However, exercise should not only be considered as a method to lose weight but also as an essential tool in remaining healthy through treating and preventing illness and diseases. This May’s Exercise is Medicine™ Month, is a time for everyone to recognize, emphasize and celebrate the valuable health benefits of exercise and to May-Kit Happen.

Exercise is Medicine is a program launched in 2007 by the American College of Sports Medicine (ACSM) and the American Medical Association (AMA) and is designed to encourage American’s patients to incorporate physical activity and exercise into their daily routine. Whilst this program is being promoted primarily in the US it is a program which is applicable globally. According to the World Health Organization, one of the major challenges in the prevention of non-communicable diseases and in the promotion of physical activity and other healthy lifestyle choices is communicating the importance of action now in return for future benefits.

Exercise should not just be advised to the overweight but promoted to everyone for overall, life-long health. The U.S Physical Activity Guidelines suggest participating in at least 150 minutes of moderate-intensity physical activity per week, whilst the Australian guidelines are to put together at least 30 minutes of moderate intensity physical activity on most, preferably all, days. The UK current physical activity guideline for children is to achieve 60 minutes or more activity on 7 days a week. But with modern transport, technology and labour saving devices how many of us actually achieve these guidelines?

Aside from weight loss, exercise also provides the added benefits of:

• better circulation, preventing heart disease, stroke and high blood pressure;
• increases strength by helping to build and maintain bones, muscles and joints to reduce the risk of injury or osteoporosis;
• improves agility and flexibility;
• reduces the risk of diabetes and certain cancers;
• promotes psychological well being and can reduce the risk of alzheimer’s disease.

Don’t forget to check with your doctor first that you are healthy enough to start exercising, they may also be able to provide you with a suitable exercise plan or classes in your area. Exercise is Medicine aims not only to promote exercise to the public but also to encourage doctors to prescribe it to their patients. Network members, including Strenua’s World, have committed to supporting the guiding principles of Exercise is Medicine:

• Exercise and physical activity are important to health and the prevention and treatment of many chronic diseases.
• More should be done to address physical activity and exercise in health care settings.
• Encourage ACSM’s efforts to bring a greater focus on physical activity and exercise in health care settings.

If you are interested in learning how you can become more active in your life then sign up for the one-month Exercise is Medicine™ email series for the public. You will receive helpful tips on how to create a life-long exercise plan and stick to it, regardless of your age or current fitness level, easy-to-use resources and plenty of motivation to keep you moving.

Robert E. Sallis, MD, the chair of Exercise is Medicine, says ‘We all know exercise is not a magic bullet. It doesn’t guarantee you won’t get cancer or have high blood pressure. But research clearly shows exercise helps treat and prevent many chronic diseases including diabetes, heart disease, cancer and hypertension. Of all the measures that can be taken to prevent illness and disease, exercise is, by far, the most worthwhile. Whether you’re sick or healthy, young or old, fit or not, exercise makes you feel better almost immediately!  The trick is to sustain a fitness regime. Help is out there. Support is available. Whatever it takes, just get moving!’

A study by Donald Redelmeier and Ari Greenwald published in the British Medical Journal randomly selected 26 marathons in the US with more than 1000 participants and followed each for up to 30 years from 1975- 2004. This amounted to 750 marathons and 3,292,268 participants encompassing 14 million hours of exercise. Over the 30 years there were 26 sudden cardiac deaths equivalent to 0.8 per 100,000 participants. The typical participant with sudden cardiac death was a middle aged man (average age 41 years, 81% men). 5 deaths were in individuals who had previously completed a marathon, with the most common location of death at or within 1mile of the finish. The risk of sudden cardiac death equated to about 2 deaths per million hours of exercise.

