Best things come in small packages
We are all keen to take a look under the tree to see what presents have our name on them. Big ones and small ones are undoubtedly the most interesting. Among the small packages this year will be a large number of multi-functional watches that are able to check your pulse, your blood pressure, your oxygen levels and record your daily amount of exercise. They all come with targets and alarms about what you should be achieving.
However, there are no ‘shoulds’ in medicine. We are all individuals and what might be sensible for one person may be unachievable for someone else. The aim of all medical care is either to cure or optimise our risks of illness. It is difficult to prevent all disease as the biggest factor in almost all cases are the genes you inherit. Luck is something we cannot control. We are able to very significantly reduce our risks of lung cancer and heart disease by not smoking but this is the only intervention that makes an enormous difference to the statistics. All other changes in behaviour are valuable but how much difference they make depends on the context. The analogy I use in consultations is comparing the difference in risks for someone driving a car or a motorbike. We are all comfortable driving cars without wearing crash helmets or protective clothing. However, we would not dream of getting on a motorbike without these on. Patients who have diabetes are at increased risk of heart attack and strokes in the same way that the motorcyclist is at increased risk of crashing. Blood pressure medication and statins are the equivalent of the helmet and leathers. The same is true for anyone who has already suffered a cardiovascular event. So, what is the best blood pressure and lipid level for those at higher risk? The simple answer to this question is the lowest that causes no problems. We titrate medications so that they are the optimal dose ie best readings with no side effects. This will be different for each individual.
The optimal amount of exercise is more complicated. Walking some distance every day is undoubtedly beneficial for our bones and joints. Taking some medication prior to exercise if needed is sensible. I have written many times about the enormous mental health benefits of being outside and interacting with nature; there is no optimal number of steps required to take advantage of this. However, cardiovascular health can be improved with short strenuous exercise. The research shows this is surprisingly short. Raising your heart rate with 1 minute of vigorous exercise everyday has a significant effect. What you need to do to achieve this will vary with age; short sprint for the younger, fast power walk for the older. The aim is to have 60 seconds of effort a day. As always not too much to cause side effects but sufficient to feel you have done something. A small package of time that will deliver large benefits; no electronic devices or large pieces of exercise equipment required.
Wishing everyone a very Happy Christmas from the Wyndham House Team