Tag Archive for: exercise

Your Independence Inventory

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I’m breaking this into two separate inventories: your physical inventory, focusing on muscles bones and joints, and your logistics inventory. Let’s begin with your physical inventory. To make this easier, we created a printable checklist that you’ll find in the Basic Health Info section of drchet.com.

Physical Inventory

Let’s start with some of the factors that can impact your ability to exercise, whether that’s getting fitter, stronger, or more flexible:

  • Can you sit and stand without assistance? Do you need assistance whether in the form of a walker or arms on the chair? All of those require basic muscular strength and balance.
  • Can you walk without assistance? How about with assistance? How far can you walk? I know this sounds so basic, but everyone starts somewhere. How fast you can walk also matters.
  • Can you bend over at the waist? Do you lose your balance if you do that? How about squatting? Full squat, half squat, quarter squat, or not at all?
  • Can you get on an exercise bike or an elliptical trainer or a treadmill? In order to use them, you have to be able to balance well enough to get on them first. If you’ve never been on a treadmill, you don’t really know whether that’s possible for your fitness program or not. Some people have balance issues they never knew existed.
  • Can you stand in place with your eyes closed, or do you get dizzy? Can you touch your finger to your nose with your eyes closed while holding your arms horizontal to the floor? This test may be associated with assessing your degree of drunkenness, but you’ve got to be able to do it sober first.
  • Can you raise your arms above your head? Can you bend your arms at the elbow? Can you do a bicep curl with a can of vegetables? Can you lift it above your head?
  • Can you usually grip the lid of a sealed jar well enough to open it? Everyone’s grip strength deteriorates over time, so it’s important to know where you rate.
  • Can you get on the floor on your hands and knees? Can you lie face down on the flood? Can you lie face up? Can you get up off the floor without leaning on any piece of furniture?
  • Can you walk up a flight of stairs? Can you walk up a single stair and step down again?

Logistics Inventory

Logistics for getting healthier requires that you assess your assets and liabilities. You’ve got to know whether you have the time, the equipment, the time, the space, the time, the gym membership, the time… Are you getting the idea that time is important here? That’s the single biggest reason people quit an exercise program, and for most, it’s the reason they never start.

  • Do you have the time in your schedule, while getting reasonable sleep, to exercise? Early in the day? Lunch? Before dinner? In the evening? Every day? Three days per week? Does it depend on your children’s after-school activity schedule?
  • What equipment do you have? Do you like it enough to use it? Do you have exercise tubes or bands? Weights like dumbbells or barbells? Do you have mats for floor routines? Do you like exercising while watching videos or do you prefer music?
  • Are you a member of a gym or club? Can you get there on a regular basis? Is there enough equipment to do what you like to do? Does it have a pool in case swimming is your thing?
  • Do you have the time to prepare meals if eating better is your goal? Do you have a selection of the right tools to cook well? It’s easier if you have the right spices, knives, cookware, and cook wear (might as well have a cute apron). Do you have the budget to buy healthier ingredients?
  • What are you willing to eat on a regular basis? I’ve made it clear I’m not drinking smoothies or eating bars, at least, not very much. That means it takes more time for prep and cooking.
  • If you’re not exercising at home, is your car dependable?
  • Do you live in a safe neighborhood to walk or jog?

Those are just some of the logistical factors to consider before you get to working toward your health goals.

If you’re thinking this is just for old people, nope—I suggest you do this no matter what your age. Mark your calendar to inventory your physical state every year when you get your annual physical. You may find that although you’re only in your 30s, you can’t easily get up off the floor. The time to work on that is now; don’t wait another decade or two to work on your physical independence. You’re building your health future. Take a full inventory before you start your plan; that’s the way to gain the health independence we all want to have.

What are you prepared to do today?

        Dr. Chet

Time to Take Inventory

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After last week’s Memo on Independence, I decided to follow it up with some thoughts on where to begin the quest for independence. Nobody is beginning at absolute zero. Regardless of where you stand (or sit) with your health, it’s time to take an inventory.

