Resistance training: a fountain of youth!

Let's face it. From the moment we're born our bodies begin to age. However, for most of us healthy folks the reality of aging doesn't have to mean a major decline in the quality of our lives. Why? Read on my curious aging friends. The clock is ticking...

You may be familiar with the expression "use it or lose it." Well, this couldn't be more true when it comes to aging and the decline of muscle. In case you're thinking that this only applies to really old people, think again. According to Dr. Mark Peterson from the University of Michigan Physical Activity and Exercise Intervention Research Laboratory,

"normally, adults who are sedentary beyond age 50 can expect muscle loss of up to 0.4 pounds a year. That only worsens as people age. But even earlier in adulthood - the thirties, forties and fifties - you can begin to see declines, if you don't engage in any strengthening activities."

 Other research shows that,

"after age 40, people typically lose 8 percent or more of their muscle mass each decade, a process that accelerates significantly after age 70. Less muscle mass generally means less strength, mobility and among the elderly, independence. It also has been linked with premature mortality." (1)

I'd venture to say that most of us want our "golden" years to be, well, golden.  In other words, it would be ideal if quality and quantity of life marched along at the same pace.  However, for many people, an increase in quantity of life comes with a relatively rapid decline in quality of life.

Until fairly recently, muscle atrophy was thought to be a natural part of aging and that this decline was inevitable and, more importantly, irreversible. However, research has repeatedly shown the opposite to be true! In one 2007 ground breaking study of resistance exercise and how it reverses aging in human skeletal muscle done by S. Melov, et. al. it was demonstrated that muscle decline is reversible with weight training and the changes occur at the gene level! This is exciting because it proves that performing resistance training really does offer us a fountain of youth so to speak.

What does all this mean for us in a practical sense? Call me Captain Obvious, but I'll state it none the less - first and foremost, we have to perform resistance training! Some of you might be saying, okay, already, I've got the message. Resistance training is important, but what should I be doing in my resistance training program?  Good question!

I had the pleasure of attending a workshop given by Mark Roozen, who was the strength coach for the Cleveland Browns.  The information he presented focused on the importance of training movements patterns, before focusing on individual muscle strength. You might be wondering what constitutes a movement pattern. Humans have 7 primary movement patterns that we learn and refine over the course of our lives. These are:

1. Gait - walking, running, sprinting
2. Squatting
3. Lunging
4. Pulling
5. Pushing
6. Pressing
7. Twisting

Now, it may surprise you as it did me to learn that even elite athletes like the pro football players Mark works with may have to return to the basics.  Mastery of these movement patterns is critical to the prevention of injury, and to the ability to train to full potential.  This applies to all of us - from weekend warriors to elite athletes and everywhere in between.

Training movement patterns is a more efficient way to train the body than isolation training because it mimics the way our bodies perform in our activities of daily living.  Ultimately this is what healthy aging is all about - training our bodies to be efficient in performing activities of daily living.

So how do we incorporate these movement patterns into our resistance training workouts? Consider the following:

• Movement planes and the axes in which movements take place 

  

  Image from http://kintasticscleanandjerkproject.weebly.com/uploads/1/7/1/4/17146288/7514150_orig.jpg

• incorporate the 7 movement patterns
• Ex: Squats, Lunges, Cleans, Deadlifts, Bench and Military Presses 
• If you're over age 50 and/or previously sedentary consider starting a resistance training program that uses your body weight. For example you can start with simple squats like chair squats and lunges (knees permitting), etc. NOTE: exercises may be challenging for those new to resistance training. Start slow and with the basics. This means performing stationary exercises in one plane and then progressing to movements that incorporate more weight and multi-planes.  Always consult your physician before beginning any exercise program.

The next post will go into more specifics about particular functional resistance training exercises. For now suffice to say, just start training because the evidence is clear. Resistance training really can be the fountain of youth! Adding functional resistance training exercises is an excellent way to increase the strength, agility and stability needed to perform activities of daily living and to maintain or improve our quality of life as we age.

Still not convinced? Check out this excellent article by Dr. Wayne Wescott found here, which details the many health benefits gained through resistance training.

(1) Source: Reynolds, Gretchen. “Aging Well Through Exercise,” The New York Times.

Increase weight loss by working out less?

