The other day I was reading about point-of-action queues and their impact on stair climbing behaviour and I came across this study, ‘Take the stairs instead of the escalator’: effect of environmental prompts on community stair use and implications for a national ‘Small Steps’ campaignIt’s a straight forward paper that looked at 8 studies and the impact they found stair climbing prompts in heavily trafficked areas had on stair climbing behaviours.
The authors found that simple point-of-action signage and prompts led to a nearly 5% increase in stair climbing among women and half that among men. Their work also predicted that every week those signs stayed in place led to 2200 new stair users.
And yet, despite these terrific and pretty much cost and effort free interventions, the authors tempered their conclusions (both in the abstract and of course the larger piece) with negativity stating,
“The projected effect on correcting energy imbalance appears small, suggesting that this intervention alone will not have a potent effect on leveraging population-level body weight or obesity prevalence“
But as I’ve calculated before, to burn the calories of a small Snickers bar you’d need to climb 122 flights of stairs.
That researchers apparently wondered whether or not a few extra daily flights of stair climbing in malls and office buildings would have a dramatic, let alone any, impact on weight, frightens me. Truly, that weight was included as a discussion piece in this study speaks to just how widespread, even among those who really ought to know better, is the erroneous belief that physical activity is such a large player in weight that even tiny increases to it might lead to weight loss.
I’ve asked before whether or not anyone is aware of any public health intervention that has led to a sustained and objectively measurable increase in the activity level of a population (adults, kids, both, whatever)
Unfortunately, I’ve yet to hear of any exciting outcomes (nor have I by the way for simply telling people to eat better).
As I see it, the value of exercise as health promoting is well known. Public health campaigns that in turn simply spread that message, probably aren’t teaching people anything new, and consequently, may not lead to any sustained changes in behaviour.
And that’s precisely what researchers in Japan recently found whereby a 3 year-long, cluster randomized controlled trial designed to evaluate extensive, community wide interventions designed to encourage more physical activity, failed to show any significant benefits.
The interventions were definitely not trivial either, but they were definitely all geared to try to encourage conscious, individual behaviour change. According to the paper, they included,
“(1) Information delivery.
Flyers, leaflets, community newsletters, posters (those are them up above), banners, and local audio broadcasts.
(2) Education delivery.
Outreach health education program and mass- and individual encouragement by professionals during community events. Mass-encouragement included a motivating talk and demonstration of PA using a common procedure to ensure standardization of the intervention and individual encouragement including face-to-face promotion of PA while waiting for
community health check-ups
(3) Support delivery.
Development of social support, i.e., promoting encouragement by community leaders and lay health workers; material support, i.e., arranging for residents to obtain light-reflective material for walking safety, pedometers, and videotapes and DVDs on flexibility and muscle-strengthening activities at each relevant community center; and professional support, i.e., establishing a call center for questions about PA and requests for outreach“
Now to be fair, evaluation was by way of survey, though given that asked people generally overestimate their activity levels, if anything you would expect a survey to be more likely to yield a positive result than for instance accelerometry data. Ultimately though, there were no significant improvements found. Not to over-all activity, not to walking, not to flexibility (though there was a positive trend), and not to muscle strengthening.
I think this speaks to the fact that good intentions fail in the face of day to day life, and that if we want to see population wide increases in physical activity, we’ll likely need to effect that by way of point of action changes (such as signs placed on escalators and elevators suggesting a person might want to instead take the stairs) and re-engineered built environments that make increased activity the unconscious default, or at the very least, the easier choice.
If I looked at 279,000 men and women for a decade and studied whether or not they qualified for the Boston Marathon, but I didn’t actually look to see if they were runners, and if they were runners I didn’t bother exploring what their training plans and distances were like, but instead simply looked at how many people from that 279,000 qualified for Boston, I’m guessing I’d be left with an incredibly small number.
And yet, that’s pretty much exactly what the latest depressing weight loss study did. They followed 279,000 men and women for ten years to see what was the probability of those with obesity losing back down to “normal” weight (a BMI less than 25). They didn’t exclude people who weren’t trying to lose weight or who might not have wanted to lose weight. They also didn’t pay any attention to the means with which those who did lose weight only to regain it lost it in the first place.
The odds weren’t good. Over the course of a decade, only 1 in 210 men with obesity, and 1 in 124 women managed to bring their weights down to a place where a table would define them as “normal“.
It’s not particularly surprising. Putting aside the surprising fact that this study didn’t exclude people who weren’t trying to lose weight, it remains that the vast majority of folks trying to lose weight these days do so by undertaking ridiculous diets. Go figure people don’t sustain the results of ridiculous diets; weight lost through suffering comes back when you get sick of suffering. This study of course misses all of that.
