Book Review

Exercise: Hot Topics
Manu V. Chakravarthy and Frank W. Booth
Hanley and Belfus Inc., Philadelphia (USA), 2003, 326 pp., index, $29.95
ISBN 1-56053-568-7

    Exercise: Hot topics champions the role of physical activity and exercise in achieving and sustaining physical and mental health. In a direct and highly readable style, Chakravarthy and Booth review the established and latest evidence that widespread inactivity constitutes substantially to morbidity, mortality and skyrocketing health care costs. This work is a tour-de-force of statistical information regarding the health benefits of a physically active lifestyle that has been immaculately researched and presented. The reader should never feel adrift in a sea of knowledge because each major point is carefully referenced and a comprehensive reading list is provided. In addition, the text is systematically peppered with web addresses for both primary sources and authoritative additional resources including recommendations by expert panels.
    Rather than pushing the perspective that physical activity is something we should do, Hot topics directs that we in the modern world cannot afford not to become more active as a species. In a direct challenge to the medical community, Chakravarthy and Booth point out that if physicians do not advocate and promote physical activity and behavior change this “constitutes a direct violation of one of the central tenets of the Hippocratic oath i.e., do no harm.” Hot topics acknowledges that sedentary habits are hard to change. However, recognizing that the cost of the inactivity epidemic may be as high as 250,000 American lives per year, health care professionals must become proactive to combat this problem. Even small steps taken in the right direction are valuable and should be initiated without delay. Hot topics should not be viewed as “THE guideline” but instead as a catalyst to fuel new and innovative ideas focused on reducing the burden of disease for humanity.
    Exercise: Hot topics is presented in three sections: “Section I: Defining the Problem” explores briefly the formation of the present human genome between 50,000 and 10,000 years ago. This section lays the foundation for understanding why the genetic predisposition for energy storage that was essential to our ancestors survival places us at odds with the modern sedentary lifestyle and may cause premature morbidity and mortality. Focus is brought to bear on the health and prospective well-being of our children. As they grow up in the computer age where physical activity is de-emphasized and safety issues are used to rationalize and promote motorized transport and television watching rather than physical activity, inactivity-related diseases are burgeoning. The old adage that “an ounce of prevention is worth a pound of cure” is placed in the context that once exorbitant stores of adipose tissue are laid down, it is extremely difficult to reduce these stores. In the short term, our children may be safer in the home watching television under parental control than exposed to a potentially hostile environment outdoors. However, we may be sowing the seeds for a generation riddled with chronic health conditions that could have been lessened or avoided by encouraging a healthy and active lifestyle for our children.
    “Section II: The Means to Action” presents evidence from 44,788 pairs of twins that for many major chronic health conditions (e.g., Type II diabetes, coronary heart disease, cancer [leukemia, and lung, breast and prostate cancer]), environmental factors including physical inactivity rather than inherited factors are largely to blame. Moreover, a moderate level of physical activity such as walking 30 or more minutes per day significantly reduces the incidence of many chronic health conditions. This section summarizes the clinical manifestations of physical inactivity, the demonstrated benefits of increased physical activity and the putative biochemical/cellular mechanisms for the healthful effects of physical activity. Rather than promoting the concept of “fitness” per se, Chakravarthy and Booth suggest participation in physical activity to advance “well-being.” The principles of caloric balance are applied to the prevention of weight gain and to weight loss. The body mass index or BMI (weight[kg]/height[m]2) is utilized almost universally to judge the appropriateness of a patient’s weight. However, it is recognized that health benefits may be gained even without losing weight. Indeed, as espoused in Glenn A. Gaesser’s book Big Fat Lies it is possible for an individual to be extremely active, have an excellent blood lipid profile normal glucose tolerance and blood pressure and yet have a BMI rating that is >30 (i.e., viewed as unhealthy by almost all weight-based standards). Hot topics emphasizes that increased physical activity levels may bring about major health benefits irrespective of weight loss.
    Section II systematically presents physical activity prescriptions on a case-by-case basis. Common pitfalls and reasons for failing to increase patient physical activity are addressed with helpful methods to overcome these problems. The challenges faced in physical activity counseling are detailed along with the wisdom of employing multicomponent interventions that combine provider advice with behavioral counseling. The Activity Counseling Trial (ACT) which is one of the first randomized, controlled trials to clearly show the benefits of primary care counseling to increase physical activity levels above that of a sedentary baseline is used as an example.
    “Section III: The Biological Basis for Chronic Diseases Caused by Physical Inactivity” details the health consequences of physical inactivity. Within this section, ten chapters are devoted to specific diseases such as cardiovascular, metabolic, and pulmonary diseases, cancer, bed rest and spinal cord injury, immune dysfunction and neurological and musculoskeletal disorders. Aging and also women’s health are also accorded their own chapters. Each disease and condition is carefully dissected and the evidence for the role of physical inactivity in promoting or physical activity in reducing the prevalence of disease is presented in a clear and compelling fashion. Focus is brought to bear on the cellular mechanisms involved at each juncture.
    Chakvarathy and Booth acknowledge that this book represents only a first step in acknowledging and addressing the problem that physical inactivity either causes or contributes to multiple chronic health conditions. They point out that at a time when health care professionals are trained to focus on treating specific symptoms of acute diseases, the diverse nature of chronic health conditions is proving problematic. Moreover, they note that the National Institutes of Health needs to acknowledge this problem by better funding research into the role of activity in preventing disease. There is a plenitude of evidence that muscular activity can help restore physiological function and health within patient populations. This book provides a mandate for healthcare professionals to implement preventive programs of which the major focus must be increased physical activity. In conclusion, Hot Topics: Exercise presents the epidemiology and the molecular-biological evidence for the role of physical activity in combating chronic disease. The information is superbly researched, clearly presented and referenced comprehensively. It is an unparalleled resource for the exercise scientist and physician or other health care professional. Whereas it may be read cover-to-cover, it is equally useful as an up-to-date resource on the role of physical activity in reducing the incidence of major disease conditions that may be “dipped” into for selective information. I have enthusiastically recommended this book to my students and professional colleagues.

