Tag Archive for: exercise

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.

Boosting Immune Function: Exercise vs. Meditation

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Every once in a while, I come across some research that’s just so interesting and unique, I have to share it with you. In this case, it’s directly related to boosting the immune system, which is what a lot of people are trying to do right now. In this case, researchers tested whether an eight-week program of either moderate exercise or meditation would reduce the variables associated with an acute respiratory infection such as time lost from work.

Researchers recruited subjects who did not get a flu vaccination and also did not exercise or meditate; they used just about every survey related to health that was available. They also took samples from nasal rinses after subjects had acquired an acute respiratory infection of any type and tested for markers of immune function in the rinses.

The mean age of the subjects was 59 years old. The subjects were randomly assigned to one of three groups: the control group who agreed to do nothing during the eight weeks; a group who would exercise at a moderate level; and a group who would participate in a specific type of meditation.

On Thursday, I’ll talk about the training programs. Looking ahead, short of looking up the paper itself, what do you think will be more effective: exercise or meditation to boost the immune system?

Insider Conference Call

Tomorrow night is the August Insider conference call. I’m going to do a COVID-19 update focusing on the recent spate of doctors plugging hydroxychloroquine as well as answering Insider questions. If you become an Insider by 8 p.m. ET, you can participate live!

What are you prepared to do today?

        Dr. Chet

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

The Bottom Line on Masks

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To satisfy my own curiosity, I wanted to do a run/walk to see how wearing a mask might impact my performance. This is tricky for someone with a scientific background; trying to duplicate everything with the exception of the one variable, the mask, is difficult when you’re outdoors. But the weather has been pretty stable: overnight lows in the mid 60s, rising to 90 degrees almost every day with little humidity.

I decided to run the half-mile loop in my neighborhood six times just like I normally do. Five days before I ran it with the mask, I had run it faster than I had in a couple of years; I’m not setting any speed records here, but my knee appears to be getting stronger and I’m able to open the jets a little bit. I ran the same six laps at the same time of day and at the approximate same temperature. The only variable was the mask.

Before I tell you the results, I have to say that I spent way too much time thinking about the mask instead of just running or walking. At this point, I’m running for one minute, and walking for 90 seconds. I maintained that with no real problems once I stopped thinking about the mask. I also must say then I decided to bulk up the day before by over-eating some great tasting pasta I made. I was four pounds heavier than last week. Five days before, I ran the six laps in 40:52. This time I ran it in 41:20—28 seconds slower.

Did I have any trouble breathing? Not really other than thinking about it too much. Did it affect my ability to run? I don’t think so. I intentionally tried not to make it a race, but just to go out and run/walk the best that I could. I didn’t feel like I was breathing any harder while walking or running. My recovery from the run seemed about the same. So I would have to overall say that wearing a two-layer, cloth mask (just like in the picture) didn’t have any impact on my ability to exercise.

Should Everyone Wear a Cloth Mask?

No. The Centers for Disease Control does not recommend cloth masks for:

  • Children younger than two years old.
  • Anyone who has trouble breathing.
  • Anyone who is unconscious, incapacitated, or otherwise unable to remove the cloth face covering without assistance.

They also list some pragmatic concerns for those who must travel in populated areas but cannot wear a mask. They do not qualify what “trouble breathing” means, but certainly respiratory issues as well as cardiac issues would probably be included. Of course, if you have heart trouble or respiratory problems, taking chances with your health doesn’t seem like a smart choice; I’d recommend staying home as much as you can.

The Size of a Pea or the Size of a House?

For those of you who think size matters, let’s talk about the relative sizes of the various items under discussion when we talk about masks.

Viruses are so small they’re measured in nanometers; a nanometer is one millionth of a millimeter. There are about 25 millimeters in an inch, so take one twenty-fifth of an inch and divide it into a million: that’s a nanometer. A human hair is around 75,000 nanometers. So here’s what you need to know:

Oxygen molecules are one-third of a nanometer; carbon dioxide is a carbon molecule with oxygen molecules on its right and left, so it measures about one-third of a nanometer by one nanometer.

Coronaviruses are 125 nanometers.

Droplets vary from 2,000 nanometers to 100,000 nanometers.

