EXERCISE AS MEDICINE AND ENHANCED PERFORMANCE

Posted on June 25, 2018 by Dr. Cheng

EXERCISE AS MEDICINE AND ENHANCED PERFORMANCE

Dr. Chuck Wile is a supervising physician at Cheng Integrative Health Center/Doctor’s Weight Loss Center, Columbia, SC.  Dr. Wile served in the US Air Force Medical corp and is a retired Air Force Colonel.

“Eating alone will not keep a man well, he must also take exercise.” {Hippocrates, 400 B.C.)   

“Exercise is loathsome.” {Mark Twain}   

“The best exercise is the one you like because then you are likely to stick with it over time.” {Martin Bibals}        

“GET MOVING; KEEP MOVING; AND, DON’T STOP.” {Jordan D. Metzl, MD}

          Regular exercise is a key to health, wellness and longevity. In the early 1900s, Medicine shifted its focus from the prevention of disease to its treatment. Simultaneously and coincidentally, Americans fell in love with spectator sports. Physical activity was no longer the medicine for the masses, but it became the privilege of elite athletes. We forgot/ignored the benefits of exercising: Regular exercise will help you to sleep better. Exercising increases blood flow to the brain helping to create new brain cells and blood vessels because of the increased Brain-Derived Neurotropic Factor (BDNF). This repairs and protects the brain cells from degeneration, both by repairing and restoring cellular mechanisms. Exercising releases endorphins and other chemicals that dull pain and improve your mood, especially decreasing your anxiety and lightening your depression. This helps with building and maintaining your resiliency.

          Regular exercise enhances memory and quicker learning. Your work will be more productive. Also, you’re medical costs will be less. You’ll have decreased risks for developing chronic diseases: for example, type 2  Diabetes is both preventable and treatable, as well as CAD and CVD. Exercising helps to burn fat better for energy, causing fat cells to shrink. {Since muscle mass is heavier than fat, don’t be over-focused on your scales, because your weight may actually increase while your body fat decreases. The real question is do your clothes fit better?} You can help to prevent and treat dementias. The increased blood flow reduces toxins (beta-amyloid and alpha-synuclein) that cause aging and cell death, and reduces inflammation. You can protect your chromosomal telomeres and slow your cellular aging: exercise increases Nuclear Respiratory Factor 1 (NRF1) which protects telomeres from shortening. You can increase blood flow to your skin and help wounds to heal faster. By producing weight bearing muscle contractions, you can make your muscles grow, and, also, increase your bone density. You can decrease your risk for at least 13 different types of cancer, including breast, ovarian and colon cancers. Regular exercising can help with rehabilitation from strokes, and help to  improve other chronic physical diseases and emotional problems.

          You will experience few or no adverse side-effects. Your costs will be low or absent. Exercise is safer and more effective than any drug on the market for health. Although it is much easier to take a pill for what ails you, the risks and side-effects are much more problematic. Exercise benefits both young and old, women who are pregnant, and people who are well or ill. You don’t need a fancy health club, clothes or equipment. JUST MOVE. ***Some exercise is better than none, and even a little exercise can do you a lot of good.

          Humans are notoriously bad at assessing the long-term benefits and risks of their lifestyle choices. The promise that: “exercise is good for you” is not a strong enough motivator to make regular exercising a part of one’s daily lifestyle and choices. Here is a glimpse at the problem: only 20% of Americans get the recommended 150 min of strength and aerobic training per week. More than 50% of “Baby Boomers” take zero exercise per week. Over 80 million Americans (over 6 years old) are inactive. Many schools have eliminated Gym classes from their curriculums. Half of High Schools don’t have weekly PE classes. Only 15% of Elementary Schools require PE 3 days per week. The result is Exercise Deficit Disorder”. Long term consequences include: obesity;  increased osteoarthritis; increased low back pain; increased anxiety; increased depression; poor skin complexion; increased risks for heart disease, cancers, dementia, diabetes, and early death.

          Humans are motivated by immediate rewards. Although people are motivated for health and personal growth, knowledge alone is usually not sufficient to motivate change. And, the best motivation is not externally imposed, but, rather, elicited from within the person. The hardest part of any work-out regimen is getting started. Don’t be stopped by the most common excuses: “I’m too…busy, tired, lazy”. Know that exercise releases “feel good” endorphins, and there are ways to manage Delayed Onset Muscle Soreness (DOMs).

