Tag Archive for: exercise

Push-Ups and CVD

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On Tuesday, I asked you to see how many push-ups you can do before you can’t do any more (if you’re fit enough with no real orthopedic issues). How did you do? I have torn biceps in both arms, but I managed to eke out 21. But you may be wondering why I asked you to do push-ups.

A study published in JAMA Online periodically tested a group of 1,500 firefighters between 21 and 66 in 2000 to 2007. They were given several tests including maximal exercise capacity, height, weight, blood pressure, blood glucose, and the number of push-ups they could do. They were tracked for 10 years.

Researchers divided the results into quintiles based on the number of push-ups. They found that as the number of push-ups increased, the rate of CVD decreased. While not all comparisons were statistically different, there was a definite pattern of benefit.

That wasn’t the only data that proved to be interesting in the study. I’ll finish it on Saturday, along with a challenge.

What are you prepared to do today?

        Dr. Chet

Reference: doi:10.1001/jamanetworkopen.2018.8341.

Once a Year, No Matter What!

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I was in the gym locker room recently when I heard a guy ask a question: “Can I use any locker or are they assigned?” I turned to see if he was talking to me, but another guy told him there were no assigned lockers and to use whatever is open. That’s when the locker seeker said, “I couldn’t remember because I’m here only once a year.”

I thought maybe he uses this gym only when he visits this area. Then I realized he meant he gets to the gym only once a year, probably making light of his infrequent visits. The problem is that seems to be what most Americans do: buy gym memberships and never use them.

That’s why a study just published this past week is important. Researchers examined a number of physical variables in a group of firefighters and tracked them for ten years; the goal was to look at factors related to cardiovascular disease. I’ll talk about that study this week.

In the meantime, if you’re fit enough with no real orthopedic issues, see how many push-ups you can do before you can’t do any more.

What are you prepared to do today?

        Dr. Chet

Fitness Trackers: Number One Fitness Trend

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The American College of Sports Medicine just released the list of top fitness trends for 2019. Top of the list is fitness trackers; second and third are group exercise and high intensity interval training. Fitness trackers taking the top spot surprised me because they’re not an exercise, they’re a tool to track exercise. But if they can help people keep exercising, I’m all for it.

What I think is really beneficial is the tracking itself. Some trackers are very sophisticated; they will include heart rate and even blood pressure. You can sync some with a scale or enter your body weight. Some track distance with GPS if you have an outdoor activity. Many will also track calories if you enter the food data. You can get readouts that are printable if you sync the device with your computer. That’s a great way to track patterns—if you take a look at the data. If you have one and use it, it’s a great tool to keep you on track.

When it comes to having energy when you need it, a fitness tracker can provide valuable information. I’ll cover how you can use any type of tracker to help you have energy exactly when you need it in this Sunday’s 9th Annual Super Bowl Webinar.

        Dr. Chet

Reference: ACSM’s Health & Fitness Journal: doi: 10.1249/FIT.0000000000000438

Will Bitter Orange Help You Burn More Fat?

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When it comes to weight loss and exercise, we’re always looking for an edge such as burning more fat at rest or during exercise. Bitter orange is an herb that contains p-synephrine, a reputed booster of fat metabolism while you’re at rest. A small study tested p-synephrine, caffeine, and both together to see the effects during exercise when compared with a placebo; the researchers wanted to find which was more effective in increasing fat metabolism during exercise.

The researchers used 13 young, healthy volunteers for the experiment. They tested each of the subjects on four separate days with three to five days between tests. In random order, subjects were tested taking a placebo, three mg/kg body weight caffeine, three mg/kg body weight p-synephrine, and three mg/kg body weight of a combination caffeine and p-synephrine.

They found that caffeine raised systolic BP by eight mm Hg and diastolic mm Hg at rest; statistically different but nothing extraordinary. During the exercise phase, subjects began at 40% of max capacity and increased effort by 10% every three minutes until they reached 90% of capacity Caffeine raised fat use during exercise more than p-synephrine or the combination of caffeine and p-synephrine. Overall energy use and carbohydrate metabolism did not change.

What does that mean for us? It could mean that a strong cup of coffee or an energy drink would help us burn more fat during exercise better than some exotic plant. Why waste money buying an herbal product with long-standing safety concerns?

What we don’t know is whether that effect would remain after the body adapted to the caffeine intake. Here’s what does work: training your body to use fat as a fuel at rest and during exercise. That’s what the Optimal Performance program is all about. Check it out.

What are you prepared to do today?

        Dr. Chet

Reference: MSSE 2018. 50(9):1899-1906.

