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“Lack
of activity destroys the good condition of every human being, while movement
and methodical physical exercise save it and preserve it.” (Plato, about 400BCE)
A more modern statement
was in Time magazine,
“…
the most effective, potent way that we can improve quality of life and duration
of life is exercise. The price is right too.” (Oaklander The New Science of Exercise, Time Health, Sept 12,
2016)
In an earlier article, I discussed nutrition and its
importance as the first key in slowing the aging process and preventing late
age-prevalent chronic illnesses. The second key is exercise, movement. We are a
sedentary population; from bed, to breakfast chair, to car, to desk, to car, to
chair for dinner, to sofa for TV and finally to sleep. This is completely
different from our recent forebears who were up and about nearly all day long.
There is good experimental evidence regarding the critical
role of exercise in maintaining good health. For example, when a group of mice
whose genetics caused them to age prematurely were divided into two groups, one
group that exercised three times per week and one group that was sedentary, the
results were striking. At the end of
five months the sedentary mice were shriveled, had less functional hearts, a
coarse and gray fur, thinned skin and hearing loss. The mice that exercised
were healthy, indeed as healthy as normal mice, and despite their genetic
predisposition to aging rapidly, they did not. This is another example that
genetics need not be destiny.
“Sitting is the new
smoking.” Sitting for long periods (over one hour) is a major risk factor for
various diseases, poor health overall and for an earlier death. Chronic sitting
increases death rates as much as smoking! Inactivity doubles the risk of
general poor health. Just standing up rapidly activates the body systems that
control blood sugar, cholesterol and triglycerides. Exercise improves the
cells’ ability to respond to insulin; sitting increases the propensity toward
insulin resistance (and later diabetes.) In essence the human body needs to
move in order for its cellular and metabolic processes to work normally.
Sitting has the opposite effect.
It is well known that exercise is valuable to heart health,
that it reduces blood pressure, strengthens and preserves muscle size and
strength, reduces blood sugar and body fat. It also preserves and amplifies
brain function and size. In short,
“If it were a drug, exercise would be considered a
miracle drug for health preservation.” (Austad, S, A Young
Field about Growing Older: Six Ways Research Is Changing How We Age, Huffington
Post, October 12, 2016)
Only a small proportion of Americans get the recommended
levels of exercise per week – 150 minutes of both aerobic exercise (30 minutes
five days per week) plus resistance exercises two or three times each week. What is also important is not to just schedule
some time each day – although that is clearly advisable – but all day long to get
up and move about at least every hour for five-ten minutes. Remember that
exercise improves all body functions, not just muscles. For example, it
benefits the structure and function of brain, skin, heart, lungs, even eyes –
every part of the body.
You already know that exercise has been well
documented to help prevent the most important age prevalent diseases such as
heart and lung disease, cancer, dementia and diabetes. This reduction in
prevalence is “dose dependent,” i.e., the more exercise (up to a point), the
less the disease rate. Too much exercise is not healthy but as a general rule,
most individuals will never get to the “too much” level.
At the other end, is there a lower limit below
which exercise is of no particular value? The answer is probably no but it is
clear that even short bouts of activity are valuable. That said, it is
certainly best to obtain the recommended intervals. Less is still valuable but
more is definitely much better.
“Physical
activity is one of the best modifiable factors for the prevention of
noncommunicable disease and mortality.” (Eijsvogels, T, J of the
Amer Med Assoc, 2015))
Here are the basics that everyone should
follow. Start with aerobic exercise for thirty minutes five or six days per
week. The aerobic exercise can be something as simple as walking at a
reasonably brisk pace for thirty minutes. If you have a fitness monitor, try to
achieve at least 10,000 steps per day. More would be even better. Don’t sit for long; stand up at least every
hour, more often if possible. Move about before sitting again. Perhaps you can
set up your desk so that you can work standing up.
There is an advantage of some
“extra push” every so often consistent with High Intensity Interval Training
(HIIT.) Assume you are using a stationary bike. Set it to a reasonable level
and exercise at a comfortable speed for two to five minutes to warm up. Then
push as hard as you can for 30 seconds. Then return to the slower rate for 90
seconds. Repeat for eight cycles. Initially you may not be able to do but a few
cycles, but with time, you can build up and increase the resistance level.
During the rapid exercise, your heart rate will increase and you will find
yourself breathing rapidly and deeply. At the end, you will feel tired and will
have sweated. Repeat this program twice each week.
These are very potent exercises that offer
great benefit in a short period. Among other things, HIIT leads to improved
muscle growth and strength and production of growth hormone and myokines that
are anti-inflammatory and which reduce insulin resistance and indeed increase
insulin sensitivity so that blood sugar (glucose) can be better utilized within
the cells.
Add in resistance
or weight bearing exercise two to three times per week. If you want to increase
your muscle mass and strength, it is best to push up to a weight that you can
only do for up to 12 - 15 repetitions. This
pushing to muscle exhaustion both with aerobic exercise as part of HIIT and in
resistance (weight) training recruits what are called the white fibers rather
than just the muscle red fibers. It is this stress on the white fibers that
leads to muscle strength and with it an increase in growth hormone. You want the growth hormone effect to persist
for a few hours so it is best to not eat a meal immediately after exercising.
More specifically you want to not eat sugars or other easily digestible
carbohydrates (such as in sports drinks) that once absorbed will lead to an
insulin spike. Insulin levels and growth hormone levels counter each other. So,
if insulin rises, growth hormone levels will rapidly decline negating the
effect you worked so hard to achieve with exercise.
Remember – this is information, not medical
advice. For that you need to talk with your personal doctor or nurse
practitioner. There may be some approaches mentioned here that the doctor will
discourage you from doing based on your health, so do that review now. Start
out slowly; there is no need to create sore muscles. Find a setting that feels
appropriate for your needs and personality. Although most people find exercise
stimulating and relaxing, it may not seem that way at first; there may be an
emotional barrier that needs to be overcome. A personal trainer might be very
valuable, especially at first. He or she can give you good advice, help you
devise a program that works for your needs and personality and can “keep you
accountable” – in a nonjudgmental manner. Remember, getting started now will
lead to benefits that compound over time just as a monetary investment for
retirement compounds greatly over the years. So start now.
It is worth repeating that sitting is
unhealthy. Getup. Move around. “Sitting is the new smoking;” don’t let it get
you.
Stephen C Schimpff, MD, MACP, is a quasi-retired internist, professor
of medicine and public policy, former CEO of the University of Maryland Medical
Center and author of Fixing the Primary Care Crisis and Longevity Decoded – The 7 Keys to Healthy Aging