Really? -
Judging from the ever rising overweight/obesity rates in the United States, I think it's safe to assume that a majority of Americans subscribe to the work out less plan. I find it a bit alarming when scientific data is released and the news takes a portion of a study's findings out of context and reports on it. Typically we can end up misguided and confused. That's why it's so important to understand the bigger picture surrounding "sound bites" like this post's title. This reminds me of a radio ad that would, ironically, air while I was training at the gym.  The advertisement was pushing a diet pill which promised weight loss without the "unhealthy stress and strain of exercise"! I'll spare you a rant, but I will say that the ad was eventually changed so that it did not include the word unhealthy.  Calling exercise unhealthy is blatantly inaccurate. Yet, unfortunately this isn't obvious to everyone. But I digress...

What's going on? -
Saying that we can increase weight loss by working out less is ambiguous because this statement tells only part of the story. So, before you scratch that workout off your to-do list, please read on. According to a study published in the American College of Sports Medicine's (ACSM) Journal of Medical Science and Sports Exercise, it's possible to burn more calories and spend less time working out. However, the key to this result lies in how intensely you workout. Before I go on, it might be helpful to recall the caloric balance equation and its role in weight maintenance, and you can read more about this in a past post found here.

Image from CDC website

Consider a typical day of food consumption and energy expenditure. Simply put, if calories eaten exceed calories burned, we end up with a calorie surplus for that day and over time this leads to weight gain. On the other hand, if we burned more calories than we ate, than over time this leads to weight loss. If  calories in are equal to calories out, the scale is in balance and weight is maintained. Another thing to keep in mind is that we are always expending energy, even while we're resting.


Back to the study - The researchers wanted to see what the energy expenditure at rest of males, aged 22 to 33, would be on a day when they performed a vigorous indoor cycling exercise bout vs. on "a controlled resting day" when they performed no exercise at all.  I underlined and bold faced the word vigorous because this is very important to note. In this case vigorous exercise is defined as performing a physical activity at a level that causes you to be too out of breath to talk. Working out at this intensity level "resulted in a significant [emphasis added] elevation in post exercise energy expenditure, that persisted for 14 hours" after the exercise bout ended (ACSM).


Wow! This sheds some much needed light on that rather ambiguous statement that implies we can increase weight loss by working out less. Now we understand that it's possible to decrease the amount of time we spend working out, but this must be accompanied by an increase in the intensity of our workout to a vigorous level. This is because the research suggests that we can burn additional calories above and beyond what we burned during the workout, even while we're at rest! This is sometimes referred to as caloric after burn.

Here's the data: During the vigorous cycling bout these guys expended 520 calories (kcal).  This isn't surprising because we all know exercise expends calories. We also know that vigorous exercise burns more calories than low and moderate intensity exercise. However, what is really exciting is that after the men finished exercising, and with their post exercise activity level restricted and monitored, they continued to  burn an additional 190 calories (kcal)  during the 14 hours after their workout, as compared with control days when the men were inactive. "The 190 calories burned after exercise above resting levels represented an additional 37% to the net energy expended during the 45-min cycling bout." 

Bottom Line - 
The study's test subjects were young men, so the results may not be the same for women, or for an older population.  Also, we might not be able to workout at a vigorous level for 45 minutes. Given this and other studies on vigorous intensity exercise which show the added benefit of caloric after burn, it seems beneficial to try to incorporate little bouts of vigorous intensity exercise in our workouts. But if you've never exercised, or haven't worked out in years - BEGIN SLOWLY and always consult your physician before beginning any exercise program. Obviously any exercise is better than none, but I like the idea of putting in a little more effort, giving it a little less time and reaping bigger rewards from my workout.  It seems like a win/win to me and that's no sound bite.

In the next post there will be some suggestions for vigorous intensity bout exercise programs and also a discussion relating to another study that shows bouts of vigorous intensity exercise have been shown to be beneficial in reducing inflammation in overweight and obese men. Chronic inflammation is linked to all kinds of health problems.

In the meantime, keep moving! 

Sources
CDC - http://www.cdc.gov/obesity/data/trends.html
ACSM - American College of Sports Medicine - http://journals.lww.com/acsm-msse/Abstract/2011/09000/A_45_Minute_Vigorous_Exercise_Bout_Increases.6.aspx
CDC - http://www.cdc.gov/healthyweight/calories/index.html
chronic inflammation -  http://www.drweil.com/drw/u/ART02012/anti-inflammatory-diet

Women, heart disease and new max heart rate formula

When it comes to women's healthcare, females are typically treated like smaller versions of males.  We women know we aren't "mini-me's" of men, but a patriarchal society hasn't been as quick to recognize this fact. Thankfully, the emerging science of gender based biology is proving what women already knew to be true. We are different. Here's a sampling of the gender differences research is revealing at the system, organ, tissue and even cellular levels:

