搞不到靈丹妙藥 那就試試運動吧
After I wrote last year that diet, not exercise, was the key to weight loss, I was troubled by how some readers took this to mean that exercise therefore had no value.
去年我寫過一篇文章，稱想要減肥，最重要的是節食，而非鍛鍊。有些讀者認爲，那意味着鍛鍊毫無價值，這讓我深感不安。
Nothing could be further from the truth. Of all the things we as physicians can recommend for health, few provide as much benefit as physical activity.
那種想法簡直是大錯特錯。在醫生給出的關於健康的建議中，幾乎沒什麼能比得上體育活動。
In 2015, the Academy of Medical Royal Colleges put out a report calling exercise a “miracle cure.” This isn’t a conclusion based simply on some cohort or case-control studies. There are many, many randomized controlled trials. A huge meta-analysis examined the effect of exercise therapy on outcomes in people with chronic diseases.
2015年，皇家醫學院學會(Academy of Medical Royal Colleges)發佈了一份報告，稱運動是“靈丹妙藥”。這一結論不只是基於一些世代研究或病例對照研究，而是基於無數隨機對照試驗。一項大型元分析研究了運動對慢性病的療效。
Let’s start with musculoskeletal diseases. Researchers found 32 trials looking specifically at the effect of exercise on pain and function of patients with osteoarthritis of the knee alone. That’s incredibly specific, and it’s impressive that so much research has focused on one topic.
我們先談談肌肉骨骼疾病。研究者發現了32項重點關注運動在緩解膝關節炎疼痛及改進功能方面的作用的試驗。這些試驗的研究對象非常具體。令我印象深刻的是，這麼多研究都是關注一個主題。
Exercise improved those outcomes. Ten more studies showed, over all, that exercise therapy increases aerobic capacity and muscle strength in patients with rheumatoid arthritis. Other studies proved its benefits in other musculoskeletal conditions, like ankylosing spondylitis, and even some types of back pain.
那些研究表明，運動對膝關節炎具有改善作用。另有10項研究表明，總的來說，運動療法能提高類風溼性關節炎患者的有氧代謝能力和肌肉力量。還有些研究證明，運動有益於其他肌肉骨骼疾病，比如類風溼性脊椎炎，甚至包括某些種類的背部疼痛。
For people (mostly middle-aged men) who had had a heart attack, exercise therapy reduced all causes of mortality by 27 percent and cardiac mortality by 31 percent. Fourteen additional controlled trials showed physiological benefits in those with heart failure. Exercise has also been shown to lower blood pressure in patients with hypertension, and improve cholesterol and triglyceride levels.
在犯過心臟病的人（主要是中年男性）當中，運動療法降低了27%的全因死亡率和31%的心臟病死亡率。另有14項對照試驗表明，運動對心力衰竭患者具有生理益處。另有研究表明，運動能降低高血壓患者的血壓，改善膽固醇和甘油三脂水平。
People with diabetes who exercise have lower HbA1c values, which is the marker of blood sugar control, low enough to probably reduce the risk of complications from the disease. Twenty randomized controlled trials have showed that patients with chronic obstructive pulmonary disease can walk farther and function better if they exercise.
經常運動的糖尿病患者的糖化血紅蛋白水平較低——糖化血紅蛋白是血糖控制指標——低到很可能足以降低這種疾病的併發症風險。20項隨機對照試驗表明，慢性阻塞性肺部疾病患者如果經常運動可以步行得更遠，肺部功能也有所改善。
Multiple studies have found that exercise improves physical function and health-related quality of life in people who have Parkinson’s disease. Six more studies showed that exercise improves muscle power and mobility-related activities in people with multiple sclerosis. It also appeared to improve those patients’ moods.
多項研究發現，鍛鍊能改進帕金森病患者的身體功能以及與健康相關的生活質量。另有六項研究表明，鍛鍊能提高多發性硬化症患者的肌肉力量以及與運動相關的活動能力。運動似乎也能改善這些患者的心情。
The overall results of 23 randomized controlled trials showed that exercise most likely improves the symptoms of depression. Five others appear to show that it improves symptoms in patients with chronic fatigue syndrome. In trials, exercise even lessened fatigue in patients who were having therapy for cancer.
23項隨機對照試驗的總體結果表明，運動最可能改善抑鬱症症狀。另有5項研究似乎表明，它能緩解慢性疲勞綜合徵患者的症狀。在試驗中，運動甚至能緩解接受癌症治療的患者的疲勞感。
What other intervention can claim results like these?
還有什麼干預能得出這樣的結果？
Even studies of older, hospitalized patients show a beneficial effect from multidisciplinary interventions that include exercise. Those randomized to such interventions in the hospital were more likely to be discharged to go home, and to spend less time in the hospital over all — and at a lower cost.
甚至對年紀較大的住院患者的研究也表明，包括運動在內的多領域干預具有益處。那些被隨機選出進行干預的住院患者更可能獲准回家療養，總體來說，他們在醫院呆的時間更短，花費也更低。
Although we don’t think of it this way, you can make a pretty good argument that exercise is as good as drugs for many conditions. A 2013 meta-analysis of meta-analyses (that’s how much data we have) combined and analyzed the results from 16 reviews of randomized controlled trials of drug and exercise interventions in reducing mortality. Collectively, these included 305 trials with almost 340,000 participants.
