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Where should my priorities be to improve my health?


5/5/2020

People are bombarded with conflicting and confusing information from multiple sources on health related topics. This makes it hard to recognize who to trust, what information to believe, and what to apply to your own life in hopes of improving health and longevity. With this resource we hope to target a handful of behaviors and metrics that will help you meet these objectives, without wasting time and energy on things that are of little or no importance.


Before we go further, what does the word “health” actually mean? This concept has been debated for a long time; recently, in a 2011 article in The BMJ, Huber, et al. argued that health is “the ability to adapt and self-manage in the face of social, physical, and emotional challenges.” This definition, with its emphasis on “self-management” is powerful and the one we have adopted at Barbell Medicine. We aim to help people build the skills, strategies, and confidence to play an active role in managing their own health.


With this in mind, our priorities for health and longevity are as follows:

1. ENGAGE IN REGULAR PHYSICAL ACTIVITY THAT MEETS/EXCEEDS CURRENT GUIDELINES

2. MAINTAIN A HEALTHY BODY WEIGHT AND BODY COMPOSITION

3. GET SUFFICIENT DURATIONS OF HIGH-QUALITY SLEEP

4. AVOID SMOKING AND THE USE/ABUSE OF OTHER ADDICTIVE SUBSTANCES

5. SEEK MEDICAL CARE FOR A LIMITED SET OF ROUTINELY MONITORED PARAMETERS

6. LEARN ABOUT AND APPLY SELF-MANAGEMENT STRATEGIES FOR PAIN

7. DEVELOP AND MAINTAIN MEANINGFUL SOCIAL CONNECTIONS WITH OTHERS


Note that all of these recommendations are general and do not focus on specific foods, supplements, exercises, behaviors, or other limited details. This is not because we wish to withhold that “one weird trick,” or the magic “biohack” that will unlock the gates to washboard abdominals and a life free from pain. Such simple, limited solutions to complex problems do not exist. Most of these sorts of things do nothing at best, and promote harmful ideas or erect barriers to making meaningful changes at worst.


With that in mind, let’s dive into each of these targets. Any one of these points represents a deep subject worthy of a great deal more attention, but for the sake of brevity and utility in this start-up guide, we are just going to touch on them to give you a starting point. The included links will take you to further resources and discussion on each topic.


Engage in Regular Physical Activity


Physical inactivity is a major health problem worldwide and is the fourth greatest global risk factor for death according to the World Health Organization (WHO), behind high blood pressure, tobacco use, and elevated blood sugar (WHO 2009). Unfortunately, only 26% of men, 19% of women, and 20% of adolescents in the U.S. meet current Physical Activity Guidelines (Piercy 2018). Even worse, most healthcare professionals are completely unaware of these guidelines.

We view physical training as the most important behavior you can implement not only due to its beneficial effects on the other risk factors, but also because it serves as the principal method for maintaining physical independence across the lifespan, even in the face of other health issues that may arise. A substantial proportion of the population carry too little muscle mass, a condition called sarcopenia. This lack of muscle mass raises risks for a number of long-term health issues as well. Resistance training in particular is a powerful intervention for combating sarcopenia.


Current Physical Activity Guidelines


ALL INDIVIDUALS (BOTH YOUTH AND ADULTS) SHOULD MEET AND/OR EXCEED THE FOLLOWING:

  • 150 TO 300 MINUTES PER WEEK OF MODERATE-INTENSITY AEROBIC PHYSICAL ACTIVITY, OR;
  • 75 TO 150 MINUTES PER WEEK OF VIGOROUS-INTENSITY AEROBIC PHYSICAL ACTIVITY, AND;
  • RESISTANCE TRAINING OF MODERATE OR GREATER INTENSITY INVOLVING ALL MAJOR MUSCLE GROUPS ON 2 OR MORE DAYS PER WEEK.


Individuals meeting both the aerobic and strength training components of these guidelines have better health outcomes across a range of conditions, including obesity, high blood pressure, diabetes, and a number of other conditions as well. Bennie 2020


We created the Beginner Prescription as a guide to getting started with resistance training and as a way towards meeting the guidelines above. If you’d prefer individualized guidance, we offer coaching for people of all levels as well, whether you’ve exercised before or not.


For those who have concerns about the safety of resistance training for children, we have you covered there as well: start here. These guidelines have also been applied to exercise in the setting of uncomplicated pregnancy as well (see here).

For clinicians, we recommend familiarizing yourself with the 2018 Physical Activity Guidelines for Americans.


Maintain a healthy body weight and composition


Overweight and obesity are characterized by excess body fat that can negatively affect health. Worldwide, obesity has nearly tripled since 1975 and in the United States, it is estimated that by 2030, nearly 1 in 2 adults will have obesity. And while many people in the world carry excess body fat, recall as discussed above that many individuals carry too little muscle mass as well. Nutrition changes can have powerful effects on both of these conditions.


Excess body fat is ultimately the result of an imbalance between energy intake and energy expenditure. While many in the public sphere blame obesity on single variables like carbohydrates, animal foods, hormones, sugar, fat, or others, there is never one isolated “cause” of obesity. It is always a complex process influenced by the interaction of a variety of biological, psychological, and social/environmental factors that all need to be addressed.(Garvey 2016)


We recommend a proper measurement of waist circumference as a quick and easy way to determine if you may be carrying excess body fat.(Ross 2020) Note that your waist size from a pair of pants is NOT the same, and is NOT sufficient here.


