In this article:
Quality vs. quantity of life
Health Profile: Alicia Lyles, age 16
Health Profile: Stephanie Parker, age 34
Health Profile: Tony Roosevelt, age 63
Also this week:
What you can learn from David Letterman's bypass heart surgery

Spring Health Report by Tedd Mitchell, M.D.

ou probably already know that the single most important thing you can do for your health is to exercise regularly. Currently, only 20-30% of Americans engage in regular physical activity. But did you know exercise also could be the solution to the cost crisis plaguing American health care? If you're like the average American, you spent more than $4,000 on health care in 1998, between co-payments for doctor's visits, medical-insurance premiums and other costs. (Figures for last year aren't yet available.) And those costs have been rising dramatically. According to the journal Health Affairs, private health-insurance premiums jumped 8.2% in 1998, more than twice as much as in each of the previous three years (2.8% in 1995, 3.3% in 1996, 3.5% in 1997).

As medical professionals, the federal government, insurance companies and others continue to debate the best way to lower the skyrocketing costs of health care, they're overlooking one simple solution: exercise.

In a study just completed at the Cooper Clinic in Dallas, where I am a staff physician, we have been investigating the influence of physical fitness on the need for health care. The results show fit people require fewer visits to their physicians as well as fewer hospital stays, which translates into significantly lower health-care costs.

On the face of it, our findings may seem obvious: Exercise more and you need to see the doctor less. But the implications are enormous. Medicare costs jumped from $37.5 billion in 1980 to $216.6 billion in 1998. Medicare expenditures as a percentage of the gross domestic product more than tripled from 1970 to 1998 (the most recent year for which data are available). If you extrapolate our data to the 97.8 million adult men living in the United States today, the least fit 25% of those men spend $4.1 billion more every year on hospitalization and doctor's visits than the most fit -- twice as much. That's money that could be saved if they improved their physical fitness by even a small degree.

Our study followed 6,679 apparently healthy men who came to the Cooper Clinic for checkups over a 20-year period. Each patient was given at least two complete physicals approximately five years apart, and each filled out a 20-page questionnaire detailing a number of lifestyle factors, including how often he had been to the doctor or been hospitalized every year.

We found that the least fit group (judging by a treadmill test and physical exam) spent almost 63% more on overnight hospitalization costs and 25% more on doctor visits each year. The extra costs for hospitalization alone for the least fit group were close to $250,000 a year -- and we used extremely conservative numbers in estimating those costs ($500 a night for a hospital stay, $50 for an office visit). The actual costs were probably even higher.

One of the most encouraging findings of our study and others at the Cooper Clinic is that you don't need high levels of physical activity to benefit substantially from being more fit. The men in our study who were in the best shape were not elite athletes. Of course, they weren't just "weekend athletes," either. They were men from all walks of life who exercised 20-30 minutes a day, four or five days a week.

Quality vs. quantity of life
Exercise regularly and you'll save money. But you'll also be in better condition to enjoy spending the money you save, especially as you age. By 2010, more than 97 million Americans will be age 50 or older. Still, as the nation's population ages, most of us want to live longer only as long as we are healthy. Lifestyle factors such as exercise powerfully influence not only quantity of life, but quality of life as well.

At Cooper's research institute, Dr. Steven N. Blair has followed our patient population for more than 20 years to study the effects of physical fitness on longevity. In a landmark study first published in the Journal of the American Medical Association in 1989, Blair found that fit men and women were 65% less likely to die during the nine years of the study period than were their unfit peers. More important, even those who were only moderately fit were less likely to die.

In another study, Blair then followed patients to see what would happen if their level of fitness changed over time. He found that physically unfit people who then started to exercise also were likely to live longer.

Is it really worth it to live a few years longer if you have to spend the extra time exercising? This gets back to quantity vs. quality. When you exercise regularly and lead a healthy lifestyle, you don't just prolong life. You also delay disability. This is a key issue. Because America's population is growing older, it's imperative that we remain healthy so we don't exhaust the limited resources available for health care and human services to the elderly.

To sum it all up, these studies reveal two key points: First, regular exercise improves your odds of living longer and, more important, living healthy until the very end of your life. Second, regular exercise reduces health-care costs dramatically.

I hope the federal government, corporate heads and others will pay attention to our study results. Think of the billions of dollars that could be saved each year in health-care costs and lost work time if more people were fit. I'd like to see more corporations institute on-site wellness programs, including incentives such as paying bonuses to employees if they don't smoke, if they work out a certain number of times a week or if they attend health seminars. I'd like the government to consider giving a tax break to non-smokers and regular exercisers.

There you have it. As we enter the new millennium, the availability of modern medicine, food, clothing and shelter has given us advantages our grandparents never had. It's up to us to make the best of those advances.

3 who prove a healthful lifestyle pays off
Meet three people enjoying good health at different ages and stages, thanks in large part to regular exercise and a sensible diet. All three (patients at the Cooper Clinic) have family histories of diseases such as high blood pressure and diabetes -- diseases they've avoided so far.

Alicia Lyles, age 16
"A very healthy, fit, typical high school girl" is how Dr. Mitchell describes Alicia. But her exercise regime is typical only for student athletes. Alicia has been a sprinter for four years. She practices three hours a day, five days a week. Her routine includes daily drills and exercises designed for sprinters, weight training three times a week and, of course, running (more than 1.4 miles a day). When she doesn't have Saturday track meets, Alicia cross-trains and weight-trains at the Y. She takes vitamin and calcium supplements and eats a low-cholesterol diet, including cereal for breakfast and turkey and fruit for lunch. She hopes her routine will help ward off family ailments such as diabetes, high cholesterol, osteoporosis and high blood pressure. These usually don't show up in youth, Mitchell notes, but Alicia's head start on healthful living may help her avoid them altogether. Her lifestyle works for her, but Mitchell says others (of any age) need not work out so intensely. Most people "will get a significant benefit from any routine activity."

Stephanie Parker, age 34
Stephanie has a family history of hypertension and high cholesterol. But for the past six years, she's kept disease at bay with regular physical activity and a good diet. Stephanie takes a 60-minute aerobic class twice a week and a 60-minute strength-conditioning class twice a week at her company's fitness center; she also walks about two miles in 30 minutes once a month. She's always been athletic: She played basketball in junior high and took aerobics in college. Stephanie maintains a low-sodium, low-cholesterol diet and is trying to cut meat out of her diet completely because she thinks vegetarianism might be more healthful. Her healthy living has brought rewards. For the past decade, Stephanie's weight has stayed between 108 and 118 pounds. It's closer to 108 when she exercises regularly. As for other benefits: "It keeps my heart rate down and I rest better." Says Mitchell: "Stephanie has always been working toward staying physically active, but not overly active. She's not training for a marathon or anything like that. She's consistent." And consistency is the cornerstone to every successful exercise program.

Tony Roosevelt, age 63
As a grandson of Franklin D. Roosevelt, Tony is predisposed to the same high blood pressure that afflicted the president. In fact, FDR died at the age Tony is now. Mitchell says Tony "is a perfect example of what happens if you control blood pressure over the long term. His grandfather is a perfect example of what happens when you don't." Tony is enjoying much better health in his 60s than his grandfather did. (FDR was confined to a wheelchair after contracting polio. His failing health was kept secret from the public; however, he is known to have had severe hypertension, culminating in a fatal stroke in 1945.) While the key to Tony's good health has been his blood-pressure medication, "all the other things help," says Mitchell, "including the fact that he doesn't smoke, stays active and tries to keep his weight where it should be. Tony is the epitome of your recreationally active man."