Colon Cancer In Women

good evening everyone very good my name is phil martin i'm the chair of the department of kinesiology and i'm very happy to welcome you tonight i'm pleased also have the opportunity to introduce our guest speaker dr. i manly the 2016-17 dean helen lebaron hilton in down chair in the college of human sciences before i

introduce dr. lee i think it's appropriate to thank college of human sciences for their support through the hilton endowed chair essentially the hilton down chair and our lecture series and to comment briefly on dean helton's legacy helena baron hilton served as the dean of the isu college of home economics from 1952 until $month 1975

throughout her career she was recognized as a visionary leader in home economics and as an advocate for the advancement of the status of women and well-being of children she was the first chairperson of the national association of administrators of home economics and was one of the first members of the american home economics association foundation

board of trustees president dwight eisenhower that's one of our early presidents for you young folks here back in the fifties appointed her to the national committee of the 1960 white house conference on children and youth and at the request of president john kennedy she served on a panel of consultants on vocational education for

the us department of health education and welfare her request of 1.4 million dollars funds the hilton chair endowment which each year allows one of the college of human sciences departments to bring a distinguished colleague or colleagues to campus to interact with faculty and students and it is the hilton chair endowment

that is made tonight's event possible doctor leaves the 22nd hilton chair so let me turn our attention to dr. lee she's a professor of medicine in the harvard medical school and professor of epidemiology and the harvard th chan school of public health she's also an associate epidemiologist at boston's brigham and women's hospital

simply stated dr. lee is one of the best-known most productive and most influential research scholars regarding the role of physical activity and promoting health and preventing chronic disease dr. lee is currently involved in two major long-running research projects funded by the national institutes of health the college alumni health study

which is a prospective cohort study of predictors of chronic disease among 70,000 alumni from harvard in the university of pennsylvania that dates back to the 1960s and the women's health study examining cardiovascular disease and cancer risks among another very large group of individuals 40,000 female health professionals dr leander

colleagues have been continuously funded by nih specifically the national cancer institute and the national heart lung blood institute since 1999 dr. lee is served on several national and international advisory panels addressing physical activity and health including the nih consensus development panel and physical activity and cardiovascular

health the 1996 surgeon general's report on physical activity and health the 2008 physical activity guidelines and the 2010 world health organization global recommendations on physical activity for health as the 2016-17 hilton chair dr. lee will return is you in the spring semester for more interactions with faculty and students but first tonight's

presentation i think you will enjoy dr. lee's presentation and titled physical activity wonder drug for chronic disease prevention help me welcome dr. i manly good evening everyone i'm so pleased and delighted to join you this evening and i'd like to thank the college of human sciences and particularly the department of

kinesiology for inviting me to come to speak with you tonight this is the first time the cio state and you have a beautiful campus so i'm going to talk about physical activity and i've titled by top physical activity wonder drug for chronic disease prevention and you all thought you're going to have an easy time here but i'm going to start

you off with a test ok doesn't seem to be alright let's try that ok i'm sure you two pictures a woman and a man and it's a little bit dark but i think you can see that they actually not the sick not born in the same year but these photographs at least they are the same age so you can see the ladies on the

track running and this gentleman is playing tennis okay take us how old do you think these individuals ila allah 80-85 ok i yes jackpot so these individuals were actually a hundred years old in these photographs the lady is a lady called ida keeling

and some of you may have read about her she ran the pen release earlier this year where she set the record for the hundred meter which already holds the record for the 95 299 she didn't have an easy life she had two sons who died in drug related incidents but she had a daughter was very encouraging another h of 67 her age her daughter suggested she

go for mini-run she went for a mini run and she found hey i like this and she continued running and co she is running at the age of a hundred this gentleman roger dental have a particular fondness for because he comes from my home state of massachusetts he lives up in the southern part of the state and he was a textile engineer you also never really

did sports till he retired and then he took up tennis when he retired and he found he was very good at tennis and actually won a lot of metals and national senior games european senior games and you see all these medals on his neck he died a hundred and two and after a short illness and he was actually very popular wherever he went

around why because in most of his circles sorry guys the guys are all debt women live longer the guys are all dead so it was really popular among the ladies so yes they were playing sports a hundred years old and i'm not so naive to believe that you know if we all go exercise will live to a hundred of course they had good

