Why You Should Be Excited to Change
We cannot change anything unless we accept it. Condemnation does not liberate; it oppresses.
Passion is superior to fear as a motivation to change. That’s why this chapter will focus on the positive outcomes you can achieve from exercise and healthy eating. Nevertheless, we still need to cover some of that doom and gloom stuff about being sedentary, eating junk and having excess body fat. It will help you understand why it’s so important to make the effort.
The Good News
Insert random motivational “you can do it” statement here.
Seriously, once you get into the groove of healthy living you’ll discover numerous reasons beyond looking and feeling better that keep you going, such as …
Adding to Your Life Résumé
If you’re overweight and don’t like being so, that’s a problem—one that’s difficult to solve. But if you do it—if you work hard and persevere and achieve your goals—you will have gained tremendous experience as a problem solver. And that’s a skill that can be applied to myriad aspects of your life.
There’s even proof. Albert Bandura, an internationally renowned behavioral psychologist and Stanford University professor, examined this phenomenon with the development of his groundbreaking self-efficacy theory. According to Bandura’s theory, sustained weight loss is a “performance accomplishment.” And repeated success (or accomplishment) makes it easier to deal with occasional failures. And overcoming these failures “can strengthen self-motivated persistence if one finds through experience that even the most difficult obstacles can be mastered by sustained effort.”1
Am I the only one who said, “Hell, yeah!” after reading that?
Those performance accomplishments build on one another. If your life could stand some improvement, getting in shape does way more than give you a healthier and hotter body to live inside. It gives you the mental discipline and willpower to kick more ass at the rest of life. It’s your return on investment.
It gets better.
Even though pursuing fitness costs money, time, effort, sweat, pain and smelly laundry, it can pay you back financially. Yes, financially. And I’m not just talking about the qualitative stuff like improved health, longevity, physical performance, appearance and self-esteem. There are hard numbers to run here, such as what happens when you compare people who exercise at least three times a week with those who exercise less (or not at all).
“I found that for men the average was a 6 percent increase on weekly earnings. For women it was more on the order of a 9 to 10 percent increase in weekly earnings.” Vasilios Kosteas, an associate professor of economics at Cleveland State University, told me this.
Kosteas’s study, published in the Journal of Labor Research in 2012, controlled for things such as education, age, gender, health status and body weight to make the exercise probability as close as possible.2
“These results support that there is a causal relationship for exercise increasing income,” he said.
“We have a good body of evidence that shows exercise is linked to having greater energy levels, better cognitive function, improved mood—all of these things lead to greater performance at work, and greater confidence as well.”
So there you go. By taking some time away from your career to focus on health, you can actually enhance your career. Who knew? But before we talk about how great your life can be, we need to talk about …
Taking Shame Out of the Equation
You’re probably familiar with a whole range of “yo mama so fat” jokes, but how many have you heard about how black, gay or Jewish “yo mama” is? Why is making fun of the overweight still okay?
“There is no question that the stigma and bias and discrimination surrounding obesity is the fairest game,” says Dr. Yoni Freedhoff. “In popular culture the vilification of obesity is constant, whether it’s obese characters who are lazy, clumsy and gluttonous, or the types of responses to public policy statements about dealing with obesity.”
Freedhoff told me that these responses stem from a simple fact: most people erroneously believe that the overweight are somehow choosing to do this to themselves. They think if we’d just push away from the table we’d be all be slim.
What a crock.
In 2011, the International Diabetes Federation released a position statement to combat the common belief that obesity is the result of a personal failing or lack of motivation, writing that “this perspective ignores the very strong genetic and developmental bases to severe obesity compounded by physical, emotional and societal issues.”3 The statement also explained that obesity stigma leads to discrimination at work, socially and even in the health care system.
