Tag Archive for: exercise

The Default Is Always Exercise

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Ever have one of those days? For no particular reason at all, you don’t really want to bother watching what you eat or doing any exercise. What do you do?

Get on the floor and do five or ten push-ups or sit-ups, or get on your exercise bike and get your legs going for one minute. Then re-assess: what’s next? Maybe you stick with floor exercise. Maybe you put on some walking shoes and walk around the yard. Then you decide it’s a nice day so you’ll go for a longer walk. Or bike ride.

Or maybe you’ll just stop. That’s okay as well. Exercise is always the default to get yourself moving in the right direction. Maybe you’ll find out you can do more sit-ups than you thought.

It’s important that you think about why you didn’t care about your exercise or meal plan. Are you coming down with something? I’m currently battling a Supercold, so I know how that can sap your good intentions. Are you feeling down about something? Is it a small setback? Or is depression slipping up on you? Whatever the reason, being active beats sitting and thinking you’re not worth anything. When it’s one of those days, getting the blood moving is the way to get going.

What are you prepared to do today?

        Dr. Chet

Getting to the Exercise Sweet Spot

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Do you realize that five minutes is only 0.3% of a day? Can you really say you can’t at least begin to exercise? “Five minutes isn’t the issue—it’s the 45 minutes a day!” Yes, although 45 minutes is only a whopping 3% of your day, I know it can be hard to work it into your schedule. How about if you could cut the time spent in aerobic exercise in half, from 45 minutes to just over 20 minutes? Interested? Just remember there will be a price to pay.

High-Intensity Interval Training (HIIT)

HIIT as is currently practiced began about 2008 and has been the focus of a lot of research since 2017. The current version alternates very intense intervals from 30 seconds to four minutes with rest periods of at least four minutes; most common is one minute of high intensity and four minutes of rest. Understand that the intensity is an all-out effort, something most sedentary people cannot and should not do—yet.

Remember the price? It’s getting in good enough aerobic condition to be able to handle the increased intensity. When you’re fit enough, four 20-minute HIIT sessions per week can provide you with the exercise sweet spot. Just remember this is only aerobic fitness. Lifting weights, yoga, stretching—that’s all separate.

Intensity

Here’s the real reason I’m getting a knee replacement done: I can’t work hard enough on the exercise bike to reach my target heart rate. Thigh pain above my bad knee hinders me from getting there. I’ve been on the cycle for at least six months, and I’m tired of not getting the workouts I’m used to getting through running.

Although running is not in my future after the knee is replaced, walking will be as well as using the elliptical again. I can replace running with walking uphill in order to achieve the fitness effect I want. It’s not as good but it will give me some variety. I can handle the pain of high-intensity training once I no longer have this level of knee pain. And that’s why I’m doing the knee replacement now.

The Bottom Line

The exercise sweet spot isn’t as precise as I would like, but it does follow a logical progression. Some exercise is better than none; if you’re not exercising at all, start with five minutes. Aspire to at least 30 minutes per day at least four days a week, then work up to 45 minutes.

When you can handle that and your physician says it’s okay, then you can start HIIT training to increase your fitness in less time and still have time to get stronger and more flexible. Even at 45 minutes a day, that’s just 3% of your day committed to exercise. That commitment of time will reduce your risk of just about every degenerative disease, which will help you really live more days of your life and not just struggle through them. Isn’t that worth the investment?

What are you prepared to do today?

        Dr. Chet

Finding the Exercise Sweet Spot

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After last week’s Memos on a sweet spot for food intake, Paula asked if I could do the same thing for exercise. The sweet spot for exercise isn’t so much between not enough movement and too much movement—it’s really between not enough movement and too much time, because most of us never have enough time to do all we need to do. So how can we put in enough time to be healthier but not so much time it becomes unworkable?

If nutrition is complicated, exercise can be more so; that’s why I’m going to stick to just one aspect of exercise: aerobic exercise. While strength, flexibility, and stamina are important, the key to better health is aerobic exercise. How much aerobic exercise is necessary to reduce the risk of all forms of disease, from Alzheimer’s disease to ulcers? There are three answers, depending on your current fitness level.

Riley, our six-year-old grandson, has a motor that doesn’t stop. He would rather be running and jumping, playing tag or battle or anything rather than sitting. Even watching a movie is an aerobic experience for him as he acts out his interpretation of each scene; he does amazing fight scenes! Unfortunately, adults don’t move nearly as much as Riley; most of us no longer have jobs that require moderate or intense physical activity. If you’re sedentary (and even home-schooling three kids is sedentary), then any exercise is better than none. Three minutes is better than two, and 12 is better than 10. Walking, cycling, aerobics—it doesn’t matter. Moving some is better than hardly moving.

