The Quest for the Perfect ExerGame

There is currently a debate raging on both sides of the Atlantic as to the future provision of healthcare treatment and whether or not it should be public or private or some combination of the two. By in large the debate is in fact about “sick service” i.e. a service for when you are sick and what is missing is any consideration of a genuine “health service” that has prevention (rather than cure) as its primary aim.

With regard to a treatment (cure) service I am still waiting for a national debate to take place here in the UK as to what treatments (say treatments A,B&C) are part of the system and guaranteed to everybody no matter where you live, thereby ending the current post-code lottery. Those treatments (say treatments X,Y&Z) which are deemed/agreed to be unaffordable by the system will require alternative arrangements if you wish to access them.

All this however is going to become somewhat academic if current trends in the prevalence of so called “lifestyle” diseases as they will ultimately overwhelm the current “sick service” in whatever form it takes. Clearly there is a need for the right form of long-term incentives for both the public and health care providers to invest in preventative measures.

It was somewhat ironic that in the Sunday Times last week not only was there coverage of the debate entitled “USA versus the NHS” but on the previous page there was an article lambasting local government councils for failing to support businesses through the recession and instead spending money on “Nanny State Jobs“.

When you get in to the body of the piece you see that the examples given of these so called “nanny state jobs” are all in one way or other connected with trying to get people to become physically active and to eat more healthily. You can’t have it both ways. People have to wake up and take responsibility and realize that good health is going to cost money for prevention and/or cure. Whilst prevention requires significant upfront investment, it is going to be cheaper and more importantly sustainable in the long-term.

A recent article published in Time Magazine tends to give the impression that exercise or “working out” won’t result in weight loss. It has created a bit of a stir and has been rebuffed by a press release from the American College of Sports Medicine. There is a substantial body of evidence to support the importance of exercise in the expenditure side of the energy balance side of the equation and it has recently be reviewed by the said ACSM in a position paper.

In contrast there is no denying the real life experiences of a significant number of people who started working out with a view to loosing weight with little or no success. So what is the problem? In my view it is part due to the gap between theory and practice and the desire for “quick fix” solutions.

The health benefits of exercise began to be widely promoted in the late 1980’s in response to increasing prevalence of heart disease, hence the concept of intense “cardio” exercise and the mantra of “20 minutes intense exercise three times per week”. Then in the 1990’s along came the obesity epidemic and the focus shifted from exercise intensity to energy expenditure and a new mantra of “30 minutes physical activity most days”. Unfortunately these messages have “stuck” and become widely popularized however they are in fact minimum recommendations and not a license for “all you can eat”.

It is worth reflecting at this point how unrecognizable our modern lifestyles would be to rest of human history. Life in the developed world is almost as sedentary as it can get. Our 24/7 lifestyles feature a ready availability of abundant refined, calorie dense food, temperature control, artificial lighting, psychological stress, sleep-deprivation etc. etc. and we are pushing ourselves to the limit and beyond.

Thus whilst research indicates that in theory we should aim for a daily 500 calorie deficit in order to loose weight all the time we are fighting against ourselves. Even the very term “workout” is overloaded with negative connotations. It is no wonder as the author of the Time Magazine article points out that people feel the need to “reward” their efforts with a calorie laden treat.

Trying to achieve a 500 calorie deficit against a starting point of a daily energy intake of 1500-2000 calories doesn’t leave any room for error and it is therefore critical to have a healthy and nutritious calorie-controlled diet.

If we were to wind back the clock in time and double our daily energy expenditure to 3500-4000 calories per day and become significantly more physically active, then the energy intake side of the equation would become much less of a problem. Indeed, the notion that significantly greater amounts of exercise are need in order to ensure a consistent negative energy balance is supported by a recent ACSM position paper that concludes that greater than 250 minutes exercise per week are needed to effectively promote weight loss.

So the bottom line is that you need to find forms of physical activity that you find enjoyable and that you are able to perform for significantly longer periods of time than for traditional “workouts”. If the activity it in itself rewarding then you won’t need to indulge yourself with calories afterwards. Games are inherently motivating and rewarding. So game-based approaches to exercise (i.e. ExerGames) might have significant potential to make you thin.