This is not the way to motivate people. In fact, a 2012 study by researchers in the Department of Psychological and Brain Science at the University of California, Santa Barbara, found that people who experience stigma over their weight experience elevated stress, which reduces self-control, which in turn can lead to weight gain.4 In a 2013 paper published in PLoS ONE, researchers from Florida State University were more damning, asserting that not only does stigmatizing obesity lead to poorer mental health outcomes, but the authors stated that, “Rather than motivating individuals to lose weight, weight discrimination increases risk for obesity.”5
Again, when obesity is stigmatized, it causes weight gain.
Kris Beneteau, 48, is an office worker in Windsor, Ontario. At her heaviest she weighed 271 pounds and had to face a lot of stigma both for being overweight and for choosing bariatric surgery (which we’ll cover in appendix B) as a tool to combat her condition. Now maintaining at 145 pounds, she told me how poorly people treated her when she was heavier.
“There was definitely a stigma attached,” she said. “Once a stranger told me I shouldn’t be in a Baskin Robbins to get ice cream, like it was somehow his business.”
And no matter how talented or accomplished a person may be, for some, only that extra weight is visible. In 2009, Brent Smith, lead singer for the multi-platinum selling band Shinedown, was on The Today Show. Right before his performance, host Kathie Lee Gifford said, “At first I thought he was Meat Loaf,” and her co-host Hoda Kotb laughed aloud at the gibe. I asked Brent how that made him feel.
“It really stung,” Smith told me. “I’m a fan of Meat Loaf, but she wasn’t talking about a musical comparison. It was national television and my heart kinda fell on the ground … It was like the performance didn’t even matter. It was a tough comparison for me that morning.”
The jokes aren’t so funny for those who are the brunt of them.
Fat shaming leads to extreme dieting, depression, eating disorders and more. Wendy Williams told me her parents called her fat all the time when she was growing up, and it led to decades of disordered eating.
Don’t listen to the shamers. You can’t adopt exercise and change your eating behaviors if you have a toxic mind-set. Hating your body is not a healthy way to approach changing it. If you don’t exercise I’m not going to blame you for not being active, and you shouldn’t blame yourself. This is not about blame but about ownership. You are the 100 percent undisputed owner of your body, and if it’s in poor shape no one suffers more than you. Your body is where you live; it’s home sweet home until the day you become worm food.
So give yourself a hug, because it’s time for a bit of doom and gloom before we get to the good stuff.
The Bad News
Being sedentary, having a poor diet, smoking and being at higher-stage obesity are all leading causes of early death. This last item is a major risk factor for all forms of heart disease, stroke, type 2 diabetes, certain forms of cancer and a host of other debilitating conditions such as mental deterioration, gout, gall bladder disease and sleep and mood disorders.6
The longer you stay glued to a couch, the greater the risk of death from myriad causes, agrees Bill Kohl, a professor of epidemiology and kinesiology at the University of Texas at Austin. And the older you get, the more infirm you become. “Continued inactivity into the 60s and 70s results in balance insufficiencies and lack of strength,” Kohl told me. “Daily living becomes much harder.”
Science Trumps Circumstances
Prior to the 20th century, lifestyles were much different than they are today, as most labor was done by human power rather than machines. People didn’t need jogging shoes or gym memberships; they busted their butts all day long just to make a living. Diets were lower calorie and not full of refined, high-calorie food, and few people were overweight. Back then we ate for fuel to live; today we eat mostly for pleasure.
And still, the poor buggers dropped like flies. Average life expectancy prior to the 20th century was less than 40 years of age.7
Don’t start celebrating. Yes, we live longer lives now, but this is in spite of our terrible lifestyles. We have modern medicine, adequate nutrition and clean water to thank for improved longevity. Rates of death from heart disease are declining, even as obesity rates, sedentary living and overconsumption of unhealthy food rises, but this is because of improved medical treatments.8 But now a major health care crisis is looming. In the not-too-distant future the whole medical system could become overwhelmed if people don’t start focusing on preventative medicine rather than treatment.9
BMI—Bogus, Maligning Information?
