Category Archives: Exercise

Random Notes on Fitness

About couple years ago, I was thinking about putting together a fitness program for myself.  My goals were endurance, strength, less low back aching, flexibility, longevity, and being able to get on my horse bareback without a mounting block or other cheat.

I spent quite a bit of time at Doug Robb’s HeathHabits site.  He has a post called The “I don’t have time to workout” Workout.  I ran across some paper notes I made during my time there.  Doug recommended some basic moves to incorporate: air squat, Hindu pushup, dragon flag, shuffle of scissor lung, Spiderman lung, hip thrust/bridge, swing snatch, dumbbell press, Siff lunge, jumping Bulgarian squat, band wood chops, leg stiff leg deadlift.  Click the link to see videos of most of these exercises.  The rest you can find on YouTube.

Another post is called “Do you wanna get big and strong? -Phase 1”.  The basic program is lifting weights thrice weekly.  Monday, work the chest and back.  Tuesday, legs and abs/core.  Friday, arms and shoulders.

  • Chest exercises: presses (barbell or dumbell, incline, decline, flat, even pushups with additional resistance  – your choice
  • Back: chins or rows
  • Legs: squats or deadlifts
  • Arms and shoulders: dips, presses, curls

Doug is a personal trainer with a huge amount of experience.  He’s a good writer, too, and gives away a wealth of information at his website.

Around this same time of searching a couple years ago, I ran across Mark Verstegen’s Core Performance, Mark Lauren’s book “You Are Your Own Gym,”  and Mark Sisson’s free fitness ebook that also  features bodyweight exercises.

Lauren is or was a Navy Seal trainer.  His plan involves 30 minutes of work on four days a week and uses minimal equipment.  Lots of good reviews at Amazon.com.

Newbies to vigorous exercise should seriously consider using a personal trainer.

Steve Parker, M.D.

Exercise Prevents Death

January 1 this year, many folks made New Years’ resolutions to start exercising in conjunction with their other resolution to lose excess weight. I’ve got bad news for them.

Exercise is overrated as a pathway to major weight loss. Sure, a physically inactive young man with only five or 10 pounds (2 to 4 kg) to lose might be able to do it simply by starting an exercise program. That doesn’t work nearly as well for women. The problem is that exercise stimulates appetite, so any calories burned by exercise tend to be counteracted by increased food consumption.

“Should I go with aerobic or strength training….?”

On the other hand, exercise is particularly important for diabetics and prediabetics in two respects: 1) it helps in avoidance of overweight, especially after weight loss, and 2) it helps control blood sugar levels by improving insulin resistance, perhaps even bypassing it.

Even if it doesn’t help much with weight loss, regular physical activity has myriad general health benefits. First, let’s look at its effect on death rates.

EXERCISE PREVENTS DEATH

As many as 250,000 deaths per year in the United States (approximately 12% of the total) are attributable to a lack of regular physical activity. We know now that regular physical activity can prevent a significant number of these deaths.

Exercise induces metabolic changes that lessen the impact of, or prevent altogether, several major illnesses, such as high blood pressure, coronary artery disease, diabetes, and obesity. There are also psychological benefits. Even if you’re just interested in looking better, awareness of exercise’s other advantages can be motivational.

The traditional Mediterranean diet of the mid-20th century may owe some of it’s healthfulness to a physically active lifestyle.

Exercise is defined as planned, structured, and repetitive bodily movement done to improve or maintain physical fitness.

Physical fitness is a set of attributes that relate to your ability to perform physical activity. These attributes include resting heart rate, blood pressure at rest and during exercise, lung capacity, body composition (weight in relation to height, percentage of body fat and muscle, bone structure), and aerobic power.

Aerobic power takes some explanation. Muscles perform their work by contracting, which shortens the muscles, pulling on attached tendons or bones. The resultant movement is physical activity. Muscle contraction requires energy, which is obtained from chemical reactions that use oxygen. Oxygen from the air we breathe is delivered to muscle tissue by the lungs, heart, and blood vessels. The ability of the cardiopulmonary system to transport oxygen from the atmosphere to the working muscles is called maximal oxygen uptake, or aerobic power. It’s the primary factor limiting performance of muscular activity.

