Exercises for Older Adults

OCT 21

Muscle Cramps: Prevention and Treatment

  

Muscle cramps occur most often at night when you are sleeping, but they also can occur when you exercise vigorously, tear a muscle, or keep one leg in an awkward position, such as sitting in a chair in the same position for a long time. Muscle cramps are classified into those that occur during exercise and those that can occur at any time not related to exercise, usually at night.

Cramps are more likely to occur in hot weather because muscles fatigue earlier with higher temperatures. Cramps are more likely to occur during intense exercise that requires you to use your fast twitch strength fibers that fatigue earlier than your slow twitch endurance fibers.

Night-Time Leg Cramps
Up to 60 percent of North American adults suffer from occasional night-time leg cramps, a sudden painful contraction usually of the calf muscles that can last from a few seconds up to 10 or more minutes. Doctors do not know what causes these cramps, but most of the time, they are not caused by dehydration or lack of minerals. The leading theory is that most night-time leg cramps are caused by lack of a normal nerve reflex that causes a muscle fiber to relax when it is held in contraction (J Sports Sci, 1997 Jun;15(3):277-85). That is why people who suffer recurrent leg cramps should be checked for:
• all conditions that can cause nerve damage, including lack of vitamin B12 and diabetes
• all conditions that can cause blood vessel damage such as arteriosclerosis
• partially obstructed blood vessels
• pinched nerves in the back
• muscle damage
• abnormal mineral levels
• abnormal hormone levels such as low thyroid
• kidney disease
• arthritis
• dehydration
• use of several medications such as statins, birth control pills, diuretics, steroids, asthma medication such as albuterol, raloxifene, naproxen, or teriparatide (BMJ Clin Evid, 2015:1113).
If you have recurrent night-time leg cramps, check with your doctor.

What Causes Leg Cramps?
When you turn during sleep, you contract your calf muscles which stretches their tendons. This stimulates nerve stretch receptors in the tendon and sends a message back to the spinal cord, telling the calf muscles to contract. After you contract a muscle, reflex messages are sent along nerves to the spinal cord to relax that muscle. If the message to relax that muscle is blocked, the muscle stays contracted and you develop a cramp. Cramping during sleep is usually due to an exaggeration of the normal muscle reflex that causes the muscle to stay contracted and hurt. Older people and those who do not exercise are at increased risk for leg cramps because they have smaller and weaker muscles.

Preventing Night-Time Leg Cramps
If you do not have a serious cause, you can often prevent night cramps by:
• exhausting the stretch reflex before you go to bed by stretching your calf muscles (using wall pushups or a similar exercise)
• applying a heating pad for 10 minutes before you go to sleep
• starting a regular supervised exercise program to strengthen your calf muscles. If you are a non-exerciser, I recommend a stationary bicycle.

The only drug that has been shown to be effective in preventing night-time leg cramps is quinine (Brit Med J, Jan 7, 1995;310(6971):13-17), but the U.S. Food and Drug Administration stopped over-the-counter marketing of this remedy because of concerns about irregular heartbeats. Doctors can still prescribe quinine pills for relief of leg cramps, but since they can cause birth defects and miscarriages, they should never be taken by a pregnant woman. Quinine can also cause ringing in the ears, headache, nausea, disturbed vision, chest pain, asthma and other problems. Some people may benefit from calcium channel blockers, such as amlodipine, or Carisoprodol (a muscle relaxer that blocks pain).

Treating a Leg Cramp
When you get a leg cramp, stop whatever you are doing and try to gently walk it out while you massage the contracted muscle with your hands. Never put force on the contracted muscle because you may tear it. If the cramp continues, apply cool compresses, which can relax the contracted muscle and numb pain. Keep on gently massaging the muscle.

My Recommendations
Most leg cramps are harmless, but frequent muscle cramps can be a sign of serious medical conditions. If you suffer leg cramps only during exercise, eat salty foods or drink electrolyte solutions, not plain water, before and after you exercise. If that doesn’t stop the cramps, you need a complete medical work up. People who suffer frequent night-time leg cramps that do not respond to the simple steps listed above also need a detailed medical work up. Check with your doctor.

OCT 15

How to Prevent Wear-and-Tear Injuries

If you think that football is the sport with the most injuries, you would be wrong. Each year, 79 percent of long-distance runners suffer injuries that force them to take time off from running (Br J Sports Med, Aug, 2007;41(8):469-80). The most-injured part is the knee, and the chance for an injury increases with running longer distances and having previous injuries. Injuries occur most often after a rapid increase in weekly distance, intensity, or frequency of hill or track workouts.

You can help to prevent wear-and-tear injuries from any type of exercise by warming up, by stopping exercise when you feel pain and by not exercising intensely when your muscles feel heavy or sore. Muscles are made of millions of individual fibers. When you first contract a muscle, you use only about one percent of the fibers. As you continue to exercise, you contract more fibers to share the load, which places less force on each fiber and helps to prevent injuries. Always warm up, and go slow before you go fast. If you take a hard workout and feel sore the next day, go easy for as many days as it takes for your muscles to stop feeling sore after you have warmed up. It usually takes at least 48 hours for muscles to recover from hard exercise. When you feel pain in one muscle during exercise, that’s a signal that it may be starting to tear and you should stop exercising for that day.

Why Running Causes So Many Injuries
When you run, one foot is always off the ground, so each foot strikes the ground with a force equal to about three times body weight (at 6-minute-mile pace) and the faster you run, the greater the force of each foot strike. Walking is much safer. When you walk, you always have one foot on the ground, so the force of a walking foot strike almost never exceeds your body weight.

A study from the University of Wisconsin-La Crosse showed that as people start to feel tired during running, they shorten their strides and this decreases the force of their foot striking the ground (Med Sci Sports Exerc, Dec 1999;31(12):1828-33). The shorter stride lessens the force of their heel striking the ground and places it forward to the area behind the big toe. To compensate for the decreased force of their feet hitting the ground, they move their legs at a faster cadence. You can use this information to help you prevent injuries when you run. Shortening your stride will help to protect you from injuries by shifting your foot strike force forward. You can keep your speed by moving your legs at a faster cadence. See Prevent Running Injuries with Shorter Strides and Orthotics

Understanding How to Train Helps to Prevent Injuries
The most common cause of injuries is not listening to your body when it talks to you. Every wear-and-tear injury you have had probably gave you signals long before you were injured. Most exercisers who are training properly have sore muscles every day when they wake up in the morning. However, as they start to exercise, the soreness goes away and their muscles feel good. On days when your muscles do not feel better after you warm up, take the day off. Pain in one area, such as a leg, with no discomfort in the other leg, is a strong warning of impending injury that could still be prevented.

To strengthen your heart and increase your ability to take in and use oxygen, you have to exercise intensely enough to feel muscle burning and become somewhat short of breath. That stresses your muscles also. To make a muscle stronger, you need to exercise vigorously enough to damage it. You go a little faster on one day, damage the muscles and feel sore on the next day. This delayed-onset muscle soreness (DOMS) is evidence that you have damaged muscles. The soreness is a sign that you should spend that day exercising at a more relaxed pace and not put much pressure on your healing muscles.

In a stress/recover training program, you should set up your schedule to go a little faster with more intensity on one day, feel sore on the next day and go at low intensity for that day and as many additional days as it takes for the soreness to go away. Then, when the soreness is gone, you can exercise more intensely again.

Strengthening Muscles Can Help to Prevent Injuries
Muscles are injured when the force on them is greater than their inherent strength, so they tear. Resistance training makes muscles stronger so that they can withstand greater forces and therefore helps to prevent injuries. A study from Sweden showed that pre-season strength training for the hamstring muscles helped to prevent injuries to those muscles (Scandinavian J Med Sci in Sports, 2003;13(4):244-250). Hamstring tears are very common soccer injuries, so players from two of the best soccer teams in Sweden were divided into two groups: a group that received specific hamstring training for 10 weeks, using a special device to overload the hamstrings eccentrically, and a control group that received no special training. The trained group had less than one third the hamstring injuries and also had greater improvement in hamstring strength and running speed.

My Recommendations
• Do not do the same exercise at the same intensity every day. Use the hard/easy principle: faster on one day and much slower on the next.
• Always warm up by going slower for several minutes before you go faster.
• If your muscles do not feel fresh after you have warmed up for a few minutes, take the day off.
• Stop exercising immediately if you feel pain in one area that does not go away when you slow down or stop.
• Whatever your sport, understanding the principles of training helps to prevent injuries.

Caution: Almost everyone should exercise. Check with your doctor before you start a new exercise program or increase the intensity of your existing program. Blocked arteries leading to your heart can cause a heart attack during exercise.

OCT 13

Want Speed? Slow Down! 

By Dr. Phil MaffetonWant Speed: Slow DownShare2KTweetEmailWhatsApp2K SHARES

Note: This is an updated version of the original 1982 article.

Training slow has always been considered a sign of weakness or laziness. However, if you want to run, bike, or swim faster, a successful and intelligent approach is to slow down! Along the way, you’ll get healthier, prevent injury and burn more body fat too.

Traditionally, it is thought that only anaerobic training – speed work – builds speed. However, developing the aerobic system first, before attempting hard work, is ideal: you get faster without the wear and tear – and injury – that often accompanies anaerobic training. Using a heart rate monitor, a basic biofeedback device, makes it even easier.

Heart Rate Monitoring

Despite the boom in heart monitor use by athletes, it is still a misunderstood training companion. (In 1982, heart rate monitors were virtually unheard of except in athletes I worked with.) While many athletes use these devices, they often don’t get their money’s worth from them. Today’s monitors are simple to operate, and are a valuable tool for developing the most important aspect of training – aerobic speed.

Heart rate monitors are really just simple biofeedback units. But without interpretation of the data they provide – heart rate changes – their true benefits cannot be realized. Dorland’s Medical Dictionary defines biofeedback as “the process of providing visual or auditory evidence to a person of the status of body function so that you may exert control over that function.” In practical terms, using a heart monitor to control workout pace can help build aerobic speed, improve overall health and burn more body fat.

As a student in the 1970s, I was involved in a biofeedback research project that measured heart rate changes in humans subjected to various physiological inputs, including running. Once in clinical practice, it became evident that using the heart rate to objectively measure aerobic function was extremely useful. This began a long process of clinical research (which continues today), and the development of techniques that help improve human performance on all levels.

By the early 1980s, all the athletes I trained used heart monitors. These were cumbersome but accurate, and unlike today’s monitors were large, bulky and not made for athletes but cardiac and other inactive patients. (While more user-friendly, modern monitors still use old technology.)

Working with beginner to professional athletes in all sports, I developed applications for heart monitor use in three key areas: 1) training, 2) self-assessment and 3) competition.

Training

During training, a heart monitor can help athletes develop their body’s aerobic system, which includes the red, aerobic, “slow twitch” muscle fibers. This process is referred to as building an aerobic base, and is the foundation of good endurance. Especially important, as outlined below, is for each person to find their specific training heart rate that will allow this optimal aerobic development.

Building a great aerobic base is accomplished by training exclusively aerobic for a certain number of weeks and months. During this period, anaerobic workouts (including higher heart rate training, competition and weight work) should be avoided. Anaerobic activity can actually impair the aerobic system, therefore, each workout during aerobic base training should be only aerobic.

The aerobic system plays a vital and primary role in all physical activity. For example, between 95 and 99% of the energy used for endurance sports, including competition, is derived from the aerobic system. This is true for events lasting more than a few minutes, and races from the mile to the marathon, and beyond. In addition to the traditional endurance events such as running, biking and swimming, aerobic-based sports also include tennis, golf, basketball and most others.

There may be several physiological reasons why anaerobic workouts can reduce aerobic function:

  • Anaerobic activity can lower the number of aerobic muscle fibers, sometimes significantly. This can happen in just a few short weeks of anaerobic training.
  • Lactic acid, produced during anaerobic work, may inhibit aerobic muscle enzymes necessary for aerobic function.
  • Anaerobic training increases the respiratory quotient (a measure of fat- and sugar-burning) indicating the body is burning less fat.

Excess stress in any form (mental, physical or chemical) can inhibit the aerobic system due to increases in the stress hormone cortisol. Just as important is that carbohydrate consumption can increase insulin levels, and impair fat burning and increase reliance on sugar. These topics have been discussed elsewhere.

Building a great aerobic base takes at least three months. For athletes who have lost their competitive edge, have chronic injury or ill health, have difficulty burning body fat, or are just starting an exercise program, a longer base period – up to six months or more – may be needed. Some athletes have learned that training aerobically is all they need to compete better than ever.

This approach is sometimes difficult initially for athletes because in almost all situations training at the prescribed level is painfully slow. In addition, there may be a social issue as your training partners may want you to work harder. And, because a normal 5-mile run, for example, will take a longer period of time at a slower pace, instead of “miles” it’s best to workout by “minutes.” Our athletic culture is still entrenched in the myth of “no-pain, no gain” making proper training a mental challenge at times. But serious training requires discipline. Hang in there: improvements in speed, health and fat burning are on the way!

What’s the best heart rate for aerobic training? The answer to this is individual, and key to building a great aerobic body. Many are familiar with the old heart rate formula: 220 minus your age, multiplied by 65% to 85%. But this method has no scientific or clinical basis. For example, an individual’s maximum heart rate is supposed to be represented by 220 minus the age. However, if you’ve ever pushed yourself on the track or in a race to find your highest heart rate, it may not be close to this formula as more than half of the population finds. Then there’s the percentage factor: which do you use – 65%, 75%, 85%? That’s an extremely wide range, and impractical. Rather than guess, use a scientifically-based formula.

One effective way of finding an optimal heart rate for aerobic training—called the maximum aerobic heart rate—is to evaluate certain physiological parameters on a treadmill, such as respiratory quotient versus heart rate. Seeing the success of this approach, I ultimately found a simple mathematical formula that predicts the same heart rate (typically within one or two beats), and in the early 1980s began using this 180 Formula. (Treadmill testing is still ideal but not readily available, and is relatively expensive.) One unique feature of the 180 Formula is individualization – the person’s general health status is factored into the equation, something automatically incorporated into treadmill testing, but not part of other formulas.

The MAF 180 Formula

To find your maximum aerobic heart rate:

  1.   Subtract your age from 180 (180 – age).
  2.   Modify this number by selecting a category below that best matches your health profile:

a.     If you have, or are recovering from, a major illness (heart disease, high blood pressure, any operation or hospital stay, etc.) or you are taking medication, subtract an additional 10.
b.     If you have not exercised before or have been training inconsistently or injured, have not recently progressed in training or competition, or if you get more than two colds or bouts of flu per year, or have allergies, subtract an additional 5.
c.     If you’ve been exercising regularly (at least four times weekly) for up to two years without any of the problems listed in a or b, keep the number (180 – age) the same.
d.    If you have been competing for more than two years duration without any of the problems listed above, and have improved in competition without injury, add 5.

For example, if you are 30 years old and fit into category b:
180 – 30 = 150, then 150 – 5 = 145.

During training, create a range of 10 beats below the maximum aerobic heart rate; in the example above, train between 135 and 145 staying as close to 145 as possible. To develop the aerobic system most effectively, all training should be at or below this level during base building. As the aerobic system develops, you will be able to run faster at the same maximum aerobic heart rate.

Once a great aerobic base is developed, an athlete can develop anaerobic function, if desired. In some cases this may not be necessary or the time and energy is not available for such endeavors. (Successful anaerobic training can be accomplished in a relatively short period of time, a topic discussed in my book, Training for Endurance.)

One other significant benefit of applying the 180 Formula is the biochemical response: production of free radicals is minimal at this training level compared to training at higher heart rates. Free radicals contribute to degenerative problems, inflammation, heart disease, cancer and rapid aging.

As important as finding the correct aerobic training heart rate is the process of self-assessment.

Self-Assessment: The MAF Test

A significant benefit of aerobic base building is the ability to run faster at the same effort, that is, at the same heart rate. A heart monitor can help objectively measure these improvements using a test I developed in the mid 1980s called the maximum aerobic function (MAF) test.

Perform the MAF Test on a track, running at the maximum aerobic heart rate. A one- to five-mile test, with each one-mile interval recorded, provides good data. The test should be done following an easy 12–15 minute warm up, and be performed about every month throughout the year. Below is a 5-mile MAF Test of a runner training at a heart rate of 150:

Distance   Time (min:sec)
Mile 1    8:21
Mile 2    8:27
Mile 3    8:38
Mile 4    8:44
Mile 5    8:49

During an MAF Test, it is normal for the running times to slow each mile – the first mile should be the fastest and the last the slowest. If this is not the case, it may indicate the lack of an effective warm up. In addition, the test should show faster times as the weeks and months pass. For example, over a four-month period, we can see the endurance progress in the same runner from the above MAF Test. Note the aerobic speed improvement between April and July:

April   May    June    July
Mile 1    8:21     8:11   7:57    7:44
Mile 2    8:27     8:18   8:05    7:52
Mile 3    8:38     8:26   8:10    7:59
Mile 4    8:44     8:33   8:17    8:09
Mile 5    8:49     8:39   8:24    8:15

This improvement is typical during the aerobic base period. Some improve at a faster rate, others slower. Most importantly, if you’re not improving within a three- or six-month period, it means something is wrong. It may be a dietary or nutritional factor, excess stress, overtraining (such as too many miles), etc. In some cases, it may be the maximum aerobic heart rate is too high (often from choosing the wrong category in the 180 Formula). Moreover, a reversal of aerobic function, i.e., slowing of aerobic pace during base training, may indicate an impending injury – enough of a reason to perform the MAF Test regularly.

Progress should continue in some form for three to six months or more before aerobic benefits may reach a normal plateau. Adding anaerobic work to the schedule before this plateau may impair (and ultimately even reverse) further aerobic progress.

The greatest benefit of the MAF Test is that it objectively demonstrates aerobic improvement in the form of aerobic speed. These changes also reflect competitive improvement.

Competition

A direct relationship exists between the maximum aerobic pace (as measured by the MAF Test) and competition. Essentially, increasing aerobic function improves competition (recall that events lasting more than two minute’s duration obtain most energy from the aerobic system).

Data gathered on hundreds of runners I trained over a period of several years showed that the MAF Test was positively correlated with race pace – as the MAF Test improved, so did competition. The chart below, based on actual MAF Tests and 5 kilometer running race times, demonstrates this relationship.

MAF            5K             5K
Min/Mile    Race Pace     Time
10:00             7:30          23:18
9:00             7:00          21:45
8:30             6:45          20:58
8:00             6:30          20:12
7:30             6:00          18:38
7:00             5:30          17:05
6:30             5:15          16:19
6:00             5:00          15:32
5:45             4:45          14:45
5:30             4:30          13:59
5:15             4:20          13:28
5:00             4:15          13:12

The above runners included those who developed an aerobic base, and raced on a flat, certified road course, or track. Most did not perform any anaerobic training, and for most, this was their first competition of the spring or fall racing season. Moreover, 76% of these athletes ran a personal best time for this distance! Similar relationships exist for longer events and for other sports.

The use of a heart rate monitor takes the guess work out of training and can help increase aerobic speed. It can also help prevent injury, ill health and burn off excess body fat.

OCT 8

Keep Muscles Strong As You Age

We can all expect to become weaker as we age, but you can markedly delay this inevitable loss of muscle strength by having a regular exercise program and following the same anti-inflammatory lifestyle rules that are recommended to help prevent heart attacks (Ageing Res Rev, 2021 Jul;68:101344; Front Genet, July 2, 2021), arthritis and many other diseases. This anti-inflammatory lifestyle has also been associated with greater protection from developing severe disease in the current epidemic of COVID-19 (Brit J Sports Med, Sept 16, 2021;55(19):1099-1105).

Older people who suffer from severe loss of muscles (called sarcopenia) are far more likely to have high levels of the markers of inflammation, measured with blood tests such as CRP, SED rate and adiponectin (Aging Clin and Experiment Res, August 2017;29(4):745-752). Sarcopenia is found in other conditions associated with chronic inflammation, including:
• having excess body fat (J Gerontology A Biol Sci Med Sci, 2011;66:888-895; Curr Gerontol Geriatr Res, 2012;2012:216185)
• eating a pro-inflammatory diet that raises blood sugar levels (J Gerontology A Biol Sci Med Sci, Jan 2012;67A(1):74-81)
• being diabetic (Med J Aust, 2016;205(7):329-333)
• having low vitamin D levels (Molecular Aspects of Medicine, Dec 2008;29(6):407-4140)
• not exercising (Euro Soc for Clin Invest J, 2017;47:600-611) 
• having any chronic disease

What is Inflammation?
Your immune system helps to heal wounds and to protect you from infections, but it is supposed to dampen down after an infection has passed or an injury has healed. If your immune system stays overactive, it can use the same cells and chemicals to attack your own tissues, which is called inflammation. It can punch holes in arteries to start forming plaques that can lead to heart attacks, it can damage the genetic material in cells to increase risk for cancers, and it can accelerate the loss of nerves to cause debilitating muscle weakness. An overactive immune system can cause muscle cells to break down through loss of energy-producing mitochondria and increased cell death (Clin Calcium, 2017;27(1):45-52; Int J Mol Sci, Apr 12, 2010;11(4):1509-26).

If inflammation is a major cause of muscle loss, treatment should include exercise, which decreases inflammation by dampening down your immune system. Competitive masters athletes 40-80 years old, who train 4-5 times a week, lose far less muscle size or strength than their non-exercising peers (The Physician and Sportsmedicine, October 2011;39(3):172-8). Eighty-year-old men who still compete in sports have been found to have more muscle fibers than inactive younger men (Journal of Applied Physiology, March 24, 2016). At this time the most effective way to decrease the rate at which you lose muscle size and function is to exercise regularly.

Inactivity Causes Rapid Loss of Muscle Size and Strength
If you inactivate a leg by putting it in a cast, you lose a significant amount of muscle size in just four days (Nutrition, Acta Physiol (Oxf), March 2014;210(3):628-41). Prolonged periods of inactivity due to bed rest, injured nerves, casting or even decreasing the force of gravity cause loss of muscle tissue (Med Hypotheses, 2007;69(2):310-21). In one study, it took only two weeks of not using their legs for young people to lose a third of their muscular strength, leaving them on par with people 40-50 years older. Six weeks of aerobic retraining after two weeks of immobilization restored their leg lean mass and aerobic capacity but did not fully rehabilitate leg strength (J of Rehab Med, June 2015).

My Recommendations
I believe that every healthy person should have a progressive resistance program as part of their regular exercise program. It can help to stave off disability and disease. If you have never lifted weights before, you should first check with your doctor for any potential problems and in the beginning, seek out instructions on progressive resistance training. See Weight Training for Middle-Aged and Older People
Resistance Exercise You Can Do at Home

Caution: Check with your doctor before starting a new exercise program or changing the intensity of your existing program.