Margaret and I struggled over whether to even include BMI—body mass index—in this book. Yes, knowledge is power, but this knowledge probably doesn’t really help you, because it attaches labels like “obesity”—not a nice-sounding word—to people. Labels are not always a true measure of health, and they certainly don’t represent individual differences in lifestyle or amount of muscle. Higher levels of body fat are but one piece of a large and complex puzzle.
There’s ample evidence to show a person who is physically active on a regular basis and eats a quality diet can still be “overweight” or even “obese” and live a long life.10
“Exercise trumps a lot of other bad behaviors,” Dr. Michael Joyner, a physician-researcher and expert in exercise physiology at the Mayo Clinic in Minnesota told me. “Large people who are very physically active are only at a slightly increased risk of all-cause mortality and cardiovascular disease compared with those who are lean and fit.” But those who are large and sedentary are at a two to four times risk, he says.
But still, excess fat creates cause for concern. There are those who say it’s no big deal, but let’s look at the evidence.
A 2013 meta-analysis published in the Journal of the American Medical Association showed that while more severe obesity was associated with higher mortality, being overweight or in a lower stage of obesity was actually associated with a lower overall mortality than those at a “healthy” body weight.11
The media went nuts over this study, yet there’s a mighty “but” that goes along with that analysis. Problem number one is that the study looked only at death rate and not illness. We may be living longer, but we’re not living better. Medical advances can keep us alive even while we’re carrying around unhealthy levels of body fat, but there is a significant difference between joyous living and mere existence.
Excess body fat is often inversely proportional to vitality. There is merit in questing for its reduction.
Problem number two is that the study didn’t adjust for the fact that people often lose a lot of weight when near death. It also didn’t correct for alcoholics, drug users or people with eating disorders, all of which can inhibit weight gain. In other words, the study didn’t compare these overweight and mildly obese people with those in the normal weight range because of a healthy lifestyle. It’s not a realistic comparison.
So what happens when there is a realistic comparison? What happens when you control for things like smoking and history of disease? Well, a 1999 study in the New England Journal of Medicine of a million people did find that the risk of disease and death from all causes increases as weight goes up.12
What’s more, a 2013 study published in the American Journal of Medicine asserts that “the dangers of obesity have been grossly underestimated in clinical outcome studies because of the failure to control for cigarette smoking, inappropriate control for the biologic effects of obesity (e.g., hypertension and diabetes), and failure to exclude subjects at baseline with severe weight loss due to subclinical disease.”13 The author notes that obesity was approaching smoking as the leading cause of avoidable death worldwide.
Fit and Fat
Even so, excess body fat by itself does not spell disaster. As Dr. Joyner said, exercise is a good trump card. I asked my wife, a family physician, what she’s thinking when she sees an overweight patient. “If the person is overweight but doesn’t smoke, exercises, has good blood pressure and cholesterol levels, I don’t worry about it too much,” she told me. How you live your life has far more impact on your health than the number on any scale.
Unfortunately, most people—overweight or not—do not follow healthy lifestyles. In fact, only 23 percent of Americans engage in the barest physical activity to garner minimal health benefits.14 Additionally, in 2010 the Centers for Disease Control and Prevention estimated that only 24 percent of American adults consume the recommended five or more servings of fruits and vegetables a day.15
Blood Type: Gravy
And know that just because someone looks fit doesn’t mean the person is healthy.
Do you remember that 1970s TV classic The Partridge Family? Former child star Danny Bonaduce grew up to have a stint on reality TV with Breaking Bonaduce, and viewers often saw him shirtless and revealing a muscular and chiseled physique. He was also a heart attack waiting to happen.
“The doctor said my blood was ‘like sludge,’ and I told everyone my blood type was ‘gravy,’” Bonaduce said to me. “My cholesterol was 357, like the Magnum.”
A total cholesterol level of 357 (9.23 for my fellow Canadians) can be just as deadly as a pistol. Bonaduce earned his number by drinking to excess, smoking and taking anabolic steroids. Someone with much higher body fat but with healthier habits would have a longer life expectancy.