雖然我們不從這個角度思考，但你完全有理由認爲，對很多疾病來說，運動和藥物一樣有效。2013年的一項對元分析進行的元分析（也就是研究我們有多少數據）綜合、分析了16項對隨機對照試驗的回顧研究。這些試驗是爲了減少死亡率而進行藥物和運動干預，共計305項，有近34萬人參與。
Diuretic drugs (but not all drugs) were shown to be superior to exercise in preventing death from heart failure. But exercise was found to be equally good as drugs in preventing mortality from coronary heart disease. Exercise was better than drugs in preventing death among patients from strokes.
結果表明，利尿藥物（而不是所有藥物）在預防心力衰竭死亡方面優於運動。但是在預防冠心病死亡方面，運動和藥物一樣有效。在預防中風死亡方面，運動優於藥物。
Many people will be surprised at how little you need to do to achieve these results. Years ago, in an effort to get in shape, I tried the P90X routine. It proved too hard for me. Later, when I tried the Insanity workout, it beat me so badly that people at work kept asking me if I was ill. Two years ago, I tried P90X3. It was a bit more manageable, but I still couldn’t keep it up.
你只需少量鍛鍊就能收到這樣的效果，很多人可能會對此感到意外。多年前，爲了保持體形，我嘗試進行P90X鍛鍊。結果發現，那對我來說太難了。後來，我嘗試Insanity鍛鍊時感到疲憊不堪，同事們經常問我是不是病了。兩年前，我嘗試P90X3鍛鍊。它的難度稍微低一些，但我依然跟不上。
I have not been alone in thinking that physical activity to improve health should be hard. When I hear friends talk about exercising, they discuss running marathons, participating in cross-fit classes or sacrificing themselves on the altar of SoulCycle. That misses the point, unfortunately. All of these are much more than you need to do to get the benefits I’ve described.
不是隻有我一個人認爲通過體育運動改善健康應該很難。朋友們在談論運動時，談的是跑馬拉松，上cross-fit健身課，或者獻身於動感單車課程SoulCycle。不幸的是，他們沒有抓住要點。爲了實現我所說的那些益處，你遠不需要做這麼多。
The recommendations for exercise are 150 minutes per week of moderate intensity physical activity for adults, or about 30 minutes each weekday.
建議成年人每週進行150分鐘中等強度的體育鍛煉，大約相當於每個工作日30分鐘。
Moderate intensity is probably much less than you think. Walking briskly, at 3 to 4 miles per hour or so, qualifies. So does bicycling slower than 10 miles an hour. Anything that gets your heart rate somewhere between 110 and 140 beats per minute is enough. Even vacuuming, mowing the lawn or walking your dog might qualify.
中等強度很可能比你想得輕很多。比如快走，大約每小時3至4英里。還有騎自行車，每小時低於10英里。任何能讓你的心率保持在每分鐘110至140的運動都可以。甚至連用吸塵器打掃衛生、割草坪或遛狗可能都是有效的。
Today, my goals are much more modest. Trekking from my office to the clinic and back again gives me 30 minutes of exercise. Or, I walk to the supermarket from my office to grab lunch, at a mile each way. In colder weather, I spend half an hour on the elliptical machine. Doing this five days a week gets me the activity I need.
如今，我的目標溫和多了。從辦公室徒步往返診所能讓我鍛鍊30分鐘。或者從辦公室走到超市買午餐，單程1英里。天氣較冷的時候，我在踏步機上鍛鍊半小時。每週鍛鍊5次就達到了我所需要的運動量。
Although it feels as if there’s nothing we can do to change people’s behavior, there is evidence to the contrary. A systematic review and meta-analysis of advice and counseling by health professionals found that promotion of physical activity works.
雖然我們似乎沒辦法改變人們的習慣，但也有證據表明並非如此。一項對健康專業人士提供的建議和顧問所做的系統性回顧和元分析發現，鼓勵人們鍛鍊身體是有用的。
Doctors and clinics that made efforts to promote exercise to patients needed to engage 12 adults on the subject to get one additional adult to meet recommended levels of activity one year later. That might not sound impressive, but it’s one of the better such results.
那些努力鼓勵患者進行鍛鍊的醫生和診所，每鼓勵12名成人才會有1位能在一年後達到建議的活動量。那也許聽起來不算什麼，但這已經算是不錯的結果了。
After the Academy of Medical Royal Colleges wrote its report, an editorial in the BMJ, a prominent medical journal, countered that exercise wasn’t a “miracle cure.” Instead, the authors argued it was “the best buy for public health.”
皇家醫學院學院發佈那份報告後，著名醫學期刊《英國醫學雜誌》(BMJ)的一篇社論反駁說，運動不是“靈丹妙藥”。社論作者們認爲，它是對“對公共健康來說最划算事情”。
If that’s the best “counterpoint,” then physical activity seems like a no-brainer.
“靈丹妙藥”也好，“對公共健康來說最划算事情”也好，反正去運動都沒錯。