Celebrate Your Independence

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Tomorrow we celebrate Independence Day in the U. S. with parades, picnics, and fireworks. We will eat our favorite grilled foods—burgers and dogs or smoked slow-cooked ribs and corn on the cob and on and on.

The problem is that while we celebrate our nation’s Independence, we are giving up our own independence. Based on a just-released report from the Centers for Disease Control, just 22.9% of all adults meet the exercise guidelines set 10 years ago (1).

It’s this simple: if you’re not working at moving, you’ll eventually lose your independence to move. You’ll need canes and walkers just to be able to prevent falls. You may graduate to a wheelchair and then the ultimate: the motorized cart. The more sedentary you are, the more independence you lose. Ever sink your behind into a chair you couldn’t get out of without help? Imagine if that’s your life all day, every day.

The guidelines aren’t that complicated. Two days a week, do some muscle-strengthening activities: lifting weights, calisthenics, yoga, whatever strengthens and stretches your muscles. Then either moderate-intensity aerobic exercise for at least 150 minutes per week or 75 minutes of vigorous-intensity aerobic exercise or some combination of the two. That’s it. Just about 30 minutes per day.

Yet less then 23% of all adults meet those guidelines. Some states are better than others. The best? Colorado at 32.5%. The worst? Mississippi at 13.5%. Just for comparison, I checked a similar map of the diagnosed type 2 diabetes rate of the U.S. If you super-imposed the type 2 diabetes diagnosis rate over the exercise levels, they would be close to identical. The lower the rate of exercise, the higher the rate of diabetes. Diabetic neuropathy, diabetic retinopathy, and a whole host of other health issues wait for those who stay sedentary.

The Bottom Line

Over this holiday and the succeeding weekend, try doing some type of aerobic activity every day for 30 minutes. Continuous or broken up into two 15s or even three 10s. If you can, try to do some stretching for 10 minutes one of those days. Find out for yourself that it’s not that big a deal. Then make it a habit to meet those guidelines. Years from now, you can celebrate your independence from canes and walkers, and so on.

Today, I record the 700th edition of my Grand Rapids radio show Straight Talk on Health. See the Health Info page for info on how to listen online; if you’re a Member or Insider, this new edition will be posted after it plays this weekend.

Happy Fourth of July, a belated Happy Canada Day, and a simple thank you to all my readers all around the world—I continue to be amazed at how many countries this Memo reaches. I’ll be back with new Memos next Tuesday. Until then:

What are you prepared to do today?

Dr. Chet

 

References:
1. https://www.cdc.gov/nchs/data/nhsr/nhsr112.pdf
2. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf.

 

Triathlon Observations: Prepare to Compete

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Let me be clear: I think that the single most important thing that you can do to be healthy is to exercise regularly. Whether walking, swimming, or one of the hundreds of other types of exercise, talking with your physician about it may be all that’s required for you to get started.

Moving from exercise that helps your health to competing in fitness events requires more—that’s independent of your body weight lest you think I’m talking only about the very heavy people that competed in the triathlon. Here’s what I recommend.

First, you should have a stress test that assesses how your heart and blood vessels perform under maximal conditions. That applies to men over 40 and women over 50, for sure. But I also think if you have been overweight for over five years, you should have the test regardless of age. The maximal exercise test is not foolproof, but it’s the best available predictor of heart problems. This isn’t just me being a worrier; I’m sad to report that one participant died of a heart attack last Sunday. Getting checked out before you start is the best way to protect yourself.

Second, you should have a complete lipid profile, HbA1c, and a blood insulin test as a minimum. As I suggested in Thursday’s memo, you need to know whether you’re a prediabetic or even an undiagnosed type 2 diabetic. The best option for you would be to exercise, but when you push yourself hard for long periods of time, it’s going to affect your blood sugar levels as it would affect a diabetic’s, not someone who has a normal carbohydrate metabolism; for instance, you could pass out if your blood sugar gets too low, and if you’re out alone on a run, that’s a problem. You can deal with it, but you have to know if it’s an issue.

Third, you should get an orthopedic analysis. By that I mean that your joints should be evaluated for range of motion, tendon and ligament stability, and gait. Swimming affects the shoulders, bicycling the lower back, and running the hips, knees, and feet. Any abnormality will be exacerbated; for example, the forces you create when you run is five times your body weight. Do the math—that’s a lot of stress on your knees and feet.

Once you get the all clear, get after it. Start conservatively but if you have the urge to compete to see what you’re capable of, do it. I think if you want a challenge, whether to walk or run a 5K, swim a mile, or bike 50 miles, or combine them into a single event such as the triathlon, you should do it. Just make sure you get your body checked out before you do.

