Tag Archive for: exercise

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

Yes, Intensity Matters

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Can you get away with less time exercising and still protect your cardiovascular system? We know from Tuesday’s Memo that more time spent on physical activity will provide more protection. Can we save some time? Or perhaps better stated, can we do something in short bursts of time that can increase the moderate to intense exercise we get?

Before I answer that, remember that physical activity means everything you do that requires movement: walking to the kitchen, gardening, cooking, and the activity involved in your job. Exercise is also a part of your overall physical activity. In the study, all activity was registered by the accelerometer the subjects wore.

Intensity Matters to Reduce CVD Risk

With that in mind, the answer is yes: exercise intensity matters when it comes to protecting yourself from cardiovascular disease (CVD). I must admit that the charts and graphs published in the study were challenging to understand. They used a percentage of calories used per day as the way to measure outcomes. For the exercise intensity analysis, they considered the percentage of calories at moderate to high intensity. They found that as the percentage of activity at moderate to high intensity increased, the rate of CVD events decreased.

Here’s an example. Let’s take a 180-pound guy who uses a low amount of energy in physical activity such as five calories per kg body weight. The total calories he uses daily would be about 400 calories, including any exercise he did. But let’s say the percentage of moderate to severe intensity exercise rises from 10% of total exercise to 20% of that total. His risk of a CVD event would be reduced from 2% lower to 20% lower. He hasn’t invested any more time, yet he gets a jump in benefit just from increased intensity.

What Does That Mean for You?

Does this mean that everyone should be doing high-intensity interval training? Not in the classic sense; what’s high intensity for you may be impossible for your elderly neighbor and a breeze for your kid’s soccer coach. You don’t have to do special workouts such as high-intensity interval training where you’re going to bust a gut for 60 seconds and then take it easy for five minutes. That is intense, but it takes less time overall and you could do that if you want; there’s more info at drchet.com if you decide to try it.

In physical activity, everything counts from housework to walking the dog to breaking into a run to catch a bus. Those would show up as mild or moderate intensity, or high-intensity exercise for the running. It doesn’t mean that all the exercise you do has to be high intensity, but investing time in higher intensity exercise may provide you with additional benefits. Working a little harder is going to reduce your risk of cardiovascular disease and, while not assessed in this study, your risk of type 2 diabetes, hypertension, and cancer would be reduced as well.

Of course, the question is what’s high intensity for you. The chart above is geared toward weightlifting, but it will give you some ways to think about how hard you’re exercising, no matter what you’re doing. If you’re running for the bus, could you run one more block? If you’re cleaning house, do you have enough juice left to go for a bike ride?

The Bottom Line

You must be fit enough and ambulatory enough to actually do moderate to high-intensity exercise. But you know something? I know of one physical therapist who encourages patients to do jumping jacks while sitting in a wheelchair. Of course they can’t do the actual jumping part of it but for 60 seconds, their arms are going up and down, up and down, up and down at a very high rate, and maybe their legs are moving, too—and that’s high intensity for them. For others of you, it may be doing a two-minute walk up a very steep hill. The intensity of the exercise stresses the heart in ways that a nice easy walk does not. And for that, you get additional benefits, no matter where you’re starting.

So check with your doctor to find out your limitations as it relates to exercise intensity, and then get after it. Not to lose a whole bunch of weight, not to win the next 5K, not every day—but often enough to make your heart stronger and fitter.

What are you prepared to do today?

        Dr. Chet

P.S. Happy Canada Day to our neighbors to the north! We’re taking next week off to enjoy the July 4th holiday and hope you do as well (even if you’re not in the U.S.) We’ll be back with new Memos the week of the 10th. Meanwhile, it’s a great time to try increasing your exercise intensity.

Reference: Eur Heart J (2022) https://doi.org/10.1093/eurheartj/ehac613

How Hard Should You Exercise?

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Exercise is my most favorite thing to talk about—not surprising for an exercise physiologist. There’s no question that diet is important to our health, but if I had to focus on just one habit that people should adopt, it would definitely be exercise first before anything else. I believe we should all eat more vegetables and fruits, take supplements for gaps in our diet, and try to reach a normal body weight. But aside from quitting smoking, the most important thing you can do for your health is to be physically active.

Let’s look at the study. The subjects in the study were a subgroup of people from the United Kingdom Biobank study. The data were collected from 88,412 middle-aged adults, with 58% women, who were specifically chosen because they had not been diagnosed with cardiovascular disease before the study.

The researchers broke the data into three equal groups by activity level. The average age of the subjects in the study was 62, and the average BMI was 27. They tracked the subjects for 6.8 years, and in that amount of time there were 4,068 cardiovascular disease (CVD) events: ischemic heart disease (reduced blood flow to the heart) or cerebrovascular disease (reduced blood flow to the brain).

Their findings were interesting and confirmational. Using no or differing covariates in the statistical analysis, as the amount of physical activity increased, the incidence of CVD decreased. That would confirm what we would expect: regardless of intensity, the risk of CVD decreased and it continued to decrease for every level tested.

How does exercise intensity impact all this? We’ll take a look at intensity on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Eur Heart J (2022) https://doi.org/10.1093/eurheartj/ehac613

Worst Stressor: Split Decision

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I intended to talk about the single most negative stressor that we face as we age, but I couldn’t pick just one. When I say stressors, I mean things we have to deal with every day, not a singular event such as an auto accident. Smoking would be the easy choice, but it doesn’t impact as many people as it used to. Here are my two choices.