  1. ***Rather than focus on how good exercise is for your health, {which it really, really is, but it is a nebulous standard}, focus instead upon how exercise will give you an energy boost, improve your mood, enhance your productivity, and improve your sleep.
  2. PICK AN EXERCISE PROGRAM THAT YOU ENJOY. Forget the idea that exercise is supposed to hurt or feel like punishment, or else its not helping you– {“no pain, no gain”}, and, therefore, not worth doing. THIS ISN’T TRUE. If you enjoy something, then you will look forward to participating again, and, thus, you will most likely take the time to make the activity a part of your daily routine.
  3. Make exercising a social opportunity. A friend will offer you encouragement and will help to keep you accountable to yourself (possibly because you want to avoid their judgmental disappointment and disapproval). Exercise can be a time for high quality personal connections with your friend(s).
  4. Don’t back down from a little competition. A competitive atmosphere focuses on different qualities than a chummy  one does. With competition, the most active participants become the benchmarks to beat, and, thus, everyone’s activity level is increased. In a social group, people who drag their feet seem to draw the most attention, draw down the group energy, and give others an excuse for less participation.
  5. Make exercising non-negotiable. Be sure to make yourself prominent reminders, and, become aware of your self-sabotaging triggers. Your goal is to make regular exercising an automatic choice.
  6. Put money on the line. Studies show that people are motivated more by losses than by gains, and that they prefer getting rewards now rather than later. For example, if you are trying to lose weight, consider sending a donation, each day that you don’t meet your exercise goal, to an organization that you hate. AND, give yourself a non-food reward for accomplishing your goal.
  7. Use a Fitness Tracker. {In order to avoid unrealistic expectations, be aware of  the caveat: a tracker can’t force you to change your behavior, it is merely a source of information.} First, establish your exercise baseline for a week. Then start your exercise program and evaluate your data over time, looking for any improvements. Then, understand what you changed so that you can do it again and continue improving. Once you have a realistic assessment of your abilities, it will be easier for you to commit yourself to an individualized program and a long term behavioral change. Remember, “it’s the learning, not the digits.” {Ref. Martin Gibala: “The One Minute Workout.”}        

                                                 AEROBIC EXERCISING:

