The history of physical activity provides lessons for today as our sedentary lifestyles contribute to type 2 diabetes, cardiovascular disease, osteoporosis and more severe Covid-19 outcomes. By Nicky Pellegrino.
Twelve years ago, writer and photographer Bill Hayes was in a San Francisco gym, climbing aboard the StairMaster for a cardio workout, when he paused for thought. "I looked around the gym and saw all these men and women lifting weights, stretching, doing chin-ups and sit-ups. And I thought, how did we all end up here? If I were to trace a line back in time, where would I land?"
That question took Hayes from the gym to the San Francisco Public Library, searching for a book that would tell him. There was nothing to be found.
Several years later, he began researching his own, the newly released Sweat: A history of exercise. By then, Hayes was living in New York and the partner of Oliver Sacks, neurologist and bestselling author, who suggested that he begin his research in the New York Academy of Medicine’s rare book library. There, he came across a volume, dated 1573, called De Arte Gymnastica by Girolamo Mercuriale. That book sent him on an expedition covering 2000 years and three continents and led to Hayes, now 60, learning to be a boxer, qualifying as a personal trainer and even trying out running in the nude.
Along the way, he learnt of the many ways modern workouts are based on ancient wisdom. Even during a time when human biology was fundamentally misunderstood, classical civilisations realised the importance of regular physical activity, building gymnasiums where the goal was to keep fit both physically and mentally.
"There was an intuitive understanding that exercise was good for your body and your mind," explains Hayes. "Gymnasiums existed in almost every city in the Greek and Roman empires. They weren't open to everyone; these were really male, upper-class spaces. And they were for philosophising as well as fitness training."
Plato, an athlete and wrestler, wrote about the importance of balancing training the body with cultivating the mind. The physician Galen believed the best exercises both tired the body and delighted the soul. And Hippocrates produced treatises on exercise and health.
"He wrote about customising an exercise plan to a person's individual life and mixing it up, as we would say today," says Hayes. "There's a really good quote from Hippocrates: 'Those who get exhausted with running should wrestle, and those who get exhausted with wrestling should run.'"
Then the Christians came along. They objected to the pagan aspects of the Olympic Games and put their focus on the soul and spirituality, rather than the body. Cathedrals replaced gyms and for centuries, formal exercise wasn't a priority. Not until the post-industrial age, with the birth of concerns about people becoming increasingly sedentary, did physical exercise start to go mainstream.
As well as being a history of physical activity, Sweat is a personal memoir. Hayes writes of growing up the son of a former West Point cadet who trained him like a paratrooper. He recalls later working out in the men-only muscle gyms of San Francisco in the Aids era. And tells of how, later still, Sacks pushed himself to exercise while seriously ill with cancer.
“He did it because it made him feel good, made him feel alive, it’s that simple,” Hayes says. “He could swim endlessly and loved it so much that, when he was sick, we still swam at least three days a week. I think it was meditative for him. One of the saddest milestones in his illness was five weeks before he died, when Oliver realised he couldn’t swim any more.”
Even confined to his bed, Sacks, 82, found ways to move his limbs, sardonically calling it "exercise for the dying".
After his loss, Hayes took a long break from physical activity and, like the early Christians, focused on his inner life. "I lost all motivation," he says. "My whole world had changed and going to the pool was just sort of heartbreaking. I didn't care as much about looking good or being fit. It all seemed unimportant."
Inevitably, his health suffered. Hayes gained weight, his blood pressure rose, and a doctor warned him that he needed to step up his cardio. By then in his mid-fifties, Hayes had discovered exercise was no longer something he chose to do just to look and feel good. He now needed to be active to stay healthy.
Active Grandparents
As we progress through our lives, we tend to exercise less and less. Maybe we are short on time, or our bodies break and hurt more, or, like Hayes, we find that other events get in the way. Yet there is mounting evidence that, rather than dialling down our physical activity in midlife and beyond, we ought to increase it.