genes but i strongly believe that their engagement in physical activity help to keep them vital and active and engaged in society in in into into triple digit ages so this is what i'm going to talk about this evening i wish i could see i invented the term wonder drop but i'm not the first person to see if you look in the news you'll see that

a lot of people have referred to it under various terms i want to drop miraculous cure so this is the new york times earlier this year it says the closest thing to wonder drop try exercise this is for a published by the united kingdom last year and it was actually from the academy of royal medical colleges where it was a paper

put out to physicians telling them that hey you need to talk about physical activity more physical activity is very important for treating diseases and it stated in the paper but it is even more important for preventing long-term chronic diseases this is a report from rep md a few years ago when there was a study looking at

exercising its benefit on survival in cancer patients and this article called exciting one to drop for cancer survival so this evening and i promise not to run over there are three things that like to talk about first what is it that kills us in this country and how can we reduce our risk of dying early from these diseases

now obviously physical activity is one of those things that we can do so the second thing i'd like to talk about is how much physical activity do we need for health and finally i'm going to show you some scientific evidence that supports assertion that physical activity is indeed a lender drop for chronic disease prevention so let's get

started what kills us and how can we reduce our risk of dying only now i don't expect us you to see a lot in this light which is though busy i just want you to see certain patterns in the slight and i'll point those out to you so this is a chart showing the top 10 causes of death in the united states

from the nineteen hundreds over the next hundred years the first thing you'll notice is look at these past the height of the bars tells you the death rates so the higher the bars the higher the death rates the lower the bars the lower the death rates so you can see that over the last hundred years the bars have gone down

and we do know that because if you get the life expectancy of individuals at the beginning of the 20th century in 1900 the life expectancy was 46 years old for a meal and 48 years old for female today what is it for us if you are a mail on this year you can expect to live to the age of 77 if you're female we can expect to live to the age

of 82 so great we've definitely increase our longevity over this period of time and why is this occurred this is occurred primarily because we've got better medicines better treatments for diseases some of the diseases that killed us in the past such as infectious disease no longer occur but over this period of time the

pattern of diseases also change such that makes physical activity all the more important so the causes of death if you look at these top 10 causes of death i just want you to look at the colors so if you look at these green shades these green sheets are all infectious diseases and you can see that at the beginning of the 20th century infectious diseases

things that fluid ammonia killed most people and here is the same thing but shown it's a line graph instead of by track you'll see this huge p and some of you may remember 1918 that was when the influenza epidemic occurred where r 20 million people died throughout the world so this is the influenza epidemic and nowadays view loot you can see that the

green sheets of all god instead you see gray in purple sheets and the gray and purple sheets are heart disease in cancer in fact heart disease and cancer today are responsible for about forty-eight percent of all just set occur so what can we do about this excuse me everything your grandmother told you is

what you should do a white smoking be physically active and we'll talk more about this in a second, eat a healthy diet and if you do drink alcohol, do so in moderation maintain a healthy weight and get enough sleep. so i said i'm gonna make you all work so this is our next test question so it is smoking and lack of physical

activity are important causes of the chronic diseases that occur throughout the world. so i'm going to give you three options we said smoking and physical activity are important in the world but exactly how important are they relative to each other. so your first choice is smoking kills more people each year

throughout the world than does lack of physical activity your second choices lack of physical activity kills more people throughout the world then they're smoking and finally the last option is they kill about equal numbers of people okay so option one raise your hand... no takers? option two raise your hand...

option three? so i'm going to say option two wins! i love this audience. but unfortunately the correct answer is actually option three. each year about equal numbers of people die throughout the world because of smoking or because they lack sufficient physical activity. so this is some work that we did about four years ago we are converted audience

we believe in physical activity but the rest of the world probably doesn't pay too much attention to it once every four years you might do so. why? because olympic games are on. so in 2012 the summer olympic games were being held in london and we decided to work with the leading medical journal in london which is "the lancet" and this was an

international effort that included 33 researchers from 16 countries throughout the world. and what we did was we painstakingly calculated using what data were available from different countries throughout the world and we came to the conclusion that each year about slightly over 5 million, 5.3 million people throughout the world died because they

don't have sufficient physical activity and we know that each year about 5 million people throughout the world died because of smoking. so there's lots of money, lots of attention being placed, toward stopping smoking. i think that's less of an effort being placed toward physical activity and yet they're equally important as risk factors for