Is there a magic number? It’s dependent on exactly how little you move, either due to physical limitations, work, or prior disease. There’s nothing like the precise recommendations similar to nutrition we covered last week.

The ultimate goal? The second answer, based on the current recommendations from every medical and exercise association, is 30 to 45 minutes of aerobic exercise per day most days of the week. There are 1,440 minutes in a day; 45 minutes would represent about 3% of a day. That’s less than the 10% change in diet we talked about last week.

What is the third answer? For those who want to be fitter, I’ll let you know on Saturday. For now, some is better than none. Are you going to begin today?

What are you prepared to do today?

        Dr. Chet

Metabolically Healthy and Obese

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The researchers in Germany continued to determine which factors associated with being obese were the most predictive of mortality from any cause and from cardiovascular disease. While not explicitly stated, it seems to me that they attempted to use variables that were simple to assess. With that in mind, here are the variables which demonstrated whether someone was metabolically healthy or not, regardless if they were normal weight, overweight, or obese.

Criteria for Metabolic Health

  • Systolic blood pressure less than 130 and no use of blood pressure lowering medication
  • Waist-hip ratio less than 0.95 for women and less than 1.03 for men
  • No prevalent diabetes

These criteria are simple enough for most people to determine for themselves, no doctors necessary. People usually know whether they’re diabetic, and they also know whether they’re taking medication to lower their blood pressure. Most people have a home BP cuff to assess systolic blood pressure or have access to one in a store.

The waist should be measured at its widest point and hip should be measured at the bony process of the femur. Divide the second number into the first, and that gives you the waist hip ratio.

The Results

The subjects who were considered metabolically healthy and obese had no greater risk of mortality from all causes or from cardiovascular disease then did normal weight, metabolically healthy subjects. This study examined only the death rate, not the rate of disease. Still, I think that if someone is working towards becoming a healthier version of themselves, intermediate goals can be very motivating.

I like this study for two reasons. First, it confirms what I thought for many years: people who are overweight or obese can be metabolically healthy. Second, it means that instead of trying to lose all the weight a person needs to lose, there can be intermediate steps on the way to becoming the best version of yourself; in fact, you don’t even need to be trying to lose weight to start being healthier.

The study also found that some people who were metabolically unhealthy and normal weight or slightly overweight were at higher risk for cardiovascular disease and total mortality. Could it be that the reason for the reduced risk was exercise? It was not considered, but it would be interesting to see further analysis on the data to determine if fitness was a contributing factor in metabolic health.

The Bottom Line

This study provides a basis for assessing risk of mortality on more than just BMI. What it shows is that even though you may be carrying too much weight, that doesn’t mean that you’re automatically at risk for death due to cardiovascular disease or other causes. I believe regular exercise is critical to achieve metabolic health and thus reduce your mortality risk, so that’s your first step to becoming and staying metabolically healthy.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Net Open. doi:10.1001/jamanetworkopen.2021.8505

How Exercise Improves Sleep

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To become the best version of yourself, it takes more than just eating better and moving more. One factor that gets overlooked is sleep.

Sleep patterns change over a lifetime; in addition, isolation during the COVID pandemic can also impact sleep patterns. Moderate to strenuous exercise has long been known to have a positive impact on sleep, but what about people who can’t exercise at a high level? Using a technology called actigraphy, researchers in Hong Kong attempted to find out whether mild exercise can help people with insomnia.

Actigraphy is a noninvasive technique that measures physical activity levels of a subject by means of a wristwatch-like motion-sensing device that can be worn for prolonged periods of time. Researchers recruited 320 participants with a mean age of 67 with most subjects being female. There were 110 in the control group, 105 subjects in the conventional exercise group, and 105 subjects in the tai chi group. Subjects in both exercise groups exercised for one hour, three days per week. The conventional exercise was a combination of brisk walking and weight training for 12 weeks, while the tai chi group attended a 12-week Yang-style, 24-form tai chi training program.

When compared to controls, both the exercise and tai chi groups showed improved sleep efficiency, reductions of wake time after falling asleep, and reduced number of awakenings. The actigraphy and sleep diary reports were consistent; there were no differences between exercise groups in benefits.

There’s good reason to believe that if mild to moderate exercise works for people with insomnia, it will work for anyone who wants more and better sleep. Seems like a good deal to me: invest three hours a week to help your entire body and get better sleep as a plus.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. 2021;4(2):e2037199.

Less Can Be More If…

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Let’s dig into the results of the National Health Interview Survey analysis to see if less really can be more: does mortality decrease even with fewer than 30 minutes per day most days of the week as long as part of the workouts was vigorous? We’re not examining other potential health benefits of exercise such as the risk of type 2 diabetes, weight loss, or gaining strength—just risk of death.

