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Exercise

Early humans were in great physical shape. Like modern cross-training athletes, they alternated between brief spurts of intense physical effort and long periods of light activity and rest1. Men hunted for 1–4 days a week. They walked or jogged for miles to find prey. Once they found a suitable target, they sprinted and attacked in a burst of energy. Women gathered food, water, and wood for 2–3 days a week. They spent hours walking, digging, climbing, and lifting heavy loads. Often, they carried a baby or young child on their hip or back. Over millions of years, the human body adapted to this pattern of aerobic and resistance exercise.

Those who think they have no time for bodily exercise will sooner or later have to find time for illness.
-Edward Stanley

Recommendations
Most of us no longer hunt and gather our own food. We turn open a tap for water, and we drive to the grocery store for food. It’s a lot more convenient than Paleolithic times, but it means we have to find other ways to get our exercise. The U.S. Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine recommend you get at least 30 minutes of moderate-intensity physical activity on most or all days of the week2,3. Moderate-intensity activities increase your heart rate and make you sweat. Examples include brisk walking and dancing. In addition to aerobic exercise, you should do strength or resistance training for 2–4 days a week, and flexibility and stretching exercises for 4–7 days a week. The recommendations are summarized in the table below.

TYPE OF EXERCISE RECOMMENDATION DESCRIPTION
Aerobic 5–7 days per week At least 30 minutes of exercise that increases your heart rate
Strength 2–4 days per week 1–2 exercises per large muscle group with 8–12 repetitions
Stretching 4–7 days per week Hold each stretch for 30 seconds

Statistics
Everyone knows that exercise is good for you, and the daily recommendations are easy to follow. Nevertheless, only 46 percent of Americans get the minimum recommended amount of aerobic exercise4. About 16 percent exercise less than 10 minutes a week—that’s less than a walk around the block.
 
Why do people exercise so little? Part of the reason may be genetics. Swedish researchers studied the exercise habits of over 13,000 twins5. They found that genetic factors accounted for 50 percent of the difference in physical activity. Before you blame bad genes, keep in mind that the remaining 50 percent is under your control. So stop making excuses and get off the couch.

If it weren’t for the fact that the TV set and the refrigerator are so far apart, some of us wouldn’t get any exercise at all.
-Joey Adams

Environment
Changing your environment is one of the most effective ways to increase your exercise. In a Scottish study, researchers posted signs in a subway station that encouraged commuters to take the stairs rather than the escalator6. The percentage of women who took the stairs increased from 5 percent to 12 percent, and the percentage of men increased from 12 percent to 21 percent.

Researchers from the University of British Columbia studied the lifestyles of 10,000 residents of Atlanta, Georgia7. They found that people walked more, drove less, and were less obese if they lived in mixed-use neighborhoods with shops, offices, restaurants, and parks. You walk more if more things are within walking distance. How can you change your environment to exercise more?

Motivation
Every January, gyms and yoga studios are packed with people who made New Year’s resolutions. By February or March, most of the newcomers are gone, and class sizes are back to normal. To maintain your exercise program for the long-term, you need to make it a permanent part of your life. Researchers have found that people exercise 35 percent more when they turn exercise into a habit8. The table below lists the most effective ways to make it happen.

HABIT EXAMPLES
Set goals and monitor progress Keep an exercise diary where you write your goals, chart your progress, and identify barriers.
Social support
Tell friends and family about your goals; work out with a partner.
Self-reward and positive self-talk Post motivational signs at home and work.
Problem-solving Overcome barriers with creative solutions.
Relapse prevention Change your environment to encourage exercise.

Make it a Habit
  1. Post a big sign beside your bed encouraging you to exercise.
  2. Keep a pair of running shoes beside your bed.
  3. Every morning, wake up early and go for a 30-minute brisk walk.

Start Now
In a study from the University of Heidelberg, German researchers analyzed the lifetime exercise habits of a group of middle-aged people9. As expected, participants who exercised throughout their life had a 62 percent lower risk of heart disease, compared to people who did not exercise. But those who started exercising after the age of 40 were still able to lower their risk by 55 percent. In comparison, people who exercised in their 20s and 30s, but stopped after age 40, only had a 35 percent lower risk of heart disease. It’s best to exercise throughout your life. But it’s never too late to start.

Start Small
Even a small amount of exercise can make a big difference. In a study of over 39,000 women, researchers from Brigham and Women’s Hospital in Boston found that walking as little as 1 hour a week was associated with a 50 percent lower risk of heart disease, compared to no physical activity10.
 
Simply staying active around the house improves your health. In a 6-year study from the National Institute on Aging, elderly people who regularly performed activities such as washing dishes, vacuuming, gardening and climbing stairs were 50 percent less likely to die compared to the least active third of participants11.