chronic disease prevention. so i'm going to move on to the next section of the top which is how much physical activity do we need? now just before this i had a dinner with some of the faculty and we were talking about different guidelines that have occurred throughout the years and it is true that guidelines have been placed in front of us throughout the years and

they have changed somewhat because of the different evidence-based. so the guidelines are going to highlight our most recent federal physical activity guidelines and these are public health guidelines. so some of you may have heard about this in 2008. in 2008, the federal government put forward a comprehensive federal guidelines for the

first time. in the past we did have guidelines from organizations such as american cancer society, the american heart association but this is the first time that the government had sort of put together a comprehensive set of guidelines. these guidelines have been used in many countries throughout the world and in fact the world health

organization in 2010 put out a document that was similar in many aspects to what the federal government had in 2008. so you might think that's a long time ago, are new guidelines going to come out? yes, these guidelines are in the process of being updated. they will probably be released in late 2018. but as for now what do the guidelines see?

so the guidelines were essentially divided into three parts. one for children and adolescence, one for adults, and one for older adults. i'm going to focus on the guidelines for adults because this is what most of the population is and the guidelines are similar for older adults but they do make allowance for the fact that order adults may have

chronic diseases and therefore they may not be able to do physical activity to the level or intensity that is recommended. so what do the guidelines say? the guidelines say that aim for 150 minutes a week of moderate-intensity physical activity such as brisk walking or 75 minutes a week of vigorous intensity physical

activity such as jogging or a combination of the two kinds of activities that expend equivalent energy. and they also asked for us to do strength training exercises on at least two days of the week. and further the guidelines say that if you want to get even more benefit do more than that. double that amount, so 300 minutes a week of

moderate-intensity physical activity or 150 minutes a week of vigorous intensity physical activity or some combination of the two that expends equivalent energy. so you might ask what is moderate-intensity physical activity? while moderate-intensity physical activity may not be a level that for example older adults or individuals who are

compromised might be able to achieve so the guidelines are actually very encouraging in that when they set up the 150 minutes or the 300 minutes, they also meet pains to see that some physical activity is better than none and adults who participate in any amount of physical activity would gain health benefits. so what is the moderate-intensity physical activity

that the federal government wants us to try to aim for? if you look at the general adult population, so young adults to say, adults probably in around the age of 64-65 or so, the technical definition of this is 3 to less than 6 mets and a met is multiple of resting metabolic rate. so if you're sitting quietly like you are listening to me talk, you are expending 1 met.

if it's the end of a long day and you're snoozing in your seat you're probably expending .9 mets. i'm standing here and waving my hands a little bit, i might be expending 1.5 mets. a brisk walk might get you 4 mets and if you go for a jog at a ten-minute mile or six miles per hour that would be about 10 mets. so to give you some

idea of what some of the high mets are say the boston marathon, the top runners the ones who win the marathon, might be exercising at the rate of something like 22, 23, 24 mets. okay this is good and fine but when we talk to the general population, you start talking in mets. you know you might as well be talking greek. patty might

understand greek but nobody else here understand greek. so what is moderate intensity? i sometimes tell people that let's think about this as the sing test. what do i mean by the sing test? so when you exercise moderately you can feel your heart rate going up, you can feel maybe you might get a little bit out of breath, you might start sweating a little

you can still talk and carry on a conversation with a friend but you cannot sing. if you...i'm sorry... you can still if you are exercising at a moderate rate, you can feel your heart rate go up, you can carry on a regular conversation, but you don't have enough breath so that you can sing a song. if you cannot talk and you cannot sing,

you are exercising at a vigorous rate. you are exercising very hard. if you can both talk and you can sing, you're not exercising at a moderate level but you're exercising at a light level. so this is what i call the sing test. cannot sing-moderate, cannot talk-vigorous, can talk and can sing, you're probably exercising at a light level.

and what counts, so when we talk about physical activity recommendations, many times people think 'oh i don't have time to go to exercise, how can i meet the 150 minutes? this is a lot of time,' but through the different studies that we have, we are increasingly beginning to realize that the energy they expend

doesn't have to be in exercise time. what you do in leisure, what you do as part of your occupation, what you do as transport and commuting to and from work, what you do as part of your household chores, they all count but they have to be at least moderate intensity. that is you can feel that heart rate going up you can feel yourself maybe getting a little bit out of breath

and we say 150 minutes a week and technically you could do it as a weekend warrior. you know all 150 minutes in 1 long hike, or 2 shorter hikes but ideally we would like you to spread it out throughout the week. why do we want you to spread it out throughout the week? first, you are less likely to get musculoskeletal injuries

and secondly, if you do it throughout the week it becomes more a lifestyle something that you're used to doing as opposed to something that you have to consciously do. so we would like for you to spread it out throughout the week and we say that it has to. the bouts of physical activity have to at least ten minutes in duration. now we say 10

minutes in duration because at the time of the 2008 guidelines the studies that were available had data on the shortest bouts. so probably about 8-10 minutes each. and there was no evidence at that time on these new kinds of training programs some of you may have heard of high-intensity interval training that are really short but of high intensity.