Walk Faster, Live Longer

 OCT 5 

Many studies show that the faster you walk, the longer you live. Picking up the pace is more healthful than just walking slowly, even if you go longer than the recommended 30 minutes per day.  Paul T. Williams, a statistician at Lawrence Berkeley National Laboratory, followed almost 40,000 men and women who walked for exercise and found that those who walked at a very slow pace (24 minutes per mile) were 44 percent more likely to die within the 10-year study period than those who walked at a faster pace (PLoS One, December 2013).  Other studies showing similar results include:

• A study of 412,596 British citizens, of average age 68, found that compared to slow walkers, people who walked fast had half the chance of developing severe COVID-19 disease and half the chance of dying from that disease. (International Journal of Obesity, Feb 26, 2021;45:1155–1159).
• A review of more than 200,000 cancer survivors, ages 50 to 71, found that those who walked fast had half the death rate when compared to those who walked slowly (Canc Epid, Biomar & Prevent, April, 2021).
• An analysis of 50,225 walkers found that the faster people walk, the lower their risk of dying from a heart attack and from all causes (Br J of Sprts Med, May 31, 2018;52(12):761-768).
• Among older runners, the faster runners had lower blood pressure, lower cholesterol and lower blood sugar levels (Med Sci Sprt Exer, October 2008).
• A review of 14 studies on walking and seven studies on cycling showed that the faster people walked or cycled, the less likely they were to suffer a heart attack (Int J Behav Nutr Phys Act, 2014;11:132).
• A review of 13 studies found that fast walkers had a 31 percent reduction in risk of death from a heart attack when compared to very slow walkers (Br J Sports Med, 2008;42:238–43).
• A review of 250,000 adults in the UK found walking to work was associated with a 36 percent greater reduction in risk of death from a heart attack, compared to those who did not walk to work (BMJ, 2017;357:j1456).
• The Copenhagen City Heart Study found that risk for heart failure was associated far more with how fast a person walked than with how much and how far he walked (PLoS One 2014;9:e89909).
• A study of 73,743 postmenopausal women aged 50–79 years found that the faster a woman walked, the less likely she was to suffer a heart attack (N Engl J Med 2002;347:716–25).
• The Whitehall study, a 40-year follow-up of 6981 British civil servants, found that faster walkers were less likely to die from heart attacks or cancer (Ann Epidemiol, 2010;20:661–9).
• An analysis of 420,000 UK individuals found that walking fast was associated with reduced risk for death from all causes and heart attacks (Eur Heart J, 2017;38:3232–40).

How to Walk Faster
Walking is one of the safest and most effective sports for fitness, but to become fit, you have to move fairly fast. Healthy people should exercise vigorously enough to increase their heart rates at least 20 beats a minute more than when they rest. Walking at a leisurely pace will not raise your heart rate very much. There are two ways to walk faster: take longer steps or move your feet at a faster rate. To lengthen your stride, twist your hips from side to side and reach forward with your feet. Pointing your feet forward after your heel strikes the ground helps you gain a few inches.

It is easier for most people to move their legs faster, rather than to try to lengthen their stride. If you move your arms faster, your feet will move faster also. Every time one leg moves forward, the arm on the same side moves back and the arm on the other side moves forward. For every step forward, there is an equal number of arm movements forward. To move your arms faster, you have to keep your elbows bent. The fulcrum of your arm swing is at your shoulder. The straighter your elbows, the longer your arms swing as a pendulum from your shoulder, reducing the frequency of arm swings. Bending your elbows shortens the swing and allows you to move faster. You may find that it helps to count out a cadence to yourself as you walk, 1-2-3-4, 1-2-3-4 — as if you were marching — or hum a tune, or play some peppy music. (Don’t use earphones if you are walking in traffic). See How to Do Interval Training 

CAUTION: People with blocked arteries leading to their hearts can suffer heart attacks with intense exercise. Check with your doctor before starting a new program of intense exercise or increasing the intensity of your current program.

OCT 1

A Big Belly Increases Risk for a Heart Attack

Having excess fat in your liver is associated with increased risk for a heart attack (The Lancet: Gastroenterology & Hepatology, Sept 20, 2021). A review of 36 studies on 5,802,226 middle-aged individuals with 99,668 cases of heart attacks, in a median follow-up period of 6.5 years, found that those with fatty liver disease had 1.5 times the incidence of heart attacks as the general population. The more fat in the liver, the greater the chances of a person suffering and dying from a heart attack.

How Can You Tell If You Have a Fatty Liver?
You can often tell if people have a fatty liver just by looking at them. A person with a big belly and small buttocks is at very high risk because those who store fat primarily in the belly are most likely to also store a large amount of fat in their liver. Many studies show that having excess fat in your liver markedly increases risk for Type II diabetes and heart attacks (JAMA, 2017;317(6):626-634), and also increases all markers of inflammation that are associated with increased risk for heart attacks (Clinical Gastroenterology and Hepatology, February 28, 2019).

At your routine physical exam, your doctor should order the usual liver function blood tests. If you have abnormal liver tests or a big belly and small buttocks, your doctor can order a simple sound-wave sonogram of your liver that does not expose you to radiation. The sonogram will show excess fat buildup as white spots in the liver (Nutrition, Metabolism & Cardiovascular Diseases, Dec 30, 2015).

How a Fatty Liver Increases Heart Attack Risk
Your liver is supposed to prevent blood sugar levels from rising too high. When a healthy person eats, blood sugar rises and the pancreas responds by releasing insulin into the bloodstream. Insulin lowers blood sugar by driving sugar from your bloodstream primarily into your liver. However, if you have a lot of fat stored in your liver, your liver cannot accept the extra sugar, blood sugar levels remain high, and this causes sugar molecules to attach to the outer membranes of cells. Once sugar is stuck on a cell, it can never get off and is converted by a series of chemical reactions from glucose to fructose and eventually to sorbitol that destroys the cell.

Your immune system then tries to heal the damaged cells by using the same cells and cytokine chemicals that it uses to kill germs. This is called inflammation, and people who have persistent high blood sugar levels will have persistent inflammation. Inflammation can punch tiny holes in the inner lining of arteries to start plaques forming in arteries. If your immune system continues to stay active all the time, it can break off plaques to cause bleeding and clotting. The clots can extend to block the flow of blood to part of your heart, then part of your heart muscle dies from lack of blood and oxygen, and you have suffered a heart attack.

What Causes a Fatty Liver?
A liver full of fat can be caused by anything that damages the liver. Doctors may separate liver damage into that caused by alcohol and that not caused by alcohol (non-alcoholic fatty liver disease or NAFLD). However, a liver damaged by excess alcohol has the same harmful consequences as a liver damaged by anything else, such as obesity or excess sugar intake (Gastroenterology, May 31, 2019).

Excess Belly Fat Increases Heart Attack Risk Even If You Are Not Overweight
In one study, women with the highest percentage of belly fat had double the risk for heart disease, compared to those with the lowest belly fat (Eur Heart, June 30, 2019). Furthermore, those with the lowest percentage of hip fat and highest percentage of belly fat (apple shape) had three times the risk for heart disease than those with lowest percentage of belly fat and highest percentage of hip fat (pear shape). The researchers concluded that reducing the amount of belly fat by itself would help to reduce heart attack risk significantly, even if the amount of hip fat was not reduced.

Why Sugared Drinks Cause the Highest Rises in Blood Sugar
When you take in liquid sugar, you get a much higher rise in blood sugar than when you take in the same amount of sugar in a solid food. Solid food is not allowed to pass into your intestines because when you eat, the pyloric muscle at the end of the stomach closes and allows only a liquid soup to pass into the intestines. Sugared drinks can pass right through into your intestines, so they cause the quickest rises in blood sugar. Compared to sugar in food, sugared drinks are more tightly associated with increased risk for excess belly fat (Circulation,January 11, 2016; Quart J Med, Apr 26, 2017).

All sugared drinks are associated with increased risk for developing a fatty liver, pre-diabetes (metabolic syndrome), diabetes, inflammation, abdominal obesity, high triglycerides, and increased waist circumference (Int J Clin Pract, Jan 10, 2017; J Acad Nutr and Dietetics, Feb 2013;113(2):219-227; Am J of Clin Nutr, March 23, 2011).

My Recommendations
Fat can be removed from the liver with diet (Diabetologia, 2011 Oct; 54(10): 2506-2514) and with exercise (Scandinavian Journal of Med Sci in Sports, March 13, 2017;27(5)).
• If you have a big belly or your blood sugar is greater than 140 one hour after a meal, I recommend that you lose weight (if overweight) with intermittent fasting; check with your doctor.
• Since most liver fat comes from sugar, avoid or severely restrict all sugared drinks and sugar-added foods.
• Restrict other refined carbohydrates such as foods made from flour (bakery products, pasta, many breakfast cereals and so forth).
• Restrict red meat, processed meat and fried foods.
• Eat plenty of the anti-inflammatory foods — vegetables, fruits, beans, whole (unground) grains, nuts and other seeds.
• Try to exercise every day.

Inactivity Causes Muscle Loss

SEPT 30  

Even short periods of inactivity cause dramatic loss of muscle size and strength. After just two weeks of having one leg put in a cast, all 32 men in the study lost a tremendous amount in all measures of physical fitness, strength and muscle size in the immobilized leg. After six weeks of pedaling a bicycle for rehabilitation, they still did not regain all of the strength that they had lost (Journal of Rehabilitation Medicine, June 2015). Another study showed that a person loses significant strength after stopping exercise for just four days (Exp Gerontol 2013; 48: 154–161).

Young Men Lost More Than the Older Men
The new study compared 17 young men (average age 23) and 15 older men (average age 68). The younger men lost 30 percent of muscle strength and the older men lost 25 percent. People with the largest muscles to begin with are the ones who will lose the most strength when an injury, illness or vacation stops them from exercising. That explains why younger people lose strength at a faster rate than older people. A young man who is immobilized for two weeks loses muscular strength in his leg equivalent to aging by 40 to 50 years.

The more muscle mass you have, the more you will lose. Young men have about two pounds more muscle weight in each leg than older men do, but after two weeks of inactivity, young men lost 17 ounces of muscle, compared to older men who lost nine ounces. This means that an injury causes fit people with larger muscles to lose more muscle size and strength than inactive people.

Muscles are made up of thousands of individual fibers like a rope is made of many strands. Regular exercise enlarges fiber size. Inactivity causes muscle fibers to become smaller. Therefore those with the largest fibers lose the most muscle size and strength when they stop exercising.

Rehabilitation after Inactivity
After the two weeks of immobilization, the participants trained on a bicycle 3-4 times a week for six weeks. They regained some but not all of the muscle size and strength that they lost. Aerobic training (such as running and cycling) should not be used as the only rehabilitation training. Strength training should be used along with aerobic activity to regain lost muscle strength and size. You need to lift weights or do some other form of strength training for recovery. Other studies show that it usually takes at least three times as long as the period of inactivity to recover full strength (J Am Med Assoc, 2007; 297: 1772–1774).

Why Aerobic Exercise is Not Enough
To make a muscle larger and stronger, you must exercise intensely enough to damage muscle fibers. When you use your muscles, you contract the muscle and shorten its fibers. However, you do not contract a muscle fiber equally throughout its length. Muscle fibers are made up of blocks touching end to end to form the long stringy muscle fiber. Each block touches the next block at a point called the Z-line. You have to damage the Z-line to make a muscle grow larger and stronger. If you pedal with great pressure, you will damage the muscle fibers at the Z-lines and when they heal, muscles will become stronger. However, most people do not pedal hard or long enough to cause enough damage to make the muscle larger and stronger when it heals. Adding weight training to the recovery program will help to regain the lost strength and muscle size.

What Does This Mean for You?
If you have to stop exercising for even just a few days because of an injury, vacation or illness, expect to lose strength and endurance. When you resume exercising, you should do some form of strength training to regain your lost strength. Caution: Pain at the site of an injury means that you are tearing the previously injured muscle fibers and should stop exercising immediately.

SEPT 24

Should You Cool Down after Exercise?

Cooling down means that after vigorous exercise, you move far more slowly for several minutes before you stop exercising for that session. The main reason for “cooling down” is to keep you from feeling dizzy or passing out after very vigorous exercise (Sports Medicine, 2018;48:1575–1595).

Can Cooling Down Improve Sports Performance?
Cooling down may improve sports performance when the time between successive events is less than 20 minutes (J Sports Sci, 2008;26(1):29–34), but it has not been shown to improve sports performance when the time between competitive events is greater than four hours (Sports Medicine, April 16, 2018;48:1575–1595; J Sport Med Phys Fit, 1993;33(2):118–129). Intense exercise generates a tremendous amount of lactic acid which acidifies the blood to make muscles burn and hurt so you have to slow down. Keeping on moving when your blood is full of lactic acid clears lactic acid significantly faster than when you stop exercising suddenly. However, lactic acid is cleared naturally in less than an hour after vigorous endurance competition (Am J of Physiol, February 1937;118(3):457-462), so cooling down helps you to recover faster for competitions within 20 minutes of each other, but after that it makes no difference in your recovery time. Also, lactic acid is good for you because it can help you recover faster for the next day’s workout. You convert lactic acid into glycogen, the sugar that helps muscles recover faster. High-intensity exercise depletes muscle glycogen storage, and this can impair subsequent high-intensity exercise performance up to 24 hours post-exercise (J Appl Physiol, May 1, 2017;122(5):1055-1067).

However, cooling down does not help to:
• make you stronger or improve fitness level (J Strength Cond Res, Nov 2012;26(11):3081-8)
• prevent injuries (Clin J Sport Med, Jan 2007;17(1):25-30)
• improve ankle range of motion, sit-and-reach score, stride length, or calf and thigh stiffness (J Sports Sci, 2006;24(8):835–842)
• improve flexibility (J Hum Kinet, Mar 2012;31:121-9)

Cooling Down Probably Does Not Help to Prevent Delayed Onset Muscle Soreness
Most studies show that cooling down does not help to reduce next-day muscle soreness called DOMS induced by intense exercise (J Hum Kinet, Dec 2012;35:59-68; Aust J Physiother, 2007;53(2):91-5). However, some smaller studies show that cooling down may help to relieve DOMS three days after intense exercise (J Strength Cond Res, Oct 2012;26(10):2777-82).

Exercise-Associated Collapse
At the end of a marathon, a runner may sprint over the finish line, fall down and lie unconscious for a short time. Most cases of exercise associated collapse are caused by stopping suddenly after intense exercise. After a long race, you should slow down gradually. Almost all athletes who collapse after finishing a marathon suffer from postural hypotension: lack of blood flow to the brain because blood drops from the brain to the legs. Cooling down prevents feeling faint and passing out by keeping blood flowing through your body to decrease your chances of a sudden significant drop in your heart rate and blood pressure.

Exercise-associated collapse is the most common reason that athletes are treated in the medical tent following an endurance event. Possible causes of exercise-associated collapse include dehydration, hyponatremia (low blood salt levels caused by excessive fluid intake with too little salt), heat stroke (a sudden uncontrolled rise in body temperature), drunkenness, a heart attack or stroke. Usually it is none of these. Professors at the University of Capetown in South Africa analyzed data on runners who collapsed during an ultra-marathon (Med Sci Sprts Ex, Sept 1994;26(9):1095-1101). They found that most cases occurred after the runner crossed the finish line. The few cases of collapse away from the finish line were caused by diseases such as asthma or heart damage. Most cases of collapse occur in runners near the cutoff time for an award. All of the runners who collapsed had an excessive drop in blood pressure when they went from lying to standing.

Mechanism of Passing Out
During vigorous exercise, your legs drive your heart, your heart does not drive your legs. First, your leg muscles contract and squeeze the blood vessels near them to pump blood toward your heart. Then the increased amount of blood returning to your heart stretches the heart and causes it to beat faster and with more force. Then your leg muscles relax and the veins near them fill with blood to start the next cycle. When you run fast, your leg muscles do a considerable amount of the work pumping blood through your body. If you stop suddenly, the blood pools in your legs and your heart has to pick up the slack. At the end of a long race, your heart may not be able to pump more blood, so not enough reaches your brain and you end up unconscious. Cooling down will help to prevent this.

The treatment is to lie the person on their back, raise their feet high over their head and wait for them to revive. If they are not alert within seconds, you should realize that there are more serious causes of unconsciousness and get medical help immediately. When a person passes out during a race, it can be caused by something that can be fatal such as a heart attack, irregular heartbeats or heat stroke (Physician and Sportsmedicine, 2003;31(3):23-29).

My Recommendations
If you are just exercising casually, you can slow down before you finish your workout if you want, but cooling down has no particular health benefits. On the other hand, if you are exercising vigorously, you should slow down before stopping to reduce your chances of feeling dizzy or even passing out.

SEPT 9

Slim Evidence for Stem Cell Treatment of Arthritis

Hundreds of stem cell clinics in the United States are promoting stem cell treatments for knee osteoarthritis without solid evidence that they help to relieve pain or repair broken cartilage (American Academy of Orthopedic Surgeons March 6, 2018 Annual Meeting in New Orleans, Abstracts P0147 and P0265). A comprehensive review of the world’s literature on the use of unchanged stem cells used to treat osteoarthritis and localized cartilage knee damage found 420 studies the authors deemed weakly designed and found only six studies they felt were randomized and well-controlled (J Bone Joint Surg Am, 2016;98:1511-1521). These six trials showed some benefit, but the benefits were nearly the same as what would be expected from placebo treatments (J Knee Surg, Published online July 24, 2017).

Why Non-Research Stem Cell Treatments are Unlikely to be Effective
Stem cells are primordial cells that can become any tissue such as bone, muscle, cartilage and so forth. Very promising research is being done now at several medical schools in which the DNA in stem cells is altered to make them become cartilage cells. However, the commercial clinics that offer stem-cell treatments today are taking blood or fat from patients, extracting the stem cells, concentrating them in a centrifuge, and then giving back the unchanged stem cells that they took from the patient. Concentrating a person’s stem cells without changing them into cartilage or into stem cells that produce cartilage could possibly be therapeutic, but concentrating stem cells by centrifuging has not been shown to produce enough cartilage to heal damaged joints.

At present, The U.S. Food and Drug Administration requires that human cells can only be minimally manipulated and not be combined with other substances such as drugs. Since changing the DNA in human cells exceeds minimal manipulation, doctors cannot legally create large amounts of cartilage stem cells for injection unless they are part of a certified research project. See my previous report, Be Wary of Stem Cell Clinics

SEP 6

Avoiding Overtraining

   

Exercising too much can affect your brain as well as your muscles. Athletes and dedicated exercisers often suffer from an overtraining syndrome in which their performance drops, their muscles feel sore and they are tired all the time. In a new study, elite athletes were instructed to overtrain for three out of nine weeks, and were then compared to a group who did a normal nine-week training program (Current Biology, September 26, 2019). Not only did the overtrained athletes perform worse on endurance tests, their brains were affected as well as their muscles and other body functions. The overworked athletes suffered from mental symptoms including depression, irritability, restlessness, insomnia, and loss of appetite. They also made poor decisions in special tests such as choosing meager immediate personal rewards over more substantial delayed rewards (i.e., taking $10 now rather than $50 in six months). MRIs of their brains showed markedly reduced activity of the lateral prefrontal cortex, a key region in which a person makes important personal decisions. This study agrees with a previous study that used MRIs and tests to show that overworked office workers made poorer decisions and had reduced activity of the lateral frontal cortex of their brains



Signs of Overtraining
A regular exercise program is supposed to make you feel good, increase your energy level and help to control your weight. You may be exercising too much if you feel:
• tired all the time
• irritable
• unable to sleep
• loss of appetite
• no improvement in your performance over an extended time
• no enjoyment of exercising
You may also have:
• frequent colds
• increased resting heart rate
• reduced maximum heart rate
• persistent muscle soreness
In particular, muscle soreness on one side of your body or localized discomfort in one part of your body are major signs of an impending injury.

My Personal History of Overtraining
Athletes train by stressing and recovering. You make a muscle stronger by stressing that muscle, feeling sore on the next day, and taking easy workouts or days off until the soreness goes away. Then you are supposed to take a hard workout again. If you do not feel muscle soreness on the day after a hard workout, you have not injured your muscles and they will not become stronger. Sometimes your muscles still feel a little sore several days after a hard workout, but you think that you have recovered and are ready to stress your muscles again, so you go ahead and try to run very fast. You start to feel sore all the time, your joints, muscles and tendons ache, and you feel tired. You can still run with the soreness in your muscles and tendons, but the soreness prevents you from running fast. Each succeeding day, the soreness increases and you think that you are sick.

This happened to me when I was training for a marathon, so I ordered tests including a complete blood count, liver tests, BUN, creatinine, urinalysis, and a throat culture, but all the results were normal. I couldn’t run my intervals as fast as usual. I had been able to run 10 quarters in 65 seconds and now I couldn’t get through more than three of them without my muscles feeling very sore. I knew something was wrong, so I asked a friend who was a researcher at a nearby university to test me. He told me that I had impaired anaerobic lactic acid clearance and a reduced time-to-exhaustion in standardized high-intensity endurance exercise tests. My maximum heart rate was 10 beats lower than normal, my lactate levels were lowered during sub-maximal performance, and I had a reduced respiratory exchange ratio during exercise. By now I was quite depressed, so I got further tests and decided I might have a hidden lymphoma, but my complete diagnostic workup was normal. I was stuck with a diagnosis of training too much.

Recovery from Overtraining
When you are suffering from overtraining, you need to go back to background work. These principles apply to any sport. For a runner, jog on the days that you can. Take days off when you feel sore. After several weeks, you are able to start regular jogging and your muscles feel fresh again. When this happens, you are ready to start training, but first you must promise yourself that you will never try to run fast when you feel soreness in your muscles and tendons. Set up a schedule in which you take a hard-fast workout, feel sore on the next day, and then go at an easy pace in your workouts until the soreness has completely disappeared. You may set up a schedule to try to take a hard workout every third or fourth day, but you will skip a hard workout on any day that you feel sore.

Most runners plan to run very fast once a week and long once a week. You recover faster from a hard workout by doing nothing, but jogging slowly on recovery days causes more fibrous tissue to form in your muscles so that they are more resistant to injury. Don’t calculate total miles per week in your diary; that will encourage you to pile up junk miles and prevent you from learning how to run fast. You can run in races only as fast as your fastest workout intervals. Set up a program in which you run very fast on Wednesdays and long and brisk on Sundays, and make all your other workouts easy recovery ones.