I could include everything from lowering cholesterol, sleeping better, or reducing medications, but those are discussions you need to have with your physician first to see if what you’re planning to do is reasonable. They know what health issues you’re facing, from auto-immune diseases to type 2 diabetes, and even more. For example, if you have a genetically determined high blood pressure, you may have to stay on medications no matter how much weight you lose and how fit you become. I would start with a consultation with your physician or healthcare professional.

Once you’ve done that if it applies to you, it’s time to take inventory, both physical and logistical. We’ll do that on Saturday.

What are you prepared to do today?

        Dr. Chet

Adaptation: Exercise

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I can’t think of a better example of positive adaptation than exercise. Whether it’s a sport skill, increasing strength, or improving cardiovascular fitness, exercise uses the adaptation principles; the difference is that it’s an intentional act instead of a response to a physical challenge. As an example, let’s use walking or running to improve the fitness of your heart and cardiovascular system as well as every other system involved—which is just about every other system we have.

Let’s begin with how your cardiovascular system would respond to beginning a walking or jogging program. The first walk with a purpose—faster than window shopping and not so fast that you’re stopping to catch your breath every minute—every system in your body is going, “What the heck is going on here?” Your heart may not be used to speeding up like that. The blood isn’t used to traveling that fast. The 5,000 genes that are typically activated when you start to exercise are awake and alert. Your muscles, ligaments, tendons, and stress hormones are challenged, along with the nervous system that controls how the muscles respond to new movement. It’s a mess, but you manage to get through it.

Depending on how hard you pushed yourself, you may feel it. Maybe fatigue a few hours later or sore muscles. That’s why you begin slowly. Save the fastest you’ve ever walked or ran for another time, and get through this first walk.

But by the third walk, your body will start to adapt; your heart rate might not get as high. By the 10th walk, you most likely will be able to maintain a faster pace, but your heart rate may not be as high as the first walk you took at a slower pace. You’re adapting—in fact every system in your body is adapting to the new stress. It will take less effort to do the same work.

You’re not ready for a marathon or maybe even a 5K yet, but exercise is a positive utilization of the adapting ability of your body. You just have to approach it in a systematic way to improve your cardiovascular health.

If you’re the kind of person who needs to see progress to keep going, track your distance, time, heart rate, and so on, but don’t let a few down days discourage you. Sometimes your body needs a bit of time to catch up; stay the course and you’ll soon see improvement again. On the other hand, if you’re the kind of person who hates record-keeping, you’ll still notice improvement—maybe you’ll walk your usual 30 minutes and feel like going another five, or you’ll realize you’re not breathing as hard as you were a month ago. Do what works for you.

I intentionally sent this Memo one day sooner because this is Memorial Day weekend in the U.S. While we celebrate and cherish those who’ve fallen in defense of our country with quiet moments, parades, and fireworks, use the three days to start your fitness program by going for a walk every morning, as long as your physician has no objections to your exercising. By the time you read Tuesday’s memo, you could be on that path to adaptation and a better healthspan than you are right now.

What are you prepared to do today?

        Dr. Chet

You’ve Got Another Chance

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Did you assess your time spent investing in your health as I outlined in Tuesday’s Memo, counting up the time per day, week, or month you spend in the activities that will benefit your long-term health? How did you do? Did you think of more than the short list I provided? Did you come away disappointed with your efforts? I know that I did in some areas.

Life is giving you another chance—in fact, it’s giving you more than one. As long as you draw breath, you can always start. You don’t even have to wait until the new year; pick one thing and begin working on it today. Then, when that change becomes a habit, start on another one. You don’t have to begin everything all at once; in fact, it’s better if you try one change at a time and see how that works before adding more.