And is getting down to a “normal” weight really the right yardstick to measure success? I mean getting down to a BMI under 25 is to weight loss what qualifying for the Boston Marathon is to running. Most runners will never qualify, and consequently qualifying would be a very poor way to measure whether or not people were runners.
But what if you change the goal posts?
If for instance, you set out to study the number of runners who continue to enjoy running as often and as much as they’re able to enjoy, rather than simply the number of runners who qualified for Boston, well suddenly the number of runners will be much much higher, though of course not all of those who take up running, keep up with it either.
Extended that to weight, if the goal posts become your “best weight” which is whatever weight you reach when you’re living the healthiest life that you can enjoy, suddenly the numbers change.
How much do they change?
Looking at, for instance, the 8 year data from the LOOK AHEAD trial, where lifestyle changes were thoughtful and the goal wasn’t qualifying for Boston, 8 years out and 1 in 2 of the participants were maintaining losses of greater than 5 percent of their presenting weights, and more than 1 in 4 were maintaining losses of greater than 10 percent.
So did the publication of this depressing study add to obesity’s literature? Quantifying the number of people who don’t qualify for the Boston Marathon of weight loss, without quantifying how many of them were actually runners, and what sort of training program they were adopting doesn’t strike me as a helpful addition.
I also can’t help but wonder what the impact the publication and coverage of studies like these have on individuals who might be considering lifestyle change – both in terms of reinforcing idiotic goalposts, and in terms of them even starting out of the gates.
The amygdala is a part of the so-called limbic system that performs a primary role in the processing of memory, decision-making, and emotional reactions. The amygdala has also been implicated in a variety of mental health problems including anxiety, binge drinking and post-traumatic stress syndrome. A study by Xu and colleagues, published in the Journal of Clinical Investigation now shows that in … Read More »
The key word there being “realistic“.
There’s no doubt that exercising in sufficient quantities will affect weight.
Yet in study after study after study, long term exercise in quantities between 150 and 300 minutes per week, while sufficient to slow weight gain, was insufficient to stop it. Know too, those 150-300 minutes a week weren’t simple strolls either, but rather were exercise bouts of moderate intensity or more.
And even if those 150 or more minutes did actually lead to a real impact upon weight, would it be a realistic expectation that they’ be doable? In my own life I just barely hit those 150 minutes a week. By way of example, two good weeks are posted below. The first week includes 3 forty-five minute weight lifting sessions and 1 thirty minute run (165 minutes).
The second includes 2 forty-five minute sessions of weights, 2 twenty minute bike rides (to/from work), and 1 thirty-five minute run (165 minutes).
And my life is hugely conducive to exercise. My office has a gym and showers. I’m my own boss and consequently didn’t run into trouble when I blocked off slots during my work week to exercise. I don’t work shifts. I have my health. I’m not injured. My family is healthy. I’m married to an incredibly supportive spouse. We’re financially stable. We have access to childcare when we need it.
In short, I’m incredibly fortunate and incredibly privileged (and incredibly thankful), and while surely I could have exercised more, I couldn’t have done so without that more becoming negative.
That said, there are those who can and do enjoy more. And of those great exercisers, some are filled to the brim with self-righteous sanctimony and assert that because they themselves are capable of exercising in large enough quantities to impact their weights, so too could everyone else. But those people, undoubtedly, don’t work with the general public on lifestyle change. Because if they did work with the general public they would understand that for most people, real-life challenges, concerns, and responsibilities often understandably trump finding 3.5 or more hours a week to enjoy moderate or greater intensity exercise. Whether it’s caregiver responsibilities, co-existing medical illnesses, mental health concerns, severe financial strain, holding down multiple jobs, chronic pain, chronic child or parental mental or physical health problems – these issues and more, definitely, fairly, and rightly challenge the luxury of enjoying large quantities of intentional exercise.
My exercise mantra remains the same. Some is good. More is Better. Everything counts. And the good news too is that lesser amounts of exercise, while unlikely to have a dramatic impact upon your weight, may well have a dramatic impact upon your health, mood, sleep, and quality of life, all the while preserving your functional independence as you age.
We need to consciously stop tying exercise to weight as its lack of affect therein and/or the incredibly large amounts required to affect it, might well lead a person to give up, or never start exercising, yet exercise, at any weight, might as well be magic when it comes to health.
Some is good. More is better. Everything counts.
Right now, there are a lot of things that make me smile. After all, as long as my children are happy, I feel content. However, we all have bad days— those moments of doubt and insecurities and fear that can take over the mind and put you in a state of complete unhappiness.