Skepticism

Fitness Is Not A Cure All

This morning I was scrolling through my Facebook feed and I ran across a link to an article that began “If there were a drug that treated and prevented the chronic diseases that afflict Americans and we didn’t give it to everyone, we’d be withholding a magic pill. If this drug was free, in a country that spends more than $350 billion annually on prescription drugs, where the average 80-year-old takes eight medications, we’d be foolish not to encourage this cheaper and safer alternative as first-line treatment. If every doctor in every country around the world didn’t prescribe this drug for every patient, it might almost be considered medical malpractice.”

My first thought in response to this was “if this drug is exercise I’m going to smack a bitch”. Alas, I opened the article, and the title “The Exercise Cure” glared back at me. The idea that exercise is necessary and easy for everyone is not only wrong, but also classist, ableist, and heavily neurotypical. Nobody can deny that exercise generally has a lot of benefits and that it can be great for improving overall health. However the idea that exercise is free, readily available, and should be something that everyone does ignores the fact that many people simply cannot exercise.

Let’s start with the claim that exercise is free. Well first and foremost exercise takes time and for those with the least amount of money, time is incredibly important. If you’re working multiple jobs, then taking time to exercise is a loss of money and shifts. In addition gyms aren’t free and simply going outside to run or walk is not always an option (as an example I am currently looking out on -2 degree temperatures. Also see: unsafe neighborhoods).

I’m also going to go out on a limb here and say that this author has never had a chronic disease. It’s one thing to suggest to a patient who is constantly in pain that exercise would make things all better. It’s another thing to be constantly in pain and then have someone tell you that you should probably get up and go move around a lot even though it hurts. Let’s also not forget that some people are simply not physically capable of exercise as traditionally imagined (those who are confined to wheelchairs or other similar situations) and that getting exercise then becomes far more expensive and difficult. Hello ableism, how’re you today?

Finally, as someone who often hears that their depression or anxiety would be improved if they just got out and exercised more, I’d like to offer a resounding “fuck you” to anyone who thinks that exercise cures chronic mental health problems, or that it is even possible when someone is severely depressed or has another difficult mental illness. Depression is debilitating, and suggesting that one can simply muscle past the lethargy, the lack of motivation, the anhedonia, and all the other elements of depression that actively make it difficult to exercise is both ridiculous and cruel. This is not to mention the intersection of eating disorders with all this, which the author casually blows past with a “There probably is such a thing as too much exercise, but I’m much more worried about inactivity”. Bully for you my friend, some of us don’t have that luxury.

I’m also not even going to touch on the fatphobia in this piece but let’s just leave this here: “Solving the obesity epidemic is the key to reducing health care costs”.

The overall suggestion of Metzl’s article is that we should offer financial incentives for movement. This might seem like a great idea, but it once again will set up a system in which those who already have the privilege to go to the gym, get a personal trainer, pay for exercise that they actually enjoy, have the time to exercise, and who are able-bodied and neurotypical will be rewarded. Not only will it reinforce those privileges, but it will financially disadvantage those who are already at great disadvantages (and let’s be honest: the overlap of class and race in this country would suggest that it will probably entrench the racial divide even further).

As a final note, we have a fair amount of evidence that weight relies heavily on genetic factors, and that many people will never fall into the “acceptable” category on the BMI scale. If we start creating official sanctions and rewards for exercise and health based on the assumption that everyone could lose weight with exercise, it could be an incredibly slippery slope to financial incentives for weight, which might mean penalizing people for something they have no control over whatsoever (once again, fatphobia). This is of course speculation, but the general attitude that everyone should be required to exercise, eat, and weigh a certain amount is incredibly damaging and incredibly dangerous.

Olivia

Olivia is a giant pile of nerd who tends to freak out about linguistic prescriptivism, gender roles, and discrimination against the mentally ill. By day she writes things for the Autism Society of Minnesota, and by night she writes things everywhere else. Check out her ongoing screeds against jerkbrains at www.taikonenfea.wordpress.com

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21 Comments

  1. “The overall suggestion of Metzl’s article is that we should offer financial incentives for movement.”

    I would encourage people who really care about this kind of thing to instead join any local group looking to make walking and biking more accessible and safe. In Chicago here we have Active Transportation Alliance.

    ” not physically capable of exercise as traditionally imagined (those who are confined to wheelchairs or other similar situations)”

    Ok but traditionally imagined or not, physical therapy should be more accessible to people. If exercise is such a great cure, the medical system sure doesn’t treat it like that. I and many other people I know with chronic pain and other illnesses have had a very hard time getting physical therapy. Exercise can actually help pain, but people with these conditions often need help or it can be impossible or unsafe.

    1. Oh man, yes I agree with you. Especially on your second point, it does seem intensely hypocritical for someone to suggest that we should have financial incentives for exercise but NOT make exercise and physical therapy readily available and easy to access for those who need it.

  2. I suspect the causal flow is in the other direction. People who are healthy are more able to exercise and thus much more likely to do so. Add in even more confounding factors than you cover and I wonder whether there’s even correlation.

