Exercise in a Pill

Physical activity has numerous beneficial effects on mental and physical health. With the reduced need for physical activity to ensure our basic needs (utilitarian activity), it is increasingly up to the individual to compensate by consciously engaging in recreational (non-utilitarian) activity, generally referred to as exercise.

Numerous barriers exist to engaging in exercise, including time limitations, lack of motivation, and pain or injury. Researchers have therefore pursued the idea of being able to mimic the beneficial effects of exercise with the help of drugs that induce the same gene-expression patterns and metabolic changes seen with exercise.

In yesterday's issue of CELL, Vihang Narkar and colleagues from the Salk Institute, La Jolla, CA report on their findings that the combination of an orally active AMPK agonist with a PPARβ/δ agonist can induce metabolic genes and dramatically enhance running endurance in sedentary mice. Furthermore, the PPARβ/δ agonist in combination with exercise synergistically induced fatigue-resistant type I fibers and mitochondrial biogenesis, ultimately enhancing physical performance

These results demonstrate that AMPK-PPARδ pathway can be targeted by orally active drugs to enhance training adaptation or even to increase endurance without exercise.

Obviously, treatments that work in mice may not be as effective or safe in humans. Furthermore, the researchers did not actually demonstrate that the induction of metabolic genes and increased endurance actually improves the health of the mice.

But the results are promising and certainly a major step towards developing a pharmacological alternative to exercise.

In the meantime, however, there is no alternative to being as physically as you can. As Angelo Tremblay, presenting today to the students at the CON Obesity Boot Camp emphasized, increased participation in physical activity is a key characteristic of individuals who lose weight and manage to keep it off.

AMS
Duschesnay, Quebec

Clip art licensed from the Clip Art Gallery on DiscoverySchool.com

Waist Loss Trumps Weight Loss

Yesterday, I had the pleasure of listening to Robert (Bob) Ross from Queen's University, Kingston, Ontario, speaking at the 77th European Congress on Atherosclerosis, Istanbul. Turkey.

Here are his key messages:

1) Exercise helps reduce visceral fat even if you don't lose much weight. Walking as little as 60 mins a weeks can have an effect - of course, the more the better

2) Measuring waist circumference can detect changes in abdominal fat even when overall weight does not change

3) People who are exercising to lose weight may lose their motivation if they solely focus on weight and fail to recognize the "other" health benefits of exercise

Anyone who has heard Bob speak, knows that he is a most eloquent and persuasive speaker.

Very much enjoyed his talk.

Great work Bob!

AMS
Istanbul, Turkey

Exercise Resistance

Recently I blogged about how few people actually take up the advise to be physically active, even when delivered by a health professional (e.g. click here).

A new study in the Lancet now shows how difficult it is, even with the greatest effort, to get a substantial proportion of people moving.

In this study by Kinmonth and colleagues from the General Practice and Primary Care Research Unit, University of Cambridge, 365 sedentary adults with a parental history of type 2 diabetes were randomly assigned to either receiving just a brief advise leaflet in the mail or a 1-year behaviour-change program, delivered either by trained facilitators in participants' homes or to the same program delivered by telephone. The program was designed to alter behavioural determinants, as defined by the theory of planned behaviour, and to teach behaviour-change strategies.

Surprisingly, at 1 year, the physical-activity ratio of participants who received the intervention, by either delivery route, did not differ from the ratio in those who were simply given the brief advice leaflet.

The bottom line of this relatively large randomised trial is clear: A facilitated theory-based behavioural intervention, even when delivered with professional home trainers and individual counseling is no more effective than simply providing an advice leaflet for promotion of physical activity in an at-risk group.

I can only imagine how disappointed the investigators must have been having to conclude that health-care providers should remain cautious about commissioning behavioural programmes into individual preventive health-care services.

This seems very much in line with the large body of evidence that states that people will either exercise or they will not - those who like activity and have done it before will do it again - those who don't - will refuse to do it (in the long term), no matter what.

Of course there will always be some exceptions, but these are likely to be few and far between - the majority is simply resistant to change.

Having predictors of who is likely to adopt exercise and who is not may be important in order to target advise (and resources) to those most likely to actually do it (and persist).

Once again - one-size is unlikely to fit all.

AMS