Category Archives: Exercise

Aerobic Versus Strength Training?

“Resistance training, similarly to aerobic training, improves metabolic features and insulin sensitivity and reduces abdominal fat in type 2 diabetic patients,” according to a recent report in Diabetes Care.

Italian researchers randomized 40 type 2 diabetics to follow either an aerobic or strength training program for four months.  The increase in peak oxygen consumption (VO2 peak) was greater in the aerobic group, whereas the strength training group gained more strength.  Hemoglobin A1c was similarly reduced in both groups, about 0.37%.  Body fat content was reduced in both groups, and insulin sensitivity and lean limb mass were similarly increased.  Pancreas beta-cell function didn’t change.

According to this one study, neither type of training seems superior overall.  If you’re just going to do one type of exercise program, choose your goal.  Do you want more strength, or more sustainable “windpower”?

The Pennington Biomedical Research Center found somewhat different results in their larger and more complex study published in 2010.  However, they were primarily testing for diabetes control (as judged by hemoglobin A1c improvement), rather the improvements in strength or aerobic power.  They found the combination of aerobic and strength training is needed to improve diabetic blood sugar levels.  Both types of exercise—when considered alone—did not improve diabetes control.

As for me, I do both strength and aerobic training.

By the way, I only read the abstract of the current research, not the full report.

Steve Parker, M.D.

PS: PWD = people or person with diabetes.  Do you like that term or would you prefer “diabetic”?

Reference:  Bacchi. Elizabeth, et al.  Metabolic Effects of Aerobic Training and Resistance Training in Type 2 Diabetic Subjects
A randomized controlled trial (the RAED2 study)
Diabetes Care.  Published online before print February 16, 2012, doi: 10.2337/dc11-1655

Baseline Measurements Before Starting a Fitness Program

Impressive jump!

Before beginning or modifying a fitness program, it’s important to take some baseline physical measurements. Re-measure periodically. That way you’ll know whether you’re making progress, holding steady, or regressing. Seeing improvement in the numbers also helps to maintain motivation.

Not taking measurements would be like starting a weight loss plan without a baseline and subsequent weights.

Around this time last year, I finished a home-based, 15-week, six-days-a-week fitness program called Core Performance, designed by Mark Verstegen. I was pleased with the results. The only problem is that it’s very time-consuming. Perhaps fitness just has to be that way.

I regret that I didn’t take any fitness measurements before and after starting Core Performance.

For much of the last year, I modified Core Performance to a thrice weekly, then twice weekly program, until a couple months ago when I pretty much abandoned it. I miss the benefits now, but just didn’t want to put in the time to achieve them. In other words, I lost my motivation.

Who needs this much flexibility?

Intellectually, I know that regular exercise is important. I’m starting to get motivated again. Not sure why. Perhaps because I’ve read that you can be fairly fit with as little as 30 minutes of exercise a week. I’m not convinced yet. I’ll be test-driving some of these time-efficient programs soon.

This new style of fitness is promoted by the likes of Dr. Doug McGuff, Chris Highcock, Skyler Tanner, Nasim Taleb, and Jonathan Bailor, among others.

What to Measure

  1. Weight
  2. Blood pressure
  3. Resting heart rate (first thing in the AM before getting out of bed)
  4. Waist circumference (upright and supine)
  5. Height
  6. Body mass index
  7. Mid-arm circumference, both arms, hanging relaxed at your sides
  8. Maximal calf circumference, both calves, while standing at ease
  9. Maximum number of consecutive pull-ups
  10. Maximum number of consecutive push-ups
  11. Maximum number of consecutive sit-ups
  12. Run/walk one mile as fast as you can
  13. Maximum vertical jump (stand by a tall wall then jump and reach up as high as you can with one arm, noting the highest point above ground your fingers can reach)
  14. Can you touch your toes? Stand up straight, locking knees in extension, then bend over at your waist and touch your toes with your fingertips. If you can touch toes, can you flatten your palms against the floor? If you can’t reach your toes, measure the distance from your fingertips to the floor.
  15. Optional blood work for special situations: fasting blood sugar, hemoglobin A1c, triglycerides, cholesterols (total, HDL, LDL, sub-fractions)

The particular aspects of fitness these measure are strength and endurance in major muscle groups, cardiovascular and pulmonary endurance, a little flexibility, and a hint of body composition.

You may appreciate an assistant to help you measure some of these.