    It might be more accurate to say “people with minor illnesses who are fit get better faster and suffer less intense symptoms”. Therefore everybody should be fit, so they will be more healthy. Put that way it almost sounds tautological.

  3. Excellent response to the article. My wife was in the hospital last year, suffering from COPD. When she came home, she needed in-home PT and assistance. The insurance only paid for a few weeks of PT and home care, not enough to help her in any measurable way. The treatment termination was not tied to any measure of improvement (say O2 level @95%). As a result her recovery has been extremely slow and difficult. Why insurance companies refuse to pay for what is very cheap and effective therapy is a great mystery to me. It is as if they are more interested in paying big bucks to doctors/hospitals instead of the cheaper, more effective alternatives.

  4. Yay, skepticism! Except, this isn’t some naturopath making untestable claims about the chi in a room. Underneath the admittedly-overhyped Slate article is some real science. For instance, the claim that exercise treats (not cures) depression has been well supported by blinded, placebo-controlled studies:

    bjsm.bmj.com/content/41/1/29.short
    bjp.rcpsych.org/content/180/5/411.short
    eurpub.oxfordjournals.org/content/16/2/179.short

    To quote from one abstract, “Forty-nine female volunteers… with mild-to-moderate depressive symptoms… were randomly assigned to either an exercise regimen or usual daily activities for 8 weeks. After the sessions of exercise the CES-D total depressive score showed a significant decrease, whereas no effect was observed after the period of usual daily activities.”

    So, I think saying “fuck you” to everyone who advocates exercise as a treatment (not cure) for depression is counter-productive. At the same time, you bring up a ton of good points. Exercise isn’t free, easy, or possible for everyone. For those that are unable to exercise due to chronic pain, or whose depression is too debilitating for them to exercise, saying “just go exercise” obviously isn’t an answer. I would like to see more research into what can be done to make exercise more accessible. For instance, my health insurance subsidizes gym access – for those with employer-provided healthcare, this could help make exercise more accessible. For those whose depression is too debilitating, perhaps pharmacological treatment plus exercise could help? I don’t know about that, but exercise, overall, is quite beneficial.

    1. The key words here, though, are “mild-to-moderate depressive symptoms.” Severe depression is often harder to treat. Anecdotally, my depression could be somewhat managed through running (my sport in middle and high school), but it didn’t really start to get better until I started pharmacological treatment and talk-therapy.

      Also, you’re definitely much more aware of the research than the average person is and I think qualifying it the way you did is appropriate (unless there is evidence to the contrary that I haven’t heard). And it’s great that you have such a nuanced view of this.

      My guess is that Olivia’s anger is coming more from the people who don’t understand either depression or exercise and aren’t familiar with the research who say “well, you should just exercise” flippantly, without thinking it through, in the way that lots of people say, “oh, you’re depressed? just snap out of it.” Hearing that kind of thing over and over is very frustrating.

  5. Gotta love patient-shaming. Someone once told me if I stopped eating cheese I could reverse my chronic (aka: I will wake up with this every day until I die) disease. Exercise can be wonderful, but health comes in a lot of forms. What is best for me is probably not exactly what is best for you.

    1. Ugh. That sucks.

      I have an acquaintance with Type I diabetes who is also overweight and people sometimes tell her that if she just loses weight, the diabetes will go away. She’s like, um, no, that’s not how Type I diabetes works.

  6. Here’s the author’s disclaimer: “I can’t promise you that if you work out daily you won’t get sick. I’m also not suggesting that exercise cures all ills. Genetics, chance, socio-economic, and other factors clearly play significant roles in affecting health profiles”

    It’s not all inclusive, and it doesn’t explicitly mention depression, poverty or chronic illness.

    The author is 100% correct when we makes the claim that exercising is better than not exercising. He’s also correct in saying that the current system of ‘disease management’ gives incentives for treatment instead of prevention. I’m about four and a half years into a pharmacy degree, and it amazes me how much our training conflicts with the financial incentives for healthcare providers and for patients. In our clinical rotations and in our classroom and lab work, we are consistently taught to help the patient manage their conditions via lifestyle modifications (healthy diet + exercise) where possible rather than throwing pills at the problem. Every pharmacist I have ever worked with wants to help the patient be healthy, but in the retail pharmacy environment profit motives can often interfere with quality care. The pharmacist doesn’t get paid to take time with patient interactions, but rather gets paid to push pills.

    When I’m in professional practice and can help a patient make some moderate changes to their diet and exercise habits, they can realistically expect to, in some cases, get off two or three chronic medications.

    If you can exercise but choose not to, you are harming yourself and helping pharmacists everywhere pay off their student loans. Some of my classmates might thank you.

    1. Here’s the author’s disclaimer: “I can’t promise you that if you work out daily you won’t get sick. I’m also not suggesting that exercise cures all ills. Genetics, chance, socio-economic, and other factors clearly play significant roles in affecting health profiles”

      It’s not all inclusive, and it doesn’t explicitly mention depression, poverty or chronic illness.
      And how many people are going to read those disclaimers? Let alone mention them as they pass along the article to all their relatives/friends?

