[MUSIC] My name is Bente Klarlund Pedersen. I'm a medical doctor specialized in infectious diseases. And I'm a professor of integrative medicine in The University of Copenhagen. I'm also the director of the Center for Physical Activity Research. In this lecture, I will show you that physical inactivity is a major risk factor for diabetes, independent of body weight. Moreover, I will explain how we fight the global burden of a physical inactive lifestyle. I hate sport. So it is a paradox that I'm giving a lecture, in which I will outline the detrimental effects of a physically inactive life. However, although I hate sport, the fact is that I'm convinced by data. I'm convinced by the signs. Physical inactivity is a major risk factor for diabetes and premature mortality. Now, let's start with the epidemiology. If you have a physical inactive life, you will have a lifespan which is five years shorter. And you would ten years more with disease than that of physically active individuals. A physically inactive lifestyle also influences our life quality and mental health. Exercise is a weapon against depression, anxiety, tiredness, stress, and even sexual dysfunction. Epidemiological studies suggest that regular exercise decreases the risk of more than 35 different diseases. It protects against Type 2 diabetes, dementia, and cancer, just to mention some. And randomized control studies provide strong evidence that exercise should be prescribed as medicine for several chronic diseases, including Type 2 diabetes. We are facing a polarization in physical activity pattern. Today, more people than ever are very fit, and at the same time, more people than ever are very unfit. Physical inactivity is a global pandemic responsible for 5 million people's death per year. And it's one of the United Nations primary targets to reduce non-communicable diseases. Let me tell you a story about two brothers. Peter and Mark both have a high BMI, but they differ remarkably with regard to their fitness level. Peter has always been very active, he ran a half marathon when he weighed 140kg. When he was young, he was an elite soccer player. To my surprise, all blood tests on Peter were normal. He had no sign of pre-diabetes. His cholesterol was normal. Everything was normal. Mark, on the other hand, was diagnosed with Type 2 diabetes and elevated blood pressure. Mark loves his car, but he would never take his own car to the airport. The distance from the parking lot to the check-in is much too far to walk. Mark has a lazy lifestyle. This anecdote tells us that exercise has a role independent of BMI. And this statement is backed up by studies, including thousands of people telling us that, no matter what your body weight is, being physical active and fit decline the risk of Type 2 diabetes, cardiovascular disease, and premature mortality of all causes. That data suggesting that with regard to all cause mortality it's better to be fat and fit than lean and lazy. The meta analysis from 2014 attempted to quantify the giant association of fitness and body weight on mortality from all causes. It appeared that obese, fit individuals have similar mortality risk as normal weight, fit individuals. Although fashion dictates a very lean body, lower body fat may lower the risk of heart disease. Whereas abdominal fat increases the risk of heart disease, cancer, and dementia. The worst condition is to have abdominal fat without any of the good fat on hips and buttocks. Abdominal fat, that is fat around the inner organs, becomes inflamed and appears to be a source of low-grade systemic inflammation, which is linked with cardiovascular disease, cancer and dementia. Abdominal adiposity has also been shown to be associated with increased risk of all cause mortality, independently of BMI. One big question is, how do you avoid abdominal fat? Very few people ask how much exercise is too much? They ask, how little can I get away with? So we ask young healthy males to adopt a passive lifestyle. They have to go to school or work, but they should take their car, take the elevator, have someone to bring the coffee. Being lazy. It appeared that it just took 1000 to 2000 steps per day. So we conducted this experiment in which we asked young healthy maids, who normally took 10,000 steps to decline their daily activity to 1,500 steps per day for 14 days. During the 14 days their fitness level decreased and they lost more than one kilo of muscle mass. When we perform an oral fat challenge test, let's say this person has to drink a fat solution, the plasma became milky due to an increase fat, a concentration in the blood. This happened because the fat burning capacity had declined. They develop whole body insulin resistance as measured both by a oral glucose tolerance test, and by a so-called insulin clamp. We use stable isotropes that were able to show that physical inactivity induced, impaired peripheral insulin stimulated glucose uptake. We also took multiple biopsies, and were able to show that the insulin signaling pathway was severely impaired when the physical activity levels was declined for just 14 days. All these tests showed us that the volunteers developed insulin resistance. That means that they were closer to developing Type 2 diabetes. When we did an MR scan of the abdomen, it showed a significant increase amount of abdominal fat, fat around the organs. All this happened just within 14 days of physical inactivity. One more thing happened. Two of the test persons were my own sons. I realized that they became irritated, depressed, and annoyed. We repeated the experiments and performed neuropsychological tests, and confirmed that during 14 days of inactivity, the ability to concentrate and focus was markedly impaired. We have used this real life model of declining daily steps in several studies. In one study, we performed an overfeeding study of normal, healthy, physically active males. During 14 days, they would increase their body weight. We randomized the test person to two groups. One group to continue an active lifestyle and take 10,000 steps per day. The other group to decline their daily steps to 1,500 steps per day. We prescribed the high caloric