Record your numbers. Re-test some or all of these periodically. If you’re in fairly poor condition at the outset, you’ll see some improved numbers after a couple or three weeks of a good exercise program. It takes months to build significant muscle mass; you’ll see improved strength and endurance before mass.

Am I missing anything?

Steve Parker, M.D.

Minimalist Exercise

Not Darrin Carlson

Darrin Carlson on March 23, 2012, shared his ideas on the minimal amount of exercise and equipment needed to achieve reasonable fitness benefits.

Public health authorities for years have recommended physical activity in the range of 150 minutes a week.  That ain’t gonna happen for most folks.  Darrin says “Two hours a week will work for most people….”

Jonathan BailorChris Highcock, and others suggest 30-60 minutes a week may be enough.  Even Darrin admits as much, for the super-dedicated.

-Steve

Review of Chris Highcock’s Hillfit

 

Chris Highcock over at Conditioning Research has just released a new ebook on strength training for hikers: Hillfit: Strength.  Hiking is one of my favorite hobbies.  I particularly like walking up hills and mountains.  If you’re ready to reap the benefits of resistance training, this jargon-free plan is an excellent starting point, and may be all you’ll ever need.  Even if you never go hiking.

Chris is a fitness columnist for “TGO (The Great Outdoors).”  He lives and hikes in Scotland.  Chris’s goal with the program is to increase your enjoyment of hiking by increasing your level of fitness. 

He clearly presents four basic home exercises requiring no special equipment; they’re bodyweight exercises.  You get it done in 15 minutes twice a week!  The key is to do one set of each exercise, slowly, to exhaustion.  What’s slow?  Ten seconds for both lift and lowering.  For instance, when you do the push-up, you push up over  the course of 10 seconds, then let your body down slowly over 10 seconds.  The exercises are for both upper and lower body.

I’m reading about similar exercise ideas from Skyler Tanner, Doug McGuff, Nassim Taleb, Jonathan Bailor, and Doug Robb.  Bailor, in his recent book, also recommends only four exercises.  Highcock’s look a little safer for rank beginners. 

The idea is to recruit three different types of muscle fiber during the muscle’s movement.  If you move explosively and finish too soon (get your mind out of the gutter!), you’re only using  one type of muscle fiber (fast twitch, I think).  You want to stimulate a strength and growth response in all three types of muscle fiber.  And explosive or rapid movements are more likely to cause injury, without any benefit. 

Once you get the basic program down, Chris takes you through some easy variations (called progressions) to make the exercises gradually harder, so you continue to improve your strength and fitness. 

Chris understands that many folks can’t do a single push-up.  He takes you through pre-push-up movements to get you prepared  to do actual push-ups.  This goes for all four exercises.  I bet even my little old lady patients could use this program.  (This is not blanket clearance for everybody to use this program; I don’t need the lawsuits.  Get clearance from your own doctor first.)

The exercises incorporate our five basic movements: push, pull, squat, bend/hinge, walk/gait.  The four exercises are: wall sit (squat), push-up, modified row, and hip extension.

My only criticism of the book is that Chris should have used young, attractive, bikini-clad models to illustrate the exercises.  (That’s right, my wife doesn’t read this blog.)  The existing photos are clear and helpful, however.

But seriously, the only suggestion I have for the next version of Hillfit would be to mention that it will take a couple or three weeks to see much, if any, improvement in strength once you start the program.  Same for when you increase the workload with the exercise progressions.  Perhaps this is in there, but I missed it.  You don’t want people quitting in frustration that they’re not seeing progress soon enough.

The author provides scientific references in support of his program, so he didn’t just make this stuff up.  Only one of the references involved mice!

Several “take home” points for me personally are: 1) stretching before or after exercise does nothing to prevent injury or soreness, and may hurt short-term athletic performance, 2) don’t hold your breath, 3) train to “momentary muscular failure.”  I’m not entirely sure what momentary muscular failure means.  It may not be Chris’s term, but it’s prominent in one of his best scientific references.  I use free weights and don’t think I can safely go 100% to momentary muscular failure.  Hitting momentary muscular failure, by the way, is more important than the amount of weight you’re moving.

Highly recommended.

Steve Parker, M.D.

PS: I’d like to see Hillfit available on Amazon’s Kindle and Barnes and Noble’s Nook.