  1. Doing an aerobic exercise program for at least 30 minutes 3 times per week will maintain your body’s basal metabolic rate (BMR). Your weight will remain stable if there is a balance between caloric input and energy output. If you don’t have an aerobic program, and you restrict calories, your BMR will decrease to conserve energy during relative starvation. In order to lose weight and remain healthy, it is necessary to maintain a normal BMR, and then restrict caloric intake.  The WHO and US CDC recommend making your exercising goal be 150 minutes per week (divided however you choose) in order to effectively lose weight, achieve cardiovascular fitness, and enhance your overall health and sense of well-being. {This includes time for twice weekly muscle strengthening.} {NOTE:  For time-conscious people: ***High Intensity Interval Training can produce the same results in half the time.***} Think of your exercise as THE BEST MEDICINE you can give yourself. REMEMBER:  in order to prevent injuring yourself by over-doing it initially, because of your enthusiasm to see results quickly, when starting out: GO SLOWLY, and then steadily build up to your desired goal. And, more is NOT necessarily better. There is a “sweet zone”. Too much exercising can stress your joints and your heart-lung capacity.
  2. Look OUTWARD (rather than the usual advice to look inward) to support your motivations for exercise. Motivation is often thought of as a quantity of inward reserve, and people often lament its absence as a personality flaw. Instead, manipulate your environment to support your motivation. For example, purchase an audiobook that you’ll really enjoy and look forward to listening to, and make it available ONLY when working out. Your desire to engage with the plot will support your motivation to exercise.
  3. When choosing an aerobic exercise activity, have FUN! Pick something that you will enjoy doing so that you will incorporate it into your lifestyle changes. If you go power walking, walk with a partner that enjoys a good conversation. Or, vary your activities from working out at a gym, to swimming, to dancing in order to keep it fun. Or, create your own energetic music CDs so that you can crank up the volume for an exuberant work out. Try exercising mindfully: bring attention to your breath, your steps, your surroundings, and you will find that your pains will be alleviated.
  4. If you choose RUNNING more is NOT better, especially as we get older. A 2 to 3 mile run is all that is needed. Runners with the greatest longevity ran at a slow to moderate speed for 1 to 2 hours/week. Time is required for recuperation after a work-out. After age 45, people generally have their joints feel better after a brisk walk compared to a run. Women runners have a greater risk to injuring their bodies than men. Women have higher arches, and, when running, point their toes outward, and land with a heel strike which increases their skeletal impact. Also, they generally have less hip and core body strength, have an anatomical shift in their hips and their knee alignments, and have increased body fat. {In contrast, women have more joint flexibility than men, and they are better at pacing themselves in a race.}  Remember that stretching and warming-up your muscles is important to preventing injuries. Also, remember to stretch again after running. If you suffer from arthritis, it is much better to participate in non-impact aerobic activities such as swimming, working out on a glider or an elliptical trainer, or rowing.
  5.           However, a theory proposed by Dennis Bramble and Daniel Lieberman in a paper published in Nature in 2004 proposes that humans are born to run and to run far. The theory proposes that early humans evolved endurance adaptations for running to be able to chase prey animals “until the animals collapsed from exhaustion and heat stroke. Winning the footrace meant dinner. In addition to being furless, we have far more sweat glands than most other mammals, giving us an advantage over furrier animals that have to stop and pant to cool down. A larger gluteus maximus muscle—a big butt—is a distinctively human feature.We rely on it minimally for walking, but it’s crucial to stabilizing us when we run. Our legs have long tendons—that act like springs, helping generate force and reducing the energy cost of running. And they don’t seem to provide much benefit to walking, another piece of evidence that our bodies are made for running.” {Reported in Discover Magazine, July/August 2018, pp. 50-51.}
  6.           “There are 2 types of muscle fibers: Type 1 (slower contracting or slow-twitch fibers) and Type 2 (faster contracting or fast-twitch fibers). Everyone has a mix of both fibers in their muscles. Fast-twitch fibers are for short, powerful bursts; they contract quickly but also fatigue quickly. Slow-twitch fibers have more mitochondria (the cell’s powerhouses that use oxygen to make energy) so they don’t fatigue as easily and are ideal for longer activities. Sprinters have more fast-twitch fibers, while endurance athletes have more slow-twitch. Although partly genetic, there’s some evidence we can train in order to change the proportion of fibers our muscle have.” {Reported in Discover Magazine, July/August 2018, p. 50.}
  7. WALKING lowers your risks for diseases and probably will extend your life. Walking helps to keep you limber longer and helps to make you feel happier. In a study of 80,000 women, their risk of breast cancer was decreased by 42% by walking for a few hours per week. Other studies similarly demonstrate a decreased risk of kidney and prostate cancer mortality by walking. Walking has the lowest “quit rate” of any exercise. In a study of 400,000 Taiwanese who walked for 15 minutes daily, they lived 3 years longer than their sedentary peers. A 5-minute walk outdoors can elevate your mood and enhance your creativity, decrease your anxiety and depression, and increase your sense of well-being. SUGGESTIONS for success: pick-up your pace so that it becomes a power-walk rather than a stroll. {Maintain a pace that makes you a little breathless when walking and talking.} Count your steps: your goal is 7,000 to 10,000 steps/day, with 3,000 purposeful steps. Break-up your day into 50-step mini-walks every 45 minutes. Walk with a group for mutual support.
  8. ***High-Intensity Interval Training (HIIT) alternates periods of intense exercise with periods of less-intense exercise or recovery time. “If you want the benefits of very time-efficient exercise, then you need to push hard. There is no way around that.” {Martin Gibals} For example, consider riding a stationary bike for 10-minutes 3 days per week for a total of 30 minutes per week: after a 3-minute warm-up, pedal very hard and fast for a 20-second spurt of intense energy, then pedal less hard for a minute, then repeating this sequence two additional times, followed by 3 more minutes of slower pedaling.
  9.                                                       TOTAL FITNESS
  10.           1)   In addition to regular aerobic exercising, Total Fitness is achieved by enhancing your muscle strength, doing regular stretching, and, improving your balance and coordination.
  11.           2)  What counts as moderate-intensity exercise? Brisk walking, playing with your kids, dog walking, carrying heavy groceries, mowing the grass with a push mower, raking leaves, car washing, gardening, snow shoveling, etc. when done for at least 10-minutes at a time. ALL movement counts. Plus, to protect against injuries and to build muscle and bone, you need interval strength training. In addition to using free weights and resistance training, Tai Chi, Yoga and Pilates are excellent forms of strength training.