Competitive runners usually use interval workouts to increase their speed. When you have recovered from overuse syndrome, you should start with short intervals before you try longer ones. For example, you could start with 110 yard intervals. Mark the track in quarters, using the fifty yard lines and the middle of the goal posts. Alternate running 110 yards fast and comfortably, and jogging 110 yards until your legs start to feel heavy and stiff. When you can run at last 20 repetitions of 110 yards fairly fast, try do repeat 220s, and as the weeks progress, work up to repeat half miles. Don’t try to run through the stiffness or you will take weeks to recover. If your legs are exceptionally sore, take the next day off. If they are not sore, jog easily on the next two or three days.

Use your Sunday workouts to try to gain endurance. Your endurance day should not be as fast as your interval day. Each Sunday, try to work up to where you can run fairly fast for up to two hours. You may have to start out with a long run of only 30 minutes, but be patient. Lack of patience can lead to overtraining syndrome. You should eventually be able to learn how to train without injuring yourself and avoid making the same overtraining mistakes again. 

AUG 30

Resting Heart Rates Can Be Too High or Too Low

Your resting heart rate should average between 50 and 70 beats a minute. Athletes can have rates between 30 and 50 and still have healthy hearts, and your heart rate temporarily can go above 70 when you are sick, stressed or sleep deprived, but all people who have persistent resting heart rates greater than 70, non-athletes who have heart rates below 55, and anyone with a heart rate below 60 with heart palpitations, fainting , dizziness or other symptoms may want to check with a doctor. Resting heart rates greater than 70 are associated with increased risk for diabetes (Int J Epidemiol, Jun 2010;39(3):900–906), heart attacks, certain cancers and premature death (CMAJ, Oct 18, 2016;188(15):E384–E392).

The Research
• More than 6000 men were followed for more than 25 years. Those with resting heart rates greater than 73 beats per minute were 140 percent more likely to die from cancer than those with resting heart rates of less than 60 beats per minute (PLoS ONE, published online August 03, 2011).
• Of more than 53,000 men followed for almost 30 years, those with resting heart rates greater than 80 beats a minute were far more likely to suffer heart attacks and cancer than those with fewer than 60 beats a minute (Mayo Clinic Proceedings, 12/12/2013).
• 58 obese men and women exercised five times a week at 70 percent of their maximum heart rate for 45 minutes. In just 12 weeks they lowered their resting heart rates by five to nine beats per minute (Br J Sports Med, 2009; 43: 924-927).
• The Copenhagen Study of 3,000 men followed for 16 years found that those with a resting heart rate between 71 and 80 beats per minute were at a 50 percent elevated risk of death, between 81 and 90 beats per minute had double the risk, and resting heart rates over 90 beats per minute tripled the risk (Glob Cardiol Sci Pract, Oct 9, 2015;2015(3):33). Furthermore, high resting heart rates were associated with lower levels of physical fitness, higher blood pressure, overweight, and higher levels of circulating blood fats. The authors concluded that “a high resting heart rate is not a mere marker of poor physical fitness, but is an independent risk factor for disease.”

A High Resting Heart Rate May Predict Heart Disease
A strong heart pumps lots of blood with fewer beats, while a weak heart has to beat more often to pump the same amount of blood. A high resting heart rate may indicate that arteries are blocked or that there is heart muscle damage so the weakened heart has to pump more often to circulate oxygen to your body.

How a High Resting Heart Rate Relates to Cancer
Telomeres are the end caps of chromosomes that help to protect them from being destroyed when a cell reproduces. The longer your telomeres, the less likely you are to develop cancer, and people who exercise regularly have longer telomeres. Exercise also helps to protect the body from inflammation, a risk factor for cancer. The more intensely you exercise, the lower the heart rate and the greater the protection against inflammation.

How to Check Your Resting Heart Rate
To find out your resting heart rate, check your pulse when you first wake in the morning, before you get out of bed. You can use a heart rate monitor, a blood pressure cuff that includes a pulse check, one of the many fitness trackers that have a heart rate feature, or any watch that shows seconds. If you have a smart phone you can download a free heart rate monitor app. Set your device on your bedside table the night before so you do not have to move around when you wake up. If you are using a watch, place your fingers on the side of your neck where you feel a strong heartbeat. Count the beats for ten seconds and multiply by six. Do this for several days and take an average.

My Recommendations
A morning resting heart rate consistently over 70 is often a warning signal that you have a weak heart and may be headed for serious disease. If your resting pulse rate is over 70 beats per minute and you are not sick or taking stimulants, check with your doctor, particularly if you also have:
• LDL cholesterol greater than 100,
• blood sugar greater than 145 mg/dL one hour after eating,
• systolic blood pressure greater than 120 at bed time, or
• a C-reactive protein greater than 10 mg/L.

Athletes often have exceptionally low heart rates indicating a strong heart, but in non-athletes a low heart rate can be caused by damage to the heart’s electrical conduction system or muscle. If you have a resting heart rate of less than 60 and are not a regular exerciser, or if you are regular exerciser and have a bedtime systolic blood pressure greater than 120 or below 90, chest discomfort, dizziness or fainting, a bad LDL cholesterol greater than 100, or any possibility of an irregular heartbeat, you should check with your doctor.

AUG 22

When Does Your Metabolism Slow Down?

Many people believe that they gradually gain weight from their 20s onward because their metabolism gets slower over the years, but now it appears that this is not true (Science, Aug 3, 2021:373(6556):808-812). Close to 6,500 people from 29 countries, ranging in age from infancy to 95 years, were followed for more than 40 years. The researchers found that metabolism (the rate at which a person burns calories) remains stable through adult mid-life, from ages 20 to 60. After age 60 it begins to slow down at a rate of slightly less than one percent per year.

The average North American gains about a pound and a half a year after age 30, which is long before metabolism begins to slow at age 60, so we need other explanations for weight gain during those years. People who have managed to control their weight up to age 60 may then begin to experience unexplained weight gain that could be caused by their metabolism getting lower.

Details of the Study
The researchers measured metabolic rates using doubly labeled water that can be traced in urine samples, giving a precise measure of the number of calories burned. After correcting for all of the factors such as body size, muscle mass, age, gender and so forth, they found that the rate an adult burns calories per pound of body weight does not drop until after age 60. They discovered that human metabolism changes at four distinct stages of life:
• infancy up to age 1, when calorie burning is at its highest (50 percent above the adult rate)
• ages 1 to 20, when metabolism slows by about three percent a year
• ages 20 to 60, when metabolism holds steady
• ages 60 and beyond, when metabolism declines by about 0.7 percent a year

The authors note that weight gain occurring during the period when metabolism is slowing down later in life, from age 60 onward, corresponds with increased rates of non-contagious diseases and health problems such as diabetes, heart attacks, strokes, some types of cancers and many others.

Other Reasons Why You Gain Weight
You gain weight when you take in more calories than you burn for any reason. Since many North Americans start to gain considerable extra weight in their 20s or 30s, long before their metabolisms begin to slow down at age 60, everyone should be aware that you control excess weight by eating less and being more active. Variables include how often you eat, the types of bacteria in your colon, your portion sizes and the types of foods you select, your exercise program and your daily activity level. If you are having trouble controlling your weight, see:
Eat Whole Foods, Not Processed Foods, to Lose Weight
Snack on High Fiber Foods
Restrict Added Sugars
Bacteria in Your Gut May Determine How Much You Weigh
Exercise and the Gut Microbiome

AUG 14

5 Reasons Why Squatting Is Important

Squatting plays a major role in my CrossFit and weightlifting training. I know that if I’ve got great squat numbers I’m going to have a great weightlifting performance to reflect it. My own training routine includes squatting a minimum of 3 times per week, mixing up both front and back squats as needed. So I’ve decided to compile a little list explaining my top 5 reasons why squatting is so important to me!

Muscle Building and overall Strength

Squatting is a foundational movement! Squatting is a completely natural movement which works the muscles of the back, quads, hamstrings, core, and calves. Practicing squats means keeping all of those muscles and the joints they articulate on both strong and mobile. I maintain a strict squatting routine to build that foundation of strength and muscle, which is what keeps me performing at my best as often as I can.

Building muscle mass (hypertrophy) is not really a priority in either Weightlifting or CrossFit, because weighing less is actually to my advantage, as long as I can maintain the level of strength I have built. However, there is always some mass that gets packed on when we do volume training, and a certain amount of mass is necessary to increase strength.

Overall strength is really what I am after. Without the functional strength I get from squatting, I wouldn’t be performing at the level that I do!

Functionality and Utility

Squatting is totally natural, we know that, so let’s talk more about why I really need to squat to perform! It’s one of the most functional parts of CrossFit; we see squatting in all the lifts, as well as wall balls, box jumps, etc.

The foundation of a good squat number and the mobility to perform front, back, and overhead squats correctly goes a long way! When I started out, a 1RM squat of 80kg would only get me so far… having a sizeable squat helps make all the other movements less intensified and more manageable.

Strong correlation to weightlifting

It’s pretty obvious to say, but any lifter is performing heaps of squats! The strength power required in my back and legs to move weights around requires a lot of squatting. After all, a clean is truly dependent upon whether you can stand up with that bar or not! Lifters typically squat 3 to 5 times per week at varying intensities and volumes, though  often staying in the 2RM to 5RM range.

Improvement in Sprinting

Back squats are a favourite for all sprint athletes. It requires us to explode, with as much power as possible and using the exact same chain of muscles, in the same sequence, though unilaterally. I don’t want to say that squatting itself makes me faster, because that would be inaccurate to some degree. Squatting makes you stronger. The definition of “power” is the change in speed over time. So squatting allows me to generate the strength needed to improve my power.

Again, a foundation of strength is the most important part of your body that will make you perform generally better in all aspects.

Side note: A great exercise that I implement is jumping barbell squats. This has helped my power and my ability to be more explosive, particularly with the starts of races.

Improvement in Core Strength

All of the movements we do are initiated in the core. Think of walking, running, lifting, and all of the overhead movements I need. All the planks and sit-ups in the world couldn’t strengthen my core like squats do!

The oblique and transverse abdominals are stabilised through squats as the load is placed at the top of the spine, forcing it to maintain and upright position. The mechanics of a front squat put even more stress on the core as the weight is shifted anterior, creating a longer lever to force through. Front squats work my core in the most functional way possible, because it replicates exactly the strength I need for cleans, wall balls, thrusters, as well as a lot of the overhead work.

AUG 12

How to Become Stronger: Weight Training for Middle-Aged and Older People

Just exercising will not make you stronger. If it did, marathon runners would have the largest and strongest muscles. If you want to make your muscles stronger, you have to exercise them against resistance that is heavy enough to damage the muscle fibers and when they heal, they will be stronger. A review of 22 studies on how to grow larger and stronger muscles found that the best way for untrained people to grow muscles is to use lighter weights with more repetitions, even though most trained athletes gained more strength by using heavier weights with fewer repetitions (Human Movement, July 23, 2020;21(4):18-29). Lifting lighter weights with more repetitions reduces your chances of injuring yourself.

How to Build Muscle Without Injuries
When middle-aged and older people start a weight lifting program, they often get injured, usually because they try to train like young people who pick the heaviest weight they can lift ten times in a row and do three sets of ten lifts. They feel sore for the next few days and when the soreness goes away, they lift heavy weights again, usually two or three times a week. This type of training almost always injures older novice weight lifters and ends their training program. The best way for middle-aged and older people to prevent injuries is to lift lighter weights.

Why You Lose Muscle Strength and Size with Aging
Muscles are made up of hundreds of thousands of individual fibers, just as a rope is made up of many strands. Each muscle fiber is innervated by a single motor nerve. With aging, you lose motor nerves, and with each loss of a nerve, you also lose the corresponding muscle fiber that it innervates. For example, the vastus medialis muscle in the front of your thigh contains about 800,000 muscle fibers when you are 20, but by age 60, it probably has only about 250,000 fibers. However, after a muscle fiber loses its primary nerve, other nerves covering other fibers can move over to stimulate that fiber in addition to stimulating their own primary muscle fibers. Lifelong competitive athletes over 50 who train four to five times per week did not lose as many of the nerves that innervate muscles and therefore retained more muscle size and strength with aging than their non-athlete peers (The Physician and Sportsmedicine, October 2011;39(3):172-8).

How Muscles Become Stronger
Each muscle fiber is made of a series of blocks called sarcomeres that are lined up end to end. Each sarcomere is attached to the one next to it at a “Z line” (diagram). Muscle fibers do not contract equally along their lengths; they contract only at each “Z line”. To strengthen a muscle, you have to put enough force on the muscle to damage the Z-lines. You can tell you have damaged the Z-lines by the feeling of muscle soreness that begins 8 to 24 hours after you have lifted weights or done any form of resistance exercise. That is the time it takes for the swelling to occur in the Z-lines. This is called Delayed Onset Muscle Soreness (DOMS). Exercising your muscles intensely enough to damage them makes muscles stronger so they can withstand higher loads and be more resistant to injury.

When a muscle is damaged, your immune system sends to the damaged tissue large amounts of the same cells (lymphocytes) and chemicals (cytokines) that are used to kill germs when you have an infection. This causes inflammation, characterized by soreness (pain), increased blood flow to the injured fibers (redness), and increased flow of fluid into the damaged area (swelling). The immune cells release tissue growth factors to heal the damaged muscle fibers, and you should allow the muscle soreness to decrease or disappear before exercising intensely again. If you do not wait until the soreness goes away before exercising intensely again, the fibers can be torn, the muscles weaken and you can become injured.

How to Start Your Resistance Training Program
If you are not already doing strength training, check with your doctor to make sure you do not have any condition that may be harmed by exercise. Then read my article on Resistance Exercise You Can Do at Home, or – when you are vaccinated and your community is returning to normal – find a gym that practices sanitizing of equipment, social distancing and good air circulation. On each exercise, pick the resistance that you can comfortably move 10 times in a row, without straining or hurting your muscles. End the workout immediately if you feel pain that does not go away as soon as you stop the movement.

If your muscles still feel sore 48 hours after your first workout, wait until the soreness is gone before you try again. As you become stronger and the resistance feels very easy for you, try to lift 15 times in a row, then perhaps 20 times. Only when you can lift that weight at least 20 times in a row, and not feel sore the next morning, should you try to increase the resistance level.

The key to this program is to avoid injuring your muscles by increasing the number of repetitions gradually so that you do not cause muscle soreness that lasts longer than a day. You should not increase the weight (resistance) until you can lift a set of at least 20 repetitions in each exercise without feeling sore the next morning.

My Recommendations
• Before you start any new exercise program, check with your doctor to rule out any conditions that might be aggravated by resistance training.
• This program is designed for beginners and is intended to prevent injuries that plague older people when they first try to lift weights. It will not build very large muscles, but it will increase your strength and provide all of the other benefits of a weight training program. After many months (injury-free) on this program, if you wish to build larger muscles, you can transition to a more traditional weight training program; see Strength Training Guidelines. Otherwise, you can continue with this safe and effective program of resistance exercise for the rest of your life.

AUG 8

How to Keep Your Maximum Heart Rate Up as You Age

  January 10, 2016  8087  

Your maximum heart rate is the fastest your heart can beat and still pump blood effectively through your body. As you age, your maximum heart rate drops. This means that your heart is weaker and more susceptible to damage, and you can’t exercise as fast over distance as you could when you were younger.

How fast you can run, cycle, ski or swim over distance is limited by the time that it takes to move oxygen into your muscles. Your heart pumps oxygen-rich blood to your muscles, so the faster your heart can beat, the more blood it can pump to your muscles and the faster you can move. Exercise physiologists use your maximum heart rate to determine your level of fitness and guide the intensity of training. This month a study from Ball State University in Indiana shows that exercising as you age slows down the loss of maximum heart rate (Med Sci Sports Exerc, Jan, 2016;48(1):73-81). Keeping your maximum heart rate up means that your heart is stronger, which allows you to exercise faster and longer. Exercising as you age can also prolong your life and help prevent heart attacks, cancers, strokes, diabetes, overweight and more.

The Study
Nearly 650 healthy men and women, ages 18-80, not taking any heart-rate-altering medications, completed two treadmill all-out efforts at least one year apart. The older participants had lower average maximum heart rates, but those who were most fit and had the highest values had the least drop in their maximum heart rates over the year regardless of age.

How to Increase your Maximum Heart Rate
The standard Maximum Heart Rate Formula (220 – Age) is based on averages and is not accurate. You can beat these averages if you exercise effectively. Your actual maximum heart rate depends more on the strength of your legs than it does on the strength of your heart. When you contract your leg muscles, they squeeze against the blood vessels near them to pump blood from your leg veins toward your heart. When your leg muscle relax, your leg veins fill with blood. When you exercise, your leg muscles pump increased amounts of blood toward your heart. This increased volume of blood fills the heart which causes your heart to beat faster and stronger. This is called the Bainbridge reflex. The stronger your legs are, the more blood they can pump back to your heart, which causes your heart to beat faster. More on Maximum Heart Rate Formula

Maximum heart rate formulae can be used to help you plan and monitor your exercise program, but they should not be interpreted as absolute limits or goals. If you want to train to become faster by increasing your maximum heart rate, you should follow a program based on “stress and recover”. To increase your maximum heart rate, you need to become short of breath at some time during your exercise. However, when you exercise at high intensity, you damage muscles and have to allow time for them to recover. If you don’t allow muscles to recover, you can become injured and can develop an overuse syndrome in which you are exhausted and won’t be able to exercise at all.

My Recommendations
I believe that all healthy people should use some variation of a stress-and-recover exercise program, in which they damage their muscles by going a little harder and faster on one day, then feel soreness in their muscles and go much slower on the next day. When their muscles feel fresh again, they can take another intense workout. For example, a runner may warm up by going slowly and then run a little faster for 50 strides, then slow down until he recovers his breath and his muscles feel fresh, and then alternate the faster and slower runs until his legs start to feel heavy or hurt. On the next day, his muscles should feel sore and he either takes the day off or runs very slowly. He should try to set up a program in which he goes faster on one day and much slower on the next.

• A hard day means getting short of breath and feeling some burning in your muscles.
• An easy day means that you do not become short of breath and should not feel muscle soreness as you continue to exercise. If your legs feel heavy after you warm up, take a day off from exercising.
• You don’t need to know your maximum heart rate.
• You don’t need to use a maximum heart rate formula to govern your training.
• You don’t need a heart rate monitor.
• All training should be governed by how you feel.
• Never train intensely when your muscles feel worse as you continue to exercise.

Caution: People who have narrowed arteries leading to the heart can suffer heart attacks when they exercise intensely. All vigorous exercisers must learn when to back off of training because not allowing enough time to recover from hard exercise can damage your heart muscle as well as your skeletal muscles. Check with your doctor before beginning an exercise program or making a sudden change in the intensity of your existing program.

Keep Moving for a Longer and Better Life

  JULY 28

Everyone should try to keep on moving their muscles every day. Sitting around for long periods of time can cause you to become diabetic and increase your risk for a heart attack, and lying in bed for long periods puts you at increased risk for heart failure and premature death (J Am Coll Cardiol, October 2018;72(14)).
• 518 postmenopausal overweight women, average age 63, wore accelerometers on their hips for 14 days to track how much they were moving each day. Women who sat longer had higher blood insulin levels because inactivity prevents your body from responding to insulin, so your pancreas releases even more insulin to overcome this (J Amer Heart Assoc, Feb 17, 2020). High levels of insulin are an early sign of diabetes because diabetes is often caused by inability to respond to insulin, so insulin levels rise. For each additional hour the women sat each day, they had a six percent increase in insulin and a seven percent increase in insulin resistance. Extended sitting time was also associated with higher levels of body fat, a wider waist and higher triglyceride levels. See Inactivity Increases Risk for Diabetes
• Researchers at the University of Liverpool in England asked 45 healthy active adult men and women who averaged walking more than 10,000 steps a day, to reduce their steps to fewer than 2,000 steps per day and to sit three and a half additional hours each day for two weeks (Diabetologia, Jun 2018;61(6):1282-1294). All of the participants had significant rises in blood sugar, lowered response to insulin, raised blood cholesterol, decreased leg muscle size and increased fat in their bellies.
• 22 diabetic, overweight adults (average age 69), who took 7000 or more steps a day, were asked to take fewer than 1000 steps a day for two weeks (J Gerontol A Biol Sci Med Sci, Jul 9, 2018;73(8):1070-1077). They all had changes predicting loss of muscle size and were less able to respond to insulin, and some had very high rises in blood sugar after meals. In most of the subjects, markers of diabetes (sugar tolerance and insulin responses) remained abnormal two weeks after they had resumed their normal activity levels.

Inactivity Increases Risk for Heart Failure
People who lie in bed day after day suffer progressive weakening of their heart muscle. Eventually the heart becomes too weak to pump enough oxygen to the brain, they stop breathing and die from heart failure. A study on mice shows how this is likely to happen. Preventing mice from using their hind limbs for just 28 days interfered with normal function of mitochondria in cells so that blood levels of oxygen dropped, preventing the sub-ventricular zone of the brain from maintaining normal nerve function and making new nerves (Frontiers in Neuroscience, May 23, 2018). The study showed that preventing mice from using their legs:
• decreased the number of neural stem cells that become nerves by 70 percent, compared to normally exercising mice,

With aging, you lose nerves and new nerves cells take their place. This study shows that lack of exercise slows down the growth of new nerves. With the loss of nerves comes loss of the muscle fiber innervated by that nerve, so lack of activity causes a progressive weakening of both skeletal and heart muscles. This may explain how inactivity can eventually cause heart failure and kill you, and why diseases that damage nerves that move muscles, such as multiple sclerosis or spinal muscular atrophy, have such high rates of death from heart failure. Many studies on humans have demonstrated that exercise protects your heart:
• Of 1,119,925 people, average age 67, those who exercised less than 30 minutes a day (brisk walking, dancing, gardening) or less than 20 minutes a day of vigorous exercise (running, fast cycling, aerobic exercise) were at 27 percent increased risk for suffering heart and blood vessel problems (European Heart Journal, Nov 8, 2019). Those who increased their levels of activity reduced their risk for heart disease by up to 11 percent, and those who changed from being inactive to becoming moderately or vigorously active three to four times a week were at reduced risk for heart diseases. Disabled people who increased their exercise programs reduced risk for heart disease by 16 percent, and those with diabetes, hypertension, or high blood cholesterol levels who increased their exercise programs reduced their risk for heart disease by 4-7 percent.
• 28,982 patients in heart failure, average age 75.7, received an implanted heart rate monitor and defibrillator, and were followed for five years. Patients were four times more likely to be hospitalized or die within two weeks after they reduced moving about by a half hour a day, or reduced their physical activity by as little as 10 minutes a day (J of the Amer Coll of Card, February 5, 2020).
• Researchers followed 21,758 healthy men over 51 years of age for more than 10 years. Those who exercised regularly long and hard (>3000 MET-min/week) had higher heart calcium scores, showing that they had higher levels of calcium in the arteries leading to their hearts (JAMA Cardiol, Feb 1, 2019;4(2):174-181). High levels of calcium in arteries signify that the plaques are stable and far less likely to cause heart attacks. Heart attacks are not caused by narrowed arteries. They are caused by plaques breaking off from arteries, causing clots to completely block blood flow through an artery. Vigorous exercisers have plaques stabilized by extra calcium that helps to prevent plaques from breaking off, so vigorous exercisers are far less likely to suffer heart attacks than those who do not exercise.