By definition, an N95 mask blocks 95% of particles of 300 nanometers.

Cloth varies so much it’s hard to determine the size of the comparative spaces between fibers, so it was hard to find any info at all. The best I could find is that it’s in roughly the same size range as the droplets; used, folded, tightly woven cotton has about 20,000 nanometers between fibers.

It’s hard to visualize the comparative sizes when we’re talking about a unit of measure that’s so incredibly small. Let’s transform everything into familiar sizes by changing nanometers to inches:

Oxygen would be about the size of a pea, and carbon dioxide would be three peas pushed together.

A coronavirus would be 10.5 feet tall, so it probably wouldn’t fit in your house.

An N95 mask blocks particles equivalent to 25 feet or more.

Droplets start at the size of a 12-story building (167 feet) up to almost 600 stories (over 8,000 feet).

So you can see how a cloth mask that stops droplets from getting through would allow plenty of oxygen and carbon dioxide to pass freely.

But how does a mask stop a 125-nanometer coronavirus if it filters out particles of 300 nanometers? It’s important to know the virus isn’t floating around by itself—it’s hitching a ride on the droplets of moisture we breathe out, and a mask definitely stops those.

Final Research Paper

Here’s a quote from the 2013 paper I used as a basis for the effectiveness of cloth masks:

“In the questionnaire on mask use during a pandemic, six participants said they would wear a mask some of the time, six said they would never wear a mask, and nine either did not know or were undecided. None of the participants said that they would wear a mask all of the time. With one exception, all participants reported that their face mask was comfortable.”

That seems to be where we are today during this pandemic, seven years after that study was published. Only today it’s reality, not answers to a questionnaire.

The Difference in Lives

If none of that convinces you to wear a mask, maybe this will: a new model by the University of Washington predicts more than 208,000 Americans will die from COVID-19 by November.

But if 95% of the population wears a mask in public from now until then, that number would drop to 162,808—a difference of more than 45,000 lives. Let’s bring that home. The U.S. has 3,141 counties; would you wear a mask to protect 14 people in your county?

The Bottom Line

This week I’ve reviewed some of the major objections that people have to avoid wearing a cloth mask, and the research doesn’t support the objections.

The final objection is that people are willing to take their chances that they will get only a mild version of the virus; it seems their freedom to enjoy life supersedes the safety of those around them. Maybe like Gus in Lonesome Dove, they’ll take their chances with an infection and die with their boots on. I challenge those people to do some research on long-term consequences of COVID-19.

It’s no longer a safe assumption that your local hospital will make everything okay if you get ill. Every area with a COVID-19 spike has seen hospitals at capacity, healthcare workers at or beyond the breaking point, and the necessary supplies running short, including PPE. All respect to healthcare workers, but they’re human and at some point mental, emotional, and physical exhaustion sets in and they’re not going to be able to give their best. Maybe you could wear a mask for the sake of the people you know in healthcare, like our daughter-in-law.

What are you prepared to do today? Wear the damn mask!

        Dr. Chet

References:
1. https://bit.ly/3gvDH0J
2. Disaster Med Public Health Preparedness. 2013;7:413-418.

Old School: One Step

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I’ve been lifting weights at home since the “Stay Home, Stay Safe” mandate closed all the fitness centers. I wanted to make the workouts a little more difficult and keep my heart rate elevated between sets, so I went old school: I used a step stool. I could have used a step on the stairs outdoors, but it’s still too cold and I would have to move the weights outdoors. Lucky for me, Paula has a sturdy wooden step made for her by her brother, Steve, many years ago.

Up-up-down-down. Over and over. Every five rotations, change the lead foot. In other words, if you stepped up with your right foot first, you switch to stepping up with your left foot first. I began with 60 seconds between sets of weight training and will cap it at two minutes. I still want to stress the muscles that are lifting as well.

Couple of important points. I always steady myself by lightly keeping my hands on a counter. You could always use handrails if you’re using a flight of stairs, but never use the top step; for safety’s sake always use the bottom step. You don’t want to fall down a flight of stairs.

You don’t need fancy equipment to get a good workout. All you need is just one step.

What are you prepared to do today?