Aerobic power is commonly measured by having a person perform progressively more difficult exercise on a treadmill or bicycle to the point of exhaustion. The treadmill test starts at a walking pace and gets faster and steeper every few minutes. The longer the subject can last on the treadmill, the greater his aerobic power. A large aerobic power is one of the most reliable indicators of good physical fitness. It’s cultivated through consistent, repetitive physical activity.

Physical Fitness Effect on Death Rates

Regular physical activity postpones death.

Higher levels of physical fitness are linked to lower rates of death primarily from cancer and cardiovascular disease (e.g., heart attacks and stroke). What’s more, moving from a lower to a higher level of fitness also prolongs life, even for people over 60.

Steve Parker, M.D.

Why Should I Care About Target Heart Rate?

To get the full health benefits of regular physical activity, you need to put some effort into it. A leisurely hour-long stroll in the mall while window-shopping doesn’t pass muster, although that’s better than nothing.

One rough way to gauge whether you’re working hard enough during aerobic exercise is to monitor your heart rate, also known as pulse. Subtract your age from 220. The result is your theoretical maximum heart rate in beats per minute. Your heart rate goal, or target, during sustained aerobic exercise is a pulse that is 60 to 80 percent of your theoretical maximum pulse. For example: maximum heart rate for a 40-year-old is 180 (220 – 40 = 180), so the target heart rate zone during exercise is between 108 and 144 (60 to 80 percent of 180). Exceeding the upper end of the target zone is usually too uncomfortable to be sustainable. Exercise heart rates below the target zone suggest you’re not working hard enough to reap the full long-term benefits of aerobic exercise.

Here’s how to determine your pulse. After five or 10 minutes of exercise, stop moving and place the tips of your first two fingers lightly over the pulse spot inside your wrist just below the base of your thumb. Count the pulsations for 15 seconds and multiply the number by four. The result is your pulse or heart rate. It will take some practice to find those pulsations coming from your radial artery. If you can’t find it, ask a nurse or doctor for help.

Like all rules-of-thumb, this target heart rate zone isn’t always an accurate gauge of cardiovascular workout intensity. For instance, it is of very little use in people taking drugs called beta blockers, which keep a lid on heart rate.

As you become more fit, you’ll notice that you have to work harder to get your heart rate up to a certain level. This is a sure sign that your heart and muscles are responding to your challenge. You may also want to monitor your resting heart rate taken in the morning before you get out of bed. Unfit, sedentary people have resting pulses of 60 to 90. Athletes are more often in the 40s or low 50s. Their hearts have become more efficient and just don’t need to beat as often to get the job done.

As you become more fit, you’ll also notice that you have more energy overall and it’s easier to move about and handle physical workloads. You’ll feel more relaxed and have a sense of accomplishment. Expect these benefits eight to 12 weeks after starting a regular exercise program.

Steve Parker, M.D.

Anti-Aging and Other Metabolic Benefits of Exercise

At my Diabetic Mediterranean Diet blog, I recently noted that regular physical activity prevented or postponed death. Onward now to other benefits.

Waist Management

Where does the fat go when you lose weight dieting? Chemical reactions convert it to energy, water, and carbon dioxide, which weigh less than the fat. Most of your energy supply is used to fuel basic life-maintaining physiologic processes at rest, referred to as resting or basal metabolism. Basal metabolic rate (BMR) is expressed as calories per kilogram of body weight per hour.

The major determinants of BMR are age, sex, and the body’s relative proportions of muscle and fat. Heredity plays a lesser role. Energy not used for basal metabolism is either stored as fat or converted by the muscles to physical activity. Most of us use about 70 percent of our energy supply for basal metabolism and 30 percent for physical activity. Those who exercise regularly and vigorously may expend 40–60 percent of their calorie intake doing physical activity. Excess energy not used in resting metabolism or physical activity is stored as fat.

Insulin, remember, is the main hormone converting that excess energy into fat; and carbohydrates are the major cause of insulin release by the pancreas.

To some extent, overweight and obesity result from an imbalance between energy intake (food) and expenditure (exercise and basal metabolism). Excessive carbohydrate consumption in particular drives the imbalance towards overweight, via insulin’s fat-storing properties.

