One of the leading exercise scientists in the world is 1.67 meters tall and weighs 93 kilos, but while that qualifies him as having a body-mass index of 34.1 and being obese, he says his body is quite able to function efficiently and effectively in work and leisure activities.
Prof. Steven N. Blair of the departments of exercise science and epidemiology and biostatistics at the Arnold School of Public Health at the University of South Carolina explains: “I often tell people that I was short, fat and bald when I started running, but that after running nearly every day for more than 30 years and covering about 70,000 miles...I am still short, fat, and bald. But I suspect I’m in much better shape than I’d be if I didn’t run.” He ran his first marathon in 1969.
“The more you weigh, the more energy you have to expend to move your body. There is an association between weight and fitness, but it is far from a clear correlation,” he insists. “The heavier you are, the more energy it takes to move your body. There are big people with a high body-mass index, but they can be quite fit and healthy. You can’t tell just by looking. About half of the people with a BMI of 30 or more [recognized as obese] are fit by our standards.”
Blair, who at the age of 70 just made his premier visit to Israel, says that while it’s better to be of normal weight than obese or overweight, he knows many thin people who aren’t fit at all, who suffer from (or are likely in the future to have) chronic diseases and have a reduced life expectancy.
Now he mostly walks. “I am a professor and unfortunately, my job is sedentary,” he says in an interview with The Jerusalem Post during his visit, during which he gave lectures on his research to the 300 physicians who attended the third Exercise is Medicine conference in Kfar Ha’maccabiah as well as at the Israel Physical Therapy Association’s annual meeting.
His best advice to couch potatoes is to get up and run, jog or at least walk. “The best exercise is the one that you enjoy doing. I’ve done treadmills, but I prefer to be outside and get some exercise. It doesn’t always bring down weight a lot. But if we all were as physically active when I was a kid, there wouldn’t be such an obesity epidemic. If you want to keep weight off, exercise if the best treatment.”
Don’t smoke, he urges, and eat nutritious food, such as vegetables, whole grains, fruits and fish. While people who kick the tobacco habit tend to gain some weight (but don’t necessarily have to), research has shown that they are better off than if they were slim and their lungs full of poison.”
Blair, a former president of the American College of Sports Medicine, is also a fellow in the American College of Epidemiology, Society for Behavioral Medicine, American Heart Association and the American Kinesiology Academy. He has been researching the health benefits of physical activity for many years, first at the Cooper Institute in Dallas and currently at his university in Columbia, South Carolina.
“I have given lectures in most US states and in 50 countries around the world, including Kuwait in the Persian Gulf; nobody invited me here before,” he says, explaining why it’s his first visit to Israel. He was invited to his first tour by Prof. Naama Constantini, director of sport medicine center at the Hadassah University Medical Center in Jerusalem’s Ein Kerem, a center that promotes exercise as the number-one “drug” physicians should be giving to their patients.
Besides being pudgy among svelte exercise researchers, Blair also has an rather unusual background. “I was born on a farm in Kansas,” he says, sounding like Dorothy in the Wizard of Oz. “I come from a poor family and was the first in my extended family to go to college.”
He is the oldest of four siblings – one brother is a well-known cancer epidemiologist, but his other brother and his sister didn’t get a higher education.
“I was interested in sports as a kid, played football in high school and at Kansas Wesleyan University. “I thought I would be a coach in some small college. My college coach was going to Indiana University, so after college, I went there as well for my master’s degree in physical education and then on for my doctorate.
In 1966, I went to the University of South Carolina to establish an exercise physiology lab. He was also a post-doctoral scholar in preventive cardiology Stanford University in California.
TAKING A look at Israeli bellies while touring Jerusalem and other cities, Blair saw that “as a population, they certainly look thinner than Americans.” In fact, there are too many obese – and anorexic – people in this country. Their diets, which on average include less fatty meat, more vegetables and fruits, more whole grains, low-fat dairy products, olive oil, fish and chicken – are certainly better than those of average Americans, he said. But the main question is whether Israelis of all ages exercise – whether children, like their counterparts in the US – spend most of their time playing with their tablets and smartphones or watching TV.
