Highlights
- The fact that heart disease is much deadlier — nearly 7 times more — than COVID, is lost in the public discourse.
- On average, COVID has killed 239,473 per month (over 19 months) or 7,982 per day; that's 332 per hour, or 5.5 per minute.
- Cardiovascular diseases (CVD) claimed nearly 7 orders of magnitude more, or 49,416 lives per day — 2,059 per hour, or 34 per minute.
- Cancers, the second-highest cause of disease, kills 3 times more than COVID.
- Experts say there’s no substitute for 'lifestyle change’ to curb risks, but it’s also the hardest thing to do.
[This article is not prescriptive, and is for informative purposes only. If you feel symptoms from any of the diseases mentioned, consult your physician.]
Food, a lack of exercise and pollution. Officially, they're today’s top killers. Bad lifestyle choices, especially eating the wrong foods, or just plain overeating, are the main culpits for nearly 18.6 million deaths from heart disease in 2019, a 17% jump from 2009, according to WHO data. It only gets worse from hereon: the annual death toll is projected to reach 30 million a year by 2030, warn experts.
Where does COVID stack up? For starters, the pandemic has killed 4.55 million in 19 months, an average of 239,473 per month or 7,982 per day. That's 332 per hour; about 5.5 per minute. Cardiovascular diseases (CVD), on the other hand, claimed 49,416 lives per day — 2,059 per hour, or 34 per minute. Cancers, the second-highest cause of disease, kills 3 times more than COVID.
A major risk factor for heart disease, "lifestyle change", is completely avoidable, say experts, but it’s also the hardest thing to do.
Still, infectious disease outbreaks grab headlines, while non-infectious diseases don't. But ignoring the risks for the latter won't make them go away.
Here are the top killer diseases, and where COVID-19 stacks up:
If you noticed the green (downward) arrows, they show where humans have improved on, in terms of reducing absolute numbers — especially on neonatal conditions and communicable diseases. That’s also thanks in huge part to inoculations. Yet, it’s the non-communicable diseases that account for the biggest disease burden.
Let's break it down:
What is it?
Ischaemic means an organ (e.g., the heart) is not getting enough blood and oxygen. Ischaemic heart disease (IHD), also called coronary heart disease (CHD) or coronary artery disease (CAD), is the term given to heart problems caused by narrowed heart (coronary) arteries that supply blood to the heart muscle.
It is caused by a decrease in blood flow through one or more of the blood vessels that carry oxygen to your heart (coronary arteries). When blood flow is reduced, the heart muscle does not receive the amount of oxygen it needs to function properly.
Atherosclerosis (thickening or hardening of the arteries) is the most common cause of myocardial ischaemia.
Impact
At 8.9 million deaths per year, CAD is the world’s top killer, accounting for 196.7 deaths per 100,000 people. The plaques that develop in thickened/hardened arteries can rupture, causing a blood clot. The clot might block an artery and lead to sudden, severe myocardial ischemia, resulting in a heart attack.
Symptoms
- Extreme fatigue
- Shortness of breath
- Dizziness, lightheadedness, or fainting
- Chest pain and pressure, known as angina
- Heart palpitations
- Swelling in legs and feet, known as oedema
- Swelling in your abdomen.
- Cough or congestion, caused by fluid in your lungs.
Treatment
Coronary heart disease cannot be cured. Treatment can help manage the symptoms and reduce the chances of problems such as heart attacks. It can include: lifestyle changes, such as regular exercise and stopping smoking, medicines such as:
- Angiotensin-converting enzyme (ACE) inhibitors, which relax the blood vessels and lower blood pressure
- Angiotensin receptor blockers (ARBs), which lower blood pressure
- Aspirin
- Nitrates
- Beta blockers
- Calcium channel blockers
- Cholesterol-lowering medications
And what of wars? Conflicts tend to gain huge press. But latest data available show that people are 137 times more likely to die of a heart attack than as a result of conflicts.
- Cessation of tobacco use (smoking / chewing etc).
- Reduction of salt intake to less than one teaspoon/day.
- Minimising the use of sugar in the diet (Adults - no more than 30g of free sugars a day, (roughly equivalent to 7 sugar cubes).
- For people with diabetes, free sugar including jaggery or honey is not to be consumed.