Final Observation

While I believe exercise is important no matter the level at which you do it, exercise won’t help you lose a lot of weight. Surprised? Remember the size of the people I mentioned that competed in the triathlon—not just overweight but obese? If they had put in the training, and I know some of the competitors and know that they did, you’d have thought they would have lost a significant amount of weight. They didn’t.

Burning calories helps with weight loss, but as a well-known expert once said “Americans can’t out run their appetites.” If you could exercise six or eight hours a day, you could probably lose weight without changing your diet, but I doubt you have that kind of time. You can use exercise as a tool to help you lose weight, and exercise pays major benefits in fitness, strength, and stamina. But you will not lose weight unless you also eat less and eat better.

What are you prepared to do today?

Dr. Chet

 

Triathlon Observations: Heavy and Healthy?

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The major observation I had as I volunteered at the Grand Rapids Triathlon was that the body weight distribution of the people participating in the triathlon mimicked the population of the U.S. We’re a fat nation; 70% of the population is overweight and half of those are obese. Those percentages also seemed to apply to the participants in the race.

In addition to being a regular Grand Rapids event, the Grand Rapids Triathlon was also the National Championship for the Clydesdale and Athena athletes. In order to qualify for the Clydesdale division, men must weigh over 220 pounds; for women to qualify for the Athena division, they must weigh over 165 pounds. Based on my observations, a majority of the participants would have qualified for that category, whether that was their intention or not.

There were men well over 300 pounds and women over 250 pounds that participated in the triathlon. Talking with several other volunteers, I said that unless they had a signed release from their physician, I would hesitate to let them participate. They countered that as long as people put in their time training, they were fit enough to compete. Good point, but that logic doesn’t really hold up. The primary concern everyone thinks of is cardiovascular disease and that makes sense. But if someone is overweight, the real concern is undiagnosed type 2 diabetes and orthopedic stress.

While I applaud their effort and would never want to prevent anyone from exercising, I would hope that they would have had a thorough medical exam before they took their first step. We can’t assume because they had trained for the race they were actually healthy enough to compete in the race. I’ll cover what those tests should be and a surprise conclusion that you don’t want to miss on Saturday.

What are you prepared to do today?

Dr. Chet

 

Life Expectancy Is More Than Living Longer

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What’s more important to you: living longer or living better with the years you have? Think about it as you read this Memo and I’ll come back to that later.

The Upside of the Study

There were three important lifestyle variables that clearly stood out (1). The more exercise you get, the better off you are. Of those who got perfect 5s, they averaged over an hour per day of exercise. Second, the lower the BMI, the better; researchers didn’t track who might have lost weight over the years to get in the lowest BMI category, but it’s clear that carrying fewer pounds helps.

Finally, the Alternate Healthy Eating Index (AHEI) is a score of the quality of the diet, not the quantity. The highest quintile was below 60 out of 100 possible points. That means you don’t have to eat perfectly; just eat your vegetables and fruit and fewer refined carbohydrates and sugars, and you’ll see benefits.

The Downside of the Study

The subjects were overwhelmingly white and they were nurses and doctors for the most part. Whether that translates to other races and professions, we just don’t know.

The biggest issue for me is the Food Frequency Questionnaire used in the original studies as well as the AHEI scores. Trying to remember what you’ve eaten in so many categories over a year never made sense to me; there’s just too much potential for error. There were also differences in AHEI scores between the Nurses Study (all women) and the Health Professionals Follow-Up Study (all men). The men had an AHEI of 59 while the women in the nurses study had an AHEI of 37.5 in the groups assigned a 5. That makes no sense to me. I know the FFQ were slightly different, but the way the data are extracted to arrive at the AHEI score should have accounted for that. Are men so much better with the quality of their diet? Not buying it.

Supplements

Here’s something I found interesting. The use of a baby aspirin went up as the overall scores went up. In contrast, multivitamin use went up as the overall scores went down. To me, that means that healthcare professionals in all professions know that taking a baby aspirin is good for you. It also means that the poorer the diet, the more people try to compensate with supplements. The goal should be to complement a good diet with a multi, not try to make up for a poor one.

Amount of Time Living with Disease

I asked you a question at the beginning of this memo: what’s more important to you: living longer or living better? Right now, the average number of years spent living with some form of disease is almost 12 years (2). Not every condition is as debilitating as others, but would you rather live longer no matter what your health is or would you rather live well right up to the day you check out? Only you can answer that one. The study didn’t examine quality of life so we don’t know how the subjects did.

Here’s my guess: I would wager that the more healthy lifestyle variables you can add to your life, the longer and better you will live. Eat less. Eat better. Move more. It all starts with those six words.