Vigorous Exercise
Low-intensity exercise is good for your health. High-intensity exercise is even better. In a 12-year study of health professionals, researchers from the Harvard School of Public Health found that 30 minutes or more of brisk walking per day was associated with an 18 percent lower risk of heart disease12. There was a 23 percent lower risk with weight training for 30 minutes or more per week. The best results came from running an hour or more per week. This high-intensity exercise was associated with a 42 percent lower risk of heart disease. The researchers concluded that the ideal workout includes strength training and aerobic exercise.

The downside of vigorous exercise is higher risk of injury. In a study from the Sports Medicine Centre at the University of British Columbia, researchers followed recreational runners enrolled in a 13-week training program for a 10-kilometer race13. The runners were unaccustomed to long distances, and were using the training program to get ready for the big race. Over the course of the program, 30 percent of runners experienced an injury, with the knee being the most commonly injured site. In contrast, low-intensity exercises have much lower rates of injury: 0.9 percent for bicycling, 1.4 percent for walking, and 2.4 percent for lifting weights over the course of a month14.

Don’t be scared by the possibility of injuring yourself. You shouldn’t have any problems if you gradually increase your routine. When I first started yoga, I enthusiastically attempted a whole series of advanced postures in the same session, even though I was warned they weren’t for beginners. When I woke up the next day, my back was locked in place. I couldn’t bend at the waist. For a week, I had a hard time putting on my clothes or going to the bathroom. Now I always remind myself to take it slow when I start a new exercise.

Strength Training
Strength training prevents heart disease and osteoporosis12. It also improves your strength and muscle mass. A proper workout starts with larger muscle groups such as chest, back, and legs, before moving on to smaller groups such as core, shoulders, and arms15. The American Council on Exercise has descriptions and pictures of strength training exercises on their website: www.acefitness.org/getfit/freeexercise.aspx. You’ll notice the biggest improvement in the first 4–8 weeks, with gradual improvements after that16.

Strength training isn’t just for young guys who want beach bodies. In a study from McMaster University, seniors improved their strength by 50 percent after 6 months of weight training17. They exercised twice a week for 1 hour per session. Their workouts included arms, legs, and chest exercises, with 30 repetitions at various resistances. At the end of the training program, researchers took biopsies of the seniors’ muscles. Genetic testing revealed that weight training reversed the effects of aging. The genetic profile of the muscles resembled those of people 40 years younger.

Hindu Pushups
You don’t need fancy equipment to do strength training. Hindu pushups are a great way to work out your back, shoulders, and arms. Start slow and work your way up. You’ll know you’re strong when you can do 50–100 repetitions.
 
Start a Hindu pushup with your feet wide apart, butt up, and head looking back at your heels.


Lower your hips and bend your arms. Your hips should almost touch the floor.


Finish with your head up and back arched. Keep your arms straight, and push back to the starting position.


Stretching
Stretching is an important part of your workout because it improves range of motion, and reduces risk of injury18. Stretching before exercise is recommended for sports such as soccer and football, which involve bouncing and jumping19. Stretching after exercise is better for sports such as jogging, cycling, and swimming, which do not require explosive power.

In a review of studies on hamstring stretches, British researchers found that the best approach was holding a stretch for 30 seconds20. There was no difference in flexibility from holding a stretch for 30 or 60 seconds, although both were better than holding for 15 seconds. Also, one stretch a day was just as effective as three stretches a day.

Neck and Back Stretches
I get a stiff neck and back when I sit too long at my computer. To loosen things up, I do the following three stretches:
 
(1) Stretch your arms up and back over your head. Bend back slowly from your waist. Hold for 30 seconds.

(2) Fold forward and grab behind your ankles. Hold for 30 seconds.
(3) Clasp your hands behind your head. Bend your head forward and keep your back straight. Hold for 30 seconds.

If you’re stretching properly, you should feel a slight pulling but no pain. As you hold the stretch, your muscles will relax a bit. Increase the stretch until you feel the slight pulling again. This is the position you should hold for 30 seconds.

Interval Training
High-intensity interval training (HIIT), also known as “sprint interval training,” takes less time than regular aerobic exercise and gives you better results. In a study from McMaster University, ordinary adults doubled their endurance with just 15 minutes of exercise spread out over 2 weeks21. That’s 15 minutes total, not per session. Before interval training, participants could only do 26 minutes of intense exercise. After training, they were able to do 51 minutes.

The interval training program consisted of six sessions spread out over 2 weeks. Each session consisted of 30 seconds of “all out” bicycle pedaling, followed by 4 minutes of rest to allow the heart rate to return to normal. This cycle was repeated 4–7 times per session. Exercise time, not including rest breaks, ranged from 2–3.5 minutes per session.

You can apply the principles of interval training to almost any exercise routine. Simply alternate a few seconds of high-intensity exercise with a few minutes of rest. Instead of spending hours on a treadmill or bike, you can get the same benefit in a fraction of the time.