David C. Poole
Kansas State University

Books Received

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Andrew A. Biewener.
New York: Oxford Univ. Press, 2003, 281 pp., illus., index, $15.00.
ISBN: 0-19-850022-X.

Calcium-Sensing Receptor.
Naibedya Chattopadhyay and Edward M. Brown (Editors).
Boston, MA: Kluwer Academic Publishers, 2003, 286 pp., illus., index, $142.00.
ISBN: 1-4020-7314-3.

Comparative Biomechanics:
Life’s Physical World.
Steven Vogel.
Princeton, NJ: Princeton Univ. Press, 2003, 580 pp., illus., index, $60.00.
ISBN: 0-691-11297-5.

Insulin-Like Growth Factors.
Derek LeRoith, Walter Zumkeller, and Robert C. Baxter, (Editors).
New York: Kluwer Acad./Plenum, 2003, 498 pp., illus., index, $165.00.
ISBN: 0-306-47846-3.

Physiology, 5th Edition.
Robert M. Berne, Matthew N. Levy, Bruce M. Koeppen, and Bruce A. Stanton.
St. Louis, MO: Mosby, 2004, 1024 pp., illus., index, $74.95.
ISBN: 0-323-02225-1.

Physiology of the Graafian Follicle and Ovulation.
R. H. F. Hunter.
New York: Cambridge Univ. Press, 2003, 397 pp., illus., index, $90.00.
ISBN: 0-521-78198-1.

Textbook of Work Physiology: Physiological Bases of Exercise, 4th Edition.
Per-Olof Astrand, Kaare Rodahl, Hans A. Dahl, and Sigmund B. Stromme.
Champaign, IL, Human Kinetics, 2003, 650 pp., illus., index, $79.00.
ISBN: 0-7360-0140-9.

Vertebrate Ecophysiology.
An Introduction to its Principles and Applications.
Don Bradshaw.
New York: Cambridge Univ. Press, 2003, 287 pp., illus., index, $35.00.
ISBN: 0-521-52109-2.
 

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