Among those leading this way of thinking is Harvard palaeoanthropologist Daniel Lieberman. In his latest book, Exercised, he outlines what he calls the “active grandparent hypothesis”. The theory is that humans have evolved to live for several decades after we stop reproducing, not in order to take it easy, but to remain physically active, seeking food for our children and grandchildren.
Lieberman has spent time observing the Hadza, a hunter-gatherer society living in northern Tanzania. “Hunter-gatherers stay active until the end of life,” he says. “Sometimes they work even harder than when they were younger.”
For the Hadza, scheduling in formal exercise isn’t necessary because they walk several kilometres a day to hunt animals, seek honey or dig for tubers. These people are 12 times more active than the average person in the developed world, purely because it is necessary for their survival. As a result, they have an extended “healthspan”, tending not to get the sorts of chronic conditions we associate with ageing such as cardiovascular disease, dementia and sarcopenia (frailty caused by accelerated loss of muscle mass).
Repair and Maintenance
Regular physical activity has far-reaching effects. It staves off the accumulation of body fat, keeps blood pressure under control, lowers bloodstream levels of sugar and unhealthy cholesterol, strengthens bones, improves function and reduces stress hormones. But it is what Lieberman terms "the costly repair hypothesis" that is believed to reverse some of the damage that can happen with age.
"Physical activity turns on repair and maintenance mechanisms in the body that keep us healthy, especially as we age," says Lieberman. "This is part of what we evolved to do; we're selected for this repair and maintenance mechanism."
Exercise is physiologically stressful. Our muscles develop micro tears and pump out waste compounds. Our mitochondria (the powerhouses of the cells) cause damage to the DNA and other molecules throughout the body. As physical activity leaves destruction in its wake, the body's defences kick in to deal with it, at the same time fixing other damage that has been quietly accumulating, turning on a host of processes to rid cells of waste products, repair DNA and damaged proteins, and producing powerful antioxidants. Lieberman describes this as "like scrubbing the kitchen floor so well after a spill that the whole floor ends up being cleaner".
He refers to conditions such as type 2 diabetes, cardiovascular disease, dementia and osteoporosis as “mismatch diseases” because they are what happens when what we evolved to do is out of step with the way we actually live.
“Genes change really slowly from generation to generation, but environments can change really fast,” he says. “And in the modern world, we’ve changed our environments so dramatically that we’re imperfectly adapted to them.”
It is not that sitting is intrinsically unhealthy. One of the first things that struck Lieberman about the Hadza is how much time they spend sitting around on the ground. Conserving energy makes sense when food is scarce and finding it requires effort.
"No sensible hunter-gatherer wastes 500 calories running five miles just for kicks," says Lieberman.
Evolution explains a lot about why we find it so hard to get to the gym. We evolved to rest when possible, like the Hadza do. Needless exercise robs our energy budget of the calories we require for reproduction. And so, in our modern lives, to lift heavy weights or pound a treadmill or even choose to take the stairs, we have to override some ancient, powerful instincts.
"We've created a world in which physical activity is now voluntary and so we have to do this very strange, abnormal thing that runs counter to our basic fundamental instincts – unnecessary, unrewarding physical activity," says Lieberman, adding that almost everybody he knows who doesn't exercise wants to exercise. "It's not that they're opposed to it, but they struggle to do it. And there's a reason why they struggle."
The fact that we are hardwired to conserve energy isn't the ultimate excuse not to go to the gym. Rather, it is a reason for compassion and a way to understand that a few strategies might be required to drum up the motivation to move.
“People who are successful at being physically active find ways to make it necessary,” Lieberman says. “I sign up for marathons not because I love them – I don’t, actually, they’re horrible – but the training forces me to do what I otherwise wouldn’t. This morning, I went for a run. It’s winter in Boston and it was just above freezing. I bitched and moaned and complained, and finally went because I had to. I’m Mr Exercise, right? If I don’t do it then I’m a hypocrite, so that’s another incentive I have.”
