搞不到灵丹妙药 那就试试运动吧

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.

去年我写过一篇文章，称想要减肥，最重要的是节食，而非锻炼。有些读者认为，那意味着锻炼毫无价值，这让我深感不安。

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.

那种想法简直是大错特错。在医生给出的关于健康的建议中，几乎没什么能比得上体育活动。

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，皇家医学院学会(Academy of Medical Royal Colleges)发布了一份报告，称运动是“灵丹妙药”。这一结论不只是基于一些世代研究或病例对照研究，而是基于无数随机对照试验。一项大型元分析研究了运动对慢性病的疗效。

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.

我们先谈谈肌肉骨骼疾病。研究者发现了32项重点关注运动在缓解膝关节炎疼痛及改进功能方面的作用的试验。这些试验的研究对象非常具体。令我印象深刻的是，这么多研究都是关注一个主题。

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，运动对膝关节炎具有改善作用。另有10项研究表明，总的来说，运动疗法能提高类风湿性关节炎患者的有氧代谢能力和肌肉力量。还有些研究证明，运动有益于其他肌肉骨骼疾病，比如类风湿性脊椎炎，甚至包括某些种类的背部疼痛。

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.

在犯过心脏病的人（主要是中年男性）当中，运动疗法降低了27%的全因死亡率和31%的心脏病死亡率。另有14项对照试验表明，运动对心力衰竭患者具有生理益处。另有研究表明，运动能降低高血压患者的血压，改善胆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.

经常运动的糖尿病患者的糖化血红蛋白水平较低——糖化血红蛋白是血糖控制指标——低到很可能足以降低这种疾病的并发症风险。20项随机对照试验表明，慢性阻塞性肺部疾病患者如果经常运动可以步行得更远，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.

多项研究发现，锻炼能改进帕金森病患者的身体功能以及与健康相关的生活质量。另有六项研究表明，锻炼能提高多发性硬化症患者的肌肉力量以及与运动相关的活动能力。运动似乎也能改善这些患者的心情。

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项随机对照试验的总体结果表明，运动最可能改善抑郁症症状。另有5项研究似乎表明，它能缓解慢性疲劳综合征患者的症状。在试验中，运动甚至能缓解接受癌症治疗的患者的疲劳感。

What other intervention can claim results like these?

还有什么干预能得出这样的结果？

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.

甚至对年纪较大的住院患者的研究也表明，包括运动在内的多领域干预具有益处。那些被随机选出进行干预的住院患者更可能获准回家疗养，总体来说，他们在医院呆的时间更短，花费也更低。

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.

虽然我们不从这个角度思考，但你完全有理由认为，对很多疾病来说，运动和药物一样有效。2013年的一项对元分析进行的元分析（也就是研究我们有多少数据）综合、分析了16项对随机对照试验的回顾研究。这些试验是为了减少死亡率而进行药物和运动干预，共计305项，有近34万人参与。

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.

结果表明，利尿药物（而不是所有药物）在预防心力衰竭死亡方面优于运动。但是在预防冠心病死亡方面，运动和药物一样有效。在预防中风死亡方面，运动优于药物。

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.

你只需少量锻炼就能收到这样的效果，很多人可能会对此感到意外。多年前，为了保持体形，我尝试进行P90X锻炼。结果发现，那对我来说太难了。后来，我尝试Insanity锻炼时感到疲惫不堪，同事们经常问我是不是病了。两年前，我尝试P90X3锻炼。它的难度稍微低一些，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.

不是只有我一个人认为通过体育运动改善健康应该很难。朋友们在谈论运动时，谈的是跑马拉松，上cross-fit健身课，或者献身于动感单车课程SoulCycle。不幸的是，他们没有抓住要点。为了实现我所说的那些益处，你远不需要做这么多。

The recommendations for exercise are 150 minutes per week of moderate intensity physical activity for adults, or about 30 minutes each weekday.

建议成年人每周进行150分钟中等强度的体育锻炼，大约相当于每个工作日30分钟。

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.

中等强度很可能比你想得轻很多。比如快走，大约每小时3至4英里。还有骑自行车，每小时低于10英里。任何能让你的心率保持在每分钟110至140的运动都可以。甚至连用吸尘器打扫卫生、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，我的目标温和多了。从办公室徒步往返诊所能让我锻炼30分钟。或者从办公室走到超市买午餐，单程1英里。天气较冷的时候，我在踏步机上锻炼半小时。每周锻炼5次就达到了我所需要的运动量。

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.

虽然我们似乎没办法改变人们的习惯，但也有证据表明并非如此。一项对健康专业人士提供的建议和顾问所做的系统性回顾和元分析发现，鼓励人们锻炼身体是有用的。

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.

那些努力鼓励患者进行锻炼的医生和诊所，每鼓励12名成人才会有1位能在一年后达到建议的活动量。那也许听起来不算什么，但这已经算是不错的结果了。

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.”

皇家医学院学院发布那份报告后，著名医学期刊《英国医学杂志》(BMJ)的一篇社论反驳说，运动不是“灵丹妙药”。社论作者们认为，它是对“对公共健康来说最划算事情”。

If that’s the best “counterpoint,” then physical activity seems like a no-brainer.

“灵丹妙药”也好，“对公共健康来说最划算事情”也好，反正去运动都没错。