Interval Workout

Beginner
  1. Warm up by walking slowly for 5 minutes.
  2. Speed up and walk briskly for 60 seconds.
  3. Slow down and stroll for 2 minutes.
  4. Repeat Steps #2–3 five times.
Advanced
  1. Warm up by jogging or cycling slowly for 5 minutes.
  2. Run or cycle for 30 seconds at 80–90% of your all-out effort (100% is the effort you’d make to save your life).
  3. Walk or pedal slowly for 2 minutes to allow your heart rate to recover.
  4. Repeat Steps #2–3 five times.

Nutrition
Your body needs food and fluids to recover after a hard workout. According to the American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada, there are four main guidelines for exercise nutrition22:
  1. Two hours before exercise, drink 400–600 mL (14–22 oz) of fluid to prevent dehydration.
  2. During exercise, drink 150–350 mL (6–12 oz) of fluid every 15–20 minutes.
  3. If you’re exercising for more than an hour, consider drinking fluids that are supplemented with sodium and carbohydrates.
  4. After exercise, eat a mixed meal of carbohydrates, protein, and fat to replace your energy stores, and improve muscle repair and recovery.
Researchers from Vanderbilt University found that volunteers who drank a mixed nutrient supplement (10 grams protein, 8 grams carbohydrate, 3 grams fat) immediately after exercise experienced three times the amount of protein synthesis in their muscles, compared to those who waited 3 hours before eating23. In other words, your muscles will get bigger faster if you eat properly after exercise.

Together with a healthy diet, an exercise routine of strength training, stretching, and interval training will help you feel great and live longer. What are you waiting for? Get started today.

References
  1. Cordain, Loren. (2002). The Paleo diet: lose weight and get healthy by eating the food you were designed to eat. John Wiley & Sons.
  2. Pate RR, et al. (1995). Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 273:402–7.
  3. Warburton DER, Nicol CW, and Bredin SSD. (2006). Prescribing exercise as preventive therapy. CMAJ. 174(7): 961–74.
  4. Centers for Disease Control and Prevention. (2005). Adult participation in recommended levels of physical activity–United States, 2001 and 2003. MMWR. 54(47):1208–1212.
  5. Carlsson S et al. (2006). Genetic effects on physical activity: results from the Swedish Twin Registry. Med Sci Sports Exer. 38(8):1396–1401.
  6. Blamey A, Mutrie N, and Aitchison T. (1995). Health promotion by encouraged use of stairs. BMJ. 311:289–290.
  7. Frank LD, Andresen MA, Schmid TL. (2004). Obesity relationships with community design, physical activity, and time spent in cars. Am J Prev Med. 27(2):87–96.
  8. Kahn EB, et al. (2002). The effectiveness of interventions to increase physical activity: a systematic review. Am J Prev Med. 22(4S):73–107.
  9. Rothenbacher D, Koenig W, Brenner H. (2006). Lifetime physical activity patterns and risk of coronary heart disease. Heart. 92:1319–1320.
  10. Lee IM, et al. (2001). Physical activity and coronary heart disease in women: is “no pain, no gain” passe? JAMA. 285:1447–1454.
  11. Manini TM et al. (2006). Daily activity energy expenditure and mortality among older adults. JAMA. 296:171–179.
  12. Tanasescu M et al. (2002). Exercise type and intensity in relation to coronary heart disease in men. JAMA. 288(16):1994–2000.
  13. Taunton JE, et al. (2003). A prospective study of running injuries: the Vancouver Sun Run “In Training” clinics. Br J Sports Med. 37:239–244.
  14. Powell KE, et al. (1998). Injury rates from walking, gardening, weightlifting, outdoor bicycling, and aerobics. Med Sci Sports Exer. 30(8):1246–1249.
  15. Braith RW, Stewart KJ. (2006). Resistance exercise training: its role in the prevention of cardiovascular disease. Circulation. 113:2642–2650.
  16. Kraemer WJ, Ratamess RA. (2004). Fundamentals of resistance training: Progression and exercise prescription. Med Sci Sports Exerc. 36(4):674–688.
  17. Melov S et al. (2007). Resistance exercise reverses aging in human skeletal muscle. PLoS ONE. 2(5):e465.
  18. Witvrouw E at al. (2004). Stretching and injury prevention. Sports Med. 34(7):443–449.
  19. Shrier I. (2004). Does stretching improve performance? Clin J Sport Med. 14:267–273.
  20. Decoster LC et al. (2005). The effects of hamstring stretching on range of motion: a systematic literature review. Journal of Orthopaedic and Sports Physical Therapy. 35(6):377–387.
  21. Burgomaster KA, et al. (2005). Six sessions of sprint interval training increases muscle oxidative potential and cycle endurance capacity in humans. J Appl Physiol. 98:1985–1990.
  22. American College Of Sports Medicine et al. (2000). Nutrition and athletic performance. Med Sci Sports Exerc. 32:2130–2145.
  23. Levenhagen DK, et al. (2001). Postexercise nutrient intake timing in humans is critical to recovery of leg glucose and protein homeostasis. Am J Physiol Endocrinol Metab. 280: E982–E993.

Copyright © 2009 by Paul Lem, M.D.
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