If you fail, start again. As Seth Godin said in a recent post, everyone needs more chances. But whether this is the time you actually lose the weight, lower your HbA1c, add that muscle, or whatever is important to your long-term health, taking that next chance is determined by only one thing:

What are you going to do with that chance this time?

It doesn’t matter what you haven’t done—you need to succeed only once at changing a poor health habit into a good one that you will maintain. Take that chance and do something with it this time. Next year, we all could be having completely different conversations. So, really:

What are you prepared to do today?

        Dr. Chet

How Much Time Did You Invest?

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As the new year approaches, it’s a good time for reflection. Regardless of your age, taking care of your body should always be a top priority, so let’s assess 2024. Here’s a series of questions—not a complete list by any means, just a place to begin. The overall question is this:

How much time do you spend each day taking care of your body?

How many minutes do you spend on aerobic exercise?

How much time in resistance exercise to maintain or gain muscle?

How much time stretching to maintain flexibility?

How much time massaging your aching muscles?

How much time do you spend cooking foods with natural nutrients?

How much time recording the foods that you eat?

How much time flossing and taking care of your teeth?

How much time caring for your skin?

How much sleep are you getting?

These are not just rhetorical questions. Spend some time thinking about it. Add other questions related to how you take care of your body or issues you’ve been having. Write down the minutes per day you spend in each one of those areas. Do it for the next three days, and you’ll see where you stand now and where you can improve.

You get out of your body what you put into it. You need to think and assess so you can identify what you need to work on in 2025.

This year’s final Insider Conference Call is tomorrow night. The main topic is going to be why research on science should never stop or slow down. This is the time to become an Insider to help you achieve your health goals in 2025. Join by 8 p.m. ET tomorrow night and you’ll be a part of the call.

What are you prepared to do today?

        Dr. Chet

Do Weekend Warriors Improve Their Health?

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Let’s finish the week with a question no one asked but was the topic of a recent study: what’s better for your health—being a weekend warrior or working out according to established guidelines? The major component of the guidelines is more than 150 minutes of moderate to intense exercise a week spread out over most days of the week. Turns out, they are both effective, but let’s take a closer look.

The Study

The UK Biobank data are connected to the medical records of all people in the UK, making it an excellent source for studies. This observational study used data collected on close to 90,000 subjects who wore an accelerometer for a week sometime between 2013 and 2015; they were tracked for at least six years. Researchers tracked the diagnosis of over 678 conditions and compared those who exceeded the minimum of 150 minutes of moderate to intense exercise, either over a weekend or stretched over a week, with those who exercised fewer minutes.

The weekend warriors had reduced Hazard Ratios for 264 conditions and regular weekday activity had reduced Hazard Ratios for 205. Most of the benefits were associated with cardiometabolic metrics such as hypertension, resting heart rate, and type 2 diabetes. When compared head-to-head, there were no conditions where the weekend warriors and the regular exercisers differed.

What Should I Do?

I wouldn’t change anything you’re currently doing as long as you’re getting more than 150 minutes of moderate to intense exercise every week. We don’t know the activities involved in either—just that the accelerometer showed they were moving.

What it can mean is that for those who are playing basketball or soccer for a couple of hours a day on the weekends, you’re getting some benefit. It also means if you have a two-hour trail walk you like to do on weekends, it can help reduce your risk of cardiometabolic diseases.

The Bottom Line

What I really think it illustrates is that any movement is good movement, and if you can’t work in as much exercise as you’d like during the week, you can make up for it on the weekend. I would have liked to have seen the different activities involved and any orthopedic injuries associated with the activities, but let’s take the win. Just get moving and stay moving during the week or packed into a weekend. Or—maybe—both! Go get ’em, you warriors!