Whether due to the increase in popularity of marathon events or the increase in previously inactive people ‘wanting to have a go at one’ the incidences of deaths in marathons have increased in recent years.  Deaths during marathon events are generally due to 4 factors:

• Heart Disease - One of the common causes of death in marathon runners due to heart attacks brought about by underlying coronary artery disease. These attacks are brought on by a combination of the physical stress of the event combined with the person’s lack of cardiac fitness.
• Sudden Cardiac Death - On average 12 young people a week die from sudden cardiac death. In 2007 the 28 year old professional runner Ryan Shay collapsed during the Olympic marathon trials. Ryan was young and highly trained and had previously run 7 marathons. His autopsy reported the cause of death to be Cardiac arrhythmia due to cardiac hypertrophy, meaning abnormal beating due to an enlarged heart.
• Water Intoxication - This occurs when there is so much water in the body that it dilutes vital minerals such as salt to dangerous levels. It can lead to confusion, headaches and fatal swelling of the brain. In 2007 22yr old fitness instructor David Rogers died from hypomatraemia after completing the London Marathon.
• Heat stroke - This is brought about by extreme dehydration. Learning to regulate body heat is important, rehydrating efficiently without becoming intoxicated by too much fluids. In the 2005 Great North Run half marathon four male runners died due to heat related illnesses.

Of the 24 autopsy reports available in Redelmeier’s study there were 21 cases of atherosclerosis, contributing factors included (2) coronary anomalies, (4) electrolyte abnormalities and (1) heat stroke.

People should not be discouraged from running full or half marathons as the health benefits of regular exercise by millions of people out weigh the tragic sudden deaths of a few participants. Whilst some deaths are medically related, a number of people who require emergency medical attention do so because they do not respect the marathon event.

My first marathon should have been a Golden Bond place in the London Marathon. The day before the race I awoke to my entire body and face swollen and red. A visit to the doctor revealed I just had a virus or allergic reaction to something and was advised not to run as I would be putting added to strain on my body attempting to complete a marathon while fighting an infection. Whilst being bitterly disappointed in missing the race I was persuaded that by running I was not only risking my own health but those of other runners if the medical teams had to treat me rather than another casualty. Three weeks later I was able to successfully run a different marathon, collect sponsorship for my chosen charity and I got a ballot place for London the following year.

Celebrities such as Katie Price, being praised for completing the race whilst still suffering from the effects of a miscarriage days earlier, or Jade Goody, admitting to have done no training but congratulated for making it to mile 18, just suggest to the public who ‘fancy a go’ that the marathon is not too much of a physical challenge and doesn’t need to be taken seriously. Thankfully there are celebrities such as Nell McAndrew, Tom Audenshaw and Gordon Ramsey who show commitment to their training, health and race performance.

Whilst deaths associated with marathons are rare, if anything can be done to reduce them even more, it should be implemented. In Italy before participating in a marathon runners are required to complete a medical sports fitness test including an electrocardiogram (ECG). Although it may seem an expensive inconvenience if this was extended to other countries this may identify those at risk of cardiac related conditions and save lives. Additionally if required to provide evidence that you have trained sufficiently or participated in at least  a half marathon, runners will have at least experienced some physical stress of endurance exercise and had the chance to learn how to deal with heat and efficiently rehydrate.

According to today’s report by the European Centre for Disease Prevention and Control there have been 136,432 worldwide reported cases of influenza A (H1N1) resulting in 765 deaths. To put things in perspective only 1 in 178 people, or 0.56% who contract swine flu globally have died from it. Whilst any death is unfortunate, in a given year there are normally 4,000 deaths in the UK and 36,000 deaths in the US attributed to influenza, so there isn’t any extra need to panic.

But if you are obese or overweight there may be some added incentive to lose some weight. During the current swine flu pandemic there have been some observational reports that obesity is a risk factor for complications of the H1N1 virus infection.

There appears to be a correlation between obesity rates in a given country and the percentage of people who die from the swine flu.

There haven’t been official studies into the number of flu victims who are obese, so it’s unknown whether the deaths from swine flu are primarily in obese patients. However, the Morbidity and Mortality Weekly reported the case of ten swine flu patients at a Michigan hospital who became so ill they were put on ventilators. Three of the patients ultimately died from the infection.  Nine of the ten were obese, and two of the three who died were severely obese with no underlying respiratory conditions.