In his book, Lieberman writes of one acquaintance so frustrated by her wasted unused gym memberships that she signed a commitment contract with the website stickk.com, pledging to walk four miles a day and send the National Rifle Association US$25 for a every week she failed to meet her goal. Determined not to pay it a cent, she stuck to her fitness schedule for a year and is now a dedicated walker.
In Lieberman's opinion, the medicalised, commercialised way we try to push people into physical activity today is counterproductive. "It makes people exercised about exercise," he says. "It makes them anxious and stressed, conflicted and confused. You get this idea you have to run marathons or climb mountains to be healthy. That's just not the case. Study after study shows that regular, moderate amounts of physical activity have enormous benefits. There's some benefit to occasionally getting a little intensity in there, but you don't need to go crazy."
The hunter-gatherers he has observed spend up to six hours a day doing a mix of light, moderate and vigorous activities and Lieberman says many of them are struggling to give their children a better life. Unfortunately, if they manage to attain that life, it tends to be a more sedentary one. He does much of his work in Kenya, where there has been a move towards cities and desk jobs and an accompanying rise in rates of obesity and type 2 diabetes.
"In Kenya, I'm the only middle-aged, grey-haired guy going for a run," he says. "They must think I'm bizarre. Yet what I do is what they're going to have to do to accommodate this better life they're living.
“I think we need to get that information out there. We need to help people understand, without condemning them, without making them feel bad, blaming and shaming. That has failed in the West. Half of Americans never exercise at all. Only 20% get the minimum of 150 minutes a week. And that’s not for lack of people knowing that exercise is good for them. It’s just that the medicalised, commercialised system that we’ve created has been a failure for most people.”
Horses for Courses
Here in New Zealand, we are doing a little better. The Ministry of Health reports that about half of adults get the basic 150 minutes a week. Still, one in eight are physically active for less than 30 minutes a week and those over 75 are likely to be less active than those under.
Science has now proved what the ancient Greeks instinctively understood – both the brain and the body need physical activity. A recent study from the University of California found that exercise reduces inflammation in the brain, particularly in areas linked to Alzheimer’s disease. More new research from Stanford suggests this may be due to elevated levels of clusterin, a protein that clears cellular debris. And even if we don’t start working up a sweat until middle age or older, it seems there are benefits for brain health.
Motivation comes from making exercise necessary, or at least making it fun, believes Lieberman. That might mean taking part in a competitive sport, but he believes the real key to enjoying exercise is having it be social.
“The poor person alone on a treadmill in a basement survives by listening to a podcast or watching something, but it’s a form of torture, not a pleasure. If you run or go for a walk with other people, all of a sudden you get a social interaction and encouragement, which makes it pleasant.”
Still, it may take a while before any form of exercise achieves the Galen ideal of both tiring the body and delighting the soul.
"Any runner knows there's a point about 10 miles in when you feel great; you're at one with your body, it's effortless, there's a kind of flow that happens," says Lieberman. "It's what runners crave, but you have to be fit enough to get to that beautiful state where you can enjoy it. One of the cruelties of our evolutionary history is that the release of dopamine and opioid, all those rewards of physical activity, don't happen if you're unfit."
He believes that it is helpful to understand that you need to put in consistent work to start experiencing that feel-good rush. Also useful is the knowledge that, although we compete against each other in most sports using strength and speed, what makes us exceptional athletically as a species is our endurance.
Lieberman proved this when competing in Arizona’s annual 25-mile (40km) Man Against Horse Race and crossing the finish line ahead of 40 horses, thus experiencing his ultimate runner’s high. At a sprint, those horses left him in the dust. But over a distance, they couldn’t keep that pace up for long, particularly in the heat. We humans, with our long, springy legs and our more efficient cooling system (we are “the sweating champions of the animal world”, according to Lieberman), were designed to cover long distances efficiently and effectively, most likely so we could “persistent-hunt” – chase down an animal until it was exhausted.
Necessary but Rewarding
To stay injury free as a modern runner, however, Lieberman believes we should study good running form.