I examined the Hazard Ratios for the number of minutes spent in vigorous physical exercise per week and the total minutes of exercise per week. For those who exercised 1 to 149 minutes per week (less than the national recommendations), if 1 to 74 minutes of the total were spent in vigorous exercise, there was a 29% decrease in all-cause mortality. For CVD, there was a 20% decrease in mortality and a 24% decrease in mortality from cancer. There were additional benefits when a greater number of minutes were spent in vigorous activity, especially from CVD. Clearly, less can be more.

But…

A person must be fit enough to be able to do vigorous exercise. The survey defined vigorous exercise as hard enough to raise the heartrate and breathing rate and to increase sweating. The older you are, the less you may be able to sustain that type of effort, whether due to a lack of fitness or pre-existing CVD or orthopedic issues; the same holds true for someone who is overweight or obese. If you’re in any of those categories, you must get your physician’s approval before doing intense exercise.

You don’t have to wait, though; work up to it over a period of months with the guidance of a professional exercise specialist. Just as with any goal, you approach it in a stepwise manner. If you can walk for exercise, it may be something as simple as walking fast for 15 seconds every 3 minutes. Progress from there, increasing the fast walking by 15 seconds every week or every few days. If your body isn’t ready yet, it will let you know.

If you can get 20 to 30 minutes most days with over half of those minutes being vigorous, you may reap the benefit of lower risk of death, according to the data. Just proceed with caution and remember, this doesn’t include time working on strength, endurance, or flexibility.

What are you prepared to do today?

        Dr. Chet

References: JAMA Int Med. doi:10.1001/jamainternmed.2020.6331

Is Intense Exercise Better?

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The national recommendation for exercise is 30 to 60 minutes most days of the week. That works out to 150 to 300 minutes per week or 2.5 to 5 hours. At one point or another, I think many people have asked “What’s the least amount of exercise that I can do and still get benefits?” It’s not a simple question because it depends on the benefits you want to get. Top of the list is probably decreasing the risk of dying. It’s time to consider that question as we try to become the best version of ourselves. A recently published study may help.

Researchers analyzed the survey results from over 400,000 subjects in the National Health Interview Survey. This survey is given every year to 35,000 randomly-selected people in the U.S. Researchers focused on questions related to physical activity. They wanted to know whether people exercised, how long they exercised, and how intense the exercise was. They also asked how much time was spent in vigorous exercise within the total time people exercised.

I could have predicted the results: as the percentage of time spent in vigorous exercise increased, all-cause mortality and mortality from CVD and cancer decreased. This held true for all age groups as well as for all BMI groups. Even if you’re obese, you can still reduce your risk if part of your workout is dedicated to vigorous exercise. The question remains: how intense and how long do you have to exercise to get the life-saving benefits? I’ll finish this on Saturday.

The Insider Conference Call is tomorrow night. I’ll go into more details on this study as well as review a video making the rounds about the safety of the COVID vaccinations. If you’re not an Insider, this may be the right time to join.

What are you prepared to do today?

        Dr. Chet

References: JAMA Int Med. doi:10.1001/jamainternmed.2020.6331

Does Exercise Reduce COVID-19?

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I’ve written about fitness and COVID-19 before, but a recent post by a colleague got my attention. I had never been able to find any research that suggested people who are fitter would have less serious cases of COVID-19 or any upper respiratory infection for that matter. I thought maybe the scientific paper he used might provide an update. In addition, there were a couple of statements in the paper that caught me by surprise. Here’s what I found.

Exercise and Fatty Lungs

The paper suggested that if a person were overweight or obese, there could be an increase in fat cells in the lungs. As such, that could increase the available components such as fatty acids that could contribute to the cytokine storm in extreme cases of infection. I’d never heard that fat cells were found in the lungs, so I decided to dig deeper.

The paper referenced an article that talked about risk factors for severe cases of the COVID-19. They cited two studies. The first was a study on overweight diabetic rats. However, we’re not rats so we can’t assume the same applies to humans. The other article dealt only with obesity. The paper said that in a small study on humans, fat cells were found in the lung parenchyma where gas exchanges occur in the lung tissue.

I decided to check out that paper as well. It was a post-mortem examination of the lungs of normal-weight and overweight subjects who died from asthma and non-respiratory conditions. Researchers found fat cells in the cell walls of large structures greater than 6 mm in diameter but none in smaller areas. There was an increase in the fat cells and immune response cells in the fatal asthma cases in obese subjects. While interesting, it does not support the original article indicating fat cells in the lungs to any significant degree, because some obese subjects had none in their lung tissue.

