“No, I do not recommend exercise,” my endocrinologist answered when I asked him if he suggests to his patients exercise as a means of medical intervention. Further discussion revealed something which made the former response slightly more palatable. My endocrinologist, an older gentleman of middle eastern descent, believes that exercise is excessive. Movement, however, is important. As a patient of this man for some 25 years, I cannot distinctly remember him prescribing movement to me as a way to manage my congenital adrenal condition.
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This conversation reminded me of another I had with a female endocrinologist - the doctor spearheading the revamping of CHOP’s endocrinology department in an effort to improve care continuity. The meeting again included the question, “Do you include exercise in patients’ care plans?” Another disheartening answer was followed by a statement about the lack of green spaces available in the Greater Philadelphia Area. The Last Child In the Woods (link) addresses this nationwide green space issue; a serious problem. Urban safety persists as a tangent concern. With this said, Philly boasts hundreds of miles of bicycle and pedestrian trails connecting people to jobs, communities, and parks in the Greater Philly Region. 

Semantics may be part of the issue, as the opening conversation suggests. Exercise might connote “excessiveness” for some. Often, the terms “exercise”, “physical activity”, and “games” provoke feelings of punishment and fear as people remember being picked last in gym class, or running sprints at the end of practice. Connotations aside, movement - or  even better move·ment -  lives at the heart of the argument. The idea that practitioners and families alike might promote appropriate use of medications and psychological support combined with adequate movement and optimal fueling through nutrition, especially as it relates to endocrinology.  

I fear that these beliefs surrounding exercise do not only live in Philadelphia’s medical institutions, but are systemic to the point where western medicine dogma trickles into contingent estuaries.  

So seems to be the case in Michigan. University of Michigan’s School of Kinesiology boasts a brilliant exercise endocrinology lab, where studies designed to translate clinical findings to applications that can impact adult health and quality of daily life, explore the ways diet and exercise can be used to prevent development of morbidities. A letter to Dr. Borer, the Director and Professor of Movement Science at UofM, revealed a disheartening truth. “I should let you know that I am not taking on new doctoral students.Exercise endocrinology is a great path, but not very strong or popular at the moment.”  

Hope remains. Last year’s CARES Conference offered presentations focusing on exercise and nutrition. CHOP’s unique Healthy Weight Program works with overweight and obese children and adolescents to improve the health and quality of life of children with excess weight by working with families to make healthy lifestyle changes. 

It is a great feeling to hear someone say to me, “I totally forgot you have a medical condition,” stating that I look fit and healthy. To them I say “thank you,” for I feel flattered yet not satisfied. I can’t help to think about those who experience the same condition who do not - who don’t know what it feels like to feel and look healthy, who don’t feel supported or empowered. 

We were born to move and amazing things can happen through purposeful acts of change. It will take curious patients, supportive families and medical holistic pragmatism to join western medicine and the sweeping exercise movement. One patient and doctor at a time.   

​​Entropy, Exercise, and BMR 

    The heat evolved by the body is called the basal metabolic rate (BMR). Different states of arousal, age, and even diet affect BMR. For example, Vegetarians have lower BMR than nonvegetarians with high proteins consumption. 

       The entropy production in mild exercise is 1.5-2.4 times as great as that in basal conditions. The entropy production in vigorous exercise is six to eight times as great as that before exercise. Studies suggest that strength training can increase BMR due to increases in lean muscle mass. 
Keeping in mind the aforementioned description of entropy, one might conclude exercise is detrimental to longevity. However, it is important to look at the human body as a whole and not individual organ systems. Just small amount of physical activity indeed helps people live longer.

     As one of my former professors stated, “Metabolism affects the heart, the heart affects the lungs, the lungs affect the blood, the blood affects the muscle, muscle affects hormones, and hormones affect metabolism!!  It is hard to just study entropy and its effect on lifespan when other factors play a role in lifespan!!"

For more information, check out Entropy Theory of Aging Systems: Humans, Corporations and the Universe. 

References 

1 HEALTH, AGEING AND ENTROPY - http://www.ped.muni.cz/z21/knihy/2011/39/texty/eng/34_navratil_eng.pdf
2 Entropy Theory of Aging Systems: Humans, Corporations and the Universe
​3 https://www.ncbi.nlm.nih.gov/pubmed/2232826