- Eating more fruit and vegetables (1 cup of fruit and at least 2 cups of vegetables).
- Regular physical activity (minimum of 30 minutes of moderate intensity exercise)
- Avoiding harmful use of alcohol.
Nearly 800 million are obese, according to latest data from worldometers.info tracking site. Obesity is a "lifestyle" issue, and is just one the biggest risk factors for both heart disease and cancer.
What is it?
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients.
Symptoms
- Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
- Sudden confusion, trouble speaking, or difficulty understanding speech.
- Sudden trouble seeing in one or both eyes.
- Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
- Sudden severe headache with no known cause.
Impact
Strokes killed 6.3 million people in 2019. When a person has a stroke, brain cells begin to die in minutes. A stroke is a medical emergency, and prompt treatment is crucial.
Treatment
Acting fast can help stroke patients. The stroke treatments that work best are available only if the stroke is recognised and diagnosed within 3 hours of the first symptoms. Stroke patients may not be eligible for these if they don’t arrive at the hospital in time.
If you think someone may be having a stroke, act F.A.S.T. and do the following simple test:
- F — Face: Ask the person to smile. Does one side of the face droop?
- A — Arms: Ask the person to raise both arms. Does one arm drift downward?
- S — Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?
- T — Time: If you see any of these signs, call for medical help.
1.72 billion
number of people who are overweight.
What is it?
It refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis.
Symptoms
Frequent coughing or wheezing.
Excess phlegm or sputum.
Shortness of breath.
Trouble taking a deep breath.
Impact
An estimated 65 million people suffer from chronic obstructive pulmonary disease (COPD) and 5.4 million died from it in 2020, making it the third leading cause of death globally.
Treatment
There's currently no cure for chronic obstructive pulmonary disease (COPD), but treatment can help slow the progression of the condition and control the severity.
Surgery is reserved for severe COPD or when other treatments have failed, which is more likely when a patient suffers from a form of severe emphysema.
800 million
number of people on the planet who are obese
What is it?
Coronavirus disease (COVID-19) is an highly infectious disease caused by the SARS-CoV-2 virus.
Symptoms
Most common symptoms are:
- Fever
- Cough
- Tiredness
- Loss of taste or smell
Less common symptoms:
- Sore throat
- Headache
- Aches and pains
- Diarrhoea
- A rash on skin, or discolouration of fingers or toes
- Red or irritated eyes
Serious symptoms:
- Difficulty breathing or shortness of breath
- Loss of speech or mobility, or confusion
- Chest pain
Impact
COVID -19 has infected nearly 220 million, and killed 4.55 million so far (over 19 months), and has disrupted life around the world due to lockdowns aimed to avoid the spread of infection.
Treatment
More than 20 vaccines approved to treat COVID-19, while antivirals, steriods, antibody therapies and a number of repurposed drugs are also approved either for emergency or full use to treat COVID-19.
What is it?
Symptoms
Less severe infections can have symptoms similar to the common cold, including:
- Stuffed up or a runny nose
- Dry cough
- Low fever
- Mild sore throat
- Dull headache
In more severe infections, symptoms can include:
- Severe cough that may produce phlegm
- Fever
- Difficulty breathing
- Blue tint to the skin
- Rapid breathing
- Chest pain
- Wheezing
Impact
In 2019, 489 million incident cases and 11 million prevalent cases of lower respiratory infections (LRI) contributed to 2,49 million deaths and 97.2 million disability-adjusted life years (DALYs), according to tracking site healthdata.org
Treatment
Some lower respiratory tract infections go away without needing treatment. Less-severe viral infections can be treated at home with:
- Over-the-counter medications for a cough or fever
- Plenty of rest
- Drinking plenty of fluids
- Treatment, however, depends on the type and severity of the exacerbation and can include bronchodilators, corticosteroids, antibiotics, oxygen therapy.
What is it?
Neonatal conditions are conditions occurring during the first month after birth (0- 28 days). The major contributors to the global burden of neonatal conditions include 1) premature birth, 2) neonatal infections, and 3) birth asphyxia.
