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Fitness or ideal weight: Which holds the key to long life?

thumbnail Stress manager—Dr. Peter Kokkinos oversees a cardiac stress test for Albert McMillan, 63, at the Washington, DC, VA Medical Center. Patients walk or run on the machine as the speed and elevation increase, until they feel fatigued. Researchers use the results to calculate fitness levels. (Photo by Robert Turtil)

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There are lots of intricate data to support the point, but the research findings of Peter Kokkinos, PhD, can basically be summed up in two words:

"Inactivity kills."

Says Kokkinos, "This comes through over and over again in the studies, no matter what type of population we're assessing."

For more than two decades, the VA investigator has explored the link between fitness and longevity. In his world, fitness—or aerobic capacity—is measured by people's endurance on a treadmill.

The research confirms that being able to exercise more is a good thing: It can add years to your life. No surprise there. But dig deeper, and there is news that may come as a mild surprise to many.

According to numerous studies, being unfit is more deadly than being overweight, or even obese. If you can walk up two flights of stairs without stopping, for instance, even if you're carrying 20 or even 40 extra pounds on your frame, you're likely to outlive a lean couch potato who can barely manage one flight of stairs without getting winded. We're talking statistically, of course—after researchers have adjusted for variables such as age, smoking, and medical history.

That's what health experts glean from epidemiologic data on hundreds of thousands of people, says Kokkinos. He and his collaborators, both within VA and at other institutions across the U.S. and abroad, including his native Greece, have contributed heavily to the literature in this field.

Kokkinos, who heads a cardiac exercise lab at the Washington, DC, VA Medical Center and is a professor of medicine at Georgetown and George Washington universities, says the bottom line is that fitness is a powerful driver of longevity that trumps the ill effects of any other risk factor, such as diabetes, hypertension, and excess weight.

So if your genes keep you forever in an uphill battle against flab, all is not lost. Get on a treadmill. Ride a bike. Whatever it is that moves you, get moving. According to Kokkinos, it doesn't take much to nudge yourself into a healthier fitness bracket that will lower your mortality risk.

"A brisk walk on a daily basis can do it," he says. "The goal is to accumulate between 150 and 200 minutes per week of moderate exercise. That's all you need."

A trim 62-year-old, Kokkinos himself pursues a moderate exercise regimen. "I jog and brisk walk. At my age, I don't need to do a whole lot. I also add some resistance training—that's also important, to maintain muscle strength and bone density."

He shuns extreme measures. "I go by the saying, "Everything in moderation.' It worked thousands of years ago, and it works today."

The researcher and his colleagues at the Washington, DC, VA Medical Center are applying the lessons they've learned on behalf of Veterans. The group has developed a program they call Lifestyle Intervention for Veterans—known by its catchy acronym LIVe. Says Kokkinos, "It's designed to empower the participants to develop and pursue a healthy lifestyle."

The program covers exercise, nutrition, and stress management. At the outset, Veterans get their fitness level tested. "In most cases, it's below the average for their age group," says Kokkinos. For the next 10 to 12 weeks, participants come to the hospital to exercise two days a week and work out at home the other days.

Kokkinos: "The message I give them is that diabetes is their enemy. I tell them, "It's a relentless enemy. You must fight back. Proper exercise, diet, and stress management are your weapons. Fight back!""

He says both he and the participants have been pleasantly surprised by the results. "In just 10 weeks, they turn things around. Their fitness level increases by about 15 to 30 percent. They lose weight, lower their blood pressure, and improve their blood sugar levels. They have more energy, sleep better, and feel better about themselves. Overall, their quality of life improves."

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