Whilst obesity has not been identified before as a risk factor for flu in humans, researchers at the University of North Carolina have studied the death rate of obese mice when they are infected with the flu virus. For 22 weeks, 70 female mice were fed a normal diet and 70 a high fat/high sucrose diet with all animals then infected with the influenza virus.

Lean mice developed mild disease and only 4% died whereas obese mice got extremely sick and 40% died due to severely impaired immunity. Obese mice also produced lower amounts of anti-inflammatory agents and also took 6 days to produce them, twice as long as the lean mice. Although the study was in mice the researchers think that obesity inhibits the ability of the immune system to respond to influenza infection and suggest that obesity may lead to morbidity from viral infections.

It’s not known whether the mice results are reflected in humans and the excess fat itself makes obese people more vulnerable by inhibiting their immune response. Alternatively it could be that people with a high body mass index who become infected get sicker because of related conditions like heart disease and respiratory complications which are harder to treat and become fatal.

Whilst the science behind the observations has yet to be confirmed, it appears that obese people have yet another health incentive to lose weight.

Depending on your ethnic background you are at risk of different diseases and illnesses.  Men from groups at risk should be aware of the symptoms, how to further reduce the risks and how to go about getting testing and treatment. In 1999 Health Survey for England, found that compared with the general population there were:

• Higher rates of angina and heart attacks reported by Indian (50%), Bangladeshi and Irish men.
• Higher rates of stroke by Black Caribbean (50%), Bangladeshi and Indian men
• Higher rates of diabetes in men from all ethnic minority groups.
• Increased obesity in Irish men, whilst men from South Asia and China were less likely to be obese.
• Nearly twice as many Bangladeshi men were likely to smoke.
• Less alcohol consumed by men all minority ethnic groups except the Irish
• And as we mentioned yesterday African Caribbean men are 3 times more likely to develop prostate cancer than white men.  

Black and ethnic minority men are also less likely to seek help for mental health problems from services. Yet the department of health’s  2002 statistics on ethnic minority psychiatric illness rates in the community found that all ethnic minority groups had higher than average incidences of psychiatric illness amongst men.  Studies show 7 times higher rates of new diagnosis of psychosis among Black Caribbean people than among the White British. Incidences in Pakistani and Irish men aged 35-54 was 21% compared to 10% of Whites and 20% of 55-74 year old Bangladeshi men suffered from psychiatric illness compared to 11% of White British men.

For these men from minority groups it’s not just getting them to access the health services that is the difficult issue. Treatment of diseases such as leukaemia with a stem cell or bone marrow transplant is more difficult in patients from ethnic backgrounds. Of the 120,000 patients around the world who need a bone marrow transplant, 2 out of 3 Caucasian patients will find a donor yet it can be as low as 1 in 4 non Caucasians, due to the lack of ethnic and mixed raced donors on the register.

It’s not only ethnic minority groups who are reluctant to access traditional health services. Gay and bisexual men are hesitant to use traditional primary care services because of experiences of homophobia. These groups of men however, experience many factors that affect their emotional wellbeing   through coming out, accepting their sexuality and being open and honest with other people. They also need to feel comfortable approaching services if they suffer from physical abuse or harassment. Without support these issues can lead to depression, anger, mental distress and even self harm.

Gay and bisexual men also have to be aware of their sexual health. In major UK cities 1 in 10 men are living with HIV. However, you don’t need to only go to your GP to access sexual health services and screenings. Most cities have clinics for gay and bisexual men with the opportunity to get full sexual health check-ups.

Whatever your ethnic background, if you are interested in becoming a donor and joining the bone marrow register visit http://www.anthonynolan.org.uk

For information on mental health visit http://www.mentalhealth.org.uk

Advice for gay or bisexual men on all matters including mental and sexual health can be found at the lesbian and gay foundation website http://www.lgf.org.uk