1. "3 out of 4 people who suffer from an autoimmune disease (such as rheumatoid arthritis, lupus and multiple sclerosis) are women" (1);
2. women are 2 times more likely than men to be diagnosed with thyroid diseases (1);
3. 2-3 times more likely than men to suffer depression (1);
4. 2 times more likely than men to contract gallstones (1);
5. more likely than men to suffer a second heart attack within the year after their first heart attack (1);
6. women who smoke are up to 70% more likely to develop lung cancer than men who smoke (1);
7. 80% of  people affected by osteoporosis are women (1);
8. women are more like to suffer migraines than men (1)
9. a woman's liver metabolizes alcohol and drugs less efficiently than a man's liver (1);
10. a woman's heart is one third the size of a man's heart and beats faster (1);
11. woman wake up faster from anesthesia after surgery (1);
12. a woman's brain is neurologically different from a man's brain (1);
13. a woman's heart responds to high blood pressure by developing thicker walls which puts them at greater risk for heart failure than men (4).

Clearly, the contrasts between the sexes go way beyond the basic XX and XY chromosomes and our reproductive capabilities. Unfortunately for women's health, prior to the 1990's men were the model on which medical research was conducted. An example of this is the practice of pharmaceutical companies testing their new drugs only on men. The exclusion of women and minorities from medical research continued until Congress mandated that they be included. As a result of this change in practice, researchers in gender based biology are starting to reexamine drugs that were tested only on men. They are checking for their potential effectiveness because women metabolize drugs differently than men. 

Women and heart disease-

Heart disease is another area where gender based biology has identified differences between men and women. In 1991 the National Institutes of Health (NIH) implemented a landmark observational study concluded in 2006 called the Women's Health Initiative (WIN). WIN provided a great deal of data on women's health. Noteworthy is the finding that women aged 65 and older were more likely to die from heart disease than men. Also, under age 50 a woman's heart attack is twice as likely to be fatal as a man's (5). Experts suggest there are several reasons for this, one of them being that the symptoms of heart attack that men experience aren't necessarily the same for a woman (3). They can be more subtle than the severe chest pain that is the hallmark symptom for men. As a matter of fact, 71% of women reported feeling flu like symptoms in the weeks prior to having a heart attack (5). You can find more information on the topic of heart attack symptoms on The Mayo Clinic website here. A simple, noninvasive way to test for heart disease is the exercise stress test and recent research has provided more insight into the uniqueness of a woman's heart and the use of this diagnostic test.

Women Take Heart Study-

The Women Take Heart Study, conducted by researchers at Northwestern University, focused on determining the normal response of a woman's heart to exercise stress testing. An exercise stress test or treadmill test is used to check a variety of heart functions including: "heart rate, breathing, blood pressure ECG, and how tired you become when exercising" (7). A stress test can also help diagnose or predict safe levels of exercise, coronary artery disease, possible causes of chest pain,  and risk for heart attack (7). During a stress test doctors monitor a patient to determine if they are unable to reach at least 85% of their maximum heart rate. Failure to reach this benchmark means a greater risk of death from heart disease. How a woman's heart rate (HR), or the number of times a heart beats per minute (BPM), responded to the stress of an exercise stress test wasn't understood very well until the Women Take Heart Study. This is because up until this point most of the research in this area had been conducted on men.

Maximum heart rate formula based on male data-

Scientists have known that maximal heart rate (MHR) decreases with aging (9). As a result, the formula that doctors typically use to calculate a normal response to exercise stress includes a person's age. However, the formula doesn't take into account gender differences. The simplest form of the maximal heart rate calculation based on data gathered from research using men is: Average maximal HR (MHR) = 220 - age in years (9).

New maximum heart rate formula for women-

Now to the Women Take Heart study's exciting findings! This year Northwestern University researchers published results of their study that found "the traditional male-based calculation [of  MHR = 220 - age] overestimates the maximum heart rate for age in women" (8) especially in women over age 35 (10). The new gender specific formula for MHR is:

MHR = 206 -  88 percent of your age

Aerobic physical activity and heart rate-

Women whose stress tests were measured using the old formula tended to show a poorer prognosis, so this gender specific formula reflects a more accurate prediction of a woman's risk for heart disease.  The new formula is also important because heart rate is the standard method for monitoring aerobic exercise intensity. Using this new formula for MHR while calculating an aerobic training heart rate will more accurately reflect how hard a woman is exercising during aerobic physical activity. For example, a 50 year old woman's MHR using the old formula would be: 220 - 50 = 170. If she were shooting to work at a moderate to vigorous intensity range her training heart rate (THR) using the old MHR formula and the simple THR formula would be: 111 (170 x 65%) at the range's lower end and 145 (170 x 85%) at the range's higher end (see the Heart Rate Training Zones Chart below).