so the guidelines may change with the next iteration but at least for now we see that it has to last at least 10 minutes in duration. so this talks about physical activity in terms of a time duration. technology has evolved and many of you probably have one of these wearable devices. devices that tracks steps and in fact one of your professors

in the department of kinesiology, dr. greg welk, does a lot of research in terms of these wearables. how accurate they are how they perform relative to each other. and these wearables tell you you can look at them and see how many steps you've accumulated throughout the day, throughout the week, throughout the month, throughout the year, and many of you have

heard about 10,000 steps, right? so we all get set, we should get 10,000 steps a day. do we really need to get 10,000 steps a day? what is a history of the 10,000 steps so it turns out that the 10,000 steps was a goal that was put out by the inventor of the pedometer. the inventor of the pedometer is a gentleman

by the name of dr. hitano and he's japanese. he said i think 10,000 sounds like a good number why? because 10,000, the japanese character for 10,000 is this, and it looks like a man walking. so he said 10,000 steps this is what one should be doing. so which is why 10,000 steps comes into our lexicon and as it turns out 10,000 steps may or may not be correct depending on which country you live.

what do i mean by that? so let's look at the u.s. in the u.s., how many steps does average population take? the average man or woman in the u.s. takes about 4,000-5,000 steps a day. so if you take the average person and you put them on an exercise program, you watch them do the exercise program such as they fulfill the 150 minutes

a week they would take maybe about 16,400 extra steps a week so let's divide that by seven assuming that you get that all evenly that comes out to be about you know 2,300-2,400 steps a day. so the average person takes 5,000 steps a day if you do that extra to be the recommendations you add another 2,000. so it turns out that for us in the u.s. you

actually do meet recommendations by taking 7,000 steps. if you can do 10,000 steps fantastic but 7,000 steps is all that takes in this country to meet recommendations. so going back to dr. hatano, it turns out that he actually was by lottery not correct because in japan people want more than they do here. in japan that average number of steps taken is about

7,000-7,500 steps. so if you added the 2,300 on top of that you come up with the 10,000 number. so he actually turned out to be correct for japan but maybe not so for the u.s. so 10,000 steps great if you can make it but if you make 7,000 steps this is sufficient to meet recommendations. so let's move on to the last part of the talk. and i'm going to talk about what evidence there is to

show that physical activity reduces the risk of our chronic diseases. it's pretty much taken for guarantee now, that if you're physically active your health will improve. i am pretty sure that there's very few people maybe as many people as will say smoking is absolutely harmless will tell you that physical inactivity doesn't hurt you.

but it wasn't always this with our way of thinking has changed a bit over the last 50, 60, 70 years. if you go back earlier say maybe 50 to 80 years ago, you'll see something like this. this gentleman henry ford said "exercise is bunk. if you're healthy you don't need it and if you're sick you shouldn't take it." of course you say that!

he made model cars! he wanted you to buy more cars. so why have we changed our opinion? we've changed our opinion primarily because of these two pioneers in the field. so this is professor jeremy morris, he was a professor at the london school of hygiene and tropical medicine. and this is professor ralph paffenbarger over in the united states.