Exercise and COVID-19

The rest of the paper discussed the benefits of exercise as it relates to weight loss, reducing cardiovascular disease, and improving metabolic systems, especially as related to type 2 diabetes. They talked about how every type of exercise improves the body enough to reduce comorbidities, and reducing comorbidities may lead to a better outcome if you get COVID-19.

The only misstatement was that exercise is a way to reduce a significant amount of body fat. It’s not; you also have to reduce your caloric intake to do that. But exercise can improve every organ system to respond better to challenges. That may help if one catches a severe case of COVID-19, so they got that right.

The Bottom Line

Exercise has been described this way: it would be the most prescribed medication in the world if it were in pill form. Based on this paper and the sum total of all the research on exercise and health, exercise can help you reduce your risk of a severe case of this or any virus, maybe not directly, but in helping you reduce your comorbidities. Move more and start today!

What are you prepared to do today?

        Dr. Chet

References:
1. Front. Physiol. doi.org/10.3389/fphys.2020.572718
2. Diabetes Metabolism. 2020. https://doi.org/10.1002/dmrr.3325.
3. Eur Resp J. 2019. 54:1900857; DOI: 10.1183/13993003.00857-2019

Exercise vs. Meditation? The Winner Is…

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As a trained exercise physiologist, if I were asked the question, “Which would prevent acute respiratory tract infections?” I would have picked exercise over meditation every time. The only reason I would choose meditation is that nagging voice in the back of my brain that says, “If they’re asking the question, maybe there were surprise results.” Science says to ask the question, so the researchers did; let’s take a look at the results.

When Meditation Tops Exercise

There were distinct differences between the exercise and stress-reduction groups versus the controls. When compared to the control group, the exercise group had fewer acute respiratory infections. The mindfulness-based stress reduction program also had fewer acute respiratory infections than did the controls, but when looking at other variables such as absenteeism and lost days of work, the stress-reduction program did slightly better than exercise.

When Exercise Beats Meditation

The researchers also examined the total number of infections, and the exercise group did better. In this study, which was completed well before the current pandemic, the exercise group had no coronavirus infections (the common cold) while the meditation and control groups both did; the difference was that the meditation-trained group handled the infections much better than did the controls.

It would have been great if they had one more group that both exercised and used the stress-reduction techniques. It would have been interesting to see if there were additive or even multiplicative benefits, or maybe there would have been no differences or even negative results. We can’t assume that it would have made the immune system function better; the “stress” of doing both might have compromised immune function.

The Bottom Line

Even though this study was done eight years ago, it’s the only study I could find that examined the benefits of exercise related to any type of upper respiratory infection. That the study also included stress reduction/meditative techniques was a bonus. What we know now, based on this study, is that moderate exercise as well as stress reduction will both reduce our risk of serious infection from many types of virus, and we may have milder symptoms if we do catch one. Whether this will serve us well during this pandemic is uncertain, but even a little protection to reduce the most severe symptoms would be worth the effort. That’s great news for people who don’t have the physical capacity to exercise and for those who don’t have the patience for meditation: either one will work. Just do something.

What are you prepared to do today?

        Dr. Chet

Reference: Ann Fam Med 2012;10:337-346. doi:10.1370/afm.1376.

Immune System Training: Exercise vs. Meditation

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What’s going to work better to prevent acute respiratory infections: moderate exercise training or meditation training? Have you predicted which would be more effective without looking at the article? Or do you not have enough information yet? Let’s take a look at what each group did.

The moderate exercise group met for 2.5 hours each week with personnel trained in exercise physiology. The time was broken up into education about exercise and time practicing on different forms of equipment such as treadmills, exercise bikes, etc. The rest of the week, they exercised for 45 minutes per day. Most subjects used walking or jogging as their home modality of exercise. The subjects were trained to exercise at a moderate level based on the Borg perceived-exertion scale; once trained in assessing exertion, it matches up quite well with the effort people are actually performing during exercise.

The meditation group met with personnel trained in mindfulness-based stress reduction techniques for 2.5 hours a week. This program “is based on the idea that an increased awareness of physical, emotional, and cognitive manifestations of stress may lead to a healthier mind-body response to stress.” The subjects were also to practice the stress reduction techniques for 45 minutes every day at home.

The control group did not do either of the techniques. The training lasted for eight weeks. The variables I mentioned in Tuesday’s memo were collected before, during, and after completion of the eight weeks training. What were the results? I’ll give you a little more time to think about it and give you the answer on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Ann Fam Med 2012;10:337-346. doi:10.1370/afm.1376.