Inactivity Causes Muscle Loss
study from the University of Copenhagen showed that wearing an immobilizing knee brace for just two weeks caused men in their 20s to lose 22-34 percent of their leg muscle strength, and men in their 60s lost 20-26 percent (Journal of Rehabilitation Medicine, June 26, 2015). Six weeks of exercising on a bicycle 3-4 times a week restored leg muscle size and ability to exercise, but did not fully restore muscle leg strength. This study shows that:
• As soon as you stop moving, your muscles begin to weaken.39
• The larger your muscles, the more muscle you have to lose.
• The younger and stronger you are, the faster you lose strength.
Other studies show that it takes three times the amount of time you were inactive to regain the muscle that you have lost, probably because you are inactive for the whole day and you exercise only a short time each day.

Inactivity Linked to Arthritis
People with arthritis should keep on moving, because inactivity worsens arthritis by preventing joints from healing. The majority of people with arthritis are inactive and are often overweight, diabetic or pre-diabetic. The CDC Morbidity and Mortality Weekly Report(November 9, 2018; 67(44);1238–1241) found that 32 percent of adults with arthritis have pre-diabetes or diabetes, 56.5 percent are physically inactive and 50.1 percent are obese.

My Recommendations
With aging comes progressive loss of muscle, including heart muscle. Not exercising as you age speeds up this loss of skeletal and heart muscle, to increase risk for heart attacks, heart failure, diabetes, obesity, arthritis, and premature death. Exercise is just one part of an anti-inflammatory lifestyle that is so important for preventing disease and maintaining your quality of life. Other anti-inflammatory lifestyle habits include:
• following an anti-inflammatory diet that includes lots of vegetables, nuts, beans, whole grains and other seeds, and restricts sugar-added foods, all sugared drinks, meat from mammals, processed meats and fried foods
• maintaining a healthful weight
• avoiding smoke
• avoiding or restricting alcohol
• keeping blood levels of hydroxy vitamin D above 20 ng/mL

Exercise for Both Endurance AND Intensity

  July 20, 2021    

For maximum health benefits, you should work for both endurance and intensity in your exercise program. We have lots of evidence that exercise prolongs lives by reducing risks for chronic diseases such as high blood pressure, heart attacks and diabetes (PLoS Medicine, January 12, 2021), and adding intensity to a workout increases its health benefits (Brit Med J, Oct 7, 2020;371).

A recent study from the University of Guelph in Ontario, Canada suggests that you will gain more health benefits by trying to exercise intensely on some days and doing slower recovery exercise on the other days (Med Sci Sports Exerc, June 2021;53(6):1194-1205). In this study, 23 overweight participants were divided into two groups that exercised on stationary bicycles for six weeks:
• Endurance Group: Five days a week, 30–40 minutes of continuous exercise at about 60 percent of maximal effort
• Intense Intervals Group: Three days a week, 4-6 intervals with each lasting for 30 seconds at almost all-out intensity, with a two-minute recovery between each intervalS

The researchers found that both the endurance group and the intense intervals group had increased heart-lung fitness and ability to control blood sugar levels after eating a meal, but only the endurance group had lower blood pressure, decreased body fat, and ability to control blood fat levels after eating a high-fat meal. This shows us that short bouts of intense exercise alone are not enough; your exercise program should include both some endurance work (time and distance in your activity) and some short bursts of intensity (increased effort).

Stress and Recover
I recommend that exercisers at all levels should follow a stress and recovery exercise program. Competitive athletes need to exercise every day to gain maximum strength, and they know that they have to exercise intensely to improve in their sport. They quickly learn that exercising intensely damages muscles to cause delayed onset muscle soreness (DOMS) and they need to follow each intense workout with less intense recovery workouts.

You will become more fit by taking a hard workout and then going at low intensity for a day or two than you will by exercising at the same leisurely pace every day. You have to damage muscles to gain strength and enlarge muscles. Every muscle is made up of thousands of fibers like a rope is made of many strands. Every fiber is made up of blocks called sarcomeres that fit end to end like a row of bricks. Sarcomeres butt upon each other, end-to-end, at Z-lines (Diagram). Muscles contract only at each Z-line. When you exercise vigorously, you damage these Z-lines and when they heal, the muscle fibers are stronger, so all knowledgeable athletes take some intense workouts to damage their muscles at the Z-lines. On the next day their muscles are sore and damaged and they exercise at a relaxed pace. When the muscles are healed and the soreness lessens, they take their next intense workout. If athletes exercise at low intensity during the healing phase of the Z-lines, their muscle fibers will become stronger than if they rest. If they exercise vigorously when their muscles are sore, they are likely to tear them and become injured.

Non-Athletes Also Should Exercise Every Day
Forty percent of North Americans die of heart attacks. One of the most common causes of the arterial damage that precedes heart attacks is a high rise in blood sugar after meals. Resting muscles remove no sugar from the bloodstream, but contracting muscles remove sugar rapidly from the bloodstream without even needing insulin. This effect is strongest during exercise and diminishes to no benefit about 17 hours after you finish exercising. If you want to use exercise to help control blood sugar, you need to do it every day.

An Exercise Program for Everyone
CAUTION: Because a person with blocked arteries leading to the heart could suffer a heart attack during exercise, please check with your doctor before starting a new exercise program or increasing the intensity of your existing program. Whatever activity you choose, try to exercise every day. If you are just starting out, spend about six weeks at a slow pace until you are comfortable in your activity for thirty minutes or more. Then you are ready to alternate more intense days with easier workouts.

Intense Days: Stress refers to intensity, not the length of your workout. You can gauge the severity of the stress by how hard you breathe and by the amount of burning you feel in your muscles during exercise. Interval training means that you start out slowly, pick up the pace, slow down immediately when your muscles start to burn, recover by going very slowly for as long as you want, and then pick up the pace again.
• On your hard days, warm up by going very slowly for five to 10 minutes. Going slowly at the start of a workout warms up muscles to help make them resistant to injury. If your muscles still feel tired or heavy, do not try interval training. Exercising with tired or sore muscles can cause serious injuries.
• After you warm up, pick up the pace gradually until you feel burning in your muscles and immediately slow down. Then go at a very slow pace until the soreness goes away, your breathing returns to normal and you feel recovered. How long it takes to recover is irrelevant. You take your next faster pick up when you feel that you have recovered, not from any preset time. Then pick up the pace until you feel burning again.
• If you are not planning to compete, you do not ever need to go at 100 percent intensity. People who are just starting to do interval workouts should pick up the pace only slightly and not become short of breath. Slow down and get out of the burn as soon as you feel it. As soon as the burning and fatigue go away, and you are not breathing hard, try to pick up the pace again. In early workouts, you may only be able to do one hard pickup. Do not start your next pick up until your legs feel fresh. As soon as your legs start to feel heavy, stop the workout. Trying to increase the pace when your muscles feel sore, or trying to work through heavy or tired muslces invites injury.

Easy Days: The day after your hard workout, your muscles will probably feel sore and you should take an easy workout. If the discomfort does not go away after you warm up, is worse on one side of your body, or increases as you exercise, stop exercising immediately and cool down. You could be injured and continuing to exercise will delay healing. If you feel better as you exercise casually, continue to exercise until you feel any discomfort or heaviness. Always stop every workout when your muscles hurt or feel heavy. Keep on taking easy days where you exercise at low intensity until you feel fresh again.

My Recommendations
I believe that every healthy person should try to exercise every day. You will gain a much higher level of fitness by “stressing and recovering.” Exercise more intensely on one day and go slowly on the next day or days. Only when your muscles feel fresh should you try to pick up the pace again.

JULY 12

High Blood Sugar After Meals Predicts Heart Attacks

  August 1, 2020  4018  

A review of 129 studies found that tests for a high rise in blood sugar after meals were better than tests of fasting blood sugar levels as a predictor of coronary heart disease, strokes, or death from any cause (British Medical J, July 17, 2020;370:m2297). Having a blood sugar greater than 155 mg/dL one hour after you eat a meal markedly increases your risk for heart attacks, strokes and premature death, even if your fasting blood sugar is normal (Atherosclerosis, Nov 17, 2016;256:15-20). This test is more dependable than HBA1c, the test used by most doctors to diagnose diabetes today (J Clin Endo & Metab, Nov 15, 2018).

More than 30 percent of type II diabetics don’t know that they have diabetes because their fasting blood sugar is normal at less than 100 mg/dL, so their doctor has told them that they are not diabetic. People who have fasting blood sugar levels between 100 and 125 mg/dL are often told that they have “pre-diabetes,” when they are already at very high risk for heart attacks (BMJ,2016;355:i5953). More than seventy percent of people with pre-diabetes eventually develop diabetes (Diabetes Care, 2020;43(Suppl 1):S32-

In my opinion, use of the term “pre-diabetes” is going to kill a lot of people because extensive damage is done to every cell in your body when your blood sugar rises too high after meals, even if your fasting blood sugar level is normal. I believe that you should be told that you are already diabetic and at high risk for all the side effects of diabetes if your blood sugar rises above 155 mg/dl one hour after you eat a meal. Most cases of type II diabetes are caused by inability to respond adequately to insulin, which can be cured with lifestyle changes but not with drugs.

Who Needs to Be Checked for One-Hour-After-Eating Blood Sugar?
People who have any of the following factors should get a blood test for blood sugar one hour after they eat a full meal:
• excess fat (body mass index greater than 25)
• increased belly fat (pinch more than 2 inches of fat underneath your skin near your belly button
• waist circumference in men > 37 inches (94 cm), in women >31 inches (80 cm)
• proportionately small buttocks (an independent risk factor for diabetes)
• smokes or lives with a smoker
• systolic blood pressure >120 at bedtime
• diastolic blood pressure > 90 at bedtime
• high bad cholesterol: LDL >100
• low good cholesterol: HDL <40
• Lp(a), a clotting factor, >30 mg/dL
• C-reactive protein >3 mg/L
• high sensitivity CRP >10 mg/L
• HBA1c >5.6

My Recommendations
Type II diabetes puts you at increased risk for heart attacks, strokes and premature death. Many people do not realize that they are diabetic because their doctors have told them incorrectly that a fasting blood sugar below 100 mg/dL rules out diabetes. Check the risk factors listed above. As part of your yearly check-up, I believe that everyone should get a blood sugar level drawn one hour after they eat a full meal. If it is greater than 155 mg/dL, make immediate lifestyle changes to reverse the damage that has already occurred from high blood sugar and to prevent further damage. We have no drugs that cure diabetes, but most type II diabetes can be prevented or cured with lifestyle changes:
• lose excess weight if overweight
• exercise
• avoid smoking
• avoid or severely restrict alcohol
• eat a healthful diet with plenty of vegetables, fruits, whole grains, beans, nuts and other seeds
• avoid sugared drinks including fruit juices, sugar-added foods and other refined carbohydrates, red meat, processed meats, and fried foods
• keep hydroxy vitamin D levels above 30 ng/mL
See Most Type II Diabetics Could Be Cured with Lifestyle Changes
How Exercise Helps to Prevent Diabetes and Heart Attacks

July 12

Blood Pressure Guidelines

The American Heart Association, the American College of Cardiology and nine other heart health groups agree that you have high blood pressure if your blood pressure is above 130/80, not 140/90 as the previous guidelines recommended (American Heart Association’s annual meeting, November 13, 2017). This means that 46 percent of North American adults now have high blood pressure which means that they are at increased risk for heart attacks, strokes, diabetes and premature death. The new guidelines will triple the number of men under 45 years of age with high blood pressure, and double the number of women under 45 with high blood pressure. Another 40 percent of the population will develop high blood pressure as they grow older.

The blockbuster SPRINT study of almost 10,000 people showed that blood pressures above 130 increase risk for death (N Engl J Med, Nov 26, 2015;373:2103-2116). High blood pressure causes heart attacks, strokes, and kidney disease and puts you at increased risk for developing dementia in later life. High blood pressure is intimately associated with high blood sugar levels after meals, and high blood pressure is one of the criteria for diagnosing diabetes.

Lowering Blood Pressure without Drugs

The majority of people with blood pressures between 120 and 140 have the potential to lower their high blood pressures without taking drugs. If they are sufficiently motivated, they can get their blood pressures to normal with lifestyle changes:

• getting rid of their excess belly fat

• losing excess weight

• exercising daily and growing larger muscles

• avoiding alcohol and smoke

• eating a high-plant diet with lots of vegetables, fruits, whole grains, beans, nuts and other seeds

• limiting or avoiding sugar-added foods and drinks, meat from mammals, processed meats and fried foods

• limiting salt intake

• drinking only water, coffee or tea, with nothing added to them

• keeping blood levels of hydroxy vitamin D above 30 ng/mL

Losing just 10 pounds can reduce systolic high blood pressure by 5 mm of mercury.

Most people who cannot get their systolic blood pressures below 130 with these lifestyle changes will probably be advised to take drugs.

Checking Your Own Blood Pressure

Never let your doctor use a single blood pressure measurement to diagnose high blood pressure. Your blood pressure can rise just because you are in the doctor’s office. It can also rise when you eat, exercise or move around, or when you are startled or afraid. I recommend that everyone should have their own arm blood pressure cuff (wrist cuffs are not very dependable). They are inexpensive and are available at any pharmacy. Every night for at least a week, take your blood pressure when you are ready to go to bed and have been resting for 10-15 minutes. That is when your blood pressure is usually lowest. Keep a record of the readings and take the average after a week. If your systolic blood pressure averages greater than 120, you have high blood pressure and need serious lifestyle changes immediately. Check with your doctor.

Who Should Take Drugs for High Blood Pressure?

People who have high blood pressure plus two or more of heart attack risk factors listed below will probably be advised to take blood-pressure-lowering drugs. Your doctor can examine you and order all of these tests:

• LDL (bad) cholesterol>100

• HBA1C>5.7 (diabetes)

• CRP>1 (inflammation)

• Abdominal obesity

• Small hips

• Resting heart rate >70

• Lp(a)>125 (blood test for a genetic disorder)

• Triglycerides >150 (primarily from dietary sugar)

• HDL (good) cholesterol<40

• Homocysteine>10 (genetic or vitamin deficiency)

• Small LDL particle size (an indicator of diabetes)

• Family history of heart attacks

See my report on Heart Attack Prevention

July 2

Runner’s Heart: The Consequences of Competitive Exercise

Medical researchers agree that exercising from the early years into old age helps to prevent heart attacks, strokes and cancers, but this month a study from The University of Manchester showed that long-term intense training for racing in animals can damage the atrial-ventricular node that regulates the frequency of heart beats to cause heart block (Circulation Research, 2021;129:e1–e20). “Heart block” means that the electrical signals that control your heartbeat are partially or completely blocked as they move from the top chambers of your heart (atria) to the bottom chambers (ventricles).

A training-induced heart block in human athletes is usually harmless and reversible when the athlete stops exercising (Dtsch Arztebl Int, Jan 7, 2013;110(1-2):14–24), but sometimes, such as when competing all-out in endurance sports, heart block is associated with increased risk for atrial fibrillation (J Am Coll Cardiol EP, Sept 2017;3(9):921–928). For example, an 80-year-old non-smoking, non-drinking life-long competitive marathon runner, with a resting heart rate of 40 beats per minute, fell while running and died from a blood clot thrown from his heart to his brain, caused by atrial fibrillation (Am J Case Rep, May 26, 2020;21:e924580). An irregular heartbeat induced by training and racing to an athlete’s limits can be detected by laboratory tests and in rare cases, may be an indication for the athlete to have an implanted heart pacemaker.

The Difference Between Racing and Just Exercising
Competing in endurance sports often requires exercising through pain and discomfort. Contracting skeletal muscles send large amounts of blood back to the heart, which stretches the heart muscle to cause it to beat faster and with greater force (Starling’s Law). When you are just exercising and feel some discomfort, you usually reduce the intensity of your workout to get back into your comfort zone. On the other hand, when you are competing in an endurance event, you try to push yourself through pain and discomfort, which can stretch the heart muscle fibers to near their limits.
• This stretching of the heart muscle can cause damage to the muscle filaments that increases stimulation of the vagus nerve that regulates heart rate, which can cause a slow heart rate (bradycardia) that can sometimes cause atrial fibrillation.
• Atrial fibrillation means that the atrium, the upper part of the heart, starts to flutter instead of contracting before the bottom part of the heart contracts. This allows blood to collect and stop moving in the upper part of the heart, which increases risk for forming clots that can pass to the brain to cause a stroke.

My Racing History
I had to work all through high school, college and medical school, so I never trained seriously for racing until I was in a fellowship at Johns Hopkins in 1963 at age 29. I worked up to running three times a day and competed seriously in races until 1974 at age 39. I trained so hard that I became an expert on running injuries because I had experienced many of them myself. Eventually I found that bicycling was much less likely to injure me, so from age 55 onward, I have tried to ride a bicycle seven days a week and now at age 86, average 150 miles each week. I have never raced on a bike, but I ride hard for about 30 miles on Tuesdays, Thursdays and Saturdays and around 15 miles very slowly on the other four recovery days.

This week I have been saddened by the deaths of two of my running contemporaries: 
• Ron Hill, who died on May 23, 2021 at age 82 of dementia and an overwhelming urinary tract infection. He ran every day for 52 years and had a marathon best time of 2:09:28. In 1968, he set the world record for 10 miles twice (46:44.0); in 1969, he won the European marathon championship; in 1970, he set the Boston Marathon record (2:10:30) and won the Commonwealth Games marathon in a European, British, and Games record of 2:09:28 (Runners’ World, May 4, 2021).
• Dr. Joan Ullyot, who died on June 18, 2021 in Aspen, Colorado at age 80 of a heart attack. She was a pioneer in women’s long-distance running who did not run until she was 30 years old and ran her first marathon in 1974 at age 33. She won the master’s section of the Boston Marathon at age 43 (2:54:17), won 10 women’s marathons, and at age 48 ran the marathon in a women’s masters record 2:47:39. She also wrote and lectured extensively and had several best-selling books on women running in marathons (Runner’s World, June 23, 2021).

As You Age, Balance Intense Exercise with Common Sense
The American Heart Association cites more than 300 scientific articles showing that exercising excessively long and intensely may be associated with heart damage, increased plaque formation in arteries, scarring in the heart itself, markers of heart damage in the bloodstream, or atrial fibrillation (Circulation, Feb 26, 2020). However, a review of 48 articles found no reduction in lifespan, no matter how much a person exercises (Br J Sports Med, Aug 12, 2019).
Can Intense Exercise Increase Your Risk for a Heart Attack?
Vigorous Exercise Won’t Hurt a Healthy Heart

People who suddenly increase the length and intensity of their training may be at increased risk for heart attacks during exercise. This includes people who are starting a new exercise program, or regular exercisers who decide to enter an endurance event such as a marathon or triathlon so they suddenly increase the intensity and duration of their training (Circulation, Feb 26, 2020). CAUTION: Before increasing the intensity of your exercise program, check with your doctor to see if you have any pre-existing conditions such as heart arteries blocked by plaques, or heart or blood vessel abnormalities.

My Recommendations
I believe that with few exceptions, virtually everyone should try to exercise every day. Older athletes can continue to compete into their later years, but they need to remember that preventing heart problems involves more than just exercising. You can help to prevent heart attacks, cancers, dementia and premature death by following an anti-inflammatory lifestyle:
• Eat a plant-based diet that includes lots of fruits, vegetables, whole grains, nuts, beans and other seeds
• Avoid or severely restrict sugared drinks, sugar-added foods, red meat, processed meats and fried foods
• Lose excess weight if overweight
• Keep hydroxy vitamin D levels above 30 ng/mL
• And of course, exercise regularly

JUNE 29

Muscle Loss from Inactivity: 34 Percent in Just Two Weeks

A study from the University of Copenhagen showed that wearing an immobilizing knee brace for just two weeks caused men in their 20s to lose 22 to 34 percent of their leg muscle strength, while men in their 60s lost 20 to 26 percent (Journal of Rehabilitation Medicine, June 26, 2015).

It took them six weeks of exercising on a bicycle 3-4 times a week to restore the leg muscle size and ability to exercise, but even that did not fully restore the leg muscle strength. This study shows that:

• When muscles of young men are immobilized for two weeks, they lose strength equivalent to aging 40 or 50 years.

• As soon as you stop moving, your muscles start to weaken.

• The larger your muscles, the more muscle you have to lose.

• Younger and stronger people may lose strength even faster than older people.

Other studies show that it takes three times the amount of time you were inactive to regain the muscle size that you have lost, probably because you were immobilized 24 hours a day and you exercise for only a short time each day.

Aging Weakens Muscles Even if You Exercise

Inactivity at any age causes muscles to weaken, and you are likely to lose muscle strength with aging no matter how much you exercise. Every muscle in your body is made up of thousands of muscle fibers just as a rope is made up of many strands. Every muscle fiber is innervated by a single nerve fiber. With aging you lose nerves, and when you lose a nerve attached to a muscle fiber, that muscle fiber is lost also. A 20-year-old person may have 800,000 muscle fibers in the vastus lateralis muscle in the front of his upper leg, but by age 60, that muscle would have only about 250,000 fibers. For a 60-year-old to have the same strength as a 20-year-old, the average muscle fiber needs to be three times as strong as the 20-year-old’s muscle fibers. You cannot stop this loss of the number of muscle fibers with aging, but you certainly can enlarge each muscle fiber and slow down the loss of strength by exercising muscles against progressive resistance using strength-training machines or by lifting weights (Experimental Gerontology, August 13, 2013).

How to Strengthen Muscles

To enlarge and strengthen muscles, you need to exercise them against resistance forceful enough to damage the muscle fibers. You will know that you have done this because you will feel a burning in the stressed muscle during the later lifts and on the next day, your muscles will feel sore. Then you lift lighter weights, or engage in other sports, for as many days as it takes for your muscles to heal. You can tell this has happened when the soreness goes away.