  12.             3)  In studies, dynamic resistance training is superior to static (isometric) resistance training for building muscles through the full range of motion of your joints. Pilates and working out with Nautilus equipment are two example of effective dynamic resistance training.
  13.             4)  RESISTANCE TRAINING increases your muscle mass, thus, generating more strength, and faster muscle force (power). Unless you over do it, you won’t become muscle bound. Resistance training also helps to make your bones more dense. Ten million Americans (80% are women) have osteoporosis (thin and breakable bones). {A decrease in sex hormones with aging helps to create this common problem.}  Resistance training also helps to improve your metabolism, increase your glucose tolerance (or, said another way, decrease your insulin resistance) and decrease your risks from type 2 diabetes. It also helps to decrease both coronary artery disease and cerebrovascular disease risks. Other than doing free weight lifting or using a dynamic weight resistance machine, such as a Nautilus device, there are various simple ways to do resistance training such as: Yoga, Tai Chi, Pilates, using flexible bands, sitting up and down using a chair and your own body weight, swimming, doing Zumba dancing, doing heavy gardening such as raking and digging, doing vigorous house cleaning, taking the stairs rather than using an elevator, jumping rope, etc. The stronger you are,  the more self-esteem, confidence, and positive thinking you will usually have.  However, because resistance training requires work and effort, only about 20% of people actually follow strength training recommendations. PLEASE DON’T BE LAZY.
  14.               Resistance exercises have a greater impact on cognitive function than aerobic exercises. It increases blood flow to the brain, thus, increasing oxygenation and the provision of nutrients. It helps to promote angiogenesis from existing blood vessels and neurogenesis from stem cells in the hippocampus {an area responsible for organizing memories}. It increases the production of neurotransmitters: serotonin {which helps to regulate mood and sleep}, acetylcholine {which helps with cognition, learning and memory}, and GABA {the main inhibitory modulator}. It also increases neurotropins {proteins that regulate neuron survival}.  [Mavros, et. al. “Mediation of cognitive function improvements by strength gains after resistance training in older adults with mild cognitive impairment: outcomes of the study of mental and resistance training,” J. of the American Geriatric Society, October 2016.]
      1.             5)  In my opinion, Hatha Yoga and Pilates are the best ways to completely stretch your muscles and joints, tone and strengthen your muscles, especially your “core” abdominal muscles, and achieve overall physical fitness, and mental, emotional and spiritual balance, inner harmony, and peacefulness.
      2.             6)  I applaud the American Academy of Sports Medicine’s program: “Exercise Is Medicine”. They recommend that physicians should inquire about exercise with each health visit. They recommend following the 5 A’s approach: Ask, Advise, Agree, Assist, and Arrange. People should be asked about what barriers they face in order to exercise and what helps to facilitate their choice to exercise. After assessing a person’s physical activity level, the practitioner is advised to prescribe physical activities that the person will agree to pursue. Physical activity counseling can be offered along with referral resources to help facilitate the process. Within a person’s social and economic context, it is important to support and empower the person, just like a good coach, by emphasizing that they have both choices and competence. Motivational interviewing is useful to explore and resolve ambivalences and insecurities and to understand and encourage/support internal motivators for behavioral changes. By understanding a person’s values and goals, a health care provider can help people to envision a better future. Depending upon a person’s personality, they may choose to “leap-into the deep end of the pool” and make massive changes in their lifestyle, which can be disruptive and stressful.  Or,  they may choose to ease into the “shallow end of the pool” and take baby-steps, focusing upon small and measurable goals and achievements. Either way, the exercise prescription must be “patient-centered” and individualized in order to be effective for the long term. Setting goals work best when they are realistic, specific and present oriented. Challenges to maintaining changes is the rule and not the exception. Thus, it is very helpful to maintain a continued coaching partnership in order to  encourage and support a person’s health goals.
  1.     SUPPLEMENTS TO CONSIDER FOR ENHANCED ATHLETIC PERFORMANCE
  1. Consuming an over-abundance of calories for a long time will suppress the AMPK (adenosine monophosphate-activated protein kinase) system—the metabolic master switch. AMPK activation: reduces insulin resistance and supports glucose transport, inhibits the metabolic syndrome’s associated inflammation, increases utilization of stored fat for energy, improves mitochondrial fat burning, reduces weight gain by enhancing the effect of the anti-obesity hormone: adiponectin, and improves immune function and other bodily functions that support longevity. A suppressed AMPK system leaves the body in a state of continued energy storage and reduced energy utilization. Cutting calories forces the body to activate AMPK. Exercise is another powerful AMPK activating strategy. (Note: Only when you are adding exercising will calorie reduction be truly effective for weight loss.) ***For people who have problems exercising because of physical problems, there are supplements to promote AMPK activation.*** Two documented ingredients include:  a) Gynostemma pentaphyllum and b) Trans-tiliroside. A proprietary product is available, called “AMPK Activator” from www.LifeExtension.com. Also,  Hesperidin, found in citrus peel extracts and in orange juice, activates AMPK, as does the medication Metformin. AMPK activation helps to remove excess stored fat, particularly metabolic abdominal fat, and to decrease metabolic syndrome risk factors. Increased AMPK activity also normalizes hyper-activated mTOR activity. {Excessive mTOR accelerates cell aging and malignant transformation, and depletes stem cells.}
  2. RE-FUEL YOUR MITOCHONDRIA:  “Mitochondrial Dysfunction” results in obesity, insulin resistance, diabetes, anxiety, depression, neuro-degenerative diseases, aging, chronic fatigue syndrome and fibromyalgia syndrome. {Consider: if the blood test Reverse T3 is high, then mitochondrial dysfunction is present.} The following NUTRIENTS can help to re-fuel the mitochondria energy generating centers in each cell:  a) D-Ribose 5 gm/tsp: 1-2 tsp three times per day. b) ALA (Alpha-Lipoic  or R-Lipoic Acid) 300 mg to 400 mg/day. c) CoQ 10 (or its activated form Ubiquinol) at least 200 mg/day. d) NADH (Nicotinamide Adenine Dinucleotide –reduced form) 10 mg twice per day. e) L-Carnitine 2,000 to 3,000 mg/day.
  3. Short term supplementation with powdered cherries boosts athletic performance. Using 480 mg of powdered cherries caused half-marathon runners to average 13% faster finish times compared to taking placebos. Inflammatory markers were 47% lower, and there were attenuated markers of muscle catabolism, a better maintained redox balance, increased performance, and post-run muscle pain faded faster. {J Int Soc Sports Nutr. 2016 May 26.}