The Why of Healthy Living
Enough of that. Sorry for bumming you out. The good news is this: if you take gradual steps to transform your body into a lean and powerful machine, you get to live in a nicer metaphorical house. Actually, forget the house analogy; houses don’t move.
Let’s talk cars instead.
Imagine someone who never exercises. She’s in bad shape. She has no energy. She’s overweight. In the automotive world, her body is a rusted-out old Pinto towing a rickety U-Haul. Now imagine what she feels like when she trades that car in for a brand- new Porsche (no U-Haul). Can’t imagine what it feels like? Well, I can tell you it’s friggin’ awesome.
You may be old, morbidly obese, injured, sick and screwed in the genetic lottery, but you can still ditch the clunky old Pinto. You may never get a brand-new Porsche, but most people can achieve a low-mileage Honda. Maybe even a slightly used Lexus.
So how do you get yourself into that Honda or Lexus? As I mentioned at the beginning of this chapter, fear isn’t going to help you. It can motivate people for a short period of time, but it has no staying power. The key to long-term success isn’t fear—it’s passion. So use the doom-and-gloom information as a small part of that initial thrust to get yourself moving, then focus on moving ahead rather than looking back. Don’t think about what you’re doing as giving up something bad; think about chasing something good. There is good news in all this.
“It’s never too late to start exercising,” Kohl said. Interestingly, these are the exact words the original fitness guru, Jack LaLanne, often repeated before his death at in 2011—at age 96. “We’ve learned that even the oldest of the old can increase their muscle mass. Even at 90,” Kohl said.
“There are few things that physical activity doesn’t help in terms of health,” reports Kohl. “It is remarkable for preventing falls and therefore risks of broken hips.” The functional health benefits from becoming a regular exerciser are tremendous for aging populations.
Speaking of Jack, I interviewed his widow, Elaine, who told me of his endless enthusiasm for helping motivate people to move. “He wanted to show people that just because you’re older it doesn’t mean that you have to give up,” she said.
Five years from now you could be feeling 10 years younger. I could compose a mighty tome about the benefits of healthy eating and exercise alone. There is a pile of research big enough to choke an interstellar sandworm. When I write “studies show the benefits of healthy eating and exercise,” I’m talking about something on the order of forty-eleven gajillion studies, and we’ve listed a micro-percentage of these in the next endnote about how exercise and healthy eating, as well as abstinence from smoking and avoiding excessive alcohol intake, dramatically improve quality of life and longevity.16
Wouldn’t you like to be stronger, able to run faster, have better endurance and more energy? Following the advice in the book will get you there. How about getting sick less often, sleeping better and being happier about your physical appearance? This book leads to that too.
And speaking of being happier, your brain and mood gets a boost, and stress decreases too (we’ll cover that in chapter 4).
These Boots Are Made for Knocking
Let’s talk about sex, baby.
Ooh, Salt’N’Pepa flashback.
“Exercise is good for overall sexual performance,” says Emily Morse, a sex expert, Bravo TV personality and author based in San Francisco. “If you’re strong and in good shape you’re going to be able to perform better,” she told me. “More important, lack of self-esteem is a big killer of sex drive, and it’s often tied to body image issues.”
“The most basic part is that when you feel better about your body, how it looks, feels and works for you, you’re just going to have better sex,” agreed Maryanne Fisher, a professor of psychology at St. Mary’s University in Halifax and a specialist in sexuality research. “You’re going to be less self-conscious and more able to be connected to your partner.”
Beyond the psychology, there’s also physiology.
“The better shape you’re in the more you can sustain the activity,” Fisher told me. “You can have a longer sexual encounter. We know that someone who exercises gets libido-boosting effects and fewer erectile problems.”
Research supports this. If you either own a penis or enjoy using such equipment, know that being obese and in poor physical condition increases the risk of erectile dysfunction between 30 and 90 percent.17 Lean and fit men aren’t the ones who need Viagra.
Compressed Morbidity? That Doesn’t Sound Good
Actually, it is good.
We’ve got mega-footnote 16 about the increased longevity that comes from living healthily, but guess what else happens? You go downhill fast! Hooray!