so professor jeremy morris he's old enough that he served as a doctor in the british army in the second world war and this is like in the 1940's. when he came back to england he found that there was a new epidemic. and what was the epidemic? it wasn't flu but there was an epidemic of heart disease. rates of heart disease

were going up much higher than they used to be. and he had this theory that you know things were getting more mechanized people could afford to buy cars, fewer people were walking and that was probably why heart disease rates will increase. so in some of the pioneer studies what he did was, i thought really brilliant, because what he did was he took a group of

individuals who all will almost exactly the same except for the amount of physical activity and these were the people in the london bus transport company. so they were paid about the same amounts which meant they probably lived in the same areas, they smoked the same amount, they probably ate the same amount of food. the difference was that in london you had

these double decker buses so the drivers sat and drove, and the conductor's collected your bus fare, they walked up and down the bus, they went up and down the stairs. and he hypothesized that these conductors because of the activity they did on the job would have lower rates of heart disease and the drivers who set all d

and he studied them and he found that indeed the conductor's had about half the heart disease rates compared to the drivers and so he did this work early on in about 10 10 or so years later professor rothenberger started the study was my advisor he started the harvard alumni health study where he took a group of habit alumni and he looked at

their exercise habits so what they did when they were college kids where they did during middle age and he essentially confirmed the same findings that professor jerry morest it the individuals were physically active at lower rates of heart disease and individuals were inactive so this was during the 1950's and 1960's so today

you know it's now 60 years later we have a large body of evidence hundreds of studies that show clearly that if your physical lecter physically active have a whole range of health benefits you live longer you have lower rates of heart disease you have lower blood pressure you have lower rates of stroke you have less cardio metabolic disease less type

2 diabetes you have lower rates are in particular breast cancer and colon cancer you are less likely to be depressed or less likely to fall physical activity also improves your cardio respiratory in your muscular fitness have better body composition you better bone health you're able to function better in the

order each like either killing and roger gentle and also improves your cognitive function so what i'm going to show you next are some representative large-scale studies that pull together data so that i hope to convince you that you see a large body of evidence showing that physical activity at the levels that are

recommended reduce your rate of chronic diseases and even better remember the guidelines say some activities better than and any amount of physical activity will benefit health and i hope to show you or convince you in these studies that even if you don't get to the guidelines you will still improve your health relative to the people who do

nothing so we will review the interest of time we will review the data for the most common chronic diseases that kill us we'll look at a premature mortality will look at heart disease and we'll also look at tech 2 diabetes because type 2 diabetes increasing incidence partly because of the obc epidemic and also

because type 2 diabetes is a very important risk factor for heart disease if you have type 2 diabetes your risk of getting a heart attack is as high as someone who's already had one heart attack so we'll look at type 2 diabetes and we'll look at cancer so we'll look at premature mortality heart disease type 2 diabetes and cancer so if you are

physically active you will live longer whether you're a man or woman these are some data from a pulling project that was involved in and i'll walk you through this light it's a pooled analysis conducted by a group of investigators that included six large studies in europe and in the united states pulling together data from more

than 660,000 individuals and these individuals were followed for a long time on average in the studies they will follow over . for 14 years so what i'm going to show you are these are essentially we can think of them as a rates of mortality during the period of study now of course everybody dies but it's how all you die

so this is how high the death rate was doing the pier of study so that higher up on this chart the higher the death rates are the lower the lower the death rates are and on the x-axis i plotted levels of physical activity according to a metric that we call me hours a week but you don't have to worry about that here and i think

it's probably not showing up to clearly to you we plotted it instead according to what what the physical activity recommendations are so at this point it is 122 times physical activity recommendations two to three times physical activity recommendations and so on up to this point it's more than 10 * physical activity recommendations so at

this point you mean physical activity recommendations what do you see we see that going from nothing to reduce physical activity recommendation gives you a sharp drop in mortality rates and i'm going to explain a little bit about the data that you see here you'll see these little dots and you see these whiskers

so what are they now when the scientists we never tell you that anything is a hundred percent will tell you what our best estimate is these are dots and these whiskers tell you what r ninety-five percent uncertainty oh uncertainty ranges around that estimate which means that if you see shot whiskers you're fairly confident of the

estimate if you see large whiskers it means that the data are sparse in that area and you're not as confident in the estimate so what a few points to highlight the first thing is that the more you do the better off you are second thing i wanted to point out and very importantly yes when you get a physical activity recommendations your

rates of mortality do go down but even before you reach the several if you did only half your mortality rates are twenty percent lower than those who didn't do any activity the more you do the more benefit you get but it's sort of diminishing returns because from here to here you see a lot reduction from here to here a lesson

reduction and you get you know even lesser reductions now at this point a lot of people have set oh that's it in that is harmful to do too much physical activity i don't think so now granted there is a point beyond which physical activity likely is harmful

you can't be doing a triathlon every day of the year and still be a normal healthy be but what the upper limit is i don't think is so clear so remember i said that if you look at the whiskers the longer the whiskers the less certain you are about this estimate so this estimate rather than the start it could be as louis here and it could be as high