In terms of losing weight, the most important metabolic effect of exercise is that it turns fat into weightless energy. We see that weekly on TV’s “Biggest Loser” show; participants exercise a huge amount. Please be aware that conditions set up for the show are totally unrealistic for the vast majority of people.

Physical activity alone as a weight-loss method isn’t very effective. But there are several other reasons to recommend exercise to those wishing to lose weight. Exercise counteracts the decrease in basal metabolic rate seen with calorie-restricted diets. In some folks, exercise temporarily reduces appetite (but others note the opposite effect). While caloric restriction during dieting can diminish your sense of energy and vitality, exercise typically does the opposite. Many dieters, especially those on low-calorie poorly designed diets, lose lean tissue (such as muscle and water) in addition to fat. This isn’t desirable over the long run. Exercise counteracts the tendency to lose muscle mass while nevertheless modestly facilitating fat loss.

How much does exercise contribute to most successful weight-loss efforts? Only about 10 percent on average. The other 90 percent is from food restriction.

Fountain of Youth

Regular exercise is a demonstrable “fountain of youth.” Peak aerobic power (or fitness) naturally diminishes by 50 percent between young adulthood and age 65. In other words, as age advances even a light physical task becomes fatiguing if it is sustained over time. By the age of 75 or 80, many of us depend on others for help with the ordinary tasks of daily living, such as housecleaning and grocery shopping. Regular exercise increases fitness (aerobic power) by 15–20 percent in middle-aged and older men and women, the equivalent of a 10–20 year reduction in biological age! This prolongation of self-sufficiency improves quality of life.

Heart Health

Exercise helps control multiple cardiac (heart attack) risk factors: obesity, high cholesterol, elevated blood pressure, high triglycerides, and diabetes. Regular aerobic activity tends to lower LDL cholesterol, the “bad cholesterol.” Jogging 10 or 12 miles per week, or the equivalent amount of other exercise, increases HDL cholesterol (“good cholesterol”) substantially. Exercise increases heart muscle efficiency and blood flow to the heart. For the person who has already had a heart attack, regular physical activity decreases the incidence of fatal recurrence by 20–30 percent and adds an extra two or three years of life, on average.

Effect on Diabetes

Eighty-five percent of type 2 diabetics are overweight or obese. It’s not just a random association. Obesity contributes heavily to most cases of type 2 diabetes, particularly in those predisposed by heredity. Insulin is the key that allows bloodstream sugar (glucose) into cells for utilization as energy, thus keeping blood sugar from reaching dangerously high levels. Overweight bodies produce plenty of insulin, often more than average. The problem in overweight diabetics is that the cells are no longer sensitive to insulin’s effect. Weight loss and exercise independently return insulin sensitivity towards normal. Many diabetics can improve their condition through sensible exercise and weight management.

Miscellaneous Benefits

In case you need more reasons to start or keep exercising, consider the following additional benefits: 1) enhanced immune function, 2) stronger bones, 3) preservation and improvement of flexibility, 4) lower blood pressure by 8–10 points, 5) diminished premenstrual bloating, breast tenderness, and mood changes, 6) reduced incidence of dementia, 7) less trouble with constipation, 7) better ability to handle stress, 8) less trouble with insomnia, 9) improved self-esteem, 10) enhanced sense of well-being, with less anxiety and depression, 11) higher perceived level of energy, and 12) prevention of weight regain.

People who lose fat weight but regain it cite lack of exercise as one explanation. One scientific study by S. Kayman and associates looked at people who dropped 20 percent or more of their total weight, and the role of exercise in maintaining that loss. Two years after the initial weight loss, 90 percent of the successful loss-maintainers reported exercising regularly. Of those who regained their weight, only 34 percent were exercising.

Steve Parker, M.D.

Getting Started With Strength Training

What’s “strength training”? It’s also called muscle-strengthening activity, resistance training, weight training, and resistance exercise. Examples include lifting weights, work with resistance bands, digging, shoveling, yoga, push-ups, chin-ups, and other exercises that use your body weight or other loads for resistance.

Strength training three times a week increases your strength and endurance, allows you to sculpt your body to an extent, and counteracts the loss of lean body mass (muscle) so often seen during efforts to lose excess weight. It also helps maintain your functional abilities as you age. For example, it’s a major chore for many 80-year-olds to climb a flight of stairs, carry in a bag of groceries from the car, or vacuum a house. Strength training helps maintain these abilities that youngsters take for granted.