My Recommendations

We are all likely to have some enforced periods of inactivity, but if you realize how quickly you lose muscle strength and how much longer it takes to gain it back, you will avoid voluntary inactivity as much as possible. For example, when you plan a vacation, make sure it involves physical activity that is at least equal to your regular exercise program.

As you age, expect to become weaker and more likely to fall and break your bones. To enlarge muscles and slow the natural loss of strength with aging, you should lift weights a few times in a row or lighter weight many times in a row. You can become quite strong by using 10 to 15 strength-training machines (for different muscle groups) three times a week. Do two or three sets of 10 repetitions on each machine. Always stop immediately if you feel any pain, tearing or excessive burning. See Making Muscles Stronger.

Caution: Check with your doctor before starting a new exercise program or changing the intensity of your existing program.

June 21

Dementia May Be Preventable

The American Heart Association has published a scientific statement on “Harnessing Healthy Behaviors to Prevent Dementia” (Stroke, Mar 15, 2021:52(6A);52:e295-e308). They report that dementia is associated with the following modifiable risk factors: depression, all heart attack risk factors, high blood pressure, diabetes, obesity, high cholesterol, physical inactivity, an inflammatory diet, smoking, social isolation, excessive alcohol use, sleep disorders and hearing loss. Changing these lifestyle risk factors can reduce your chances of suffering from dementia.

Studies presented at the Alzheimer’s Association International Conference in 2019 found that specific healthful lifestyle changes can reduce dementia risk (JAMA, published online July 14, 2019), and that even if you have high genetic risk for Alzheimer’s disease, a healthful lifestyle can reduce your chances of developing dementia (Neurology, published online July 10, 2019). This is very encouraging news, since just about every lifestyle risk factor for suffering a heart attack is also a risk factor for dementia (Alzheimer’s & Dementia, May 12, 2018), and we already have extensive data to show that healthful lifestyle factors help to prevent and treat heart disease.

Dementia means loss of brain function, and your chances of being affected increase with age (Neurology,2013;80(19):1778-83):
• 3 percent of those aged 65-74
• 17 percent of those aged 75-84
• 32 percent of those aged 85 or older

Doctors can predict your risk for developing dementia by ordering an MRI which can show decreased volume of grey matter in the brain (Brain Imaging and Behavior, May 9, 2018). Grey matter is where the brain processes speech, hearing, feelings, seeing, and memory. Having low levels of the good HDL cholesterol increases risk for losing brain tissue and developing dementia 20 years later (Brain Imaging and Behavior, September 26, 2018).

More Studies on Lifestyle to Reduce Risk for Dementia
A study from Rush University Medical Center in Chicago (Neurology, published online July 10, 2019) followed 2,765 individuals for 10 years and found that older people can reduce their risk for dementia by as much as 60 percent by:
• actively using the brain every day, by writing, playing chess, doing crossword puzzles and so forth
• eating a healthful diet
• avoiding smoke
• avoiding or severely restricting alcohol
• exercising regularly
Their healthful diet consisted mostly of vegetables, nuts, berries, beans, whole grains, seafood, poultry and olive oil, and avoided red meat and processed meats, butter, cheese, pastries, sweets and fried foods. Their exercise program consisted of at least 150 minutes a week of biking, walking, swimming, gardening, yard work or similar activities.

Another study, from Exeter Medical School in England, found that people at high genetic risk for dementia who followed a healthful lifestyle for six years had a 32 percent reduction in developing dementia (JAMA, published online July 14, 2019). Studies presented at the same meeting showed that smoking and excessive drinking increase dementia risk. Other studies found that:
• Regular exercisers have much higher brain function in later life, and exercising in your teens correlates with higher memory scores in later life (Age and Ageing, Mar 1, 2019;48(2):241-246).
• A long-term diet high in vegetables and fruit in middle and late adulthood was associated with less memory loss in men (Neurology, Jan 1, 2019;92(1):e63-e75).
• Being overweight and carrying extra belly fat was associated with dementia and brain shrinkage (Neurology, Jan 9, 2019).

My Recommendations
You may be able to prevent or at least to delay Alzheimer’s disease and other forms of dementia with healthful lifestyle habits, such as:
• exercising regularly
• eating a healthful, plant-based diet
• avoiding alcohol and smoking
• exercising your brain with any activity that requires thinking
• avoiding overweight
• avoiding or controlling high blood pressure, high cholesterol and high blood sugar
See Aging and Risk for Dementia

Note: In this month’s radio show on WRTA in Altoona PA, I discussed the newly approved drug for Alzheimer’s disease patients (aducanumab, brand name Aduhelm) and many other topics. You can listen here:
https://www.lightnercommunications.com/episode/podcast-dr-gabe-mirkin-june-2021-wrtas-the-11th-hour-with-doug-herendeen/

June 16

Exercise for Endurance AND Strength

If you want to gain maximum benefit from your exercise program, you should try to do both endurance (heart-lung) activities and resistance (muscle strength) training. The usual way to do this is to:

• do your endurance training with an activity that uses primarily your legs, such as running, walking or cycling

• use weight-training machines aimed at strengthening primarily your upper body and core (belly and back).

If your main sport does not focus on your legs, you will want to do some resistance work for leg strength as well.

How to Combine Strength and Endurance Training

Researchers in Australia showed that adding a weight lifting program to cycling or running will help to improve performance only if you know that when your muscles are sore, you have to take the day off or go slow and easy (Sports Medicine, July 2017;1–14).

• After running or cycling very intensely, you need to go slow and easy for more than 24 hours.

• After lifting weights intensely, you should go easy on those muscle groups for several days

If you want to train the same muscle groups for both endurance and strength, you need to use long recovery periods of less intense exercise after each intense workout, or you will be at high risk for injuries and an over-training syndrome of chronic fatigue and muscle damage. You should not exercise at a fast pace or lift heavy weights when your muscles are still sore from a previous workout.  High-intensity interval cycling done after heavy-resistance exercise decreased strength gains because of the soreness it caused (Scand J Med Sci Sports, Sept 23, 2016).

You can set up a schedule for lifting weights every second or third day and alternate running or cycling intensely on one day and easy on the next, but always listen to your body and back off if your muscles hurt. One study showed that in just six days of training the same muscles intensely, your muscles will be so sore that you won’t be able to exercise intensely and you will have a significant decrease in strength (Research Quarterly for Exercise and Sport, Aug 2015;86(4):387-396).

If you are an athlete who competes in total body endurance sports such as rowing, cross country skiing or swimming,  you should do your resistance training on the same day that you take an intense workout.  Then you may need two or three days for recovery.  Cross country skiers and rowers have the highest rates of fitness and modern runners and cyclists are now  following their training methods, with more than 87 percent of their workouts being recovery and about 10 percent being very intense.

My Program (84-Year-Old Man)

• Strength Training: I try to go to the gym three times a week and use the upper-body weight machines. I do only one set with a comfortable weight until my muscles start to fatigue. On most of the machines I do 20 to 100 repetitions. This type of training does not give me large muscles, but it does help me to maintain strength and avoid injuries.

• Endurance: On Tuesdays, Thursdays, and Saturdays, I cycle 25 to 30 miles on a recumbent tandem with Diana in our tandem bicycle group. We do not go flat out but we do pick up the pace at the end of each ride. On the other four days, I attempt to do intervals on my upright single bike. My legs usually feel stiff in the morning. If they do not recover after a 5 to 10-minute warm-up, I either ride 10 to 13 miles at around 11mph or take the day off completely. I usually have to ride slowly two or three times a week because of muscle soreness.

My interval workouts are done fast enough to make me short of breath, but they are not done at my maximum effort. I do 50 half-pedal strokes at about 80 percent of my maximal heart rate.  Each interval takes 24 seconds and I go about 400 yards.  I do not start my next interval until I feel that I have recovered completely from my previous interval. I stop my workout when my legs do not recover a few seconds after I finish an interval. I usually do between 21 to 24 repeat intervals. See Short Intervals are Best

Caution: Intense exercise can cause a heart attack in a person who has blocked arteries or heart damage. Check with your doctor before you start a new exercise program or increase the intensity of your existing program

JUNE 2

Walk Faster, Live Longer

Paul T. Williams, a statistician at Lawrence Berkeley National Laboratory, has followed almost 40,000 men and women who walk for exercise for more than 10 years. His latest report shows that the faster you walk, the longer you live (PLoS One, December 2013). Picking up the pace is more healthful than just walking slowly, even if you go longer than the recommended 30 minutes per day. In his study group, those who walked at a very slow pace (24 minutes per mile) were 44 percent more likely to die in 10 years than those who walked at a faster pace.

Six years ago, the same author showed that among older runners, the faster runners had healthier medical profiles. They had lower blood pressure, lower cholesterol and lower blood sugar levels (Medicine and Science in Sports and Exercise, October 2008).

Intervals: The Best Way to Increase Intensity

The most efficient way to increase intensity and feel less stress on your muscles is to use interval training. When you exercise, pick up the pace for a short period. As you start to feel burning or fatigue in your muscles, slow down. When the burning and fatigue are gone, pick up the pace. When you feel the burning again, slow down. Alternate these pickups and recoveries until your muscles start to feel stiff and then quit for the day.

Intervals Better than Continuous Pace Exercise

Norwegian researchers showed that high intensity interval training improves every conceivable measure of heart function and heart strength and also helps to prevent both the pre-diabetic metabolic syndrome and the heart damage it causes (Exercise and Sports Sciences Reviews, July 2009). Controlled interval training is now a treatment for heart failure. High-intensity interval training:

• raises the good HDL cholesterol far more than less intense exercise does (Journal of Strength and Conditioning Research, March 2009).

• enlarges telomeres, the end caps that protect your chromosomes. The size of your telomeres predicts how long you will live (Proceedings of the National Academy of Sciences USA, Jan 2012).

• increases both the number and size of mitochondria. The larger and more mitochondria, the longer you can expect to live.

• increases VO2max, the maximum amount of oxygen that your body can take in and use. VO2max can be used to predict your likelihood to suffer a heart attack (Med Sci Sports Exerc, November 2011;43(11):2024-30).

Calculate your VO2max

• makes your cells more sensitive to insulin, which in turn helps to prevent diabetes, heart attacks, obesity and certain cancers.

Interval Training Takes Less Time for Greater Health Benefits

To be competitive, all athletes must train very intensely some of the time. Interval training on a bike can provide you with all the health and fitness benefits of exercising less intensely for a much longer period of time (The Journal of Physiology, March 2010). In this study, subjects used a stationary bicycle to do ten one-minute sprints with a one-minute rest between each at 95 percent of their maximal heart rate, three times a week. This takes less effort than an all-out sprint at close to 100 percent of maximal heart rate. The study supports other research that shows that high-intensity interval training improves all the measures of fitness far more than continuous, less intense exercise. The same authors showed that a similar short workout of all-out sprinting at maximal heart rate took about 90 minutes per week (three workouts of 30 minutes each) and was as effective in achieving fitness and health benefits as many hours of exercising at a much more leisurely pace (The Journal of Physiology, September 2006).

More Benefits from Intense Exercise

Intense exercise for older people is still a controversial subject, but it is far more effective than casual exercise in preventing and treating diabetes (Circulation, July 2008) and reducing belly fat (Medicine & Science in Sports & Exercise, November 2008); Vigorous exercise protects obese people from heart attacks and prolongs their lives, even if they don’t lose weight (Medicine and Science in Sports and Exercise, October 2006); Intense exercise is more effective in preventing heart attacks than less intense exercise done more frequently (MSSE, July 1997); Death rate from cardiovascular disease is lowered by high intensity activities such as jogging, swimming, hiking, tennis and climbing stairs, but not by lower intensity activities such as walking, bowling, sailing, golf and dancing (Heart, May 2003).

What Does This Mean for You?

Since exercise can cause heart attacks in people who already have blocked arteries leading to their hearts, you may want to check first with your doctor. If you are not a regular exerciser, start out very slowly and jog, cycle or do your chosen exercise at a very low intensity each day until you feel the least fatigue in your muscles and then stop. If your muscles feel stiff when you start to exercise, take the day off. In six weeks, most people can work up to a half hour a day of very slow exercise.

You are now ready to start training. Your new workouts will start as your old ones did. Start out very slowly. After five or more minutes, you should be warmed up and ready to start training. Pick up the pace for a few seconds and slow down as soon as you start to feel short of breath or burning in your muscles. Go slowly for as long as it takes to recover your breath and for your muscle to feel fresh again. Then pick up the pace again. Alternate these pickups and recoveries until your muscles start to feel tight and then stop for the day. If your muscles feel tight at the start of a workout, take that day off. Tight muscles mean that your muscles have not recovered from a previous workout. You are now training like a real athlete.

MAY 25

Reduce Inflammation and Clotting to Prevent Heart Attacks

Heart attacks and strokes cause 50 percent of the deaths in North America today, yet many people are not adopting the lifestyle changes needed to prevent the factors that cause them: inflammation and clotting. A new study from the University of Michigan shows how important inflammation is as a cause of heart attacks and strokes (JCI, May 28, 2019). In this study, when mice formed clots in their blood vessels, they also had a rise in blood levels of interleukin-1 beta, a cytokine molecule that causes inflammation. Giving the mice an enzyme called CD39, which blocks inflammation by markedly reducing interleukin-1 beta, reduced the size and number of clots that formed in their bodies. Blocking the anti-inflammatory CD39 increased the number and size of clots.

CD39 is an enzyme found on the surface of white blood cells and the inner lining of blood vessels that inhibits inflammation. It is produced by humans, but its use in humans has not yet been tested and it is not an available treatment at this time.

What is Inflammation?

Your immune system is supposed to protect you. When you get an infection, your immune system produces white blood cells and chemicals that attack and kill germs. When you damage tissue, your immune system produces exactly the same white blood cells and chemicals and uses them to heal damaged tissue. As soon as your tissue is healed or the infection is gone, your immune system is supposed to dampen down. However, if your immune system stays on all the time, it can attack your healthy tissue in the same way that it attacks invading germs or injuries. This is called inflammation.

Many studies show that inflammation (an overactive immune system) can cause the clots that cause heart attacks and strokes. Heart attacks are not caused by narrowed arteries. Heart attacks are caused by a plaque breaking off from an artery, followed by bleeding and clotting. Then the clot extends to completely block blood flow to a part of the heart muscle. Inflammation, which is supposed to punch holes in the membranes of attacking germs, also punches holes in the inner linings of arteries to cause plaques to form and then knocks off plaques to cause the bleeding and clotting that leads to a heart attack.

Reducing Inflammation with Lifestyle Changes

Exercise: Exercising muscles help to control after-meal blood sugar rises that damage tissues to cause inflammation. An extensive review of studies shows that exercise can reduce inflammation even more than statins do (Clin Chim Acta, Jun 3, 2010;411(0):785–793).

Weight Loss: Excess fat, particularly in your liver, causes inflammation, and having markers of inflammation can predict future weight gain (Diabetes, 2003 Aug; 52(8): 2097-2101). Apparently healthy people who have elevated blood markers of inflammation are at high risk for developing insulin resistance and diabetes (Circulation, Jul 4, 2000;102(1):42-7) and gaining fat that, by itself, increases inflammation (J Clin Invest, 2005;115(5):1111–1119). I recommend intermittent fasting for weight loss and weight control.

Avoid Toxins: Toxic substances damage cells to cause inflammation, so you should avoid or limit as much as possible your exposure to smoke, alcohol, recreational drugs or unnecessary prescription drugs, industrial chemicals, pollutants and so forth.

Treat Chronic Infections: Having any chronic infection turns on your immune system to cause inflammation (J Clin Invest, May 2, 2005;115(5):1111–1119), so identifying and treating chronic infections should be part of an anti-inflammatory lifestyle.

Anti-Inflammatory Diet: The food that you eat can turn on or turn off your immune system. See Anti-Inflammatory and Pro-Inflammatory Foods. All fruits, vegetables, nuts, whole grains, beans and other seeds contain soluble fiber that is converted to Short Chain Fatty Acids (SCFAs) in your colon. SCFAs dampen down inflammation, and lower high blood pressure and cholesterol.

Drugs to Reduce Inflammation and Clots

We have many studies that show that inflammation can cause clotting and heart attacks in people who have low and normal blood levels of cholesterol. Doctors regularly prescribe anti-clotting drugs to treat or prevent clotting, but statins are often the only drugs they prescribe that treat inflammation. Giving Canakinumab, a drug to block inflammation, to people with high, normal or low blood cholesterol levels has been shown to help prevent heart attacks even though it does not lower cholesterol (N Engl J Med, Sept 21, 2017;377:1119-1131). See Blocking Inflammation to Prevent Heart Attacks

While statins are routinely prescribed to lower cholesterol, reducing inflammation may be their most important function. The Jupiter study reported that giving statin drugs to people who had normal blood cholesterol levels and high levels of inflammation (C-reactive protein) resulted in 54 percent fewer heart attacks, 48 percent fewer strokes, 46 percent fewer angioplasties or bypass operations and 20 percent fewer deaths from any cause, compared with those taking placebos (NEJM, November 9, 2008).

My Recommendations

Inflammation can cause or contribute to heart attacks, strokes, some types of cancers, diabetes, obesity, auto-immune diseases, loss of muscle and bone, and many other diseases and conditions (J of the Am Heart Assoc, May 31, 2019). To a large degree, lifestyle changes can decrease inflammation, whether or not your doctor prescribes drugs

MAY 18

Running and Walking May Be Good for Your Back

People who run or walk regularly have healthier and stronger spinal discs than non-exercisers do (Scientific Reports 7, April 19, 2017). This is very reassuring because some doctors tell patients with back pain not to run because they think that the jarring of the foot striking the ground will damage discs and injure backs, even though there is no good data anywhere to support such opinions. However, if your back hurts when you run, you should stop running.

back.jpg

The vertebral bones of the spine are separated by pads called discs that absorb the shock of hard exercise such as running or lifting weights. The nerves that supply your body pass out from the spine between the vertebral bones where the discs are located. With aging or inactivity, the discs weaken and can be squashed between the much tougher vertebral bones. A squashed disc can protrude between the vertebral bones and may pinch nerves to cause excruciating pain.

Scientists have known for hundreds of years that lack of exercise weakens muscles and bones, while exercise strengthens them (Sports Med, 2016;46:1165–1182), but until recently, no good studies have shown that exercise also strengthens discs. Some doctors believe that rapid movements and pressure will damage discs, but several animal studies show that a regular exercise program strengthens discs (Eur. Spine J, 2011;20:1796–1812), makes discs larger and stronger (Spine, 2012;37:1440–1447) and strengthens discs in rat spines (Spine, 2010;35:1429–1436). Now we have data that a regular exercise program strengthens human discs and is probably the most effective means of treating many cases of back pain caused by weak or damaged discs (Sports Med, 2016;46:473–485). We also have strong MRI data that people who run or walk regularly have larger and stronger discs that contain more fluid to pad and protect them from injury (Scientific Reports 7, April 19, 2017).

Back Surgery Has an Incredibly High Failure Rate

A spinal fusion includes surgery to remove at least part of a disc and a bone graft to fuse the upper vertebral bone to the lower vertebral bone. Many reports show that regular back exercises are usually more effective than this surgery to treat back pain caused by disc compression (Ann Rheum Dis, 2010;69:1643–1648). In spite of this, the number of spinal fusions performed in the U.S increased progressively until 2012. Then the rates of spinal fusions decreased, primarily because Blue Cross of North Carolina and several other insurers refused to pay for the procedure (The Spine Journal, February 1, 2015;15(2):265–271). This implies that the rate that some surgical procedures are done is driven by insurers’ willingness to pay for a procedure.

My Recommendations

• If you have back pain, you should check with your doctor for a specific diagnosis and treatment.

• Specific daily back exercises are the primary treatment for most causes of chronic back pain. Realize that some conditions can be worsened by exercise.

• If you have a condition that is treated with exercise, you should get instructions from a physical therapist who can teach you specific belly and back exercises and how to use exercise machines properly. Improper exercise can worsen your condition.

• Start off with very low resistance and stop immediately for the day if the pain worsens. The best indicator of damage from exercise is pain. Listen to your body.

• Try to exercise every day and do not do anything that increases pain in the injured area.

APRIL 30

Recreational Exercise Better Than Physically Active Jobs

A new study from Denmark shows that while leisure-time physical activity is associated with reduced heart attack risk, occupational physical activity is associated with increased risk (European Heart Journal, April 14, 2021;42(15):1512–1515). The Copenhagen General Population Study followed 104,046 participants for 10 years and found that compared to low levels of leisure-time physical activity, moderate, high and very high volumes of leisure-time physical activity reduced risk for heart attacks and death significantly, but the opposite was true for physical activity on the job. Participants with leisure-time physical activity had a 15 percent reduced risk for heart attacks, while those with heavy physical activity at work had a 35 percent increased risk.

Differences Between Leisure-Time and Work-Time Physical Activity
People who have physically demanding jobs often believe that they do not need to exercise because their work keeps them moving much of the time. However, there are differences between work and leisure activity:
• Recreational exercise is usually more intense and sustained for aerobic endurance, whereas work activity is usually repetitive motions of short duration at low intensity, such as standing for hours, walking up and down steps, moving arms to load boxes and so forth.
• Leisure time exercise improves cardiorespiratory and metabolic fitness and health, while physical activity on the job is associated with fatigue, insufficient recovery, elevated blood pressure and elevated heart rates.
• Heavy manual job workers are more likely to be stressed by noise, air pollution and other poor working conditions, and they may be too tired from their jobs to exercise after work.

Stable Plaques: A Possible Explanation
The authors of the Copenhagen study did not pursue reasons why there would be higher rates of heart attacks among people with high physical activity at work, but here is my opinion. Heart attacks are not caused by plaque buildup on the inner lining of arteries; they are caused by a sudden complete obstruction of the blood flowing to part of the heart muscle. The sudden complete obstruction of blood flow to a part of the heart muscle is usually caused by a plaque breaking off, followed by bleeding where the plaque broke off. Then clots form at the bleeding site, and the clot extends to block completely the flow of blood to the part of the heart muscle supplied by that artery. The part of the heart muscle deprived completely of blood flow then dies, to cause a heart attack.