as here so in other words i'm not very confident about the results at this point but i do know that if you do some physical activity or better than nine if you meet guidelines you're even better than the people who did half if you did double the recommended level the 300 minutes a week which is the second level of recommendation you get even

additional benefit and even moist you go along this track so i tell you you reduce your risk of dying and you think oh that's really abstract what exactly do you mean by their so this is a chart that i think it's a very nice chart that the magazine from my university put up it's based on data from the previous study but earlier . and follow-up so

where individuals have been followed up for only about 10 years as opposed to 14 years and what this chart does it shows the amount of walking and the years of life that you might gain from walking so you probably don't see this too clearly but this is 200 minutes a week of walking this is 400 minutes of walking six hundred minutes of walking or if you

choose to run the 200 minutes of walking is about equivalent to a hundred minutes of running 400 minutes of walking equivalent to approximately 200 minutes of jogging 602 300 now those of you are studying exercise physiology are going to come up to me and say no no that's not quite correct depends on how fast you run but think about it in broad

terms because walking can be different speeds but in broad terms so this is c brisk walking and this is saying let's say running jogging or six miles per hour so again what do you see you see that if you meet guidelines which is a hundred and fifty minutes a week wow you gained almost three years of life compared to someone who does nothing and

this is three years of life from the age of about the same mid-fifties because the individuals in this study when they got started on average they were in their mid fifties too late fifties so compared to someone who does no physical activity you get almost three years of life but what if you did a little bit less if you did even say 75 minutes of

walking a week which is half of what does recommend it you gain about 1.8 years of life so going from doing nothing to doing a little bit you still gain and su do more obviously you gain more years of life such as the person is doing six hundred minutes of walking or 300 minutes of running will gain more than four years

of life compared someone who's inactive so let's talk about sitting we've all heard about sitting right i'm sure you've seen recent reports that co sitting is really bad for you so you see things like this killer chairs killing as a new smokey is going to kill you but some of us don't have a choice many people who commute long distances

on public transportation have to sit for long hours at what some of us have desk jobs and we might not have the luxury of being able to not sit you can see i choose my job because i want to be physically active i think very few people do that there's some people who might have the luxury of deciding this but for those of you who say i teachers

why we're going to go to the dark and start unloading containers i don't think so it's hard work and it also doesn't pay as much as teaching us so sometimes you can't choose this so what we wanted to do recently is this is published online couple months ago and in prince last week we wanted to look and see okay see suppose you had to

sit a lot you you have a choice is there anything you can do about it and the answer is yes you can offset some of the harms of sitting by being physically active so again i'm going to walk you through this slide is a very businesslike what we have here is again these starts and think of them as

weights of death the higher the dots the higher the death rate and hear what we have are individuals group by levels of physical activity so these are the most active people they're active for about 60 to 75 minutes addy so they're active and moderate intensity for 60 to 75 minutes and these are the least active people

they're active for less than five minutes a day so in the least acted so let's go back a bit so within each of these activity categories there are different levels of sitting the ones on the left of the ones who set the least less than four hours a day the ones on the right are the ones who

set the most and more than eight hours a day so the first thing you notice that the least active people all of them regardless of their sitting level clearly have a higher death rate compared to the individuals are physically active but then within each of the activity categories if you have someone was very inactive even if you

sit very little you are badly off you sit more you're terribly off but what if you're someone was very very active statistically none of these starts are different so essentially among those who are physically active at 60 to 75 minutes a day you can sit for more than eight hours andy and not increase your death rate now of course again not

everybody can reach this level but even if you are active at this level and this level is probably about 50 to 60 minutes a day you still mitigate your risk of sitting somewhat and this is about what current guidelines are you're still better after the people who do essentially nothing so sitting is bad for you but by being physically active

you can mitigate some of the increased risk associated with city so let's now look at heart disease physically active men and women have lower rates of heart disease so again i'm going to show you a pooled analyses are some data done by dr. student of mine and what he did was he pull data from different studies so all the light

bars you see our individual studies and as scientists what we do is we don't really believe in the findings of one study what we want to know is the consistency of evidence and you looked at all these different studies and plotted kind of you can see the average finding across all the different studies and this again shows pretty much what we