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1161/CIRCULATIONAHA.124.068669

I’m Alive: V2.55

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When I opened my eyes this morning, I knew I had another year to do what I was created to do: teach people how to be healthy and fit. For those of you who are new readers or those who need a refresher, here’s the story: when I wake on May 10th every year, my superstitious belief is that I have at least one more year to live. My dad died on May 10, 1969. In case you’re wondering, I’m version 2.0 (my father was the first Chester John Zelasko), and it’s been 55 years since my father died. It makes no sense in the real world, especially for a guy who’s a scientist, but every May 10 is a milestone for me.

Last weekend as I pulled into the parking lot where I work out, there was an SUV with a number of plastic bags on the roof arranged in no particular order. As I walked past it, I couldn’t help but notice the car was packed to the ceiling, including the passenger’s seat. In fact, it encroached on the driver’s seat. I don’t know how anyone drives without being able to see the rearview or sideview mirrors, but I guess that person somehow managed. I could speculate whether they were moving or living in their car, but here’s how I saw it.

We all carry the baggage with us—memories of every time we didn’t complete a goal we set, especially health goals. We know the foods we should eat and the ones to avoid. We know that exercise will make us fitter, stronger, and more flexible. We know we have supplements and/or medications we should take for our health or to deal with conditions we may have. In retrospect, we ask ourselves why? Why don’t we do that?

It may not be the only reason or reasons, but I think we carry the baggage of past failures with us. And we continue to lose fitness, strength, and on and on. You know the worst sentence I can think of? “What difference will it make now?” It will make a huge difference. Can you walk your daughter down the aisle, or will you need a walker? Will you need a wheelchair in five years, or can you postpone that? Will you still have the flexibility 15 years from now to take care of your own personal needs, or will you need someone else to bathe you and clip your toenails? In 20 years, will you still be chugging along, or will you be so heavy you can’t stand up without help? I can think of hundreds of examples, but insert your own. It matters.

The important point is that you can change your trajectory. Joining a workout group or taking charge of your diet can make a world of difference in your future, so stop putting it off till next month.

I have my own baggage to deal with, so this version is going to overcome as much of it as I can this year. I’m going to spend the year encouraging you to do the same. We have things to do, and we just have to find a way to drop the baggage and get out of our own way to be the next version of ourselves. All the people who need you will be glad you’re making the effort.

What are you prepared to do today?

        Dr. Chet

Your Last Resort

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Did you ever have one of those days where you just didn’t have it?

  • Maybe you wake up just a little later than expected.
  • Maybe your energy got up and went before you had a chance to get up and go.
  • Maybe everyone in the world seemed to want a piece of you today—and they succeeded.
  • Maybe nothing you wanted to do got done.

What do you do? Here are some ideas:

  • Put on some weather-appropriate clothes and go for a walk.
  • Get on the exercise bike and move those legs.
  • Grab the dumbbells and work those biceps and triceps.
  • Or just get up and sit down 25 times to work those quads.

It doesn’t matter what type of exercise you do, but get that one thing done and you’ve done something positive you can feel good about. It may do wonders for you mentally and make the day a success, or at least not a total loss. Use exercise as the last resort to rescue your day.

What are you prepared to do today?

        Dr. Chet

On the Road Again

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To say that I’ve had a little agony over not running would be an understatement. I certainly don’t want to do anything that’s going to impact the new joint in my knee; on the other hand, my frustration continued to grow over the inability to exercise as hard as I want to exercise. I did what I always do: I looked at the research. Here’s what I found.

Total Knee Replacement and Revision Rates

I decided to look at the most recent research on revision rates in people who ran or started running after total knee replacement. Revision is the word used to describe replacing the original knee replacement because it has loosened or gotten worn. I wanted to see the most recent research because the prosthetics themselves have evolved over the years, as have surgical techniques. There were two research papers that were large enough for me to help make a decision. The references are both open access if you want to read them.

The first study was a meta-analysis of research done on the difference between low physical activity and high physical activity in people who had total knee replacements. While the focus was not on running alone, there were no differences in revision rates in over 4,000 subjects who participated in high physical activity versus low physical activity over a follow-up period of 12 years.