According to the U.S. Centers for Disease Control and Prevention: “To gain health benefits, muscle-strengthening activities need to be done to the point where it’s hard for you to do another repetition without help. A repetition is one complete movement of an activity, like lifting a weight or doing a sit-up. Try to do 8–12 repetitions per activity that count as 1 set. Try to do at least 1 set of muscle-strengthening activities, but to gain even more benefits, do 2 or 3 sets.”

If this is starting to sound like Greek to you, consider instruction by a personal trainer at a local gym or health club. That’s a good investment for anyone unfamiliar with strength training, in view of its great benefits and the potential harm or waste of time from doing it wrong. Alternatives to a personal trainer would be help from an experienced friend or instructional DVD. If you’re determined to go it alone, Internet resources may help, but be careful. Consider “Growing Stronger: Strength Training for Older Adults” (http://www.cdc.gov/physicalactivity/downloads/growing_stronger.pdf). Don’t let the title turn you off if you’re young—its a good introduction to strength training for folks of any age. Doug Robb’s blog, HealthHabits, is a wonderful source of strength training advice (http://www.healthhabits.ca/).

People with diabetes must be particularly cautious before starting a fitness program.

Current strength training techniques are much different than what you remember from high school 30 years ago—modern methods are better. Some of the latest research suggests that strength training may be even more beneficial than aerobic exercise.

Steve Parker, M.D.

Target Heart Rate

To get the full health benefits of regular physical activity, you need to put some effort into it. A leisurely hour-long stroll in the mall while window-shopping doesn’t pass muster, although that’s better than nothing.

One rough way to gauge whether you are working hard enough during aerobic exercise is to monitor your heart rate, also known as pulse. Subtract your age from 220. The result is your theoretical maximum heart rate in beats per minute. Your heart rate goal, or target, during sustained aerobic exercise is a pulse that is 60 to 80 percent of your theoretical maximum pulse. For example: maximum heart rate for a 40-year-old is 180 (220 – 40 = 180), so the target heart rate zone during exercise is between 108 and 144 (60 to 80 percent of 180). Exceeding the upper end of the target zone is usually too uncomfortable to be sustainable. Exercise heart rates below the target zone suggest you’re not working hard enough to reap the full long-term benefits of aerobic exercise.

Here’s how to determine your pulse. After five or 10 minutes of exercise, stop moving and place the tips of your first two fingers lightly over the pulse spot inside your wrist just below the base of your thumb. Count the pulsations for 15 seconds and multiply the number by four. The result is your pulse or heart rate. It will take some practice to find those pulsations coming from your radial artery. If you can’t find it, ask a nurse or doctor for help.

Like all rules-of-thumb, this target heart rate zone isn’t always an accurate gauge of cardiovascular workout intensity. For instance, it is of very little use in people taking drugs called beta blockers, which keep a lid on heart rate.

As you become more fit, you’ll notice that you have to work harder to get your heart rate up to a certain level. This is a sure sign that your heart and muscles are responding to your challenge. You may also want to monitor your resting heart rate taken in the morning before you get out of bed. Unfit, sedentary people have resting pulses of 60 to 90. Athletes are more often in the 40s or low 50s. Their hearts have become more efficient and just don’t need to beat as often to get the job done.

As you become more fit, you’ll also notice that you have more energy overall and it’s easier to move about and handle physical workloads. You’ll feel more relaxed and have a sense of accomplishment. Expect these benefits eight to 12 weeks after starting a regular exercise program.

Steve Parker, M.D.

Starting Hillfit

Today I started Chris Highcock’s Hillfit exercise program.  It’s basically four exercises I can probably finish in 40 minutes a week, split into two sessions.

In addition I’ll be doing twice-weekly interval training on a treadmill:

  1. 3-minute warm-up at 5.3 mph, then
  2. 12 minutes of 1-minute fast runs (7-8 mph) alternating with 1-minute slow jogging (5.3 mph), then
  3. 3-minute cool-down by walking 2.5-3 mph

I’ll dial a 1% grade into the treadmill to simulate wind resistance I’d get if outdoors.

After six or eight weeks I’ll switch to another program, such as Jonathan Bailor’s Smarter Science of Slim, which also promises reasonable fitness with relatively little time and equipment investment.