"One of the strange things about exercise in the modern world is that we teach people to play tennis and how to swim, but for some reason we don't teach them how to run," he says. "There are some exceptions. There was the famous New Zealand coach Arthur Lydiard, who trained people how to run properly. But today, we seem to have forgotten that running is a skill and we just give people a pair of trainers and tell them to go out and run, which is sad because it's not a very difficult skill."
A newly compelling source of motivation to get off the couch is evidence that physical inactivity and obesity are linked to more severe Covid-19 outcomes. One study published in the British Journal of Sports Medicine looked at almost 50,000 adult Covid patients in the US and found those who were consistently inactive over the previous two years were more likely to be admitted to hospital, require intensive care and die than patients who had been consistently active. Even exercising sporadically improved the odds of beating the virus.
“The best thing you can do the day you have your Covid vaccine is go for a run or a jog, because it increases the antibody response,” says Lieberman. “This is especially important if you are older.”
For centuries, we have understood that physical activity is vital for our well-being, and for centuries we have been struggling to do it.
"We in no way dispute that exercise can sometimes be hard and, when it is being performed, unpleasant. But good health is not incompatible with some discomfort," wrote Girolamo Mercuriale way back in the 16th century.
Lieberman believes that the answer is to start treating exercise like we do education. “Education is also a modern thing,” he says. “Nobody learned to read until relatively covly, nobody learned algebra, calculus and statistics. We make education work in the modern world by making it necessary and rewarding. It’s fun to go to school; you meet friends and do all kinds of other good stuff. We should apply the same model to exercise. Make it necessary, but also rewarding. I think that’s the future, because selling or prescribing it only gets you so far.
Park Life
Karma McGowan, 44, has been a fitness instructor for nearly 25 years, and some of her clients have been with her for a good chunk of that time.
“Over time you have to modify what you do with people because it takes a bit longer to recover,” she says. “I’ve changed my work-outs, too. In my twenties, I pushed myself until I was in pain. Collapsing with exhaustion was a badge of honour. I could still do that if I wanted but it’s not what I’m looking to achieve any more.”
Although she started her career based in a gym, McGowan has moved away from that environment and now chooses to train all her clients in Auckland’s parks, where she believes they get a more functional and thorough workout, maintaining strength with body-weight and resistance-band exercises, keeping up a brisk pace for cardio fitness and incorporating movement for balance and stability.
“I always thought gyms were kind of bizarre,” she says. “They’re these completely manufactured environments where you go to do all the things that we’ve manufactured out of everyday lives.”
McGowan says the fixed-weight machines and much of the cardio equipment in gyms have been designed for men and are not always well suited to women with smaller frames.
“If the handles are too wide apart, you’re going to hurt your shoulders,” she says. “That’s where using your own body weight and trying to do really functional movements is your best bet. If you can do a decent range of motion – squats or lunges, pushing something, pulling something, bending over, twisting a bit – then you’re covering all the bases.
“A lot of what you see in gyms is about isolating muscles and that is not how your body works. The mindset that people get into when they’re in the gym is they have to play with all of the toys without really stopping and considering, ‘Does this suit me? Is it functional? Is it a thing I do in my everyday life?’”
Injuries happen when people throw themselves into high-intensity exercise sessions, having been sedentary in between, rather than keeping the body conditioned with regular physical activity.
“Where a lot of people who see a personal trainer come unstuck is that they don’t necessarily do anything between those sessions,” says McGowan. “They may work out two or three times a week and consider that they’ve ticked that box. It’s not ideal. Realistically, you need to be doing something every day. You should be moving slowly a lot and moving vigorously every now and then.”
Lieberman’s tips for good running form
- Avoid over-striding, which means landing with your feet too far in front of your body.
- Take about 170 to 180 steps a minute.
- Don’t lean too far forward, especially at the waist – it encourages over-striding.
- Land gently with your feet nearly horizontal. Barefoot runners land on the ball of their feet before letting down the heel. This mid-foot strike avoids a rapid impact force with the ground. If you are trying to change the way your foot lands, do so gradually and build up strength.
This story was first published in the January 15, 2022 issue of the Listener.