Symptoms
- Fussiness
- Decreased level of consciousness
- Abnormal movements
- Feeding difficulty
- Changes in body temperature
- Rapid changes in head size and tense soft spot
- Changes in muscle tone (either high or low)
Impact
Neonatal conditions lays a heavy burden on families, society, and the health system. Because they occur in the first few weeks of life, neonatal conditions are major contributors to the global toll of DALYs (disability-adjusted life years, having the most potential Years Lived with Disability (YLD) and Years of Life Lost (YLL).
There were 2.4 million neonatal deaths recorded worldwide in 2019.
Treatment
- When doctors think a serious infection may be the reason why they are sick, newborns may be treated with antibiotics (to fight infection).
- To treat infant jaundice, the baby may be placed under a set of lights.
- Some neurological disorder treatment consists of putting a child on a specific diet.
- A small line placed into an artery (at the wrist or ankle) that allows continuous monitoring of blood pressure and drawing blood for lab tests.
- To check for problems in the brain, heart, or urinary system, and checking the position of lines or tubes, ultrasound pictures of the head, heart or belly, or other locations may be taken.
- A ventilator may also be used to provide positive pressure breaths but it may also provide additional oxygen.
What is it?
Most lung cancers start in the lining of the bronchi, but they also can begin in other areas such as the trachea, bronchioles, or alveoli.
Symptoms
- Coughing, which may involve coughing up blood.
- Difficult or laboured breathing.
- Stridor, which is a high-pitched sound that occurs as breath is drawn in.
- Wheezing.
Impact:
This group of diseases accounted for 2.26 million deaths in 2019 worldwide. Exposure to air pollution is a major risk factor. Lung cancer has become more common before the twentieth century. It ranks the second and is the leading cause of cancer mortality.
In the case of the trachea, surgical removal of the tumour is the preferred treatment if the cancerous (malignant) or noncancerous (benign) tumour involves less than half of the trachea. Depending on the severity, bronchoscopic treatment, radiation/chemotherapy may be prescribed.
If the tumour is more extensive which precludes surgery, a patient may be given a number of palliative therapies to help restore breathing and slow tumour growth.
Treatment
It largely varies depending on the cancer may have spread to (a) the main bronchus; (b) lung lining, chest wall lining, or chest wall; (c) diaphragm; (d) heart or the membrane around it; (e) major blood vessels that lead to or from the heart; (f) trachea; (g) esophagus; (h) sternum; and/or (i) carina; and/or (j) there may be one or more separate tumours in the same lobe of the lung.
“The main risk factors for these diseases is obesity, high-fat diet, high blood pressure and high cholesterol, diabetes, oral contraceptives, excessive alcohol consumption, lack of exercise with a sedentary lifestyle,” said Dr Taori, a clinician at Aster Hospital, Qusais, Dubai. “High blood pressure is a major risk factor for heart disease and stroke because it damages the lining of the arteries, making them more susceptible to the buildup of plaque, which narrows the arteries leading to the heart and brain,” added Dr Taori.
Then there's also the cross-morbidity with cardiovascular diseases, which raise the risk for cancer patients. “Cancer patients are at higher risk of dying from heart disease and stroke. For some cancers, like breast, prostate, endometrial, and thyroid cancer, one out of 10 patients die from cardiovascular disease," he added.
Dr Pranay Taori, an oncologist warned about the cross-morbidity between cardiovascular diseases and risk. He said "lifestyle” choices lead to diseases like coronary artery disease (CAD), lower respiratory infections, respiratory cancers and diabetes.
Moreover, it is thought that the leading cause of premature death including high blood pressure, high blood sugar, obesity, smoking and environmental risk factors (i.e. air pollution), according to the WHO.
Data from the world body show combined effects of ambient (outdoor) and household air pollution cause about 7 million premature deaths every year — largely as a result of increased mortality from stroke, heart disease, chronic obstructive pulmonary disease (COPD), lung cancer and acute respiratory infections.
It would be foolhardy to ignore this unseen enemy: almost all of the global population (99%) breathe air that exceeds WHO guideline limits containing high levels of pollutants — from smog hanging over cities to smoke inside the home.
It’s usually the with low- and middle-income countries that suffer from the highest exposures.
What is it?
