Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study by Martin J O'Donnell & multiple colleagues. [If you create an identity and password you have access to this article even if you don't subscribe].
Although I wish they'd come up with something different, the verdict was:
"Phase 1 of INTERSTROKE suggests that hypertension, smoking, abdominal obesity, physical inactivity, and diet are the most important modifiable risk factors for stroke. These important findings should help to inform stroke prevention strategies around the world and to reduce the global burden of stroke." (Comment: Reducing the global burden of stroke: INTERSTROKE by Jack V Tu, The Lancet, Volume 376, Issue 9735, Pages 74 - 75, 10 July 2010)
Yeah sure mate- "help inform stroke prevention strategies"- I think most moderately health-conscious societies are quite well informed on this already- but how the hell do you get us (the at risk people right now) to exercise against that awful, ingrained "physical inactivity". We are NOT MOTIVATED YET!! I think someone has to come up with something new to get us all off our bums!
Quite honestly, I have been exhorting myself to exercise regularly since the age of 15 when my family doctor handed me the old XBX exercise paperback and said "Start here!". For no more than 14 days of my life have I exercised vigorously EVERY DAY- and that's when I have gone on holidays specifically to walk at least 10km/day over someone else's hills! I have plenty of photos to prove it, too!
Here I am at the famous Beseggen Ridge in Norway in mid 2004, a cardiovascular treat if ever there was one!
I see absolutely nothing in my neighbourhood, which is full of middle aged and older citizens, prominently encouraging us to come along to exercise sessions or enrol in a government-sponsored walking program. I have deliberately sought out suitable programs on the internet and discovered a Heart Foundation Walking Program, but I haven't managed to get along yet. There is also an early morning exercise class for "Seniors" at a local community centre, but it's at 7am and that is just dumb for most people who have blood pressure medication to take with breakfast!
At the other end of the spectrum, my neighbour has a 13 year old girl who rather fancies herself as Australia's answer to Paris Hilton (without the hotels, unfortunately), but I haven't seen her doing regular exercise around the neighbourhood, either. Isn't there a school health and fitness program to get these kids enjoying regular exercise as a normal part of their daily routine? Evidently not! This young lady HAS been attracted into a program where appearance is important- a cheerleading team- where some calisthenic moves are combined with a great deal of ribbon-waving and strutting around in glittery costumes! Are we missing something in the marketing department about what motivates regular exercise these days? Obviously, the promise of a glittery costume is not going to get me to the community centre at 7am any time soon, but I wonder what would?
I daresay I have quite a few risk factors for a stroke later in life:
1. I have had elevated blood pressure all my life, even during childhood.
2. Both my parents had high blood pressure- mum from her 50s, dad from his 70s.
3. I'm on some medication for another problem which actually CAUSES elevated blood pressure, but I have no alternative at the moment.
4. My mum started having mini-strokes/TIAs [transient ischaemic attacks] from her late 60s and died as the result of a stroke during an unrelated operation at 81.
5. I am rather physically inactive, though not as much as most people my age who I know.
6. Although currently at the upper limit of normal weight for my height, my weight is concentrated around my middle.
7. I weigh 157% of my weight on leaving highschool!
OK- I have a few helpful factors going for me- I've been prescribed (and take) a pill for hypertension and it works moderately, but not all the way back to "normal"; I haven't used sodium salt sprinkled on food for nearly 40 years- we used to have a container of 50/50 sodium/potassium salt for me to use on potatoes (the only thing I liked a bit of salt on), but it took 10 years to use it up!; I eat a diet which others would regard as fairly healthy and I rarely eat anything prepackaged like sweet biscuits, frozen meals; I have never had artificial sweeteners as I thought they might be bad for my liver- I had weird ideas that they must be taking up a metabolic pathway that should have been utilised by another foodstuff, goodness knows what- and I figured if I didn't like an unsweetened version of something I could just give it up!; my diet is almost vegetarian but I believe I need animal meat because I am an animal born to utilise eaten muscle to maintain my own muscle; my diet is also rich in raw fruit and vegetables containing lots of anti oxidants, plus I eat raw, fresh nuts of various sorts for lunch every day- also a 30-year habit. The only cheese in the house is low-fat and I drink plenty of water and black tea, rarely coffee or soft drink. Lastly, my father lived to the age of 95, despite having a congenital heart valve problem, which did lead to heart failure in the end- but you'd hardly say he had the usual kind of cardiovascular disease!
SO!!! What will persuade me and others like me to exercise regularly? I know that when I went to aquarobics twice a week with friends, it was the social contact and the regular expectation that got me there. Now I don't earn a living and don't qualify for government assistance, paying $40/week to attend is out of the question. However, this would be a good way to go for people with a normal income. I still like my idea of having community fitness trainers/leaders who are paid out of the national health budget to get people into regular exercise programs to the extent of thumping on the front door and yelling at them to come out!
The National Heart Foundation walking program for seniors should be what I attend, as it's free (mainly), but I haven't managed to get there despite several tries! I haven't seen the new video publicising the walks on TV, either- where is it?? Since it's about dog-walking, it's not really for me, but might encourage plenty of others.
I keep returning to the research on depressed young people, where researchers found that regular exercise was quite therapeutic and wonder how this sort of program could be financed and monitored locally. It could be quite attractive to public health campaigners as it literally kills two birds with one stone! There is plenty of good research on psychological health and exercise for older people as well, even for those who already have heart disease!
Goodness knows why I'm still here, sitting on my proverbial and not out there treating myself to a dose of free depression treatment while lengthening my expected life span!