see with up mortality rates which doesn't surprise you right because heart disease is one of the major killers one of the main causes of death in the us and what you see is from doing nothing to doing a little bit your heart disease goes down this is where you meet guidelines the more you're willing to do the lower your heart disease fries and

this is another study that was done by one of my fellows and it's a single study not data from several studies but i think it's really encouraging because what it does is it looks at rates of heart disease among women in our women's health study of different weights so these are the normal weight women these are the overweight women and these

are the obese women and what you see our weights of heart disease plotted by women of different week groups going from the most active women to the least active women and what you see is yes if your normal way your heart disease are better than someone who is overweight or obese but even if you are obese if you are someone was physically active

these are the front two bars you are better off then your colleagues were inactive each other back to bars so physical activity benefits individuals of all shapes and sizes if you are someone was already heavy it's very hard to lose sweet but you can still be physically active going to move on now to the next disease which is physically

active men and women have lower rates of take two diabetes now this is not a new study but it's a really important study it's from a trial called the diabetes prevention program trial so what is it was a multicenter trial it involved participants from 27 centers throughout the united states and what investigators

did was they enroll 3234 overweight or obese men and women who had impact glucose tolerance so men that these people couldn't process glucose normally and they will be at high risk of developing diabetes what they did was they randomized this group of individuals to three groups so one group was the placebo group in the placebo

group took a placebo essentially a sugar pill the second group took a drug called metformin which is a drug that we use to treat diabetes and the last group was assigned to an intensive lifestyle intervention program that encourage people to lose seven percent of their body weight through physical activity and a sensible diet so what you see here

is the years ago this trial goes on and what these lines our okay all these people had no diabetes they are high risk of getting diabetes but they did not yet have diabetes and as they develop diabetes you plot in the graph so over time why more people develop diabetes so as you might expect the individuals in the sugar pill had the

highest rates of diabetes but what was i would say shocking even for the investigators who believe their physical activity and diet will be important was that the lifestyle group did better than the drug rule at the end of the intervention the lifestyle group had a fifty-seven fifty-eight percent reduce risk of developing diabetes and the drug

group had thirty one percent reduction in risk even the most converted of us weren't expecting this rate i think we might have expected that they might do equally well maybe the drug group will do slightly better so you might see all well you know this is only 34 years what happens after that last year the investigators published a finding

after 15 years of follow-up and what happened was that you essentially still see the patent the same pattern the sugar pill had the highest rates the drug group still had a higher rate and the lifestyle group is the group that did best so in this particular example is a combination of diet and physical

activity i'm going to show you another pooled analysis so this is a combination of data from 10 different studies looking at different levels of physical activity and rates of developing diabetes so these are not individuals at high risk of diabetes by the general population and you can see what we saw as for all-cause mortality and heart

disease do some you get some benefit when you reach the guidelines to get a significant amount of benefit the more you willing to do the greater your benefit so we're getting close on time i'm going to end up with the last disease condition i want to talk about which is that physically active individuals have lower weights of

certain types of cancers so when i showed you the guidelines from the 2008 physical activity guidelines we set that active individuals at lower rates of breast and colon cancer because these other more commonly occurring cancers and there weren't much data for some of the other cancers some of you may have seen this in the newspapers about a

month or two ago so this is a study that we did again we try to pull data from 12 different studies so that we would have large groups of individuals and what we found was that physically active individuals had lower rates of 13 different types of cancers so not just breast and colon colon cancer but many different cancers including some of the

more common cancers we have such as endometrial cancer bladder cancer liver cancer cancer of the esophagus in the gastric cardia liver and so on and so forth if you're interested i've provided the reference here and you can see all the different cancers that are on this site i'm not going to spend more time going

to them other than you see that you're physically active you can reduce your reach of many different cancers so i'm stoner and summarize what we talked about in the last period of time we know that in the u.s. chronic disease are the leading causes of death we talked about what the recommended levels of physical activity are and we clearly see that

what is recommended will reduce our risk of developing many chronic diseases but encouragingly if we do some physical activity even if it is less than what is recommended we still get benefits for chronic disease prevention which is why i think physical activity should be labeled a wonder drug and i'm going to close by showing you this card then my

secretary farm for me and it says walking shoes are 80 bucks and you go to discount store they're probably even cheaper than that which is where i buy my shoes a triple bypass 80 grand and you go to the more expensive centers you can go up to a quarter million dollars think of all that cash in hand and march or to shillong the land so be physically

active and thank you for listening to this lecture