Dementia is the term applied to a group of symptoms that negatively impact memory, but Alzheimer's is a progressive disease of the brain that slowly causes impairment in memory and cognitive function. The exact cause is unknown and no cure is available. They can be caused by vascular cognitive impairment, traumatic brain injuries from vehicular accidents, falls, concussions, Parkinson's disease, Huntington's disease, HIV, as well as infections of the central nervous system.
Symptoms
Most common early symptoms include:
- Memory loss.
- Difficulty concentrating.
- Finding it hard to carry out familiar daily tasks, such as getting confused over the correct change when shopping.
- Struggling to follow a conversation or find the right word.
- Being confused about time and place.
- Mood changes.
Impact
A major symptom of dementia is memory loss. If depression is also experienced, it makes it harder for a person with dementia to remember things and enjoy their life. Some people with dementia also experience hallucinations that can lead to paranoia, extreme anxiety and panic. 1.65 million people died of Alzheimer's disease and other dementias in 2019.
Treatment
Donepezil (also known as Aricept), rivastigmine (Exelon) and galantamine (Reminyl) are used to treat the symptoms of mild to moderate Alzheimer's disease. Donepezil is also used to treat more severe Alzheimer's disease, according to the UK’s National Health Service (NHS).
In June 2021, the Food and Drug Administration (FDA) approved aducanumab for the treatment of some cases of Alzheimer's disease. This is the first drug approved in the United States to treat the underlying cause of Alzheimer's by targeting and removing amyloid plaques in the brain.
What is it?
It is defined as the passage of three or more loose or liquid stools per day. Diarrhoeal diseases refer to a collection of diseases caused by multiple viral, bacterial, and parasitic organisms that share the common symptom of diarrhoea. Digestive tract problems may also be triggered by long-term use of some medicine, or with change in diet or medicines intake before or after surgery.
Symptoms
- Frequent loose, watery stools
- Abdominal cramps
- Abdominal pain
- Fever
- Bleeding
- Lightheadedness or dizziness from dehydration
Impact
Diarrhoeal diseases are seen behind 1.4 million deaths globally. In general, they cause death by depleting body fluids resulting in dehydration. In children, diarrhoea can have a detrimental impact on childhood growth and cognitive development. About 88% of diarrhoea-associated deaths are attributable to unsafe water, inadequate sanitation, and insufficient hygiene.
Treatment
- Drink plenty of liquids, including water, broths and juices.
- Avoid caffeine and alcohol.
- Add semisolid and low-fiber foods gradually as your bowel movements return to normal.
- Some home remedies include bitters and soda.
- Ginger.
- Chamomile tea.
- Peppermint.
- BRAT (Bananas, Rice, Applesauce, Toast) diet.
- Apple cider vinegar.
Other options: crackers, toast, eggs, rice or chicken.
What is it?
Diabetes mellitus (DM) refers to a group of diseases that affect how your body uses blood sugar (glucose). In general, it refers to uncontrolled high blood sugar over a prolonged period. This chronic (long-lasting) health condition affects how your body turns food into energy, CDC explains. Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream. When your blood sugar goes up, it signals your pancreas to release insulin.
Insulin acts like a key to let the blood sugar into your body’s cells for use as energy. A diabetic person's body either doesn’t make enough insulin or can’t use the insulin it makes as well as it should. When there isn’t enough insulin or cells stop responding to insulin, high levels of blood sugar stays in your bloodstream. Over time, that can cause serious health problems, such as heart disease, vision loss, and kidney disease.
Symptoms
In general, symptoms of DM include:
- Urinate (pee) a lot, often at night
- Extreme thirst
- Lose weight without trying
- Extreme hunger
- Blurry vision
- Numb or tingling hands or feet
- Tiredness
- Very dry skin
- Sores that heal slowly
- More infections than usual
Impact
Diabetes is responsible for 26.7 deaths per 100,000, according to the WHO. The impact of diabetes is felt long before a person’s death from complications. Possible long-term effects include damage to large (macrovascular) and small (microvascular) blood vessels, which can lead to heart attack, stroke, and problems with the kidneys, eyes, gums, feet and nerves.
Diabetic retinopathy, affects one-third diabetics, can cause blindness, if left untreated. “One of the major complications of diabetes is its effect on the eye, predominantly diabetic retinopathy,” said Dr. Soman Sukumaran Nair, an ophthalmologist at Zulekha Hospitals.
