Opinion | With exercise, don’t let perfect be the enemy of the good

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Imagine a medical therapy that reduces your risk of stroke and heart disease by 27 percent. It cuts your chance of developing cancer by 12 percent. And it decreases your overall risk of premature death by 31 percent.

These are astounding numbers. If such a drug existed, it would be hailed a miracle.

In reality, such a “miracle” exists, and we’ve known about it for years. Decades of research have demonstrated the benefits of exercise to physical health, cognitive stability and emotional wellness. Studies during the pandemic have also linked physical activity to lower rates of hospitalization and death from covid and reduced likelihood of developing long covid.

A new systematic review published in the British Journal of Sports Medicine summarizes 196 previous studies involving more than 30 million adult participants. Their findings include the astounding reductions in cardiovascular disease, cancer and death I mentioned above.

These results were seen in individuals who engaged in at least 150 minutes of moderate intensity exercise a week, which is a little more than 20 minutes a day. This is the amount of physical activity recommended by a number of health-promotion entities, including the Centers for Disease Control and Prevention and Britain’s National Health Service.

Interestingly, the researchers found that just half the recommended amount brings significant health benefits as well. Seventy-five minutes of moderate intensity activity a week, or about 11 minutes a day, was associated with a 17 percent reduction in cardiovascular death, 7 percent reduction in cancer and a 23 percent lower risk of early death.

The authors estimate that if everyone engages in at least 75 minutes of exercise a week, approximately 1 in 10 early deaths could be averted.

The 75-minute finding is important. For people working multiple jobs and caring for kids and older parents, 150 minutes of exercise can seem daunting. For us clinicians, it’s helpful to tell patients that while more is better, just 15 minutes of exercise five times a week can have a meaningful impact.

People can get to that number by incorporating just a little more activity into their daily routines. For example, they can park a block away from work and then take the stairs instead of the elevator. Those with desk-based jobs can set notifications to get out of their chair a few times a day, and they could convert some video meetings to phone calls that can be taken while walking.

Of course, those who are able to do more exercise shouldn’t limit themselves to only 75 minutes. There is a dose-response relationship to exercise, meaning that more is better (though beyond 150 minutes a week, the added benefit is proportionally less).

Those who wish to expand their exercise regimen beyond walking can consult The Post’s excellent Well+Being section. I particularly liked this article on the importance of strength training (which I’ve recently incorporated into my own exercise regimen), and another, complete with videos, that demonstrates five aerobic exercises that can be done anywhere, no gym equipment required.

My main takeaway about exercise is that some is better than none. This is one area where we really shouldn’t let perfect be the enemy of the good. Starting somewhere will make a difference.

And remember that increased physical activity isn’t just good for our physical health; it is instrumental in improving mental well-being, too.

What questions do you have about exercise? Please send them through the submission form. I read all your entries and will be covering this topic more in the coming weeks.

Newsletter subscribers are invited to submit questions to Dr. Wen. Not a subscriber yet? Click here to sign up.

“My husband (age 67), my son (age 25) and I (age 66) all had the initial two Pfizer vaccines and one booster. My husband and I also had a second booster in the summer of 2022. All three of us planned to get the bivalent booster at the beginning of November but all became ill with covid instead. We are now wondering if we should still get the bivalent booster, four months after infection.” — Nancy from Virginia

All of you are probably still well-protected because you have hybrid immunity from recent infection as well as vaccination.

At the moment, the second bivalent booster has not yet been authorized, though the Food and Drug Administration is reportedly considering making available the additional shot to people 65 and over as well as immunocompromised individuals in the coming weeks. This would be the right decision, as I have written.

Once federal regulators make their decision, you and your husband could consider getting the bivalent booster as your age places you at higher risk for severe outcomes. This is not urgent for you, though, as you are probably still well-protected due to your recent infection. Assuming your son is generally healthy, he could wait until the fall, when annual boosters are likely to be recommended for most Americans.

“I am committed to a cruise on the Rhine with my husband. We are both over 70, hypertensive and slightly obese. We have reached out to our medical provider to obtain a prescription for Paxlovid. Do you recommend that seniors eligible for Paxlovid have a prescription on hand just in case we test positive for covid while traveling overseas?” — Eiko from California

I think this is reasonable and advisable. Some providers are willing to issue a “just in case” prescription, in which case you should fill the script and carry Paxlovid with you on your trip. This is particularly important if you’re going to areas that may not have this antiviral easily accessible (for example, if you are on a cruise that doesn’t dock daily).

If your doctor won’t issue the prescription, find out your options for getting Paxlovid in the locations where you will be traveling. Can you visit an urgent-care clinic and get a same-day test and prescription? Planning ahead could give you peace of mind — and help ensure you get the care you need.

“You wrote before on the Marburg virus. What’s the latest? Should we in the United States be concerned yet?” — Roy from North Carolina

There are now two areas with active Marburg virus disease outbreaks. One is in the West African country of Equatorial Guinea, where at least nine cases have been confirmed. A second outbreak has been identified in East Africa, in Tanzania, which recently identified its first-ever case of this viral hemorrhagic fever.

While Marburg virus disease is highly deadly — some estimate that the case fatality rate could be as high as 88 percent — it is transmitted through direct contact, not as an airborne pathogen. Outbreaks have occurred before and have been successfully contained. There is not yet a vaccine or specific treatment for the disease.

The CDC has issued a Level 2 alert for travelers going to affected countries, meaning that people going to areas with active Marburg cases should practice enhanced precautions such as avoiding contact with sick people and trying not to go to health-care facilities for nonurgent issues. This is not yet an issue for people in the United States, but it requires continued careful monitoring and expedited development of therapeutics.

The Post has also compiled Q&As from my previous newsletters. You can read them here.

A modeling study in JAMA Health Forum projected that 78 percent of covid-19 cases that would ultimately require hospitalization were detected within five days of symptom onset, when patients would be eligible for the antiviral pill Paxlovid. Yet, only 5 percent among eligible infected patients received the drug. If Paxlovid uptake increased to 80 percent of eligible individuals, there would be a 42 percent reduction in hospitalization and 51 percent reduction in mortality. This model shows that a focus on treatment could offload strain on hospitals and save lives.

A CDC report found that nearly half of children under 5 years old did not eat a vegetable every day, and nearly a third did not eat a fruit every day. But 57 percent of kids drank at least one sugar-sweetened beverage that week. The analysis included state-by-state variations; nearly 80 percent of children in Mississippi drank at least one sugary drink in the preceding week, while that number was less than 40 percent in Maine.

I enjoyed this audio tribute in the New England Journal of Medicine to Anthony S. Fauci, the former director of the National Institute of Allergy and Infectious Diseases. Featuring voices from other noted scientists, advocates and even Fauci’s wife, the series of interviews offers a unique and personal perspective into the life and career of an inspiring doctor, noted researcher and dedicated public servant.