Seriously, hooray! This is good news. Think about it: say you get yourself into awesome shape and live to 90. Wouldn’t you rather be spry right up to 89? The whole “falling apart just to let you know death is looming, so make your peace” messaging takes maybe a year, and then you’re fertilizer. Cue Elton John: “It’s the circle of liiiifffffeeee … and it rules us aaaaalllll …”
Okay, maybe that sounds less than awesome. After all, we’re talking about the Big D here, and it’s coming for you. It’s coming for us all.
Man, I suck at this. Back on track. You want to know how most people die these days? Not that rainbows-and-puppy-hugs version I showed you up there, that’s for sure. They’re dying way younger than those who live healthy lifestyles, and after an extensive downhill slide to boot. They suffer longer. By comparison, people who take good care of themselves not only live longer, but they get a lot more life, quite literally, out of their years. The nosedive into dirt nap is mercifully brief.18
Biology > Machinery
Yeah, I’m going back to the car thing, but only to tell you why humans are more awesome than BMWs.
Your body is the opposite of a mechanical machine. When machines are pushed to their limits and used for long periods day after day they wear out much faster. In animal biology, however, the opposite happens. Machines don’t have the capability of self-repair built in. We do.
When we challenge our body with physical activity, we send it a message that says, “I expect more.” The body answers by adapting to the new challenge. Systems are activated right down to the cellular level to make you better.
Unfortunately it works in reverse too. When you sit around, you break down.
No matter how bad your level of fitness is right now, you can improve it. Maybe one day, science will discover the fountain of youth in a pill, but that is a long way off. For now, there is only one fountain of youth, and we’ll show you how to find it in Stage III.
You need to be thinking long term. Humans are programmed for instant gratification, but planning for the distant future can make the difference in your golden years between climbing Mount Kilimanjaro and puttering around a retirement home on a motorized scooter.
I said death is coming for us all, but that doesn’t mean you can’t fight it.
Blood and Creative Juices Flowing Together
I am Best. Dad. Ever.
The day I interviewed singer Sarah McLachlan also happened to be my daughter’s 12th birthday. Did I mention that my daughter worships Sarah? After the interview McLachlan got on the phone with my little girl and wished her a happy birthday.
Now, go clean your room.
No one would question McLachlan’s creativity, and a 2012 article published in PLoS ONE determined that being physically active out in a natural environment boosts creativity because it is an “emotionally positive” experience, but also “low arousal” when compared with things like television and Internet, which inhibit creativity.19 I know about half of this book was written in my head while in the saddle of a bike, and I mentioned this research to Sarah to see if she had similar experiences.
“I totally agree,” McLachlan told me. “Running is very rhythmic and I have written a lot of lyrics while out running. It’s a very musical exercise, and sometimes I like to sing when I run. Your whole body is doing the same thing. I’d much rather be in the expanse of the wilderness because it feels like part of my world. It’s a unique perspective. You’re this tiny speck in a huge environment and it’s nice to be reminded of that.”
McLachlan also likes surfing, but I expect that in the interest of safety her mind is more focused on the task at hand while riding waves.
The Valiant Delaying Action against Age
Train hard enough and you’ll peak eventually. I haven’t hit my peak yet. I’ve still got that Ironman on the bucket list. Hopefully a Boston Marathon qualification too.
We all get older. The tough ones don’t let it slow them down. Neil Peart is not slowing down.
Peart is the drummer for the legendary Canadian rock ’n’ roll group Rush. In 2011, Rolling Stone named him the greatest drummer alive. “Playing a three-hour Rush show is like running a marathon while solving equations,” he told me right before the band’s penultimate performance of its “Time Machine” tour in Vancouver. “My mind is as busy as it can be, and so is my body—full output all the time.”
Peart is dedicated to maintaining his endurance. He’s fighting a valiant delaying-action against age.
“I have to pretty much not ever get out of shape,” he said. “The stamina aspect is great because you don’t lose that with age so quickly. I know there will be a day when I just can’t do it, but at 58 years of age it hasn’t come yet. I can still play as fast and as powerful and as long as I ever could.”