“This is a silent disease in the early stages but can cause blindness in the later stages. This imposes a severe economic and social impact as it predominantly affects people in their ages of peak productivity i.e. the fourth and fifth decades of their life,” Dr. Nair added. If diabetic retinopathy is diagnosed in a patient he/she needs to be examined by a retina specialist. The disease is subsequently staged after performing specialised tests. Based on the stage of the disease further treatment options such as lasers, eye injections and vitreous surgery may be considered.
Treatment
Adequate control of blood glucose and high blood pressure, correction of anaemia and elevated blood lipids can mitigate most of the morbidity associated with the disease.
Metformin is a tried and tested medicine that has been used for many decades to treat type 2 diabetes, and is recommended by most experts as first-line therapy. It is affordable, safe, effective, and well tolerated by most people. When metformin does not adequately control blood sugar, another medication must be added.
If diabetic retinopathy is diagnosed in a patient he/she needs to be examined by a retina specialist. The disease is subsequently staged after performing specialised tests. Based on the stage of the disease further treatment options such as lasers, eye injections and vitreous surgery may be considered.
In terms of foods, these are generally helpful in curbing the disease:
- Garlic
- Fatty Fish
- Leafy Greens
- Avocados
- Eggs
- Chia Seeds
- Beans
- Greek Yogurt
- Nuts
- Broccoli
- Extra-virgin olive oil
- Apple cider vinegar and vinegar
- Flaxeeds
- Strawberries
- Squash
What is it?
Tuberculosis (TB) is an infectious disease that mainly affects the lungs. Mycobacterium tuberculosis, the bacteria that cause TB, spreads through tiny droplets released into the air through coughs and sneezes. Tuberculosis can also affect other parts of the body, including kidneys, spine or brain. Risk factors include weak immune systems, a medication that weakens the immune system, poverty, HIV infection, homelessness, being in jail, substance abuse, kidney disease and diabetes, organ transplants, healthcare workers, cancer and cancer therapy, smoking tobacco, among others.
Symptoms
- Coughing that lasts three or more weeks
- Coughing up blood
- Chest pain, or pain with breathing or coughing
- Unintentional weight loss
- Fatigue
- Fever
- Night sweats
- Chills
- Loss of appetite
Impact:
Tuberculosis can be found in all parts of the world. According to WHO, 44% of the cases in 2019 occurred in Southeast Asia, followed by Africa (25%) and Western Pacific (18). Significantly, 87% of the new cases were diagnosed in occurred in 30. Eight countries accounted for two-thirds of the new cases — India, Indonesia, China, Philippines, Pakistan, Nigeria, Bangladesh and South Africa.
Treatment
- Skin test: The Mantoux tuberculin skin test can be used to test for tuberculosis infection. Additional tests are required to confirm TB disease.
- Blood tests: They are used to confirm or rule out latent or active tuberculosis. These tests use sophisticated technology to measure your immune system's reaction to TB bacteria.
- Imaging tests: If the skin test is positive, the doctor is likely to order a chest X-ray or a CT scan.
- Sputum tests: If your chest X-ray shows signs of tuberculosis, your doctor may take samples of your sputum to test for TB bacteria.
- Vaccine: Bacillus Calmette-Guérin (BCG) vaccination can protect against tuberculosis
- Preventing transmission: Patients must be isolated from workplaces, schools and college and crowded areas. Patients should covering mouth and nose while coughing or sneezing, and use a facemask. Avoid Sharing beds and rooms with un-infected persons.
What is it?
Chronic kidney disease (CKD), also called chronic kidney failure, involves a gradual loss of kidney function. The most common causes of CKD are diabetes and hypertension, though the disease can be caused by many other conditions. Some examples of CKD are glomerulonephritis (kidney inflammation); polycystic kidney disease (inherited condition where growths called cysts to develop in the kidneys); blockages in the flow of urine – for example, from kidney stones that keep coming back, or an enlarged prostate.