From American Council on Exercise

Using the new Women Take Heart MHR formula a 50 year old woman's MHR would be: 206 - .88(50) = 162. So, now the lower end of her THR range would be: 105 (162 x 65%) and at the higher end of her THR: 138 (162 x 85%).

Most charts will reflect training heart rate zones calculated with the old "men only" formula so keep this in mind when you're at the gym monitoring your exercise intensity. Also, exercise equipment and heart rate monitors have usually calculated THR using the old formula. However, some companies are already updating their equipment, but ask to be sure. There's also talk of an I phone app that can do the calculations for us.

It's important to note that some medications, like beta blockers taken for blood pressure control for example, can give false pulse readings. In this case, it is more accurate to measure your level of aerobic exercise intensity using Rate of Perceived Exertion or the Talk Test. You can read more about the rate of perceived exertion here, and the talk test here. Next week's post will go into a little more detail about the aerobic training zones, discuss the myth of the fat burning zone and also look at how doctors are using heart rate response to exercise as a predictor of disease and even death.

There were some limitations to the Women Take Heart study. Nevertheless, the researchers at Northwestern state that their findings "should be incorporated into clinical practice" (12). This research also underscores the importance of conducting more studies that take into consideration the fact that women are biologically unique and not just mini-men. Thanks to gender based biology research, health care might begin to treat the sexes differently.  

Sources

(1) Gender Biology: Men and Women Really Are Different. Films Media Group, 1998. Films On Demand. Web. 20 November 2010. <http://digital.films.com/PortalPlaylists.aspx?aid=10103&xtid=11115>.

(2) http://www.nature.com/nm/journal/v2/n11/abs/nm1196-1248.html 

(3) http://www.mayoclinic.com/health/heart-disease/HB00040 

(4) http://www.washingtonlifescience.com/readlist/ceo_bianco.htm

(5) http://www.womensheart.org/content/HeartDisease/heart_disease_facts.asp, http://www.womensheart.org/content/HeartAttack/heart_attack_symptoms_risks.asp

(6) http://www.nhlbi.nih.gov/whi/  

(7) http://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Non-Invasive-Tests-and-Procedures_UCM_303930_Article.jsp
(8) http://www.medpagetoday.com/PrimaryCare/ExerciseFitness/20954

(9) American College of Sports Medicine, Resource Manual for Guidelines for Exercise Testing and Prescription, 2nd ed.

(10) http://seattletimes.nwsource.com/html/health/2012244688_heart05.html 

(11) http://www.cdc.gov/physicalactivity/everyone/measuring/index.html
(12) http://www.medpagetoday.com/PrimaryCare/ExerciseFitness/20954

Because you're worth it!

If you've ever flown you probably have listened to the flight attendant's safety drill. They talk about how in the event of cabin depressurization a parent needs to put their oxygen mask on first and then put their child's mask on. Obviously, if we put our child's mask on first we run the risk of passing out from lack of oxygen ourselves. Isn't this a good metaphor for motherhood?

Good metaphor or not, it typically isn't easy for a mom to put herself first. I hear it all the time. Who has time to exercise? I'm too busy with ______________ (fill in your list here). I don't mean to single out women, but generally speaking we do tend to put ourselves at the very end of our list of priorities. Yes, women tend to be more nurturing and giving, but usually not to themselves. So, in honor of Mother's Day let's consider ourselves for just a moment.

Constantly putting yourself last is an unhealthy habit that can be difficult to break, especially if you might end up feeling a little selfish and guilty about taking time out for you. As a result, we may end up feeling stressed out, anxious, irritable and maybe even a little depressed. The result? Sort of like an empty cup, with not much left to give. Ultimately, this isn't healthy for us, or for the ones we care for.

What if we change our perspective and view making time for ourselves as important as taking care of others? This mindset is a win/win! We fill up our cup and when it is full we have more to give. This allows us to be more patient and loving caregivers. If you're not convinced yet I took these points straight from a paper on the mental health benefits of physical activity published by Dr. Daniel Landers, a leading authority on exercise and mental health.

Physical activity:

• Reduces anxiety and depression.

• Increases positive self-esteem.

• Increases restful sleep.

• Improves ability to respond to stress.

These are just a few of the health benefits associated with increased physical activity. Don't put yourself last on your list. It's okay to put your oxygen mask on first.

Happy Mother's Day.