What are you prepared to do today?

Dr. Chet

 

References:
1. https://doi.org/10.1161/CIRCULATIONAHA.117.032047.
2. https://ourworldindata.org/life-expectancy.

 

It’s All in the Dash

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In this Memo, we’re going to pretend the survey’s treatment options for high blood pressure are real. The choices were a pill, a cup of tea, exercise, and an injection once a month. If they were real, which one might be the best option for you? To me, it all comes down to The Dash.

You’ve probably heard about The Dash before. It’s a story about a person’s life such as yours. On your gravestone, there’s a dash between the day you were born and the day you died; your life is in the dash. How does this relate to the treatments offered in the survey, even though hypothetical?

What treatment option will give you the best potential quality of life? Not just adding a month, year, or even five years; what will those years be like? Will you just be alive or will you be really living?

It’s a no-brainer. Whether real or imaginary, the treatment that offers you the best chance to really live during those five years is exercise. A cup of tea may provide some good phytonutrients. A pill or an injection may affect an organ or a system to keep your blood pressure under control. But regular exercise will actually treat the systems involved in hypertension: the heart, blood vessels, muscles, nerves, and even hormone levels. Exercise is not a salve to make you feel better. It’s going to have profound effects and give you the best chance at a good quality of life during those extra five years.

I know the study was just a pilot survey and no treatment can guarantee you that you’ll live longer. But what I said about exercise is real. It gives you the best chance at having a better quality of life, not just during a potential extra five years, but all the years before then as well. What do you want your dash to be like? It just depends on the answer to one real question:

What are you prepared to do today?

Dr. Chet

 

Reference: AHA http://bit.ly/2uXd6qH

 

Can We Prevent Sarcopenia?

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Based on the research presented in Thursday’s Memo, the earlier we address the possibility that sarcopenia will affect us, the more likely we’ll succeed (1). I use fudgy words such as “likely” because we don’t know for sure, but based on the current status of research, here’s what we can do to prevent sarcopenia.

Use It or Lose It

In the study I talked about Thursday, the men who exercised regularly had a lower rate of decline in muscle function. The researchers speculate that chronic exercise helps preserve the motor units, thus preserving the ability of the nerve cells to send out nerve fibers to attach to muscle fibers.

That’s all well and good, but how can we make sure that we preserve the potential and perhaps increase our motor unit activity if we’ve lost some? Research shows that weight training will help. In several studies, resistance training increased muscle strength in the elderly; strength will improve balance and quality of life.

What kind of exercise will work best? It seems to be high intensity exercise. In a study on elderly mice, high intensity interval training (HIIT) increased the muscle mass, muscle fibers, and the number of mitochondria (2). This was a small study and it was on rodents, so the application to humans isn’t assured. To me, it means use your muscles as you mean to keep using them. The harder you exercise within your physical limitations, the better.

Focus on Protein

Retaining muscle mass is not only about exercise. For some reason, as we get older, we decrease our protein intake, but research shows that increasing protein intake can help retain muscle mass. If you don’t have protein in muscle cells, retaining or adding connections to those cells won’t matter much.

How much protein should people try to get? The current recommendation is 0.8 grams per kilogram body weight per day or a third of a gram per pound body weight; someone who weighs 200 pounds would need about 66 grams of protein per day. But research shows that bumping that up to 1.1 grams per kilogram body weight or a half gram per pound may be better as we get older. That’s 100 grams for a 200-pound person (3). That’s easy for even those who are math-challenged: whatever your goal weight, divide by 2, and that’s your daily goal for grams of protein.

It also seems better to stretch protein intake out throughout the day rather than a big slug at one time. Balanced intake will produce a sustained level of amino acids available for muscle repair throughout the day.

The research is far from complete in this area but it seems that as we age, our protein needs revert to when we were younger: we need more of it.

The Bottom Line

Sarcopenia can result in loss of strength and mass, but more important is the loss of quality of life. We don’t think balance while standing or moving is important until we fall; we don’t think brute strength is important until we need to move something and can’t. This week’s Memos give you an idea of how to prevent and perhaps improve nerve and muscle function.

Don’t think this is for only retirees; once you hit 40, it’s a downward trend. Starting early may help minimize the decline. One thing is clear: if you expect to be mobile when you get older, you need to work on it earlier rather than later.

What are you prepared to do today?

Dr. Chet

 

References:
1. J Physiol. 2018 Mar 11. doi: 10.1113/JP275520.
2. J Gerontol A Biol Sci Med Sci. 2018 Mar 14;73(4):429-437.
3. Nutrients 2018, 10, 360; doi:10.3390/nu10030360.