Older endurance athletes may have more plaques in their arteries than non-exercisers, but they often have the type of plaques that are far less likely to break off to cause heart attacks (Circulation, April 27, 2017;136:138-148; May 2, 2017;136:126-137). They have:
• low 10-year-history risk scores for suffering heart attacks (Framingham study data),
• greater plaque thickness,
• more calcium in their plaques,
• wider and more dilated arteries that are far less likely to be blocked, and
• more stable plaques that are far less likely to break off to cause heart attacks.
A study of 21,758 men, average age 51.7 years, followed for an average 10.4 years, showed that men who exercised the most can have more plaques in their arteries, but did not suffer more heart attacks or deaths than those with less heart artery calcification (JAMA Cardiol, Jan 30, 2019). The least active men with excessive arterial plaques were twice as likely to die of heart disease. Compared to low-level exercisers, the heavy exercisers without increased plaques had half the risk of dying during the study period. See Stable Plaques: Why Exercisers Have Fewer Heart Attacks

How to Measure Plaque Stability
Your doctor can help to predict your risk for a heart attack with a test called a Calcium Score, which is a special CT X ray or sound wave test that measures the thickness of plaques on the inner lining of arteries. A CT scan can also show how stable a plaque is. It can show the difference between stable plaques that are usually safe and those that are unstable and more likely to break off to cause heart attacks (American Journal of Roentgenology, March, 2015;204(3):W249-W260). Signs of plaque stability include extensive calcification, less lipid-rich areas, increased fibrous areas and structural changes.

My Recommendations
We do not know why leisure-time exercise appears to give you stronger protection against suffering a heart attack than having a job that requires you to be physically active. It is my opinion that the recreational activity is usually more intense and sustained than repetitive-motion movements at work and therefore may be more likely to stabilize plaques so they do not break off to cause a heart attack. The Copenhagen study suggests that even if you have a job that involves a lot of physical effort, you should still have a program of recreational exercise that gives you the benefits of aerobic activity.

APRIL 27

Do you have an injury or you know somebody that has an injury a chair work out they can perform keep up their fitness and blood circulating in their body

April 27

Research on Intense Exercise

The more intensely you exercise, the less likely you are to suffer a heart attack, even though heart attacks can be caused by intense exercise in some people who already have irregular heartbeats or blocked arteries leading to their hearts.

• Researchers had 4582 men and women, average age 46, wear mechanical accelerometers to measure their intensity of exercise. After ten years, they found that the more they moved about and the less time they sat without moving around, the less likely they were to develop heart disease and the higher their blood levels of the good HDL cholesterol (Preventive Medicine, published online May 02, 2019). Also, the women who were even moderately active had lower total cholesterols.

• The HUNT study from Norway followed 26,163 healthy men and women, average age 55.7, for an average of 13 years and found that the more fit they were, the less likely they were to develop a first heart attack (Journal of the American Heart Association, April 19, 2019). They found that a high level of fitness was even more protective in the women than in the men.

• The SUN study from Spain followed 18,737 men and women, average age 38, for six years. The researchers found lower rates of heart attacks in those who exercised intensely as opposed to those who exercised at low intensity (American J of Cardiology, Dec 1, 2018;122(11):1871–1878). They used intensity of exercise per time spent exercising to show that those who exercise intensely had half the heart attack rate, compared to those who did the same amount of exercise less intensely.

Exercise to Prevent a Heart Attack

The association between a regular exercise program and improved health is unquestioned (J Clin Prev Cardiol, 2017;6:109-14; Am J Lifestyle Med, July 1, 2009;3(1 Suppl):44S–49S), and a healthful diet in addition to exercise helps even more to help prevent heart attacks and many other diseases (Eur J Prev Cardiol, Jul 2018 ;25(11):1186-1197).

Intensity makes all muscles stronger including your heart muscle. All people lose heart muscle as they age, which increases risk for frailty and heart failure. Strengthening your heart muscle helps you to live a more vigorous lifestyle and to protect you from heart failure. Intense exercise stabilizes plaques in arteries and widens heart arteries to help protect you from a heart attack. Men with the highest ability to take in and use oxygen (VO2max) have the least high blood pressure, high HBA1C (a test for diabetes), high fasting blood sugar levels, obesity, coronary calcium scoring, abnormal treadmill exercise test, and calculated 10-year risk for heart attacks (American J of Cardiology, March 2012;109(6):839-843).

Preventing heart attacks involves both exercising and eating healthfully. Since exercise helps to stabilize plaques to help keep them from breaking off from arteries, exercise should be part of any heart-attack-prevention program. Dedicated exercisers who need to eat large amounts of food to meet their caloric needs should choose healthful, anti-inflammatory foods to avoid forming more plaques in their arteries. Check with your doctor if you have evidence of heart disease caused by a faulty diet: high blood pressure, high blood cholesterol, high triglycerides, high blood sugar, high CRP (c-reactive protein, a measure of inflammation), an abnormal EKG, or chest pain, particularly with exercise.

Can Intense Exercise Be Harmful?

Exercisers live longer and have far less heart damage than non-exercisers. However, elite athletes may be at increased risk for irregular heartbeats, increased arterial plaque size or thickened heart valves.

• Even though master athletes may be at increased risk for irregular heartbeats (atrial fibrillation), they can still benefit from continuing to exercise. Compared to non-exercisers with atrial fibrillation, they appear to be at reduced risk for suffering from serious side effects such as clots. See Irregular Heartbeats in Senior Athletes and Exercisers.

• Elite athletes may be at increased risk for larger plaques in their arteries than non-exercisers, but narrowing of arteries by plaques does not cause a heart attack. Heart attacks are caused by plaques breaking off from arteries, and exercise helps to prevent heart attacks by making plaques more stable and less likely to break off. See Exercisers Have More Stable Plaques.

• Vigorous exercisers may be at increased risk for thickened heart valves, but compared to non-exercisers, athletes with thickened heart valves still have stronger heart muscles so that they are less likely to suffer heart failure. See Exercise to Prevent a Heart Attack

My Recommendations

I think everyone should have a regular exercise program, and it is never too late to start. See How to Start an Exercise Program.

• Before you try to increase the intensity of your exercise program, you should have exercised regularly for many months, be in good shape and not have any health conditions that can harm you. Because intense exercise can cause heart attacks in susceptible people, you may want to check with your doctor before increasing the intensity of your workouts.

• Try to set up your exercise program so that you increase the pace enough on an intense day to feel mild muscle soreness on the next day. Then take easy workouts for as many days as it takes for the soreness to go away. Only then should you take your next hard workout.

• When you are training properly, your muscles can feel sore every morning. If they don’t feel better after a 10 minute warm-up, take the day off.

• If you feel pain in one spot that does not go away after you slow down, stop that workout immediately for that day. Otherwise you are likely to be headed for an injury.

CAUTION: Intense exercise can cause a heart attack in a person who has blocked arteries or heart damage. Check with your doctor before you start a new exercise program or increase the intensity of your existing program.

APRIL 23

Exercise Every Day or Every Other Day?

The old guideline recommending 30 minutes of exercise three times a week just isn’t enough, according to the latest research. Athletes know that they need to work out every day, and all people who just want to stay healthy can benefit from the same type of exercise program.

Why Athletes Need to Exercise Every Day

Knowledgeable athletes train by stressing and recovering. You have to damage muscles to gain strength and enlarge muscles. You become more fit by taking a hard workout and then resting for a day or two than you will by exercising at the same leisurely pace every day. Every muscles is made up of thousands of fibers like a rope is made of many strands. Every fiber is made up of blocks called sarcomeres that fit end to end like a row of bricks. Sarcomeres butt upon each other, end-to-end, at Z-lines.

Muscles contract only at each Z-line. When you exercise vigorously, you damage these Z-lines and when they heal, the muscle fibers are stronger. So all athletes train by stressing and recovering. On one day, they take an intense workout to damage their muscles at the Z-lines. On the next day their muscles are sore and damaged and they exercise at a relaxed pace. When the muscles are healed and the soreness lessens, they take their next intense workout.

If athletes exercise at low intensity during the healing phase of the Z-lines, their muscle  fibers will become stronger than if they rest. If they exercise vigorously when their muscles are sore, they are likely to tear them and be injured. Athletes need to exercise every day to gain maximum strength.

Why Non-Athletes Also Should Exercise Every Day

Forty percent of North Americans die of heart attacks. One of the common causes of the arterial damage that precedes heart attacks is a high rise in blood sugar after meals. Blood sugar always rises after meals and because of faulty lifestyle habits, most North Americans have blood sugars that rise too high. Resting muscles remove no sugar from the bloodstream, but contracting muscles remove sugar rapidly from the bloodstream and can do so without even needing insulin. This effect is strongest during exercise and diminishes to no benefit after about 17 hours. If you want to use exercise to help control blood sugar, you need to do it every day.

An Exercise Program for Everyone

Because a person with blocked arteries leading to the heart could suffer a heart attack during exercise, please check with your doctor before starting a new exercise program. Whatever activity you choose, try to exercise every day. If you are just starting out, spend about six weeks at a slow pace until you are comfortable in your activity. Then you are ready to alternate more intense days with easier workouts.

Intense Days

Stress refers to intensity, not the length of your workout. You can gauge the severity of the stress by the amount of burning you feel in your muscles during exercise. interval training means that you start out slowly, pick up the pace, slow down immediately when your muscles start to burn, recover by going very slowly for as long as you want, and then pick up the pace again.

On your hard days, warm up by going very slowly for five to 10 minutes. Going slowly at the start of a workout warms up muscles to help make them resistant to injury. If your muscles still feel tired or heavy, do not try interval training. Exercising with tired or sore muscles can cause serious injuries.

After you warm up, pick up the pace gradually until you feel burning in your muscles and immediately slow down. Then go at a very slow pace until the soreness goes away, your breath returns to normal and you feel recovered. How long it takes to recover is irrelevant. You take your next faster pick up when you feel that you have recovered, not from any preset time. Then pick up the pace until you feel burning again.

If you don’t compete, you do not ever need to go at 100 percent intensity. People who are just starting to do interval workouts should pick up the pace only slightly and not become short of breath. Slow down and get out of the burn as soon as you feel it. As soon as the burning and fatigue go away, and you are not breathing hard, try to pick up the pace again. In early workouts, you may only be able to do one hard pickup after you have just started your workout. Do not start your next pick up until your legs feel fresh. As soon as your legs start to feel heavy, stop the workout. Trying to increase the pace when your muscles feel sore and heavy invites injury.

Easy Days

The day after your hard workout your muscles will probably feel sore and you should take an easy workout. If the discomfort does not go away as you continue to exercise, is worse on one side of your body, or increases as you exercise, stop exercising immediately. You are injured and continuing to exercise will delay healing. Take off the next day also if you still feel sore in one place. If you feel better as you exercise casually, continue to exercise until you feel any discomfort or heaviness. Always stop every workout when your muscles feel heavy or sore. Keep on taking easy days where you exercise at low intensity until you feel fresh again. Do not do another hard workout until the soreness in your muscles has gone away.

My Recommendations

Every healthy person should try to exercise every day. You will gain a much higher level of fitness by “stressing and recovering”. That means to exercise more intensely on one day, feel sore on the next and go slowly. Only when your muscles feel fresh should you try to pick up the pace again.

April 19

Don’t Use Aspirin or NSAIDs for Muscle Pain from Exercise

  May 5, 2019  6255  

Some athletes and exercisers take pain medication (aspirin or NSAIDs) because they think it may prevent muscle soreness or will help them to heal faster after a workout. However, taking pain medicines before or during exercise will not block pain, help you to exercise longer or recover faster from exercise. They can increase risk for bleeding and damage to muscles, tendons or kidneys, and they can also delay muscle recovery from exercise. I believe that you should not take aspirin or NSAIDs (nonsteroidal anti-inflammatory drugs) before, during, or soon after exercising unless your doctor specifically recommends that you need to take them.

• Aspirin increases risk of bleeding into your stomach, brain, or any area that is bumped in an accident. Aspirin kills as many people by causing major bleeds as it saves by preventing heart attacks (JAMA, Jan 22, 2019;321(3):277-287). Caution about stopping daily aspirin: Do not stop taking aspirin suddenly. If you want to stop taking aspirin after taking it for a while, your doctor will tell you how to gradually taper your dose.
• NSAIDs do not block the muscle burning you feel when you exercise intensely (Med Sci in Sports and Exercise, Aug 1997;29(8):0999-1012). When you exercise intensely, you run low on oxygen which causes lactic acid to accumulate in muscles to cause muscle burning. The only way that you can stop this muscle burning during intense exercise is to slow down to allow lactic acid to be cleared.
• NSAIDs taken the next day may reduce delayed-onset muscle soreness (DOMS), but do not increase the rate of recovery from exercise (J Strength Cond Res, Feb 2003;17(1):53-9).
• NSAIDs reduce new muscle protein synthesis after intense exercise (Am J Physiol Endocrinol Metab, Mar 2002;282(3):E551-6), and reduce muscle growth after intense exercise (Sports Med, Dec 1, 2012;42(12):1017-28).
• Aspirin decreases protein synthesis after exercise (J Biol Chem, April 2007;282(14):10164-71).
• Taking NSAIDs after injuries delays healing (South African Medical Journal, Jun 6, 1995;85:517-522), and taking NSAIDs for several weeks after a fracture delays the healing of broken bones (J Orthop Trauma, May 1995;9:392-400).

Common types and brands of NSAIDs include ibuprofen (Motrin, Advil), indomethacin (Indocin), ketoprofen (Ketoprofen) and naproxen (Aleve, Anaprox, Naprelan, Naprosyn).
Also see NSAIDs Interfere with Exercise Training
NSAIDs May Block Gains in Endurance and Strength

APRIL15

Exercise and the Gut Microbiome

The hottest area of research in medicine today is about the bacteria in your colon called the microbiome. More and more studies show that exercise, in addition to a healthful diet, helps to increase the numbers of healthful bacteria in your colon that may prevent or treat obesity, diabetes, heart attacks, inflammation and even certain cancers (Ex and Sport Sci Rev, April 2019;47(2):75-85).

More than 100 trillion microorganisms live in your body (FEMS Microbiol Rev, 2014;38:996-1047) and weigh two to five pounds (PLoS Biol, Aug 19, 2016;14(8):e1002533). Of the more than 1000 different types of bacteria that live in your colon, some are healthful while others can be harmful (Nature, Jan 23, 2014;505(7484):559–563). The healthful bacteria are content to eat what you eat as food passes through your intestines, so they stay in your colon and do not try to cross into your cells and bloodstream. Healthful colon bacteria can form metabolites that help to prevent obesity, diabetes, heart attacks and even depression. On the other hand, the harmful bacteria are not happy with your food supply so they try to find food somewhere else by invading the cells lining your colon. Your immune system responds by producing proteins and cells that attack and try to kill the invading bacteria. If the invading bacteria continue to try to penetrate your cells day after day, your immune system stays active all the time. This is called inflammation. The same antibodies and cells that are supposed to kill invading germs can attack and damage your arteries to cause plaques to form, and can damage your DNA to cause cancer (PLoS One, Apr 13, 2017:12(4):e0176062). The harmful bacteria can also convert nutrients in your colon to other chemicals that can be harmfuland cause diseases.

Exercise Can Increase Good Bacteria in Your Colon
In 2016, researchers showed that exercise increases the number of healthful gut bacteria in mice and decreases the numbers of harmful ones (PLoS One, Mar 8, 2016;11(3):e0150502.) A later study showed that just six weeks of exercise markedly increased levels of healthful gut bacteria in humans, and after the study subjects stopped exercising, the levels of healthful gut bacteria dropped to their previous lower levels (Med Sci Sports Exerc, Apr 2018;50(4):747-757).

There are many theories on how healthful gut bacteria dampen inflammation to help prevent disease (Gut Microbes, Mar 4, 2018;9(2):115-130). Healthful intestinal bacteria:
• convert soluble fiber in your colon into short chain fatty acids (SCFAs) that dampen inflammation, lower high cholesterol and blood pressure, and help you lose excess weight (Diet Microbiome Health, 2018:299–345).
• markedly reduce pro-inflammatory cell-signaling proteins and increase anti-inflammatory ones, as well as antioxidant enzymes (Exercise and Sport Sciences Reviews, April 2019;47(2):75-85)
• lower high blood sugar to help prevent diabetes (Annual Rev Med, (2011) 62:361–80)
• increase mucus production to help protect the colon linings from harmful bacteria
• increase intestinal motility (J Neurogastroenterol Motil, 2012; 18(1):64–9) and push gas through (Am J Med, 2004; 116(8):536–9) to move food faster through the intestines and help to prevent constipation
• increase the circulation of bile acids from the liver; accumulation of bile acids increases inflammation (J Hepatol, 2013; 58(5):949–55).

My Recommendations
You can help to prevent heart attacks and certain cancers by adopting a lifestyle that promotes the growth of healthful bacteria in your colon and reduces inflammation:
• Try to exercise every day
• Eat a plant-based diet with lots of vegetables, fruits, whole grains, beans, nuts and other seeds
• Restrict pro-inflammatory foods, such mammal meat, processed meats, fried foods, and drinks with sugar in them
• Avoid being overweight
• Avoid smoke and alcohol

APRIL 5

More Reasons to Exercise as You Grow Older

Muscles are made up of thousands of muscle fibers just as a rope is made up of many strands. Each muscle fiber has a nerve that innervates it. 

With aging you can lose nerve fibers that, in turn, cause you to lose the corresponding muscle fibers, but exercising against resistance will make the remaining muscle 

fibers larger so they can generate more force.

A recent experiment measured the force that a rat’s muscle fiber generates when it is electrically stimulated at the nerve or at the muscle. 

Electrically stimulating the muscle directly showed that the muscles of young rats generated 40 percent more force than those of old rats. On the other hand, when t

he nerve endings were stimulated electrically for five minutes, the muscles of the old and young rats generated the same amount of force. 

The authors suggest that loss of strength with aging is primarily due to loss of nerve function rather than just muscle function (Experimental Gerontology

March 2018). The repetition of a regular and consistent training program teaches your brain how to contract your muscles more efficiently.

Researchers at the University of Guelph have another explanation why people, even those who exercise regularly, 

lose muscle size and strength as they age. They showed that aging causes loss of mitochondria, the tiny furnaces in 

cells that turn food into energy (Cell Reports, March 13, 2018). This causes the accumulation of breakdown 

products called Reactive Oxygen Species (ROS) that delay healing and weaken muscles (Cell Metabolism

March 2017;25(3):581–592).

More New Studies on Muscle Growth for Older People

• Osteoporosis: Lifting weights helps to strengthen bones of postmenopausal women who suffered from os

from increasing their intake of protein above the current RDA (recommended dietary allowance) of 0.8 gm/kg of body weight/day. Even older men who are taking extra testosterone 

do not gain any extra strength or muscle growth from increasing their intake of protein to 1.3 g/kg/day (JAMA Internal Medicine, April 2018).

• High-Plant Diet after Menopause: Older women who follow a Mediterranean-type diet (based on 

plants, with fish but restricting red meat and added sugars) have larger muscles and bones after the 

menopause than women who eat the typical Western diet (ENDO 2018, the Endocrine Society 

annual meeting in Chicago, March 19, 2018).

• Recovery Time: Older people who do strength training need to realize that their muscles 

will not heal as fast from workouts as muscles of younger people because aging causes their mitochondria

 to become smaller in number and size (Cell Metabolism, March 2017;25(3):581–592).

Starting a Resistance Program

The most effective way to slow down the loss of muscle strength with aging is to start a resistance 

exercise program that includes using strength training machines or lifting weights. A review of 25 well-designed 

and performed scientific studies shows that resistance training can grow larger and stronger

 muscles in older men and women (Sports Med, Dec 2015;45(12):1693-720). Older people who 

use strength training machines two or three times a week can make themselves stronger to decrease their risk for 

falling, breaking bones, and suffering osteoporosis, arthritis, heart attacks, diabetes, and premature death (Am J Prev Med

Oct 2003;25(3 Suppl 2):141-9). See Slowing Loss of Bone and Muscle Strength with Aging

Before you start a new weight training program, check with your doctor and get expert advice 

from a trainer so you can learn proper lifting techniques for the equipment you will be using. 

Most beginners will be far more successful on weight lifting machines, rather than using free weights. 

The machines are safer because they can guide the way you move the weights with the specific muscles for each machine.

How to Make Muscles Stronger

Just exercising does not make a muscle stronger. The stimulus to make a muscle larger 

and stronger is to exercise that muscle against resistance to the point where you 

feel a burning in that muscle. However, if you continue to exercise after you start 

to feel that burn, you run the risk of injuring the muscle, so most older people 

can prevent injuries by stopping each set of lifting as soon they feel a burn in their muscles. 

You can exercise to the burn by using heavy weights with few repetitions or by using lighter 

weights with more repetitions. Older people gain the most strength by doing more sets 

of lower repetitions per set than using fewer sets with higher numbers of repetitions 

Per set (Experimental Gerontology, March 29, 2018;108:18-27). The lighter the weight you use, 

the more repetitions you have to do to feel the burn. For example, several sets of three repetitions

 each is safer than performing fewer sets of the same weight with sets of 10 repetitions. For more detailed suggestions see Strength Training Guidelines from Dr. Richard Winnett of Virginia Tech.

My Recommendations

Aging can take away much of your quality of life unless you keep your muscles strong 

enough to perform all of your daily activities. A regular strength training program will 

help you to move faster, walk with more security, be less likely to fall and hurt yourself, 

and have more confidence in every movement of your body.

CAUTION: People with blocked arteries leading to their hearts can suffer heart attacks 

with exercise. Check with your doctor before starting a new exercise program or increasing the intensity of your current program.

APRIL 2

Too Much Intense Exercise May Harm You

Exercising regularly helps to prevent disease and prolong lives, and exercising intensely can prevent disease and prolong lives even more (PLoS Medicine, January 12, 2021). However, a study from Karolinska Institute suggests that exercising intensely too often can harm your health, and perhaps even shorten your life (Cell Metab, Mar 13, 2021;S1550-4131(21):00102-9). This study showed that people who tried to do intense workouts on an almost daily basis developed severe damage to their mitochondria that markedly:
• reduced their ability to exercise by reducing their maximum ability to take and use oxygen, and
• increased their risk for suffering high blood sugar levels and diabetes by making their cells less responsive to insulin.

Mitochondria are chemical structures inside your cells that help to turn food into the energy needed to drive biochemical reactions. When participants in this study reduced the frequency of their intense workouts, their mitochondria recovered and their health and training problems disappeared.

Stress and Recover — The Basic Rule for Exercisers
Every healthy person should exercise by stressing and recovering because you gain more health benefits and a higher level of fitness by exercising more intensely on one day, feeling a little sore on the next day and then going at a slow pace for as many days as it takes for your muscles to feel fresh again.

