Exercise Throughout Life, a recent popular and comprehensive book, has a dramatic subtitle: the ultimate guide to a long and healthy life. As if this was not a good enough promise, it features other desirable results of exercise on the cover. These imply that by following their exercise programmes, the readers will not only achieve longevity, but other attributes that should ensure a rewarding life. The well-exercised reader is expected to “feel good in mind and body”, “remain supple and mobile” and “get slim and stay slim”.
There is very little evidence that competitive strenuous exercise will prolong life unless it is either carried out three or four times a week, or there is a vigorous training schedule as well. There is, however, overwhelming evidence that indulging in competitive contact sports, or those that impose unnatural use of joints and limbs, induces early osteo-arthritis which can strike in middle age even if the participant escapes serious injury while still young. There is also evidence that violent exercise taken occasionally, say once or twice a week, without a supplementary exercise regime together with a modified lifestyle may actually shorten life. The Saturday afternoon game of squash, the hard-fought tennis match on a Sunday morning, the strenuous holiday after months in an office tied to the desk, all take their toll.
It needed a man as revered for his intelligence and powers of reasoning as John Mortimer, barrister, novelist and playwright, to warn the general public of a truth that is easily forgotten. Physical fitness resulting from the ability to run around a game field or to contort the body into strange shapes in the gym is not the same as being healthy.
It is healthy people who have a long life, not necessarily the former athlete or those obsessed by work-outs. Mortimer maintains that “exercise has become, in my lifetime, the modern form of prayer. When religious belief faltered, and faith in immortality and an afterlife free of any kind of physical disability faded, it became essential to prolong a healthy life on earth by all available means. Gyms, saunas and swimming pools took the places of churches and chapels”.
If exercise is to improve the odds that someone will live to a ripe old age, it must be designed to keep them healthy rather than keep them physically fit. Long livers need the type of health Sir John Mortimer looks for, and they will be more likely to achieve this together with active independence in their later years if their metabolism is so well balanced that the cardiovascular and respiratory systems remain in good order, their blood adequately oxygenated and their blood sugar and serum fats (such as cholesterol) well controlled. Conversely, if either heart, lungs or both are failing, the resulting lack of oxygenation of the essential organs will undermine the whole system.
The danger to any nation if there is an obsession with competitive games, gyms and marathons, while excellence in academia goes almost unnoticed and comparatively unrewarded, is obvious. The heroic status and disproportionate honours and riches awarded by society to football players and other prominent athletes distorts society and provides role models that are unlikely to encourage children to work hard at academic subjects on which their future depends. Unfortunately, so great are the rewards of success, that not only does striving to achieve excellence endanger health and physique, but it corrupts. The most obvious example of this corruption is the misuse of performance-enhancing drugs.
Drugs have been used to enhance performance in sport for longer than is supposed.
It is said that the ancient Greeks used herbs, but the first documented report of drug misuse in sport was by a swimmer in 1865. Some sports have been more prone to drug-taking than others. Cyclists have always been regarded with some suspicion, as muscle power and stamina, rather than great skill, are important. Nearly 50 years ago, 20 per cent of the cyclists who entered one of the French cycling races tested positive, and that was before drug testing was as efficient as it now is.
Over 20 years ago, before I had been working for The Times for more than a year or two, a then-senior sports journalist gave me a list of the revered athletes of the day who were generally thought by the cognoscenti to be taking drugs. Over the years, I have watched as one by one they have tested positive. Drug-taking at this time wasn’t confined to top rank performers. My own inner city London patients chatted to me openly about muscle- and performance-enhancing drugs that were available in local gyms or through their trainers. A survey in West Glamorgan has shown that 40 per cent of body builders were taking anabolic steroids to improve their muscle bulk; in America another recent study has shown that the proportion is even higher. Lack of knowledge of the prohibited substances by athletes’ own doctors and pharmacists is only likely to be significant for lesser athletes. Top class sport trainers, coaches and the athletes themselves know far more about these drugs than does the ordinary GP or pharmacist.
The most important group of drugs to be misused are the anabolic androgenic steroids. These were introduced in the 1950s to encourage muscle development after debilitating illness or surgery, but there are now over one hundred available. Some mainly affect the muscle building (anabolic) powers of the body, while others have a greater androgenic effect.
These are taken during training and left off before a competition, which makes detection difficult. The list of side-effects, ranging from infertility to aggression and heart disease, is long. Some anti-asthma drugs, including the commonly used salbutamol, also have an anabolic effect if taken in a large enough dose. The pep pills – the sympathomimetics and the indirect sympathomimetics such as the amphetamines – have been banned for years. Their role in improving performance by improving determination is obvious. Drug cheating is now becoming more subtle. Peptide hormones that are difficult to detect are increasingly used.
They encourage the body to produce more of its own androgenic hormones. Likewise, erythropoietin stimulates the body to make more red blood cells so that the oxygen-carrying power of the blood is enhanced and with it the athlete’s stamina. Recently, aromatase inhibitors, the action of which is similar to Tamoxifen (the well-known breast cancer drug), has been misused in sport, as it alters the hormone balance to improve performance. In the short term, drug testing needs to be much more frequent, so that sports competitions are between athletes rather than between pharmacologists. In the long term the nation’s health generally would improve if more people could be persuaded to take physical activity because they enjoyed it, rather than because they were competitive.