      If you can exercise but choose not to, you are harming yourself and helping pharmacists everywhere pay off their student loans. Some of my classmates might thank you.

      Health: Still not a moral imperative!

      1. Where is this “moral imperitive” shit coming from? Work out or don’t but being more active will make you more physically fit will make you generally healthier, will make you happier. It isn’t a cure all, but it sure as fuck helps.

        1. Can we please stop with this whole “exercising is always good” bullcrap? Because it’s not. It’s not always good for your health. It doesn’t always help. To take the most obvious example I can think of, one of my friends yesterday posted about her life with an eating disorder and how exercise sent her to the ER with kidney failure and heart problems. YAY exercise!
          There are circumstances where it’s not good for you. Nothing is ever as simple as “do a get b” because there are always confounding variables.
          So yeah, oftentimes it helps. Not always.And you’re not always harming yourself by not exercising (I’ve had doctors forbid me from exercise for a year!).
          Just maybe we should think more complexly about this.

  7. I’ve got mixed feelings about this one.
    Honestly, most people who are out of shape complain a lot about being out of shape but aren’t willing to dig in and start exercising. You can say it’s education, that they “don’t know” what to do, but the more you pry at it, the more the “reasons” sounds like excuses.
    “I’m out of shape ” “Oh. Hm. Is that a problem you want to fix?”
    “Yeah, but there’s no time.” “Well, my dojo offers free trials of their circuit class, we can go tonight.”
    “My back hurts too much to do that.” “Alright, let’s go for a bike ride and stretch afterwards.”
    “The bicycle seat is too hard for me.” “How about a walk?”
    “It’s only 10 C (50 F) out.” “That’s okay. We’ll wear clothes.”
    So on and so forth until we’ve exhausted every possibility except sitting in front of computer lamenting how out of shape we are. Should I have exhibited pity? Sympathy? I’ve never found either of those to be effective in doing anything except making myself the target of more complaints and excuses.
    I’m not trying to be a jerk here, but the writer of that article was clearly trying to figure out how to get as many people as possible as healthy as possible in the quickest possible ways. It’s really unfair to look at what was written and then get upset because disabled people and those with chronic depression can’t take the advice given. Sure, there are people who can’t take that advice, but figuring out how to motivate people to adopt healthier, more active lifestyles is very important and I find it very unfair to criticize the writer as some kind of bigot because there was no specific mention of each and every kind of health and socio-economic factor that might interfere with taking this advice to the hilt.

    1. The reason I was criticizing the author was not because he said exercise can help or that there are ways to get people to exercise but rather statements that implied exercise is readily available and free throughout the entire first section of the essay (not true) or that it’s good for every system in the body (nor really enough evidence) and that it will help with chronic illnesses (so he did specifically bring this one up and didn’t address how to give these people access to physical therapy).There was NO mention of other health and socio-economic factors. That’s the issue.

      1. An analogy:
        Suppose I woke up this morning to a gorgeous, snowscaped, sunrise, complete with those cool rainbow-ee looking sundogs. I’m so swept up by the beauty of the thing that I write this amazing article telling everyone how it overwhelmed me with the beauty of the universe and made me wish I could share the experience with everyone.
        Would you consider it insensitive of me to write that article, using the word “everyone”, without prefacing it with an apology to the blind, colour-blind and impoverished near-sighted, who of course could never share it with me? That’s a very high level of vigilant sensitivity you’re asking for there.
        That aside, exercise is good for the vast majority of people and it *is* free. Sure it takes time, but most can shave their Internet time by 30 minutes a day. It requires no equipment and can be done in whatever tiny living space one might be able to afford.

        1. If you prefaced your article with the opinion that you know of a cure for the chronic ails of Americans who are duped by the pharmaceutical companies and that this wonderful cure-all was free and easy to access for everyone I would say it would be insensitive. Sort of the same way that the rich’s cure for the woes of poverty is to “don’t be poor”, it stems from privilege.

          The original article was that flippant with regard to the ease of exercise, the intent of that article does not shield it from criticism as well it shouldn’t.

          1. Sorry, but I just don’t see any place where he claims it’s easy to exercise.
            The closest I see is this: “We have that drug today, and it’s safe, free, and readily available.”
            Those are all true things for the vast majority of the population. “Readily available” is not “easy”, it’s a contrast to the difficulty in getting pharmaceuticals.
            The article goes on from there to discuss how hard it is to motivate people to exercise.

          2. Safe, free, and readily available. That is different to free and easy to access in what way?

            Olivia’s point was that exercise is not safe for everyone, free for everyone, or readily available for everyone. Those facts don’t change the validity of the article, just that they were not taken into account.

  8. “Safe, free, and readily available.”

    Am I just thick, and this reference is obvious to everyone else? Where have I heard this phrase before? Oh, yeah, reproductive health care.

    We are discussing a health problem, and free, safe (under a doctor’s or physical therapists’ supervision when warranted by the individual’s condition, in a safe environment, indoors in an excessively hot or cold climate) and readily available (within a few minutes of everyone’s home or school or work) should be part of any health care plan (and is part of some of them, but not the bare-bones, Republican-approved plans generally available in the US.)

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