Stress Days: On your stress day, warm up by starting out at a very slow pace, and then alternate a series of going a little harder and faster until you feel a slight burning or tightness in your muscles. Immediately slow down and go at a slow pace until you feel fresh again. In the beginning, you may want to pick up the pace for only 5 to 10 seconds (“intervals”). As you improve, you can work up to 30-second “intervals” at your harder pace. For non-competitive exercisers, you don’t ever need to stay in an intense “interval” for more than 30 seconds. You then go at a slow pace for as long as it takes for you to breathe normally and for your muscles to feel fresh again. When your muscles feel fresh, you can pick up the pace and slow down immediately when you feel a burning or tightness in your muscles again. Novice cyclists can do 5 to 10 pedal strokes, and then go slow for as long as they need to recover. Novice runners can start out by taking only 5 to 10 running steps. Swimmers can do short bursts of their favorite stroke, and so forth for any activity you choose. Continue to alternate these slight pickups of intensity until your muscles stop feeling better as soon as you slow down. Eventually you may want to work up to 30-second intervals. At your peak, your stress workout can include a 10 minute warmup, a maximum of 30 minutes of intervals, and a 5 to 10 minute cool-down.

Recovery Days: Your recovery days (“easy days”) will always be governed by how you feel. On the day after a stress day, your muscles will probably feel slightly sore and you are supposed to recover by going at a very slow pace. The muscle discomfort is called Delayed Onset Muscle Soreness (DOMS). You warm up by going very slowly, and if your muscles don’t feel more comfortable after a 5-10 minute warm up, take the day off altogether.
• If your muscles feel better after your warmup, go at an easy pace for as long as you like and stop your workout when your muscles feel any protracted discomfort. You are never supposed to work through pain. Always stop if you feel fatigue or muscle tightness or discomfort.
• Continue to take slow recovery days for as many days as it takes for your muscles to feel fresh after you warm up for 5-10 minutes. Only then should you take your next hard stress day workout. Most exercisers follow each stress day with one to three or more recovery days before they take their next intense workout.

How Often Should You Do A Stress Day?
Non-competitive exercisers can gain significant health benefits, such as lowered high blood pressure and body fat, with just one intense workout a week followed by six days for slow recovery workouts. You can harm yourself by doing stress workouts too often. In one study, exercisers who worked out intensely three times a week for six weeks did not lower their high blood pressures or body fat as much as those who exercised more casually five times a week. (Med Sci Sports Exerc, Dec 11, 2021).

You will recover faster from a hard workout by doing nothing at all, but going slowly on your recovery days causes more fibrous tissue to form in your muscles so that they are more resistant to injury.

How Can You Tell If You Are Exercising Too Much?
Most competitive athletes learn sooner or later that when they exercise intensely too often, they may suffer an overtraining syndrome in which they can’t train or race at all. There are no laboratory tests that will tell you that you are overtraining. You should take days off, or markedly reduce your workouts, if you suffer:
• any injury
• muscle soreness that does not go away after you warm up
• continued difficulty falling asleep or staying asleep
• continued loss of appetite
• continued fatigue or loss of energy
• recurrent or prolonged infections
• any illness (check with your doctor)
• a persistent increase in resting heart rate of more than 10 beats per minute
• decreased muscle strength, endurance, or ability to perform and recover from your regular workouts

If you are a competitive athlete who is suffering from overtraining, you need to go back to background work. These principles apply to any sport. For a runner, jog on the days that you can, and take days off when you feel sore. After several weeks, you will be able to start regular jogging and your muscles will feel fresh again. When this happens, you are ready to start training, but first you must promise yourself that you will never try to run fast when you feel soreness in your muscles and tendons. Set up a schedule in which you take a hard-fast workout, feel sore on the next day, and then go at an easy pace in your workouts until the soreness has completely disappeared. You may try to take a hard workout every third to seventh day, but skip a hard workout on any day that you still feel sore after you warm up.

My Recommendations
Exercise helps to strengthen your heart, prevent disease and prolong lives, and intense exercise one or more times a week increases these benefits. However, you should know the signs and symptoms of exercising too much and the warning signs of damage from excessive exercise. Non-competitive exercisers can do very well on one day a week of intense intervals followed by six days of easy exercise.

Caution: Check with your doctor before you start or increase the intensity of an exercise program, particularly if you have chest pain, heart attack risk factors or heart problems.

MARCH 30

How to Prevent Wear-and-Tear Injuries

You can help to prevent wear-and-tear injuries from any type of exercise by warming up, by stopping exercise when you feel pain and by not exercising intensely when your muscles feel heavy or sore. Muscles are made of millions of individual fibers. When you first contract a muscle, you use only one percent of the fibers. As you continue to exercise, you contract more fibers to share the load, which places less force on each fiber and helps to prevent injuries. Always warm up. Go slow before you go fast. If you take a hard workout and feel sore the next day, go easy on every day that your muscles continue to feel sore after you have warmed up. It usually takes at least 48 hours for muscles to recover from hard exercise. When you feel pain in one muscle during exercise, that’s a signal that it may be starting to tear and you should stop exercising for that day.

Runners Get More Injuries

If you think that football is the sport with the most injuries, you are wrong. Each year, 79.3 percent of long-distance runners suffer injuries that force them to take time off from running (Br J Sports Med, Aug, 2007;41(8):469-80). The most-injured part is the knee and the chance for an injury increases with running longer distances and having previous injuries. Injuries occur most often after a rapid increase in weekly distance, intensity, or frequency of hill or track workouts (Sports Med, 1996. Jan;21(1):49-72).

A survey of participants in a Rotterdam marathon found that:

• 55 percent of the runners had suffered serious injuries during the year before the marathon

• 15.6 percent of the runners reported at least one new lower extremity injury in the month before the race

• 18.2 percent reported injuring their legs during the marathon

• Immediately after the marathon, runners reported severe pain in two to four different parts of their legs

• One week later, most felt well enough to go back to work, even though almost all had painful muscles (Scand J Med Sci Sports, April, 2008;18(2):140-4).

Why Running Causes So Many Injuries

When you run, one foot is always off the ground, so each foot strikes the ground with a force equal to three times body weight (at 6-minute-mile pace) and the faster you run, the greater the force of each foot strike. Walking is much safer. When you walk, you always have one foot on the ground, so the force of a walking foot strike almost never exceeds your body weight. To convince yourself, place your hands on the huge quad muscles in the front of your upper leg while you run. Each time your leg strikes the ground, you will feel the muscle shake like jelly.

A study from the University of Wisconsin-La Crosse shows that as people start to feel tired during running, they shorten their strides and this decreases the force of their foot striking the ground (Medicine and Science in Sports and Exercise, Dec 1999;31(12):1828-33). The shorter stride lessens the force of their heel striking the ground and places it forward to the area behind the big toe. To compensate for the decreased force of their feet hitting the ground, they move their legs at a faster cadence. You can use this information to help you prevent injuries when you run. Shortening your stride will help to protect you from injuries by shifting your foot strike force forward. You can keep your speed by moving your legs at a faster cadence.

When You Need To Take a Day Off

The most common cause of injuries is not listening to your body when it talks to you. Every wear-and-tear injury you have had probably gave you signals long before you were injured. Most exercisers who are training properly have sore muscles every day when they wake up in the morning. However as they start to exercise, the soreness goes away and their muscles feel good. On days when your muscles do not feel better after you start to exercise, take the day off. If you are exercising and you feel discomfort in one or more non-symmetrical areas, stop exercising and take the day off. Pain in one area, such as a leg, and no discomfort in the other leg, is a strong warning of impending injury that could still be prevented.

Understanding How to Train Helps to Prevent Injuries

I think it is unwise to do the same workout at the same intensity every day because:

• it will not give you the same health benefits as a stress/recover training program,

• it will not make you a better athlete,

• it may increase your chances of injuring yourself,

• it will not help you to lose as much weight as you may want, and

• it makes no sense.

To strengthen your heart and increase your ability to take in and use oxygen, you have to exercise intensely enough to feel muscle burning and become somewhat short of breath. That stresses your muscles also. To make a muscle stronger, you need to exercise vigorously enough to damage it. You go a little faster on one day, damage the muscles and feel sore on the next day. This delayed-onset muscle soreness (DOMS) is evidence that you have damaged muscles. The soreness is a sign that you should spend that day exercising at a more relaxed pace and not put much pressure on your healing muscles.

In a stress/recover training program, you should set up your schedule to go a little faster with more intensity on one day, feel sore on the next day and go at low intensity for that day and as many additional days as it takes for the soreness to go away. Then, when the soreness is gone, you exercise more intensely again.

Arches and Running Injuries

Runners with high arches are at increased risk for suffering stress fractures, small cracks in the bones of their feet and lower legs. Those with low arches are at increased risk for knee cap pain. Your legs are shocked by the force of each foot hitting the ground, and the faster you run, the harder your foot strikes the ground. This force can break bones, damage joints and tear muscles. To protect yourself from this tremendous foot-strike force, your leg is designed so that you never are supposed to land flat-footed when you run. Almost all people land on the outside (lateral) bottom of the foot and roll inward toward the medial side where the big toe is. This is called pronation and helps to distribute the force of your foot strike throughout your foot and leg and protect you from injury. The further you roll inward, the greater the protection against this force. However, when you roll in too much, your lower leg twists inward excessively, causing your kneecap to rub against the long femur bone behind it and cause pain. Pain behind the kneecap is called Runner’s Knee which is one of the most common running injuries.

If you have pain behind the knee cap during running or walking, ask your podiatrist to look at your feet. If your arches appear to be flat, you usually will have a normal arch, but you roll inward so far that your arch touches the ground. Flat feet usually means that your foot rolls inward so far that the arch rolls all the way to touch the ground. If you have flat feet and no pain, you do not need to do anything. However if you have pain anywhere from your feet all the way up to your lower back, the treatment is to place special inserts called orthotics in your running shoes. You can also do special exercises that strengthen your vastus medialis muscle that pulls your knee cap inward.

If you develop pain in the medial side of your lower leg or your feet, your podiatrist will probably order a bone scan to check for stress fractures, small cracks in the bones of your feet. If you have stress fractures, you should stop running for a while and ride a bike, which causes no road shock. When you can run without feeling pain, you can start running again, but you should take shorter strides to decrease the force of your foot striking the ground. If you have high arches, you probably are not pronating enough to reduce the force of your foot strike. You can reduce the force of your foot strike by shortening your stride.

Strengthening Muscles Helps to Prevent Injuries

A study from Sweden showed that pre-season strength training for the hamstring muscles helped to prevent injuries to those muscles (Scandinavian Journal of Medicine & Science in Sports, 2003;13(4):244-250). Hamstring tears are very common soccer injuries, so players from two of the best soccer teams in Sweden were divided into two groups: a group that received specific hamstring training for 10 weeks, using a special device twice a week to overload the hamstrings eccentrically, and a control group that received no special training. The trained group had less than one third the hamstring injuries and also had greater improvement in hamstring strength and running speed. Muscles are injured when the force on them is greater than their inherent strength, so they tear. Resistance training makes muscles stronger so that they can withstand greater forces and therefore helps prevent injuries.

My Recommendations

• Do not do the same exercise at the same intensity every day. Use the hard/easy principle: faster on one day and much slower on the next.

• Always go much slower for several minutes before you go faster.

• If your muscles do not feel fresh after you have warmed up for a few minutes, take the day off.

• Stop exercising immediately if you feel pain in one area that worsens with exercise.

• Whatever your sport, understanding the principles of training helps to prevent injuries.

Caution: Almost everyone should exercise. Check with your doctor before you start a new exercise program or increase the intensity of your existing program. Blocked arteries leading to your heart can cause a heart attack during exercise.

MARCH 25

Muscle Cramps: Prevention and Treatment

Muscle cramps occur most often at night when you are sleeping, but they also can occur when you exercise vigorously, tear a muscle, or keep one leg in an awkward position, such as sitting in a chair in the same position for a long time. Muscle cramps are classified into those that occur during exercise and those that can occur at any time not related to exercise, usually at night.

Cramps That Occur During Exercise
Lack of electrolytes is a more common cause of muscle cramps during exercise than lack of water (BMJ Open Sport Exerc Med, Mar 5, 2019;5(1):e000478). Electrolytes are minerals that are essential for body functions, including sodium, potassium, calcium, bicarbonate, magnesium, chloride, and phosphate. Having low blood levels of sodium (salt) is a well-known cause of muscle cramps (Clin J Am Soc Nephrol. 2007;2:151–161). Dehydration, by itself, is a far less common cause of cramps (Br J Sports Med, 2013 Jul;47(11):710-4). You can be salt deficient and still have normal blood levels of electrolytes.

Researchers in Australia studied runners who drank either plain water or an electrolyte solution before and after exercise. They found that the runners were at increased risk for suffering muscle cramps when they drank plain water, probably because water dilutes the electrolyte concentration in the body and doesn’t replace what they lost through sweating (J Int Soc Sports Nutr, Mar 15, 2021;18(1):22). In this study, 10 men ran multiple sessions on a downhill treadmill in a hot (95 degree F) room for 40 to 60 minutes, to sweat enough to lose 1.5-2 percent of their body weight (about two pounds). They were then tested before, immediately after and 40 minutes after exercising, with two trials: first, drinking plain water; and second, drinking an electrolyte solution. The tests used a special device that electrically stimulated their calf muscles enough to cause muscle cramps. The runners developed muscle cramps on much lower electrical stimulation frequencies after drinking plain water than after drinking the electrolyte solution. These results suggest that lack of electrolytes is more likely to cause muscle cramps than just lack of water (dehydration).

Cramps are more likely to occur in hot weather because muscles fatigue earlier with higher temperatures. Cramps are more likely to occur during intense exercise that requires you to use your fast twitch strength fibers that fatigue earlier than your slow twitch endurance fibers.

Night-Time Leg Cramps
Up to 60 percent of North American adults suffer from occasional night-time leg cramps, a sudden painful contraction usually of the calf muscles that can last from a few seconds up to 10 or more minutes. Doctors do not know what causes these cramps, but most of the time, they are not caused by dehydration or lack of minerals. The leading theory is that most night-time leg cramps are caused by lack of a normal nerve reflex that causes a muscle fiber to relax when it is held in contraction (J Sports Sci, 1997 Jun;15(3):277-85). That is why people who suffer recurrent leg cramps should be checked for:
• all conditions that can cause nerve damage, including lack of vitamin B12 and diabetes
• all conditions that can cause blood vessel damage such as arteriosclerosis
• partially obstructed blood vessels
• pinched nerves in the back
• muscle damage
• abnormal mineral levels
• abnormal hormone levels such as low thyroid
• kidney disease
• arthritis
• dehydration
• use of several medications such as statins, birth control pills, diuretics, steroids, asthma medication such as albuterol, raloxifene, naproxen, or teriparatide (BMJ Clin Evid, 2015:1113).
If you have recurrent night-time leg cramps, check with your doctor.

What Causes Leg Cramps?
When you turn during sleep, you contract your calf muscles which stretches their tendons. This stimulates nerve stretch receptors in the tendon and sends a message back to the spinal cord, telling the calf muscles to contract. After you contract a muscle, reflex messages are sent along nerves to the spinal cord to relax that muscle. If the message to relax that muscle is blocked, the muscle stays contracted and you develop a cramp. Cramping during sleep is usually due to an exaggeration of the normal muscle reflex that causes the muscle to stay contracted and hurt. Older people and those who do not exercise are at increased risk for leg cramps because they have smaller and weaker muscles.

Preventing Night-Time Leg Cramps
If you do not have a serious cause, you can often prevent night cramps by:
• exhausting the stretch reflex before you go to bed by stretching your calf muscles (using wall pushups or a similar exercise)
• applying a heating pad for 10 minutes before you go to sleep
• starting a regular supervised exercise program to strengthen your calf muscles. If you are a non-exerciser, I recommend a stationary bicycle.

The only drug that has been shown to be effective in preventing night-time leg cramps is quinine (Brit Med J, Jan 7, 1995;310(6971):13-17), but the U.S. Food and Drug Administration stopped over-the-counter marketing of this remedy because of concerns about irregular heartbeats. Doctors can still prescribe quinine pills for relief of leg cramps, but since they can cause birth defects and miscarriages, they should never be taken by a pregnant woman. Quinine can also cause ringing in the ears, headache, nausea, disturbed vision, chest pain, asthma and other problems. Some people may benefit from calcium channel blockers, such as amlodipine, or Carisoprodol (a muscle relaxer that blocks pain).

Treating a Leg Cramp
When you get a leg cramp, stop whatever you are doing and try to gently walk it out while you massage the contracted muscle with your hands. Never put force on the contracted muscle because you may tear it. If the cramp continues, apply cool compresses, which can relax the contracted muscle and numb pain. Keep on gently massaging the muscle.

My Recommendations
Most leg cramps are harmless, but frequent muscle cramps can be a sign of serious medical conditions. If you suffer leg cramps only during exercise, eat salty foods or drink electrolyte solutions, not plain water, before and after you exercise. If that doesn’t stop the cramps, you need a complete medical work up. People who suffer frequent night-time leg cramps that do not respond to the simple steps listed above also need a detailed medical work up. Check with your doctor.

MARCH 16

Why World Records in Endurance Sports Events Keep Getting Faster

On May 6, 1954, Roger Bannister ran the first sub-four-minute mile. In the 66 years since that world record was set, more than 1600 men have run sub-four-minute miles (Track & Field News, May 2019). The current world record is 3:43.13.

The incredible improvement in world records in endurance events in all sports is mostly due to changes in training techniques, with workouts that are now so intense that they cause a lot of muscle fiber damage and the athletes have to spend more days doing slower recovery workouts. For example, 50 years ago, endurance runners would run fast interval workouts twice a week and also race or run long distances fast. That meant that they usually ran intervals on Tuesday and Thursday and a long run or race on weekends. They would allow only one day to recover from an interval workout. Today the interval workouts are so brutal that the athletes usually allow at least two days for slow recovery workouts after each intense day, so they are doing more intense workouts less often.

What are Intervals?

In intervals, you run a short distance very fast, slow down until you recover your breath, and then repeat alternating the very fast runs followed by much slower recovery runs until your muscles feel stiff and sore. For example, a top runner may run a quarter mile in 60 seconds, followed by a slow jog for an eighth of a mile and repeat it 12 or more times. That means that they are training at 4-minute-mile race pace.

Lack of Oxygen is the Limiting Factor

The limiting factor to how fast you can move over distance is the time it takes for oxygen to go from your red blood cells into your muscles. When you run fast, your muscles use large amounts of oxygen to burn carbohydrates, fat and protein for energy. You get most of the power to move your muscles from each of several successive chemical reactions, called the Krebs cycle. If you can get enough oxygen to meet your needs, food you have eaten is converted all the way to carbon dioxide and water that you blow off from your lungs when you breathe out. However, if you run so fast that your lungs cannot supply all the oxygen that you need, the series of chemical reactions slows down, you start to accumulate large amounts of lactic acid in your muscles, and the lactic acid spills over into your bloodstream. The lactic acid and carbon dioxide make your blood acidic and the acid burns your muscles to make them feel hot and painful. (Your non-exercising muscles do not burn because they are not accumulating large amounts of lactic acid inside their cells). You then try desperately to breathe hard enough to get rid of the acidity in your blood by taking in enough oxygen to get rid of the excess lactic acid and blow off the excess carbon dioxide that is accumulating in your blood.

Competitive Runners Must Run Up Severe Oxygen Debts in Training

Running fast enough to cause severe oxygen debts in training helps you to:

• tolerate higher blood levels of lactic acid,

• strengthen your heart and lungs so you can bring in more oxygen to your muscles, and

• help your muscles to convert lactic acid to be used as energy to fuel your muscles.

George Brooks at the University of California in Berkeley has shown that lactic acid is the chemical that requires less oxygen to power your muscles than any other source of fuel (Cell Metab, 2018 Apr 3;27(4):757-785). The marked accumulation of lactic acid in your muscles during training causes muscles to use more lactic acid as their primary source of energy in races. Lactic acid requires less oxygen than almost anything else to power your muscles, so by doing this, your muscles require less oxygen and you catch up on your oxygen debt. This neutralizes the acidity in your blood, so your muscles stop burning and hurting and you can pick up the pace.

Getting Your Second Wind

The muscle burning and shortness of breath caused by the accumulation of lactic acid forces you to slow down. We used to think that “second wind” meant that you slowed down to allow yourself time to recover from your oxygen debt, but research from the University of California in Berkeley gave another explanation (Fed Proc, 1986;45:2924-2929). After you slow down briefly, you feel better and could pick up the pace because the same lactic acid that caused the burning in your muscles and shortness of breath could be used as an efficient source of energy for your muscles. Since lactic acid requires less oxygen to power your muscles than most other sources of energy, you catch up on your oxygen debt, the concentration of lactic acid in your muscles drops, the burning and gasping lessens, you feel better and you can pick up the pace. Of course, when you keep on pushing the pace, you can again accumulate large amounts of lactic acid in muscles, which will make them burn and hurt again (Am J of Physiol-Endocrin and Metab, June 2006).

Using This Information to Have Greater Speed and Endurance

Since you can move faster in races by increasing the rate of forming and removing lactic acid, you should train intensely enough to accumulate large amounts of lactic acid in your body. Exercising with high blood levels of lactic acid stimulates your body to make more enzymes that turn lactic acid into a source of energy and strengthens your heart to be able to pump more oxygen to your exercising muscles. That is why virtually all athletes in sports that require speed over distance use some form of high intensity interval training.

You also need to eat carbohydrate-rich foods to be able to increase the meager amount of sugar that you can store in your muscles and liver. Carbohydrates are the source of the sugar, glucose, that is converted to the energy-efficient lactate during exercise. Lactate is used as a very oxygen-efficient fuel during exercise and also helps to replenish liver sugar stores during exercise.

MARCH 12

Weight Lifting for Middle-Aged and Older People

A resistance exercise program can help to slow the loss of muscle fibers and improve mobility as people age (Physiol Rev, Jan 1, 2019;99(1):427-511). Lifting weights or using Nautilus-type resistance training machines will strengthen your skeletal muscles, help to prevent broken bones from falls, and make your heart stronger to reduce risk of heart failure. Running, walking, riding a bicycle or playing tennis will not prevent the loss of muscle strength and size that occurs with aging. After age 40, most people lose more than eight percent of their muscle size per decade and by age 70, the rate of muscle loss nearly doubles to 15 percent per decade, markedly increasing risk for disability and disease (Am J Epidemiol, 1998;147(8):755-763).

Virtually all middle-aged and older people should do some form of resistance exercise, since extensive data show that having weak arm and leg muscles:

• increases risk for diabetes, heart attacks and premature death (British Medical Journal, Sept 2009; J of Phys, Sept 2009)

• is associated with smaller and weaker upper and lower chambers of your heart (J Am Geriatr Soc, Dec 2019;67:2568-2573)

• predicts death in people who have chronic heart failure (Cardiology, March 25, 2019). Heart failure means that the heart became too weak to pump adequate amounts of oxygen to the brain.