Symptoms
According to the NHS, symptoms can include:
- Weight loss and poor appetite
- Swollen ankles, feet or hands – as a result of water retention (oedema)
- Shortness of breath
- Tiredness
- Blood in your pee (urine)
- An increased need to pee – particularly at night
- Difficulty sleeping (insomnia)
- Itchy skin
- Muscle cramps
- Feeling sick
- Headaches
- Erectile dysfunction in men
Impact
The major consequences of CKD include loss of kidney function leading to end-stage renal disease (ESRD), accelerated cardiovascular disease (CVD) and death. Other important complications include anaemia, bone disease, infections, reduced cognitive function and increased risk of acute kidney injury (AKI).
CKD killed 1.4 million in 2019.
Treatment
Later stages of CKD is known as kidney failure, end-stage renal disease or established renal failure. It may eventually require treatment with dialysis or a kidney transplant.
What is it?
Cirrhosis is a liver disease. It is one of the top causes of death globally, it’s also known as liver cirrhosis or hepatic cirrhosis. The liver damage done by cirrhosis generally can't be reversed. But if it is diagnosed early and cirrhosis can be treated, more damage can be prevented or limited.
Cirrhosis is a condition in which the liver is unable to function well due to long-term damage. When liver tissue is injured by disease (hepatitis B or C), excessive alcohol consumption or any other cause, it tries to repair itself. In the process, scar tissue replace live tissue resulting in fibrosis. The late-stage scarring is irreversible.
Symptoms
Cirrhosis normally don’t display signs or symptoms until the liver is damaged extensively. Some of signs and symptoms listed by the Mayo Clinic in the US include:
- Fatigue
- Nausea
- Bleeding or bruising easily
- Swelling in legs, feet or ankles
- Weight loss
- Itchy skin
- Confusion, drowsiness and slurred speech
- Yellow discoloration in the skin and eyes
- Fluid accumulation in your abdomen
- Spiderlike blood vessels on your skin
- Redness in the palms
- Women: Absent or loss of periods unrelated to menopause
- Men: Loss of interest in sex, breast enlargement or testicular atrophy
Impact
In 2017, 1.32 million died due to complications arising from cirrhosis. Cirrhosis deaths increased from around 676,000 in 1980 to over 1.55 million in 2010, a research paper published in BMC Medicine said.
Global cirrhosis deaths account for about 2% of the global total), a study published in The Lancet Gastroenterology & Hepatology states. The disease growing in both the West and the East. Egypt had the highest age-standardised mortality rate, while Mexican had the highest number of deaths in Latin America. In Asia, Thailand has the highest incidence of cirrhosis.
Risk factors for cirrhosis listed by Winchester Hospital in Maryland, US, include:
- Excessive alcohol consumption
- Hepatitis infections caused by viruses (Hepatitis B, C or D)
- Non-alcoholic fatty liver disease
- Diabetes
- High triglyceride levels in the blood
- Coronary artery disease
- Intestinal bypass surgery
- Long-term treatment with corticosteroids
- Bile duct diseases
- Gallstones
- Pancreatitis
- Inherited disorders
- Cystic fibrosis
Treatment
Cirrhosis is normally first detected through a routine blood test. A combination of laboratory and imaging tests is carried out to confirm the diagnosis.
- Laboratory tests. Blood tests will check for signs of liver malfunction, kidney function and blood ability to clot. A screening for hepatitis viruses.
- Imaging tests. Magnetic resonance elastography (MRE), MRI, CT and ultrasound may also be done.
- Biopsy. A tissue sample may be used it to identify the severity, extent and cause of liver damage.
Cleveland Clinic recommends ways to prevent cirrhosis:
- Don't abuse alcohol
- Eat a well-balanced, low-fat diet, comprising fruits, vegetables, lean proteins and whole grains.
- Don’t eat raw seafood as they can contain a bacteria that can cause serious illness.
- Cut back on the amount of salt in your diet
- Maintain a healthy weight
- Exercise regularly
- Quit smoking if you smoke.
- Avoid high-risk behaviors that can lead to infection with hepatitis B or C
- Get vaccinated against hepatitis B.
- Get your annual flu shot
- Avoid non-steroidal anti-inflammatory drugs
Most common reasons why people don't exercise:
- There’s no time.
- Life is stressful, can’t add more to it by exercising.
- I’m too busy at work/home (or both), and I'm too exhausted at the end of each day.
- Gym membership is too expensive.
- I can’t sacrifice my job to get good exercise each day.
- I used to exercise, but once I got out of my routine, it's so hard to get back into it.