The second study was a cross-sectional study of over 4,000 people who had total knee replacement or total hip replacement. The researchers used online questionnaires to determine activity modes and intensities, postoperative characteristics, revision surgeries, and the Commitment to Exercise Scale and Brief Resilience Scale. The patient-reported follow-up reached five years.

Of the 549 subjects who described themselves as runners before knee replacement, 65 subjects either returned to running or started running after the surgery. After the follow up, 6.2% of those who took up running again required revision surgery while 4.8% of those who didn’t run required revision surgery. The results were not significantly different—about one person. The prevailing recommendation from physicians was to stay active, but don’t run.

On the Road Again

I made the decision to start running again on July 1st. The research that I found was sufficient to give me the confidence to know that if done properly, a return to running can be safe.

What does that mean? Start slowly. While I like to think I’m running, I’m actually talking about a very slow jog. One of the reasons that I decided to return to running was because my fitness level had reached rock bottom, in my opinion. I also know it’s going to take some time.

I began with 20 seconds of jogging about every five minutes. On the day that I wrote this, I did 30 seconds every four minutes. And that’s about the way I’m going to progress: slowly. I’m not interested in running continuously anymore. I got used to a combination of walking and running before the replacement and before my knee got so bad I couldn’t run.

The Bottom Line

I’m glad that my irritation level got high enough to check the research on revision rates after knee replacement. Perhaps it was really more about gaining confidence that, after a year and a half of recovery, the healing of bone to prosthetic was at a point that could support running as I’ve described it. I’m not suggesting that anyone else should do it without checking with their physician. This is my decision and my decision alone. I’m basing it on the best information available today. However, I’d recommend walking or jogging over tennis or pickleball, which include a lot of side-to-side movement; even golf with its twisting motion would be more problematic. You should definitely resume exercise after knee replacement, but talk to your doctor first and make a plan to get where you want to be.

No matter what health, weight loss, exercise, or nutrition goal you set, basing it on the most current scientific information is the best that you can do. I’ll keep you posted on my progress.

What are you prepared to do today?

        Dr. Chet

References:
1. The Knee 2022; 39: 168–184
2. JAAOS Glob Res Rev 2023;7: e23.00019

Knee Replacement Update

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It’s great to be back! I hope your 4th of July holiday was great. Spending some time in Nashville with a few thousand of my closest friends just before the 4th, one of the questions that I was often asked was “How about an update on your knee?” I’ll tell you how I’m doing, but before I do, I just wanted to let you know that Paula will be getting her left knee replaced later this month and probably the right one next year. My knee was bad because of the 20-degree sideways deviation of my lower leg. Paula’s knees are much worse due to arthritis, and she’s really going to benefit from having them replaced.

As for me, I think the thing that surprised me the most was the length of time it took to gain the confidence in the knee to return to full mobility. I had reached the range-of-motion target within a few weeks. Strength I’m still working on. But the fine muscle control necessary for side-to-side movements, turning, posture, and especially balance took at least a year. That doesn’t mean I was inhibited from walking, climbing steps, and doing yard work, but walking downstairs, moving quickly side to side, and even turning sharply is not always there yet. I feel like I’m at about 95% right now.

I’m also terribly frustrated. I’ve been using the recumbent bike, elliptical trainer, and upright bike to exercise. I’ve also been walking outside when the weather permits in the winter and most days of the week now that it’s summer, but for me there’s nothing like running. Could I go back to it, even in some limited capacity? We’re told we can’t run after a knee replacement, but is that accurate? I’ll tell you what I found on Saturday.

Next Wednesday is the next Insider conference call. You have plenty of time to sign up for an Insider membership so you can participate. Get your questions answered and listen to the answers to other Insiders’ questions. Sign up by 8 p.m. on the 19th and you can participate live or listen to the rebroadcast at a later time.

What are you prepared to do today?

        Dr. Chet