Contrary to the common view that residents of the US eat much more today that decades ago, Blair says, “here is no evidence that Americans are eating any more calories a day than 30 years ago. According to real data, there was a huge increase in sugar intake there in the 1930s and 1940s, but it has flattened out since then, while obesity levels have tripled. I don’t believe that all the sugary drinks, which are not good for you, are to blame. The sedentary life is.”
Although the Kennedy administration is usually given credit for promoting fitness in the early 1960s, Blaire notes that Dwight D. Eisenhower launched the Presidential Council on Physical Fitness. First Lady Michelle Obama is active in a campaign called Let’s Move, “but I don’t see a lot of federal initiatives putting funding into exercise programs around the country.”
Obesity rates in US children have leveled off a bit, continues Blair. Smoking rates have gone down sharply over the past 30 years. Diets are fairly constant. What has changed is the reduction of physical activity in occupations.
“Over the last half century, the average American man has expended 140 fewer calories and women 120 fewer calories daily on the job,” says the exercise medicine specialist.
“Housekeeping requires much less exertion. Cooking and cleaning takes a lot less physical effort. Lifestyles are changing and not for the better. It is said that this is first is the first generation of American kids who will live shorter lives than their parents.”
BLAIR AND colleagues “try to persuade people to change their lifestyles. We do randomized experiments. The bottom line is that if you give us sedentary adults who are unfit but say they are willing to work with us and actually cooperate, in two years, a quarter to a third of them will meet fitness guidelines.”
Being unfit is the best predictor of getting chronic disease and dying prematurely.
“There is a lot of junk science. Even this week will be articles published in leading journals on obesity – and physical activity won’t even be mentioned in article. That is junk science.”
Asked what “fitness” is, Blair explains that it has different components. The primary one is cardiorespiratory fitness – also known as aerobic fitness.” The heart is able to pump oxygen-rich blood through the body. This can be measured by testing the patient on a treadmill or stationary bike. Also important in fitness is an assessment of muscular strength and endurance – this is non-aerobic.
The third part is balance; this is especially important in older people. At 70, my balance is declining. You’re not as surefooted as you once were. There is a greater risk of falling and hip fractures. Joint flexibility is another type of fitness, but we don’t have much research on it. I have followed up tens of thousands of people over time to determine who survives and who doesn’t.”
There are many places where one could go for a fitness test. They usually measure mostly cardiorespiratory fitness, and they are not very expensive. One could even go a self assessment by going into Google to look for the Rockport Walking Test, which has been validated and used for 20 years. All you do is walk a mile and measure your heart rate at the end and note how long it takes you, says Blair.
Asked how much exercise the average person should get, he advises 30 minutes of moderate-intensity exercise on five or more days of the week is really the minimum; this amount of exertion can reduce one’s mortality risk by half. “Moderate intensity is a relative term – depending on how old you are. “A brisk walk may be moderate intensity for you, whereas jogging is moderate intensity for your friend.”
If you do even more than half an hour – maybe an hour of brisk walking or 45 minutes of jogging – you get another 10% to 15% reduction in mortality risk. But if you can’t keep it up for 30 minutes at a time, Blair says one can get benefits even by dividing up the half hour into three different segments.
He gives patients digital step counters and pedometers. “I am a fan of objective measures to assess changes in fitness. There are a lot of good devices now. I usually don’t trust patients’ self reporting of what they do, because they are often ashamed to say how much exercise they’ve really done and what they’ve eaten. There still is a place for self reporting in research, but if you really want to know what they are doing, you need objective monitors, says Blair.
Smartphones can be used to measure activity in real time. “There are apps for encouraging activity. I have received a $6 million grant to set up technological apps to encourage exercise, a better diet and giving up smoking.”
Although Israel Defense Forces studies of fitness and lifestyles are famous for their long-term results from before the time young people go into military service through reserves duty, Blair notes that he has never studied the military in the US. “I have a lot to learn.”