  4.         Tart cherry juice is also helpful for osteoarthritis pain and other inflammatory conditions, particularly gout. It is easier to take when mixed in a fruit smoothie. For example, 100 patients with a history of gout received 1 Tbs of Brownswood Acres tart cherry juice concentrate [which can be obtained at Whole Foods] twice per day. 92% of the patients had >50% reduction in the number of gout attacks. Their uric acid levels did not change. Tart cherry constituents can switch critical genes off and on; modulate cell-signaling molecules like tumor necrosis factor; and, target multiple cardiovascular factors producing a 65% reduction in early mortality. Tart cherries surpass red wine and dark chocolate in antioxidant content. Tart cherries are rich in the flavonoid anthocyanin and contain novel anthocyanins absent from blueberries or bilberries. They also contain higher amounts of phenolics and anthocyanins than sweet cherries. It is useful for treating osteoarthritis, inflammation related to obesity and the metabolic syndrome, and lowering triglycerides associated with cardiovascular disease.
  5.           Rich sources of polyphenolic compounds, such as tart cherries, play a neuro-protective role and exert a variety of anti-carcinogenic effects. 20 women were given 2, 10.5 ounce bottles of tart cherry juice or a placebo for 3 weeks. Those taking the cherry juice had reduced levels of the inflammatory marker C-reactive protein. Obese adults given 8 ounces daily of tart cherry juice for 4 weeks had markedly decreased inflammatory markers: sedimentation rates, tumor necrosis factor levels, and monocyte chemotactic protein. Runners were given tart cherry juice or a control drink for 5 days before, on the day of, and for 2 days after a marathon race. Runners drinking the tart cherry juice had significantly lower inflammation biomarkers (Interleukin-6 and C-reactive protein) than the placebo group. They also recovered isometric strength quicker and demonstrated an accelerated recovery following strenuous exercise. Runners in a double-blind trial participating in a 24-hour relay race drank two 355 ml beverages containing either tart cherry juice or a placebo daily for 1 week prior to the race and during the race. Both groups reported muscle pain after the race but the runners who drank tart cherry juice experienced a substantially smaller pain increase after the race.
  6. Cordyceps sinensis extract is a parasitic fungus that grows on caterpillar larvae native to high altitude regions of China, Nepal and Tibet. It has pharmacologically active anti-oxidant, anti-inflammatory and lipid lowering properties. It enhances the immune system and increases stamina for endurance athletes through greater aerobic capacity and oxygen use. It stabilizes blood sugar metabolism and increases libido and sexual functionality.
  7. Velvet Deer Antler (VDA) is a pillar of Traditional Chinese Medicine used to strengthen and replenish blood, reduce and reverse signs of aging, relieve pain and inflammation, overcome exhaustion, accelerate wound healing, reduce blood pressure, treat insomnia, relieve headaches, improve mood and memory, help infertility, restore vitality, heighten libido and increase muscle strength and endurance. One key component is a growth hormone called insulin-like growth factor “IGF-1”. This keeps muscles strong and helps to heal cartilage and tendon injuries. Also, glycosaminoglycans are plentiful which help to restore healthy cartilage. It contains Type II collagen along with a rich supply of minerals including potassium, sodium, calcium, copper, zinc, iron, selenium, magnesium and phosphorus. A proprietary product called “VDA Pure” can be obtained from www.VDAPure.com . The recommended dose is 2 caps daily before eating.
  8. Asian ginseng (Panax ginseng) and Siberian ginseng (Eleutherococcus senticosus) “can be used as a tonic to combat feelings of lassitude and debility, lack of energy and ability to concentrate, and during convalescence,” according to the German Commission E advisory about herbs.  The suggested dose is 1 tsp steeped in a cup of boiling water to make a tea.  Ginseng can improve athletic performance when taken regularly for up to a month, and it can also beneficially stimulate the immune system.  It is an adaptogen for managing adrenal stress, and improves alertness, coordination and memory.
  9. Dimethylglycine (DMG): is an amino acid adaptogen made in the liver which diminishes in quantity as we age. It was formerly promoted by athletes as “vitamin B-15”. DMG aids in critical processes associated with cellular respiration and energy production, immune response, and oxygen utilization in the body. It helps to prevent fatigue, improve physical endurance and performance, and supports mental clarity. DMG stimulates both antibody response and cellular immunity. It has also been used to support cardiac function in heart disease. Additionally, it makes all other nutrients taken with it work better. High quality DMG can be obtained from www.TargetedNutrients.com . Typically usage is 1 cap once or twice daily.
  10. Beetroot juice can raise serum nitrate levels which can improve athletic performance, lower blood pressure and protect against glaucoma. Nitrate is metabolized to nitric oxide which helps to dilate smooth muscles, and improve blood vessel flexibility and tone. It enables athletes to use less oxygen while exercising at the same intensity, which makes exercising easier, and one can continue it for longer. Blood nitrate levels peak two to three hours after consuming beetroot, and remain elevated for six to nine hours. The key is to drink beetroot juice three hours before exercising, and take it daily to maintain higher blood levels of nitrate. One of the leading 2.4 ounce beetroot “sport shots”, called “Beet It”, provides 400 mg. Most blood pressure lowering studies have used 180 mg of beetroot juice daily. So, you could take half of “Beet It” one day and half the next. Serious athletes can use one or two shots daily. Two shots will saturate the blood stream and provide maximum benefits, so larger amounts will have no additional effects. Be aware, your urine may turn pink, but this is a harmless side effect.
  11. Resistance training is supported by key nutrients. And, when used together, they  provide synergistic benefits: a) Whey Protein: helps to preserve lean body mass. Although the Institute of Medicine recommends 0.8 grams/kg body weight (which equals about 58 gm in an aging adult weighing 160 lbs), the optimal dose is 1.0 to 1.3 gm/kg body weight (which equals 73 to 94 gm in an aging adult weighing 160 lbs). b) Creatine:  improves the Type 2 (fast contracting) muscle fibers that commonly atrophy in older adults. It helps to increase muscle force, power and mass and to decrease fatigue. c) Branched Chain Amino Acids (BCAAs):  especially leucine, isoleucine and valine (which are also found in whey protein), helps to promote muscle tissue synthesis. Also, they help to decrease the perception of exertion and mental fatigue during exercising. d) Glutamine:  helps to replenish muscle stores of glycogen (a ready source of stored energy). Also, in healthy adults, taking 2 gm of the amino acid glutamine will increase the output of human growth hormone by four times. e) Vitamin D3:  helps to preserve Type 2 muscle fibers and to protect cognitive function. f) Carnitine:  is an amino acid which helps to transport fatty acids into the intracellular mitochondria for fuel for the production of ATP energy. It supports exercise recovery, enhances performance, and decreases general fatigue. Propionyl-L-carnitine helps to regulate levels of ATP. g) D-Ribose:  helps to facilitate ATP production and to facilitate the speed of muscle function recovery after high-intensity exercising.  h) Omega-3 Fatty Acids:  eicosapentaenoic acid (EPA) helps to preserve muscle mass. And, both decosahexaenoic acid (DHA) and EPA are anti-inflammatory, and help to manage sarcopenia. 6 gm of deep sea fish oil can help to eliminate muscle soreness after resistance training.