        Dr. Chet

Observations and Questions About the Step Study

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Most research papers such as the step study I began to review on Thursday have a main point, sometimes a couple points, and that’s all we take from it. But there some interesting things that may not get headlines but are still worth mentioning. Let’s take a look at some other results from the steps and mortality study.

Observations

Whatever you might believe about exercise was proven true by this study—not the positive outcomes such as the decrease in overall mortality, as well as CVD and cancer mortality, but questions that paint a picture of who exercises. For every category, from education to smoking to alcohol consumption, what we would expect was confirmed. But we also learned that people are high steppers who we would not expect to be.

For example, would we expect obese subjects to be in the fewer than 4,000 steps per day category or in the greater than 12,000 steps per day category? You would be right if you thought most were in the more sedentary category; 36.7% of those with a normal BMI were in the highest step category. But it doesn’t mean that there were no obese subjects in the greater than 12,000 steps per day category; in fact, 24.8% of those with BMI greater than 30 were in the highest step category.

Why? That’s what we really need to find out. What makes them different? Why are they doing what we don’t expect, or did they just do that well when they wore the accelerometer? If we want to change behavior, that’s what we need to find out.

This was an observational study, so it cannot prove cause and effect, but it gives us insight into the type of studies that will be able to determine cause and effect, such as randomized controlled trials. They can be better designed by building on this study.

Questions

Because we’re in a “Stay Home and Stay Safe” environment, there were some logical questions about stepping and coronavirus infections but I couldn’t find a single answer. When I searched for “fitness and coronavirus,” I found the term fitness meant fitness of the virus, not humans.

I used different search combinations and finally decided to try exercise and coronavirus. There were a number of papers that were written in the last couple of months about the safety of exercise during the pandemic as well as exercise to relieve stress for first responders, but those are still not exactly what I wanted. I wanted to see if steps or exercise would reduce the rate of catching coronavirus, any coronavirus.

I didn’t find that, but I discovered an interview with exercise immunologist Dr. Jeffrey Woods. Rather than summarize it for you, I’m giving you a link to this article for you to read. While it’s difficult to prove improved resistance to coronaviruses, Dr. Woods’s creative research has come close. As long as most of us have the time, I suggest that you read it.

The Bottom Line

Research studies such as the one I’ve reviewed this week tell us a lot about what we know and what we still need to find out. There are too many questions left on the table that never get answered related to diet, nutrition, and exercise. Do you really get all the nutrients you need if you eat a perfect diet? No one knows because no one has ever tested it. Let’s hope we get some answers related to diet, fitness, and supplementation as it relates to the prevention and possible treatment of the coronavirus when this challenge is all over, but I’ll go out on a limb and say you’ll never be worse off by being in better shape. Now that many of us have more time, let’s work on that.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2020;323(12):1151-1160. doi:10.1001/jama.2020.1382.
2. Journal of Sport and Health Science 9 (2020) 105-107.

Step It Out!

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By the looks of it, “Stay Home and Stay Safe” will extend through the beginning of May and perhaps longer. As we adapt to our new normal, here is a little incentive to make exercise a regular part of your life from now on.

Researchers analyzed data from the 2003–2005 National Health and Nutrition Education Survey (NHANES). During that version of this recurring study, they collected seven-day accelerometer data from over 4,850 adults 40 years and older representative of the population of the U.S. They tracked the group of subjects through 2015 to look at all-cause mortality and steps per day.

If you look at the graph, you can see that deaths per 1,000 decreased as the number of steps per day increased. The mortality rate was half the amount at 8,000 steps per day than at 4,000 steps per day. While it continued to decrease slightly, the optimal amount of steps seemed to be between 8,000 and 10,000 steps per day. One surprising outcome was that intensity didn’t seem to matter; just volume.

All-cause means just that: all causes. That’s a real motivating factor to work on stepping it out every day. But it raised a question: could steps per day reduce the risk of getting upper respiratory infections? I won’t make you wait until Saturday. The answer is that no research has answered that question yet. But there was a lot more to this study, and I’ll cover that on Saturday.

Reminder: this week you can save 19% on two items at drchet.com. Use the coupon code virus.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA. 2020;323(12):1151-1160. doi:10.1001/jama.2020.1382.