My best friend and I watched him perform his drumming marathon from the front row that night. Neil was telling the truth.
A Final Word of Encouragement
You could be facing a turning point in your life.
Let’s leave science behind for a moment, and I’ll just give you some good old-fashioned advice.
Maybe your life is a crud sandwich. Alternatively, it may be excellent and the only part missing is a healthy body. More likely is that you fall somewhere between the two. Things are okay, but they could be better.
You may feel there are things you should be doing with your life. You may have a list of unrealized ambitions, half of which you’ve forgotten. There is a nagging itch in the back of your mind that you’re supposed to be doing something more, something better. So here’s my real-life advice: don’t give up on this.
Persevere at getting in shape, because it is going to make everything else in your life better. At the very least, it will make things suck less. Don’t discount that, because sucking less is often the first step in getting better.
Remember what I wrote earlier in this chapter about physically active people making higher salaries on average? It’s because they have the added energy, confidence and a positive outlook on life that promotes ambition. Such people chase their dreams and are more likely to achieve them.
Getting in shape changed my life for the better in ways beyond measure. I wasn’t in a full-on death spiral when I took the plunge; I just wanted to ask my girlfriend to marry me. She was light-years out of my league, and I wished to minimize the chances of her saying no when I handed her a sparkly little rock and asked her to please put up with me forevermore.
I knew she wasn’t shallow like that. I just wanted to look good and be healthy for her. Considering a proposal of marriage seemed like a good impetus to change. And so I did.
There are a number of things Fit James ended up doing with his life (so far) that I’m certain Unfit James never would have accomplished. Oops. Apologies for the Bob Dole moment, but perhaps if I stick with third person the following will seem informative and not conceited.
Fit James completed two master’s degrees and had a successful business career. Fit James worked his butt off to become a syndicated columnist for the Chicago Tribune and Los Angeles Times. Fit James’s soul mate said yes to the sparkly rock.
Living a healthy lifestyle isn’t easy, but it has a benefits package that is second to none. As you’ll see in the next chapter, it’s not just your body that changes for the better but your brain, and that’s pretty awesome.
It’s not an instantaneous change, though. All these positive outcomes emerge at what may seem like a snail’s pace, which is why patience is key.
I’ll say it again: don’t give up on this. Slow progress is still progress.
- Albert Bandura, “Self-Efficacy: Toward a Unifying Theory of Behavioral Change,” Psychological Review 84 (March 1977): 191–215.
- B. Dixon et al., International Diabetes Federation Taskforce on Epidemiology and Prevention. “Bariatric Surgery: An IDF Statement for Obese Type 2 Diabetes,” Diabetes Medicine 28, no. 6 (June 2011): 628–42.
- Brenda Major et al., “The Psychological Weight of Weight Stigma,” Social Psychological and Personality Science 3(November 2012): 651–58.
- Claude Bouchard, ed., Physical Activity and Obesity. (Champaign, IL: Human Kinetics, 2000), 3; George Bray, “Overweight, Mortality and Morbidity,” Physical Activity and Obesity:
- Martin Hagger and Nikos Chatzisarantis, The Social Psychology of Exercise and Sport, (New York: Open University Press, 2005), 8–9.
- Edward Gregg et al., “Secular Trends in Cardiovascular Disease Risk Factors According to Body Mass Index in U.S. Adults,” Journal of the American Medical Association 293, no. 15 (April 20, 2005): 1868–74.
- Hagger and Chatzisarantis, The Social Psychology of Exercise and Sport, 8–9.
- Timothy Church et al., “Exercise Capacity and Body Composition as Predictors of Mortality among Men with Diabetes,” Diabetes Care 27, no. 1 (January 2004): 83–88; Peter Katzmarzyk et al., “Metabolic Syndrome, Obesity and Mortality,” Diabetes Care 28, no. 2 (February 2005): 391–97; Chong Do Lee et al., “Cardiorespiratory Fitness, Body Composition, and All-Cause Cardiovascular Disease Mortality in Men,” American Journal of Clinical Nutrition 69(March 1999): 373–80. Gail Marchessault, “Obesity in Manitoba Adults,” University of Manitoba Faculty of Medicine, October 2011.