                   DELAYED ONSET MUSCLE SORENESS (DOMS)

          Immediate muscle soreness is due to the partial metabolism of glucose (for energy) into lactic acid, which accumulates waiting for increased oxygenation after an exertion has finished, in order to be fully metabolize into carbon dioxide and water: the “oxygen debt”. The results of the incomplete oxidation of glucose  into lactate resolves within a few hours after exercise. DOMS occurs a day or two later as a consequence of repairing the micro-tears in the muscles caused by the exercise. The soreness, stiffness, mild swelling, tenderness, decreased strength and decreased range-of-motion will resolve in a few days. And, with your next exercise, you will be stronger and DOMS will be milder. Since it takes time for healing, it is important to space-out your resistance training during the week.

          You CAN have gain without (a lot of) pain. Drinking 2 cups of tart cherry juice can reduce both exercise-induced  inflammation and DOMS. {Be aware of  consuming the extra calories.} NOTE: A pre-emptive use of NSAIDs the day before and the day of a long distance race did NOT reduce DOMS (compared to non-users), and the users had mild endotoxemia due to the consequent drug-induced leaky-gut. Using NSAIDs intermittently for pain management after exercising may be helpful, if needed. BOTH localized Cold Therapy and Heat Therapy can reduce joint and muscle soreness, but cold is superior. However, tub hopping from hot water to cold water and repeating, probably isn’t worth the effort. Therapeutic Massage can help with DOMS. {Most studies look at massage within 3 hours after exercising for at least 20 minutes.} A foam roller is a low-cost alternative for self-massaging.