PPS: When you go to the Hillfit website to order, you’ll find the price is £9.95 (that’s GBP, British pounds sterling).  I’ve never ordered anything priced in GBP.  In today’s U.S. dollars, that’s a little under $16.00.  You can pay via PayPal or a major credit card.  I assume the conversion from one currency to another is automatic and seamless.  I don’t know if there’s a extra fee by the payment processor for doing the conversion.

Disclosure:  Chris kindly sent me a free digital copy of his ebook.  I don’t know Chris.  I will receive no remuneration for this review, nor for book sales.

Is Your Strength Training Regimen Outdated?

Not Chris Highcock

I’m reading Hillfit: Stength, an ebook  by Chris Highcock of Conditioning Research.  One of the scientific review articles he cites in support of his recommendations is an eye-opener.

Evidence-Based Resistance Training Recommendations is available free online.  It’s published in Medicina Sportiva, which I’m not familiar with.  I’ll confess I’ve read little of the hard-core literature on the science of strength training.  It’s one of my more recent interests.

An excerpt:

We recommend that appreciably the same muscular strength and endurance adaptations can be attained by performing a single set of ~8-12 repetitions to momentary muscular failure, at a repetition duration that maintains muscular tension throughout the entire range of motion, for most major muscle groups once or twice each week. All resistance types (e.g. free-weights, resistance machines, bodyweight, etc.) show potential for increases in strength, with no significant difference between them, although resistance machines appear to pose a lower risk of injury.

The article has already got me questioning some of my notions, such as how often to work out, number of reps moving a weight, speed of moving a weight, and whether I should stick with free weights.  Why not see if your dogma is supported?  Worth a look.

Steve Parker, M.D.

Fisher, James, et al.  Evidence-based resistance training recommendations.  Medicina Sportiva, 15 (2011): 147-162.

Is the “Calories In/Calories” Theory Outdated?

Not watching The Biggest Loser

Dr. Barry Sears (Ph.D., I think) recently wrote about a lecture he attended by a dietitian affiliated with “The Biggest Loser” TV show.  She revealed the keys to weight-loss success, at least on that show.  Calorie restriction is a major feature, with the typical 300-pounder (136 kg) eating 1,750 calories a day. 

On my Advanced Mediterranean Diet, 300-pounders get 2,300 calories (men) or 1,900 calories (women). 

Although not stressed by Dr. Sears, my impression is that contestants exercise a huge amount. 

Go to the Sears  link above and you’ll learn that all contestants are paid to participate.  In researching my Conquer Diabetes and Prediabetes book, I learned that the actual Biggest Loser wins $250,000 (USD).  Also, “The Biggest Loser” is an international phenomenon with multiple countries hosting their own versions, with different pay-off amounts.  A former winner, Ali Vincent, lives in my part of the world and still has some celebrity status.

This TV show demonstrates that the calories in/calories out theory of body weight still applies, including the fact that massive exercise can help significantly with weight loss.  In real-world situations, exercise contributes only a small degree to loss of excess weight. 

The major take-home point of the show, for me, is that you can indeed make food and physical activity choices that determine your weight.

Most of us watch too much

I know losing 50 to 10o pounds of fat (25–45 kg) and keeping it off for a couple years is hard; most folks can’t do it.  Do you think you’d be more successful if I gave you $250,ooo for your success?

Steve Parker, M.D.

How Active Were Stone Age Humans?

The Paleolithic standard for daily physical activity was about 490 calories (2.1 MJ), according to estimates by S. Boyd Eaton and Stanley B. Eaton in a 2003 article.

The Eatons estimated late Stone Age activity levels based on recent hunter-gatherer societies and skeletal remains from 50,000 to 20,000 years ago.  In case you didn’t know, our bones reflect how much work we ask them to do.  Heavy physical work loads over time lead to thicker, stronger bones, even changing the cross-sectional shape of long bones from round to oval. 

From a diabetes viewpoint, the scientists expect that our prehistoric ancestors had excellent insulin sensitivity in view of their relatively larger muscle mass and high activity levels.  They would have been less prone to develop type 2 diabetes.

Habitual high levels of physical activity of our ancestors put them in the same class as today’s elite cross-training athletes.

The Eatons suggest that replication of the Paleolithic activity level would require we exercise about an hour a day, not the 30 minutes recommended by some public health authorities. 

Steve Parker, M.D.

Reference: Eaton, S. Boyd, and Eaton, Stanley B.  An evolutionary perspective on human physical activity: implications for healthComparative Biochemistry and Physiology: Part A Molecular and Integrative Physiology, 136 (2003): 153-159.