- M. Flegal et al., “Association of All-Cause Mortality with Overweight and Obesity Using Standard Body Mass Index Categories: A Systematic Review and Meta-Analysis,” Journal of the American Medical Association 309, no. 1(January 2, 2013): 71–82.
- E. Calle et al., “Body-Mass Index and Mortality in a Prospective Cohort of U.S. Adults,” New England Journal of Medicine 341, no. 15 (October 7, 1999): 1097–1105.
- H. Hennekens and F. Andreotti, “Leading Avoidable Cause of Premature Deaths Worldwide: Case for Obesity,” American Journal of Medicine 126, no. 2 (February 2013): epub.
- Curt Lox et al., The Psychology of Exercise: Integrating Theory and Practice (Scottsdale: Holcomb Hathaway, 2006), 27.
- Pranesh Chowdhery et al., “Surveillance of Certain Health Behaviors and Conditions Among States and Selected Local Areas—Behavioral Risk Factor Surveillance System, United States, 2007,http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5901a1.htm, Accessed November 17, 2012.
- Ian Janssen et al., “Fitness Alters the Associations of BMI and Waist Circumference with Total and Abdominal Fat,” Obesity 12, no. 3 (2012): 525–37; L.B. Andersen et al., “Fitness, Fatness and Clustering of Cardiovascular Risk Factors in Children from Denmark, Estonia and Portugal: the European Youth Heart Study,” International Journal of Pediatric Obesity 3 (2008): 58–66; Chiung-ju Liu and Nancy Latham, “Progressive Resistance Strength Training for Improving Physical Function in Older Adults,” Cochrane Library, July 8, 2009; Pierpaulo De Feo et al., “Physical Inactivity Is the Main Cause of Metabolic Syndrome,” in Vilberto Stocchi et al., eds., Role of Physical Exercise in Preventing Disease and Improving the Quality of Life, (Milan: Springer-Verlag, 2007), 30; Kay-Tee Khaw et al., “Combined Impact of Health Behaviors and Mortality in Men and Women: The EPIC-Norfolk Prospect Population Study,” PLoS Medicine 5, no. 1 (January 2008): epub; L. Ferrucci et al., “Smoking, Physical Activity and Active Life Expectancy,” American Journal of Epidemiology 149, no. 7 (1999): 645–53; Juha Pekkanen et al., “Reduction of Premature Mortality by High Physical Activity: A 20-Year Follow-up of Middle-aged Finnish Men,” Lancet, June 27, 1987: 1473–77; Dellara Terry et al., “Disentangling the Roles of Disability and Morbidity in Survival to Exceptional Old Age,” Archives of Internal Medicine 168, no. 3 (February 11, 2008): 277–83; David Hood et al., “Exercise-Induced Mitochondrial Biogenesis in Skeletal Muscle,” in Stocchi et al., Role of Physical Exercise in Preventing Disease and Improving the Quality of Life, 52; Michele Guescini et al., “Molecular Modifications Induced by Physical Exercise: A Significant Role in Disease Prevention,” in Stocchi et al., Role of Physical Exercise in Preventing Disease and Improving the Quality of Life
- Esposito et al., “Obesity and Sexual Dysfunction, Male and Female,” International Journal of Impotence Research20, no. 4 (July–August 2008): 358–65.
- Dellara Terry et al., “Disentangling the Roles of Disability and Morbidity in Survival to Exceptional Old Age,” Archives of Internal Medicine 168, no. 3 (February 11, 2008): 277–83.
- Ruth Ann Atchley et al., “Creativity in the Wild: “Improving Creative Reasoning through Immersion in Natural Settings,” PLoS ONE 7, no. 12 (December 2012): epub.