                  PRECISION EXERCISE RECOMMENDATIONS

  1. For Weight Management:  Initially, focus on adjusting your diet to decrease your total calorie intake.  Adjusting one significant lifestyle change at a time is a successful strategy to increase your own compliance and persistence. {For example, a decreased input of 500 cal/day equals 3,500 cal/week, which equals 1 pound of body fat reduced per week. Compare this to vigorous walking for 2 hours which equals using 500 cal.} In a 12-week comparison study, people who attended Weight Watchers lost about 9 lbs, versus people who simply worked-out at a Gym, who lost about 3 lbs. So, initially establish a structured eating-plan that you will adhere to, that includes reducing your portion size and the amount of food that you actually consume. And, for exercise, at first, simply determine to move more.
  2.           Once you have experienced successful weight loss, then combine your dieting with exercise. {It becomes easier once you have lost some weight and feel better rather than when you feel heavy and lack energy.} Pair cardio training with resistance training. Cardio activities burns calories and resistance training keeps you toned so that you lose fat rather than muscle. People who regularly work-out are twice as likely to keep the weight off than those who don’t. Exercise stimulates hormones which signal burning more fat as fuel. Emphasize to yourself how much better you feel when you are active. This may help to cancel-out any feelings of deprivation which could result in self-sabotaging behaviors. Remember that exercising is NOT a free-license to binge eating.
  3. To improve your Stress level, Self-Esteem and Mood:  In a 1999 study at Duke University, people who did aerobic exercise for 45-minutes 3x/week improved their moods equivalent to matched sedentary people using the SSRI Zoloft. Exercise increased their serotonin levels and their endorphin levels, and decreased their cortisol levels. The effect on mood only lasted for about 24 hours, so, regular exercise is the key to success. Mix-up your activities for fun and fitness: vary the kinds of exercise, frequency, timing and intensity. Remember that you need both cardio and strength training.
  4. To increase your Energy and decrease your Fatigue:  try a low to moderate intensity exertion for 20 minutes, 3 to 4 times per week. You will feel better within 4 weeks for all conditions. The intracellular size and number of your mitochondria {energy centers} will increase. You will increase burning your fat for energy, decrease your insulin resistance with a consequent good decrease in your glycation process, and balance both your intracellular and extracellular salts and fluids. You will sleep better: fall asleep quicker, remain asleep longer, and awaken more refreshed. Exercise energizes you. Don’t give-in to feeling drained of energy. Fake yourself-out: instead of saying that you feel “too tired”, say that you will walk for just 10-minutes—you’ll likely go longer because you will start to feel better.
  5. To ease chronic health problems and limit medical visits:  monitor yourself with a fitness tracking device such as FitBit or a Garmin watch. All movement counts. An encouraging 2013 study compared people doing short activity bursts, such as raking leaves or pacing when talking on the phone, with 150 min/week of aerobic bike riding. The groups had similar BP, lipid levels, waist circumference, and C-reactive protein inflammatory markers. When starting out: be sure to see a Pro and Go Slow. Increased endorphins will ease your pains. Try to minimize IMPACT aerobic activities: your joints will feel happier because they will be better lubricated and respond to inflammation more effectively, thus, easing your arthritis. Your heart rate and blood pressure will decrease, and your glucose intolerance will improve. Anticipate a slow and steady improvement.

