s political leaders really don’t want to do anything to make that happen because any public effort aimed at edging people toward more physical activity – for instance, improving bicycle infrastructure to get more people cycle or slowing traffic on residential and urban streets so people feel it is safe to walk along them – runs into political blowback.

American motorists – see motonormativity – rebel at the idea of anything they think might interfere with their ability to drive everywhere and anywhere at any time as fast as they possibly can. And our cities and suburbs are now designed around cars, not people.

Maybe this is a good thing.

Saving Social Security

Killing off a lot of older Americans – as of this writing, according to the CDC, more than 75 percent of the dead, 860,979 of them, were over age 65 – has bought the Social Security Administration some time on the road toward insolvency.

Insolvency now isn’t projected to happen until 2035 for the agency that funds retirement for millions of Americans. In 2015, the Congressional Budget Office was reporting “Social Security’s trust funds, considered together, will be exhausted in 2029.”

The average American lifespan then was 78.8 years. It is now 76.1.

For reference sake, the average lifespan has risen to 83.33 years in Sweden, the country ostracized for refusing to order its citizens to wear masks. And lifespans there actually crept upward during the pandemic while American lifespans were diving downward.

As one now collecting Social Security (and thankfully so, given that actual, in-depth reporting pays about 12 cents per hour by my calculation), I personally took the changes in Social Security’s financial future as good news while feeling bad for all those who lost loved ones to Covid-19.

I’m personally happy to be alive.

I’ve now outlived both my father, dead of cancer at the age of 46, and my mother, a late-term victim at 70 of heart failure linked to the childhood infectious disease scarlet fever, which regularly reached epidemic proportions in this country in the 1930s. 

A black, nurse – Mattiedna Johnson – appears to have discovered the key to the development of antibiotics that now make that disease pretty easily treatable while working on the U.S. Army Medical Corp penicillin project at the University of Minnesota in the 1940s, though Johnson never got credit for her discovery.

My mother grew up in Minnesota to become a nurse and a big fan of penicillin. It probably saved my life as a child. My earliest childhood memories are of penicillin shots, sulfa pills the size of quarters that were near impossible to choke down, and hallucinations of giant spiders on the wall, a consequence of a pneumonia-induced fever that reached 106 and scared the hell out of my parents, or so I was later told.

Modern medicine is a wonderful thing. I don’t mean to dispare it.

It saved me as a kid, and more than 30 years later, back surgery might have done that once more. An acquaintance of the time, another living with back-pain hell with whom I regularly exchanged stories of suffering, was not so lucky. He eventually couldn’t tolerate the pain and committed suicide.

I could understand. Life doesn’t seem much worth living when you’re spending most of the day lying on the floor watching the TV and fearing that point at which you’ll have to crawl to the bathroom to pee, force yourself upright so you can use the toilet despite the pain, and hope that is all you have to do is pee because anything beyond that is excruciatingly painful.

I owe a former Anchorage doctor and modern medicine a huge debt for fixing me, but medicine is not health. It is related to health, but it is not health.

Health is something that starts at home, a fact of which Americans seem to have wholly lost sight. I did an hour of it Monday walking the dogs. Veterinarians say they need at least a half hour per day, but I’m happy to give them more.

The day before that, I did four hours on the mountain bike on a circuitous climb to Rabbit Lake in the Chugach Mountains and then home.

I did another hour and a half on the bike last night because a friend’s messages about dealing with mistreated sled dogs were depressing me, and exercise has been shown to be good for treating depression. 

That’s 390 minutes for the week, and it’s only Wednesday. The minimum requirement of 150 minutes doesn’t seem all that much. And it isn’t if you can pry yourself away from the TV set or the computer.

The alternative is to continue to ignore our evolutionary history at your own peril and hope that when the next pandemic-driving pathogen comes along big pharma is quicker to find a treatment than it was this time because technology is our friend when it is saving us rather than killing us.