diet so that the two groups increased their body weight to the same extent. After 14 days, we performed an MR scan of the abdomen, and found that the group who decreased the daily step accumulated fat, where as the actual group did not. Following the two week period, the inactive group also experience a poorer glycemic control. Increased endogenous glucose production, decreased hepatic insulin extraction, increased baseline plasma levels of total cholesterol, and LDL, and decreased cognitive function with regards to capacity of attention. The study for the support, the physical inactivity is an independent cause of abdominal obesity, and metabolic impairment that may lead to metabolic syndrome and type 2 diabetes. Imagine that you're sick, you may have an infection or undergo surgery. Imagine that you go to bed for three weeks. A study showed that three weeks of bed rest had a more profound impact, on physical work capacity than 30 years of aging. Looking at fitness level and metabolism it appears that you become 30 years older in 3 weeks if you stay in bed. It's shocking and it takes approximately ten times as long time to regain fitness as it takes to lose it by being lazy. The anabolic signaling pathways involved in building muscle, and the catabolic signaling pathway's involved in muscle wasting, and so are totally different. Also with regard to kinetics. Other short term studies have shown that excessive sedentary, behavior such as prolonged bed rest can initiate biological processes, which weaken muscles, bones and circulation and reduces the ability to maintain a healthy metabolism. These processes can to some degree be reversed by exercise or breaks from the sedentary behavior. Sedentary behavior is defined as those activities performed in sitting or lying positions during waking hours that have low metabolic costs. The person may fulfill the minimum daily recommendations for physical activity, that is 30 minutes per day for adults, or 150 minutes per week, and still accumulate a large amount of sedentary time during the day. In contrast, a person may have a low amount of daily sedentary time without reaching the recommended levels for being physically active. Several recent studies have shown that sedentary behavior is associated with increased mortality and morbidity. Physical inactivity contributes to a last degree to the development of Type 2 diabetes had good reasons to quote Edward Stanley when he says, those who think they do not have time for bodily exercise, may sooner or later have to find time for sickness. But if you hates both, what can you do for yourself? The world literature tells us that eg, active commuting, by walking or bicycling, is associated with better health. There's a lot we can do individually. But we have to face the fact, that the environment affects our physical activity level. When people are asked why they cycle to work, less than 20% say that it's because of the SSIs. Most people state that it's because it's convenient, fast, and easy. We do not move because we had chose to do so. We move when a context compel us to do so. People who live in walkable neighborhoods, that are densely populated, have interconnected streets, and are close to shops, services, restaurants, public transports, and parks, tend to be more physically active, than residents of less walkable areas. A recent study included 6,822 adults from 14 cities in 10 countries on 5 continents. They objectively measured daily minutes of moderate to vigorous intensity physical activity by four to seven days of accelerometer monitoring. The following four built environments appear to be positively, and linearly associated with higher physical activity levels in the single environment models. More public parks within walking distance from residence, which were free and open to all. Higher density of public transport such as number of bus, rail or ferry stops and stations divided by the land area. Higher net residential density. And higher number of streets, intersections that are pedestrian accessible. The difference in physical activity in participants living in the most and least activity friendly neighborhoods, ranks from 68 min per week to 89 minutes per week which represents 45 to 59%. Of their 150 minutes per week recommended by guidelines thus the environment determines our physical activity level. History clearly demonstrates that structural changes in society have more impact on health than any group interventions or sophisticated discovery strategies. This was illustrated in Cuba's Economic Crisis of 1989-2000, which occurred after the collapse of the Soviet Union. The crisis resulted in reduced energy intake, increased physical activity, and sustained population wide weight loss. During the crisis period the proportion of physically active adults increased from 30% to 67%. And the prevalence of obesity declined from 14 to 7%. During 1997 to 2002 there were declines in deaths due to diabetes, coronary heart disease, stroke, and all cause mortality. These results suggest that population wide measures designed to reduce energy stores, and/or increase physical activity level, may lead to declines in diabetes and cardiovascular disease prevalence, and mortality to an extent that has not been seen any other strategy. Obesity and physical inactivity affects minorities and lower income populations disproportionately. And generally high income populations typically follow official recommendations will regard your health. Whereas lower income populations do not. The typical commuting cyclists, are not people who cannot afford cars. But those were well-educated, conscious about the environment and also with health. Regarding food consumption and physical activity, lower income communities are more resistant to campaigns, but sensitive to availability. Therefore, structural changes that make healthy lifestyles more accessible to these communities will reduce health disparities. Therefore infrastructural initiatives including urban planning that support walking and bicycling as means of transportation, is highly important in the fight against obesity and diabetes. Thank you for your attention. [MUSIC]