                             EXERCISE AND CARDIOVASCULAR DISEASE

          An observational study published in Circulation, 5/15/2018, of 11,000 adults in the Atherosclerosis Risk in Communities (ARIC) study, demonstrated people doing 150 minutes of vigorous exercise weekly were 31% less likely to develop congestive heart failure (CHF). Couch potatoes who started exercising decreased their risk of CHF by 23%. This study supports the JAMA July 22/29, 2009 study of 20,000 male physicians who had a healthy lifestyle for more than 20 years who developed significantly less CHF. A similar study of 36,000 Swedish women published in the Archives of Internal Medicine, 5/11/2009 who were eating a DASH diet (to manage hypertension) along with doing regular exercise for 7 years had a 37% decrease in CHF.

                     THE PROBLEM OF SARCOPENIC OBESITY IN AGING

          After age 50 there is an exponential drop in muscle function. (This starts to occur after age 40 and accelerates after age 75.) Sarcopenia means a loss of muscle mass, strength and function. There is a faster decline in Type 2 (fast contracting) muscle fibers compared to Type 1 (slower contracting) muscle fibers. Therefore, there is a decreased speed of muscle contractions with aging. Evaluating muscle function and strength is more important than evaluating muscle mass. Muscle “power” is a function of force-strength and velocity. {Imagine the difference between just placing a fist against the side of a head (force) and then adding velocity to the fist placement (power)}. Power drops quicker than muscle mass. With decreased muscle power, especially in the core and lower extremities, there is decreased capacity to accomplish the functional tasks of daily living and an increased risk of falls and injuries, with an increased risk of consequent death. Because women start out with less power then men, older women have increased problems with a loss of balance and decreased muscle power which increases their risk of falls and hip and vertebral fractures (especially with their additional increased risk for osteoporosis.) This is primarily caused by suboptimal sex hormonal support, inadequate dietary protein intake and nutritional deficiencies, oxidative stress and inflammation. This is most often found in people who are physically sedentary and inactive.

          Obesity has become a significant increasing problem in America. In a study of nursing homes, in 1992 about 15% of patients (mostly women) had a BMI (Body Mass Index: weight divided by stature) of >30 (defining obesity). By 2002 the average BMI had increased to >25%. A fall risk for over-weight people was 15% compared to a fall risk for obese people of 25%. The combination of obesity plus sarcopenia (decreased muscle power) makes the loss of independence 2 to 3 times more likely because of diminished capacity for activities of daily living (ADL).

          Our aging population needs a combination of power training (eg. high velocity dynamic muscle resistance training using lower weights at higher speeds) twice per week along with aerobic interval training three times per week in order to improve their functional outcomes. While aerobic training helps the cardiovascular and cerebrovascular systems, resistance training provides superior protection against injuries. It stimulates human growth hormone which supports cell growth and regeneration. It also supports local mechano-growth factors. And, it enhances bio-identical hormone replacement therapy (BHRT) interventions.

           A report in the magazine The Week, 6/15/2018, (from reviewing an article on  MedicalNewsToday.com,) states that moving the large muscles of the legs (walking, climbing stairs, running) triggers brain stem cells to renew brain neurons. Researchers immobilized the hind legs of mice for 28 days then they examined the subventricular zone in their brains. They found a 70% decrease in neural stem cell activity. This helps to explain why people who are bedridden often deteriorate rapidly in their cognitive functions.

                                        JUST DO IT!   {Nike Shoes Slogan}

A good reference is “The Science Of Exercise” edited by Siobhan O’Connor and Mandy Oaklander, TIME Inc. Books, 2018.

This entry was posted in Misc. Bookmark the permalink.

Comments are closed.