How to Build Muscle Without Injuries

When middle-aged and older people start a weight lifting program, they often get injured, usually because they try to train like young people who pick the heaviest weight they can lift ten times in a row and do three sets of ten lifts. They feel sore for the next few days and when the soreness goes away, they lift heavy weights again, usually two or three times a week. This type of training almost always injures older novice weight lifters and ends their training program. The best way for middle-aged and older people to prevent injuries is to lift lighter weights. You can gain almost the same muscle growth and strength by lifting a lighter weight many times as you do by lifting a heavier weight fewer times (J Appl Physiol, Jul 1, 2016;121(1):129-3).

Why You Lose Muscle Strength and Size with Aging

Muscles are made up of hundreds of thousands of individual fibers, just as a rope is made up of many strands. Each muscle fiber is innervated by a single motor nerve. With aging, you lose motor nerves, and with each loss of a nerve, you also lose the corresponding muscle fiber that it innervates. For example, the vastus medialis muscle in the front of your thigh contains about 800,000 muscle fibers when you are 20, but by age 60, it probably has only about 250,000 fibers. However, after a muscle fiber loses its primary nerve, other nerves covering other fibers can move over to stimulate that fiber in addition to stimulating their own primary muscle fibers. Lifelong competitive athletes over 50 who train four to five times per week did not lose as many of the nerves that innervate muscles and therefore retained more muscle size and strength with aging than their non-athlete peers (The Physician and Sportsmedicine, October 2011;39(3):172-8).

How Muscles Become Stronger

Each muscle fiber is made of a series of blocks called sarcomeres that are lined up end to end. Each sarcomere is attached to the one next to it at a “Z line.” Muscle fibers do not contract equally along their lengths; they contract only at each “Z line”. 

 To strengthen a muscle, you have to put enough force on the muscle to damage the Z-lines, as evidenced by bleeding and swelling into the Z-lines. You can tell you have damaged the Z-lines by the feeling of muscle soreness that begins 8 to 24 hours after you have lifted weights or done any form of resistance exercise. That is the time it takes for the swelling to occur in the Z-lines. This is called Delayed Onset Muscle Soreness (DOMS). Exercising your muscles intensely enough to damage them makes muscles stronger so they can withstand higher loads and be more resistant to injury.

When a muscle is damaged, your immune system sends to the damaged tissue large amounts of the same cells (lymphocytes) and chemicals (cytokines) that are used to kill germs when you have an infection. This causes inflammation, characterized by soreness (pain), increased blood flow to the injured fibers (redness), and increased flow of fluid into the damaged area (swelling). The immune cells release tissue growth factors to heal the damaged muscle fibers, and you should allow the muscle soreness to decrease or disappear before exercising intensely again. Muscle fibers become larger and increase in number by splitting to form new fibers. If you do not wait until the soreness goes away before exercising intensely again, the fibers can be torn, the muscles weaken and you can become injured.

A Rule for Gaining Muscle Size and Strength As You Age

Inexperienced weight lifters over 40 should not try to lift very heavy weights because that increases your chances of injuring yourself. Remember, it is recovery from damage to muscle fiber Z-lines that causes muscles to become stronger, so you can gain just about the same muscle growth and strength by lifting a lighter weight many times as you do by lifting a heavier weight fewer times (Dtsch Arztebl Int, May 2011;108(21):359-364). This type of resistance exercise can significantly increase muscle size and strength in older people

How to Start Your Resistance Training Program

If you are not already doing strength training, check with your doctor to make sure you do not have any condition that may be harmed by exercise. Then join a gym and ask for instructions on how to use the weight-training machines. On each machine, pick the weight that you can comfortably lift and lower 10 times in a row, without straining or hurting your muscles. Then move on to the next machine. End the workout immediately if you feel severe pain or if you have pain that does not go away as soon as you stop lifting the weight.

Take the next day off and return to the gym 48 hours later. If your muscles still feel sore 48 hours after your first workout, wait until the soreness is gone before you return to the gym. Try to use 15-20 of the strength training machines every other day or every third day. As you become stronger and the weights feel very easy for you, try to lift 15 times in a row, then perhaps 20 times. Only when you can lift that weight at least 20 times in a row, and not feel sore the next morning, should you try to increase the resistance by going to the next heavier weight on that machine.

The key to this program is to avoid injuring your muscles by lifting weights and increasing the number of repetitions gradually so that you do not cause muscle soreness that lasts longer than a day. You should not increase the weight (resistance) until you can lift a set of at least 20 repetitions on each machine without feeling sore the next morning.

My Recommendations

• Before you start any new exercise program, check with your doctor to rule out any conditions that might be aggravated by weight lifting.

• This program is designed for beginners and is intended to prevent injuries that plague older people when they first try to lift weights. It will not build very large muscles, but it will increase your strength and provide all of the other benefits of a weight training program. After many months (injury-free) on this program, if you wish to build larger muscles, you can transition to a more traditional weight training program; see Strength Training Guidelines. Otherwise, you can continue with this safe and effective program of resistance exercise for the rest of your life.

MARCH 5

Running and Walking May Be Good for Your Back

People who run or walk regularly have healthier and stronger spinal discs than non-exercisers do (Scientific Reports 7, April 19, 2017). This is very reassuring because some doctors tell patients with back pain not to run because they think that the jarring of the foot striking the ground will damage discs and injure backs, even though there is no good data anywhere to support such opinions. However, if your back hurts when you run, you should stop running.

back.jpg

The vertebral bones of the spine are separated by pads called discs that absorb the shock of hard exercise such as running or lifting weights. The nerves that supply your body pass out from the spine between the vertebral bones where the discs are located. With aging or inactivity, the discs weaken and can be squashed between the much tougher vertebral bones. A squashed disc can protrude between the vertebral bones and may pinch nerves to cause excruciating pain.

Scientists have known for hundreds of years that lack of exercise weakens muscles and bones, while exercise strengthens them (Sports Med, 2016;46:1165–1182), but until recently, no good studies have shown that exercise also strengthens discs. Some doctors believe that rapid movements and pressure will damage discs, but several animal studies show that a regular exercise program strengthens discs (Eur. Spine J, 2011;20:1796–1812), makes discs larger and stronger (Spine, 2012;37:1440–1447) and strengthens discs in rat spines (Spine, 2010;35:1429–1436). Now we have data that a regular exercise program strengthens human discs and is probably the most effective means of treating many cases of back pain caused by weak or damaged discs (Sports Med, 2016;46:473–485). We also have strong MRI data that people who run or walk regularly have larger and stronger discs that contain more fluid to pad and protect them from injury (Scientific Reports 7, April 19, 2017).

Back Surgery Has an Incredibly High Failure Rate

A spinal fusion includes surgery to remove at least part of a disc and a bone graft to fuse the upper vertebral bone to the lower vertebral bone. Many reports show that regular back exercises are usually more effective than this surgery to treat back pain caused by disc compression (Ann Rheum Dis, 2010;69:1643–1648). In spite of this, the number of spinal fusions performed in the U.S increased progressively until 2012. Then the rates of spinal fusions decreased, primarily because Blue Cross of North Carolina and several other insurers refused to pay for the procedure (The Spine Journal, February 1, 2015;15(2):265–271). This implies that the rate that some surgical procedures are done is driven by insurers’ willingness to pay for a procedure.

My Recommendations

• If you have back pain, you should check with your doctor for a specific diagnosis and treatment.

• Specific daily back exercises are the primary treatment for most causes of chronic back pain. Realize that some conditions can be worsened by exercise.

• If you have a condition that is treated with exercise, you should get instructions from a physical therapist who can teach you specific belly and back exercises and how to use exercise machines properly. Improper exercise can worsen your condition.

• Start off with very low resistance and stop immediately for the day if the pain worsens. The best indicator of damage from exercise is pain. Listen to your body.

• Try to exercise every day and do not do anything that increases pain in the injured area.

MARCH 2

Statin Drugs and Exercise

The evidence is overwhelming that statin drugs do help to lower cholesterol and to reduce risk for heart attacks. However, one study confirms that statins interfere with the ability to exercise and to compete in sports, even in patients who report no symptoms (J Clin Endocrinol Metab, 2018;103(1):75-84). Statins cause muscle damage and reduced ability to exercise by decreasing the number and function of muscle mitochondria, the energy sources for muscles during exercise. This study agrees with others showing that statins interfere with a person’s ability to compete in sports (J Am Coll Cardiol, 2013;62(8):709–714). Up to 30 percent of patients who take statins suffer muscle pain or torn muscles (Eur Heart J, 2015;36(17):1012–1022), and people who exercise are far more likely to complain of muscle pain, muscle injuries and fatigue while taking statins (Br J Clin Pharmacol, 2004;57(4):525–528).

The Study

Twenty people who had taken statin drugs for many years were included in this new study. Ten suffered muscle pain and undue fatigue during exercise, while ten reported no symptoms during exercise or at rest. The authors used the following tests:

• maximal incremental cycling test,

• involuntary electrically stimulated isometric quadriceps muscle contractions, and

• biopsy of the vastus lateralis muscle.

Both groups had the same maximal endurance and maximal ability to take in air and use oxygen. However, compared to people who had never taken statin drugs, those who took statins (whether they reported symptoms or not) had:

• decreased anaerobic threshold (muscle pain and burning during exercise because of the accumulation of lactic acid in muscles from lack of oxygen),

• prolonged muscle relaxation time (delayed recovery from exercise),

• decreased rate of maximal force rise during exercise (loss of strength),

• reduced numbers of mitochondria in their muscles, and

• in the symptomatic statin takers only, reduced activity of mitochondria (decreased ability for muscles to use oxygen during exercise).

This shows that, compared to people who never took statins, the people who took long-term statins tired earlier during maximal exercise because they had lost some of their ability to take in and use oxygen, since their mitochondria could not use oxygen as efficiently to turn food into energy to power their muscles. This suggests that statins interfere with a person’s maximum ability to exercise long and hard, even in people who have no complaints.

My Recommendations

If your bad LDL cholesterol is above 100 or you have other factors that increase risk for a heart attack, most guidelines recommend that you take statin drugs to help protect you from suffering a heart attack. However, statin drugs come at a price. They can cause muscle pain and damage and can interfere with your ability to exercise. If you are a competitive athlete, they can interfere with your ability to compete at your best.

Studies show that strict lifestyle changes can be as effective as statins in lowering high blood levels of the bad LDL cholesterol and reducing your risk for a heart attack. I recommend that everyone, whether they take statins or not, should:

• follow a diet that is rich in vegetables, fruits, whole (unground) grains, beans, nuts and other seeds

• restrict or avoid sugared drinks and sugar-added foods, mammal meat, processed meat, fried foods, and refined grains (foods made from flour or white rice)

• avoid being overweight

• try to exercise every day

• keep blood levels of hydroxy vitamin D above 20 ng/dL

• avoid smoke, alcohol and recreational drugs

MARCH 1

Cyclists Age Better

Two exciting studies show that older men and women who have cycled for many years do not have the markers of aging found in non-exercising people (Aging Cell, March 8, 2018). Their muscle size and strength, amount of body fat, levels of hormones such as testosterone, and blood cholesterol levels were close to those of much younger people. Their maximal ability to take in and use oxygen was more like that of people in their twenties than in non-exercisers of their own age group. Incredibly, the cyclists’ immunity did not show the deterioration that is expected with aging. These studies focused on cyclists, but similar results would probably be found with other types of sustained exercise.

The Studies

Researchers from London and Birmingham, England, studied the same groups of people with one study concentrating on muscles and the other on the immune system. The participants were 125 amateur cyclists (84 men, 41 women) aged 55-79 years. These were not elite athletes; to qualify for the study, the men had to be able to cycle at least 60 miles in 6.5 hours, and the women, 36 miles in 5.5 hours (a moderate pace of less than 10 miles per hour for the men and 6 1/2 miles per hour for the women). All of the participants had been cycling regularly for most of their adult lives, with an average of 26 years. These cyclists were compared to 75 healthy non-exercisers aged 57-80, and 55 younger non-exercisers aged 20-36. The authors excluded all people who were smokers or heavy drinkers or had high blood pressure or medical problems.

Amazing Benefits in Immunity

With aging, the thymus gland in the front of your upper chest shrinks and progressively loses some of its ability to make T-cells that help to protect you from developing cancers and infections. The most surprising news from this study is that the thymus glands of the older cyclists produced as many T-cells as those of the young people.

T-cells recognize foreign proteins on the surface of invading germs and cancers to tell your immunity to attack and kill these cells. They then stimulate your immune system to make antibodies to attach to and kill invading germs and cancer cells, and produce chemicals called cytokines that activate other T-cells to remove germs and cancer cells from your body. Other regulatory T-cells dampen down your immunity so that your immunity does not attack and destroy your own healthy cells.

Larger and Stronger Muscles and Better Use of Oxygen

The authors took muscle biopsies from the vastus lateralis muscle in the front of the cyclists’ upper legs, the muscles strengthened most by cycling. The cyclists’ muscles did not show the expected signs of aging:

• drop in muscle size,

• drop in mitochondrial protein content, and

• decrease in ability to take in and use oxygen.

Their muscles did show a decrease in capillary blood vessel density. The cyclists’ maximal ability to take in and use oxygen, move air in their lungs, and develop muscle power (wattage) were like those of the much younger people.

Loss of Muscle Size and Strength with Aging

All people, even regular exercisers, can expect to lose muscle size and strength as they age. Researchers at the University of Guelph in Canada have offered a new explanation (Cell Reports, March 13, 2018). All muscle fibers contain many mitochondria, small furnaces that turn food into energy. However, this process of providing energy for muscle cells produces end products called Reactive Oxygen Species (ROS), also known as free radicals, that damage parts of muscle cells and are directly responsible for the loss of muscle fibers with aging. Muscles normally use another chemical called ADP to rid themselves of ROS. This study shows that everyone loses muscle fibers with aging because older muscles lose some of their ability to respond to ADP and as a result, they accumulate higher levels of ROS which cause the permanent destruction of muscle fibers with the resultant loss of muscle size and strength. However, the muscles of older regular exercisers are able to clear excess ROS far more efficiently than the muscles of non-exercisers, so they have less loss of size and strength.

Exercise Helps You to Live Longer, Even If You Already Have Heart Disease

Another new study reviewed 30 years of records of 3,307 adults who had had heart attacks or angina (pain from blocked arteries leading to the heart). Those who exercised at least a little bit were 36 percent less likely to die during the study period (J of the Am Coll of Card, March 2018;71(10)). Weight loss without exercising did not reduce their death rate. This study agrees with another study of more than 15,000 heart disease patients that also showed that exercise helps to prevent death in people who have already had heart attacks (J of the Am Coll of Card, October 2017;70(14:). Moderate activities can include walking, gardening, ballroom dancing, water aerobics or casual cycling. Vigorous exercise includes cycling faster than 10 miles an hour, jogging or lap swimming, according to the American Heart Association.

My Recommendations

These studies show that many of the accepted signs of aging come from lack of exercise, not just from getting older. Regular vigorous exercise as you age helps you to maintain healthful qualities of your younger days so that you will have a healthier and more active later life. Exercise helps to prevent disease and death, even if you have not been a life-long exerciser. Everyone should maintain a daily exercise program. It does not have to be intense to prolong your life. If you have existing health problems or questions, consult with your doctors about any limitations that may apply to you.

FEB 18

Resting Heart Rates Can Be Too High or Too Low

Your resting heart rate should average between 50 and 70 beats a minute. Athletes can have rates between 30 and 50 and still have healthy hearts, and your heart rate temporarily can go above 70 when you are sick, stressed or sleep deprived, but all people who have persistent resting heart rates greater than 70, non-athletes who have heart rates below 55, and anyone with a heart rate below 60 with heart palpitations, fainting , dizziness or other symptoms may want to check with a doctor. Resting heart rates greater than 70 are associated with increased risk for diabetes (Int J Epidemiol, Jun 2010;39(3):900–906), heart attacks, certain cancers and premature death (CMAJ, Oct 18, 2016;188(15):E384–E392).

The Research

• More than 6000 men were followed for more than 25 years. Those with resting heart rates greater than 73 beats per minute were 140 percent more likely to die from cancer than those with resting heart rates of less than 60 beats per minute (PLoS ONE, published online August 03, 2011).

• Of more than 53,000 men followed for almost 30 years, those with resting heart rates greater than 80 beats a minute were far more likely to suffer heart attacks and cancer than those with fewer than 60 beats a minute (Mayo Clinic Proceedings, 12/12/2013).

• 58 obese men and women exercised five times a week at 70 percent of their maximum heart rate for 45 minutes. In just 12 weeks they lowered their resting heart rates by five to nine beats per minute (Br J Sports Med, 2009; 43: 924-927).

• The Copenhagen Study of 3,000 men followed for 16 years found that those with a resting heart rate between 71 and 80 beats per minute were at a 50 percent elevated risk of death, between 81 and 90 beats per minute had double the risk, and resting heart rates over 90 beats per minute tripled the risk (Glob Cardiol Sci Pract, Oct 9, 2015;2015(3):33). Furthermore, high resting heart rates were associated with lower levels of physical fitness, higher blood pressure, overweight, and higher levels of circulating blood fats. The authors concluded that “a high resting heart rate is not a mere marker of poor physical fitness, but is an independent risk factor for disease.”

A High Resting Heart Rate May Predict Heart Disease

A strong heart pumps lots of blood with fewer beats, while a weak heart has to beat more often to pump the same amount of blood. A high resting heart rate may indicate that arteries are blocked or that there is heart muscle damage so the weakened heart has to pump more often to circulate oxygen to your body.

How a High Resting Heart Rate Relates to Cancer

Telomeres are the end caps of chromosomes that help to protect them from being destroyed when a cell reproduces. The longer your telomeres, the less likely you are to develop cancer, and people who exercise regularly have longer telomeres. Exercise also helps to protect the body from inflammation, a risk factor for cancer. The more intensely you exercise, the lower the heart rate and the greater the protection against inflammation.

How to Check Your Resting Heart Rate

To find out your resting heart rate, check your pulse when you first wake in the morning, before you get out of bed. You can use a heart rate monitor, a blood pressure cuff that includes a pulse check, one of the many fitness trackers that have a heart rate feature, or any watch that shows seconds. If you have a smart phone you can download a free heart rate monitor app. Set your device on your bedside table the night before so you do not have to move around when you wake up. If you are using a watch, place your fingers on the side of your neck where you feel a strong heartbeat. Count the beats for ten seconds and multiply by six. Do this for several days and take an average.

My Recommendations

A morning resting heart rate consistently over 70 is often a warning signal that you have a weak heart and may be headed for serious disease. If your resting pulse rate is over 70 beats per minute and you are not sick or taking stimulants, check with your doctor, particularly if you also have:

• LDL cholesterol greater than 100,

• blood sugar greater than 145 mg/dL one hour after eating,

• systolic blood pressure greater than 120 at bed time, or

• a C-reactive protein greater than 10 mg/L.

Athletes often have exceptionally low heart rates indicating a strong heart, but in non-athletes a low heart rate can be caused by damage to the heart’s electrical conduction system or muscle. If you have a resting heart rate of less than 60 and are not a regular exerciser, or if you are regular exerciser and have a bedtime systolic blood pressure greater than 120 or below 90, chest discomfort, dizziness or fainting, a bad LDL cholesterol greater than 100, or any possibility of an irregular heartbeat, you should check with your doctor.

FEB 12

Testosterone for Older Men

Medical journals have reported trials that examine the benefits and harms of taking testosterone for men over 65 with low blood levels of testosterone (less than 275 ng/dL). At 12 study sites across the country, a total of 790 participants were given testosterone gel or a placebo applied daily to the skin. Most of these men had low testosterone due to aging, not due to damage to the testicles or brain where testosterone levels are controlled. Over a year, investigators measured the effects of testosterone on:

• bone density and strength

• anemia

• heart health

• cognitive function

• sexual function

Bone Density and Strength: Testosterone increased bone density and strength in 200 older low-testosterone men (JAMA Intern Med, February 21, 2017). These increases were greater in the spine than in the hips.

Anemia: Testosterone raised hemoglobin levels by at least 1 g/dL in nearly 130 men with anemia (JAMA Internal Medicine, Feb 21, 2017).

Heart Health: Testosterone increased plaques significantly in the arteries leading to the heart likely to increase risk for heart attacks (JAMA, 2017;317(7):708-716). However, another study of more than 44,000 men with low testosterone showed that three years of testosterone gel reduced heart attack rate by 25 percent compared to those given placebos (JAMA Internal Medicine, Feb 21, 2017). The effects of testosterone on heart attack risk are controversial.

Cognitive Function: Testosterone did not improve memory or other brain functions including verbal memory, visual memory, executive function or spatial ability in 500 men with age-associated memory loss (JAMA, 2017;317(7):717-727).

Sexual Function: Improvement in sexual function is the benefit most strongly supported by research studies. However, having low testosterone levels does not determine whether a man will respond to erection-increasing drugs such as tadalafil in older men with enlarged prostates and erectile dysfunction (J Sex Med, May 2016;13(5):843-51).

A review of several other studies showed that testosterone gel can improve depression, bone mineral density, energy, libido, erectile function, muscle mass, insulin resistance, and lower urinary tract symptoms (Curr Opin Urol, Mar 2016;26(2):152-7). Testosterone treatment did not appear to increase a man’s risk of developing an enlarged prostate.

Testosterone Is Often Given to Men Who Will Not Benefit from its Use

A study from Baylor Medical School shows that more than 85 percent of men treated with testosterone do not have any disease caused by low testosterone. Most of the men suffer from adult-onset hypogonadism associated with chronic medical conditions such as diabetes, metabolic syndrome, arteriosclerosis and obesity. They do not have a deficiency of testosterone caused by damaged testicles or brain hypothalamic and pituitary glands that cause low testosterone. They should be treated for these conditions and not take testosterone, which may increase their risk for future heart attacks (Mayo Clinic Proceedings, June 24, 2016).

My Recommendations

• Men with normal blood levels of testosterone (>300) should not take testosterone since it may increase risk for heart attacks, liver damage and shutting down their own natural production of testosterone.

• Older men with normal testicles and brain hormones should not take testosterone unless their testosterone is very low (below 150).

• Usually men should take testosterone if they have low levels of the brain hormones that stimulate the testicles to produce testosterone or testicles that are damaged so they cannot make testosterone.

• Most men who suffer from poor sexual function because they have conditions that damage their sexuality, such as overweight, diabetes, arteriosclerosis or other life-shortening conditions that affect sexual function, should work to reverse those conditions rather than resorting to testosterone.

• Testosterone pills can damage the liver, so if a man chooses to take testosterone, the form of choice is a gel that is absorbed through the skin so it avoids the liver.