Too Much Weight

Someone asked me a simple question before an Insiders Conference Call: if you could do one thing differently when you were young to improve your health, what would it be? Without hesitation my answer was I would have gotten to a normal body weight and maintained it. Being overfat impacts you as soon as you try to get out of bed: you have to overcome gravity. And it doesn’t stop there.

Every system, every organ, and every cell in your body is impacted by excess fat. Some effects are worse than others, but every cell is impacted in some way. If you can avoid gaining the weight to begin with, that’s ideal. If you’re like me and you didn’t, it’s a lifetime challenge to get to a normal weight and maintain it. I’m still working at it.

If you’re still a youngster in your 20s, 30s, or 40s, don’t postpone weight loss. Do whatever it takes to get to a normal weight (short of drug abuse or eating disorders), then develop a healthy lifestyle to keep your weight down. Even if you’re older, you can still lose weight just as my mother-in-law did in her 80s.

Chronic Pain

There are some people who don’t know what it’s like to face pain every day, but the majority of people face the daily challenge of having their lives impacted by pain as they get older. It may be joint pain in the knees. Lower back pain afflicts many. It may be nerve damage from prior accidents. But as we age, pain is the stressor that may be present all day, every day.

There is no magic wand for this stressor. For some people, if they didn’t have to think about pain, they could do so much more. Instead, it’s trying to find the right everyday changes that can make life bearable.

The Bottom Line

I think you can understand why it was a split decision. In addition, these two stressors affect each other: being overfat can make the pain worse, and having pain can prevent us from exercising to help with weight loss. It doesn’t mean there are no stressors of aging we can deal with—there definitely are. That’s what we’ll talk about in my upcoming program Aging with a Vengeance.

On next week’s Insiders Conference Call, I’ll talk more specifically about the stressors of aging and what we can do about them. Become an Insider by 8 p.m. Wednesday, December 14, and you can join the Insider call at 9 p.m.

What are you prepared to do today?

        Dr. Chet

The Best Stressor

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Stressors aren’t all the same; they can be positive and they can be negative. I’m going to begin with the single most powerful positive stressor: exercise. It’s not just one type, such as aerobic exercise or strength training. It’s all of them, and there are specific negative stressors that specific types of exercise can address. But no matter what body system or organ you examine, exercise has a beneficial effect.

Can too much exercise cause problems? Yes, but overdoing most positive things can yield negative results. With only 10% to 15% of the U.S. population exercising enough to do themselves any good, we have a long way to go before we have to worry about the majority of our fellow citizens.

I can’t remember who said it, but this quote sums it up quite well: If you’re not exercising regularly, you’re dying prematurely. There are hundreds of types of exercises to address many specific issues, but start with a walk. Right now. That most important muscle, your heart, will love you for it. Saturday, on to the most negative stressor.

What are you prepared to do today?

        Dr. Chet

The Stress Response

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Anyone who studies the stress response will be familiar with the general adaptation syndrome (GAS) that’s depicted in the graphic. The response was developed by the Canadian scientist Dr. Hans Selye over years of experiments; his research focus was the hormonal response to chronic stress. To promote his adaptation concept, Dr. Selye was just as good a marketer as he was scientist. Although we know a lot more today about the hormonal and neural responses to stress, the GAS still applies to chronic stress for the most part.

Stress, both acute and chronic, is going to happen—it’s inevitable. What matters is how we respond to stress. After 35 years as an exercise physiologist, I know there are two ways to prepare for stress of all kinds: exercise and mental preparation.

Exercise

Like the concept of fighting fire with fire, you can fight stress with exercise, which is a stressor. If you examine the hormonal and neural response to exercise, it’s the classic response. (If you want to read more about the particulars of the stress response, please go to reference 1.) What makes exercise different is that we can increase our resistance because we control the amount and intensity of that stress; or in terms of the GAS graphic, we can gradually move that white line up higher.

The side benefit is that it can help when we are exposed to other types of stress as well. For example, while we may still be disrupted by the hustle and bustle of the holidays, it will not have the same impact on our immune or cardiovascular system. There’s no better way to be prepared to deal with stress than regular exercise, and it helps to prepare your mind as well.

Mental Preparation

There are dozens of ways to prepare your mind for how you respond to the stress of life; there are courses to take, books to read, positive affirmations to say, and other techniques such as prayer and meditation. But here’s the thing: you never really know how you’ll respond to stress until you’re exposed to it. There’s a big difference between someone taking your parking space and getting a cancer diagnosis. One is over in a few seconds while the other may alter your life in many ways.

The way your mind responds will also be impacted by prior experiences, both positive and negative. You have to call upon how you responded in the past to know the best way to respond when you face the same or similar stressors. It would certainly help if you had some warning when the stressors would show up.

Aging Causes Stress

Aging is one of the major stressors we face. To get an idea, read the material in the second reference. Near the end of the article, you can read the impact of aging on every organ and system in the body. We can’t stop aging, but we can prepare for it. Remember what I said about when stressors would show up? We have a pretty good idea when that will happen with aging, so we can work to reduce the impact on our bodies. That’s what Aging with a Vengeance is all about. In the next few Memos, I’m going to tell you those areas I think we can impact the most as we age.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.ncbi.nlm.nih.gov/books/NBK541120/
2. https://medlineplus.gov/ency/article/004012.htm