If you hope to exercise regularly, you’ll need to be motivated.  I’ve recorded my motivations.  What’re yours? 

Steve Parker, M.D.

April is Fitness Month: My Motivation

My wife, Sunny, decrees April to be Fitness Month.  No joke.

But it’s more than just fitness.  It’s about eating right, plus exercise.  No dining out for the entire month.  No junk food.  Renewed commitment to physical activity.

In the spirit of Fitness Month, I’m restarting my exercise efforts, which have been on hold for the last month.  I’ve simply been lazy.

I’m trying a new program based on resistance exercise and high-intensity interval training.  All in less than an hour a week.  To help me judge effectiveness, I’ve measured and recorded my baseline fitness.  I’ll re-measure every couple weeks or so.  After six or eight weeks, I’ll switch to a different program.

Exercise isn’t fun.  You need good reasons to do it.  Here are mine:

  • it keeps you young (fountain of youth)
  • longevity
  • less low back aching
  • injury resistance
  • keep my supraspinatous tendonitis (rotator cuff) in remission
  • prevention dementia, heart disease, and cancer
  • I’m a sheepdog, not a sheep
  • weight management
  • emergency preparedness (e.g., carry out an injured Boy Scout from a wilderness area)
  • more energy to enjoy life (hiking, camping, horseback riding, horse stall mucking, horse grooming, hay bale wrangling, long walks with others, etc.)

If you hope to exercise regularly, you’ll need your own list of reasons.  You’ll have days, weeks, or months when you just don’t want to exercise.  Review your list then.

Steve Parker, M.D.

PS:  This is my first post done on my new MacBook Pro.  Woo hoo!  I haven’t given any thought to sources of royalty-free photos to accompany posts.  Any ideas?  I’m used to MS Clip Organizer, which isn’t on this machine.

Should Exercise Be Fun?

Exercise is not supposed to be fun. If it is, then you should suspect that something is wrong.

That quote is from an essay by Ken Hutchins posted at the Efficient Exercise website.

When I was a young man in my 30s, I was jogging 20 miles a week and ran a couple marathons (26.2 miles). I enjoyed it and didn’t do much else for exercise or overall fitness. I thought I was in pretty good shape. You can get away with that when you’re 35, but not when you’re 50. At 57 now, I can’t think of any single recreational activity that can help me maintain the overall strength, functionality, and injury resistance I want and need as I age.

I’ve come to view exercise as a chore, like flossing/brushing teeth, changing the oil in my car, and sleeping when I’d rather not. I’ve got my current exercise chore whittled down to an hour three times a week. OK, sometimes just twice a week.

Skyler Tanner takes a thoughtful and in-depth look at the exercise versus recreation dichotomy at his blog. If you have comments, more people will see them at his site than here.

Steve Parker, M.D.

U.S. Army Fitness Benchmarks

I’ve written previously how it’s helpful to have some baseline physical fitness measurements on yourself.  That post mentioned up to 14 different items you could monitor.  In the comment section, I recognized that’s too much for some folks.  For them, I suggested just doing the five-item functional testing: 1-mile run/walk (timed), maximum number of push-ups and pull-ups, toe touch, and vertical jump.

A week ago, I was at a training session for adult Boy Scout leaders.  One of the items covered was environmental heat illness: how to avoid, recognize, and treat.  One of the risk factors for heat illness is “poor fitness,” defined as taking over 16 minutes to run two miles.  Inquiring minds want to know where that number came from.  No reference was given.

About.com has an article on fitness requirements for U.S. army soldiers, who are tested at least twice yearly.  There are only three components tested:

  • Number of push-ups
  • Number of sit-ups
  • Time to complete a two-mile run

Fortunately, the Army doesn’t expect a 57-year-old man to perform as well as a 17-year-old.  For instance, a 17-year-old has to run two miles in 19 minutes and 24 seconds or less; the 57-year-old is allowed up to 23 minutes and 24 seconds.  Females and males have different performance standards: a 17-year-old woman has 22 minutes and 24 seconds to run two miles.

The simplicity of the Army’s approach appeals to me.  Check out the APFT tables in the About.com article if you want to see how you compare to Army soldiers.

Steve Parker, M.D.