DOCTOR AT SEA – New Year Resolutions

By the time this appears in the February issue, a number of New Year resolutions will have come and gone. I prefer to make lifestyle changes stick all year round without the allure of a date in the calendar but 1st January might just be the welcome stimulus that gets some people started. One of the features of the turn of the year to me is the time and effort spent gathering the data for the MCA Annual Return of Medical Examinations of Seafarers for the previous year – not exactly a party but read on!

 

The Return form requires the total number of ENG1s done and also the breakdown in terms of shortened and/or restricted, and temporary or permanent failures. These figures are then broken down over all the medical (or age-related) reasons for the various outcomes – for instance, a cardiac event such as a heart attack or a stent insertion might justify a one year review or colour deficiency leads to a restriction on lookout duties or under 18 has a maximum one year certificate. This year, for the first time, there is a section on seafarers with a Body Mass Index greater than 35 ie how many, and how many underwent physical exercise testing and how many had other significant conditions (such as diabetes, arterial disease, hypertension, joint problems) and then a breakdown of the various type of ENG1 issued.

It is a relatively small (sic) group but clearly it is to be under the spotlight in the coming years and I think that exercise testing for physical fitness is likely to become more standard. There are various standardised procedures available to do this. Essentially the subject carries out a number of step exercises at a standard timed rate over a few minutes and a numerical indication of physical fitness can be calculated from the pattern of pulse rate recovery post-exercise. A variation on this theme looks set to creep into future ENG1 medicals.

It would be a mistake to think that this trend is aimed solely at the very heavy because it is quite apparent that some heavy folk are fitter than some thinner ones. An active obese person may actually be fitter than an inactive thin person. We have probably all argued this from our own observations but recently a very large clinical study has produced hard evidence to support this idea.

The 12-year study from Cambridge University, published in the American Journal of Clinical Nutrition, looked at more than 300,000 people throughout Europe. They recorded exercise levels and waist circumferences and every death. “The greatest risk (of an early death) was in those classed inactive and that was consistent in normal weight, overweight and obese people” one of the researchers, Prof Ulf Ekelund on BBC News. He said eliminating inactivity in Europe would cut mortality rates by nearly 7.5% or 670,000 deaths, but eliminating obesity would cut rates by 3.6%.

The level of exercise deemed sufficient to make a difference according to Prof Ekelund is brisk walking for about twenty minutes each day and this would have substantial benefits. He himself does much more as a Norwegian cross country skier and manages at least five hours of vigorous exercise each week. This is not unlike many yachties who often underestimate their efforts but are actually functioning at a high level of fitness. However, natural energy falls off with the years or maybe young families produce sleep deprivation and use up the exercise time, or study courses become a higher priority for a while – and eventually, in the fullness of time, comes promotion and more senior positions are often more sedentary and administrative. The slow creep of inactivity and consequent weight gain is all too familiar which brings us back to resolutions to change (at whatever the time of year) and bearing in mind the challenge is eminently achievable – substituting a brisk walk or a cycle, climbing the stairs rather than using the lift (depending on how high the building!).

Obese people who exercise are in better health than those who do not but both obese and also inactive is not good – obesity produce problems such as cardiovascular disease, and maturity-onset diabetes is more common with obesity. So the take-home message is that everyone should do at least twenty minutes daily exercise and everyone should lose weight but thin and inactive is also not good – which coincides with Frank Leaver´s column today in Majorca Daily Bulletin as I write this piece (16 January) – to quote, “I am in the process of writing the only diet book that I believe needs to exist, and here it is………Chapter One, Eat a bit less………..Chapter Two,  Move about a bit more………The End”  A bit brutal but we know what he means!

 

 

 

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