Our recommended waist circumference limits are as follows (see footnote for demographic caveats):

MALE WAIST CIRCUMFERENCE HEALTH RISK FEMALE WAIST CIRCUMFERENCE

Less than 37 in or 94 cm No Increased Health Risk Less than 31.5 in or 80 cm

37–39.9 in or 94-101 cm Increased Health Risk 31.5–36.5 in or 81-88 cm

Greater than 40 in or 102 cm Significantly Increased Health Risk Greater than 36.5 in or 88 cm


*These waist circumference values are for individuals in North America, Europe, or who are of European or African descent, and are independent of height. For those of Asian descent, subtract 3 inches / 7 cm from each value.

If you find that you have obesity or are at risk for it, the next step involves changing eating behaviors and dietary patterns. Resources for this can be found in our article, “To Be A Beast” and using the NIH Body Weight Planner, as well as our nutrition lectures (Part 1, Part 2). These changes can be difficult for many individuals. In the same way that a variety of biological, psychological, and social/environmental factors play a role in the development of obesity, many similar factors can influence our ability to initiate and stick to a dietary plan over the long term.


For example, hunger often intensifies during periods of dieting, and we have written about strategies to deal with this. Metabolic changes, access to food, socioeconomic status, education and food preparation skills, among many other factors, often also play a role. In some situations, certain medications can be very helpful in the treatment of obesity by making it easier for people to stick to their dietary plan. We discussed these options here (Part 1, Part 2), as well as the role of bariatric surgery, when appropriate.


In general, our recommended dietary approach prioritizes a select few components:


TOTAL CALORIES: CONSUMING AN APPROPRIATE AMOUNT OF TOTAL ENERGY


PROTEIN: MEETING DIETARY PROTEIN TARGETS TO OPTIMIZE LEAN BODY MASS AND MITIGATE THE RISK OF SARCOPENIA. THIS USUALLY INVOLVES AN INTAKE OF ABOUT 1.6 GRAMS OF PROTEIN PER KILOGRAM OF BODYWEIGHT PER DAY (0.7 G/LB BW/DAY) FROM EITHER ANIMAL OR PLANT SOURCES, ALTHOUGH THIS TARGET MAY SHIFT BASED ON INDIVIDUAL FACTORS.


FIBER: CONSUMING A DIET HIGH IN FIBER FROM FOOD SOURCES, USUALLY ABOUT 30–35 GRAMS PER DAY FOR HEALTHY INDIVIDUALS.

CARBOHYDRATE AND FAT: INTAKE CAN VARY BASED ON PERSONAL PREFERENCE (E.G., HIGH/LOW FAT OR HIGH/LOW CARB). HOWEVER, DIETARY FAT INTAKE SHOULD BE BIASED TOWARDS UNSATURATED SOURCES (E.G., FISH/PLANT SOURCES), WITH ANIMAL-BASED SATURATED FATS HELD TO APPROXIMATELY 10% OF CALORIES OR LESS. ONE NOTABLE EXCEPTION IS THAT SATURATED FATS FROM DAIRY SOURCES (EXCLUDING BUTTER) APPEAR TO BE HEALTHFUL AS WELL.


If you are interested in individualized guidance with nutrition, we offer coaching with our staff, including registered dietitians. Operating within these criteria gives people lots of room for individualization based on personal preferences. We do not give strong default recommendations for other methods such as low-carb diets, ketogenic diets, or intermittent fasting (among others). This is because the current body of research does not show consistent superiority for these methods over any others, assuming equivalent adherence. With that said, if an individual is able to set up a diet using one of these approaches while meeting the above-listed criteria, and is able to adhere to it over the long term, that is great. However, if using one of these methods violates one or more of the above criteria, we would recommend re-evaluating the dietary priorities.


For clinicians, we recommend familiarizing yourself with the 2016 AACE Clinical Practice Guidelines for Medical Care of Patients with Obesity.


Get sufficient durations of high-quality sleep

Sleep is important for a variety of reasons; it has benefits in mental health and cognitive function, recovery from and adaptation to exercise, cardiometabolic health, and many others. Unfortunately, many people get insufficient or poor quality sleep, and this is always the first area we ask about when an individual reports symptoms of fatigue. Note that we DO NOT recommend using “sleep trackers” or apps, as discussed here.


We recommend the following good sleep habits (known as “sleep hygiene”):

  1. MAINTAIN A CONSISTENT BEDTIME & AWAKENING TIME
  2. AVOID NAPPING DURING THE DAY (IF YOU MUST, LIMIT THE NAP TO LESS THAN 30–45 MINUTES)
  3. AVOID ALCOHOL AND CAFFEINE FOR 4–6 HOURS BEFORE BEDTIME.
  4. IF YOU EXPERIENCE HEARTBURN, AVOID TRIGGER FOODS FOR 4–6 HOURS BEFORE BEDTIME.
  5. MAINTAIN A COOL TEMPERATURE AND ADEQUATE VENTILATION IN THE BEDROOM.
  6. BLOCK OUT DISTRACTING LIGHT (E.G., BLACKOUT CURTAINS, COVERING LIGHT SOURCES).
  7. USE A FORM OF CONTINUOUS, NON-DISTRACTING AMBIENT NOISE (E.G. A FAN OR “WHITE NOISE” MACHINE / PHONE APP).
  8. RESERVE THE BED FOR SLEEP AND SEX ONLY. DO NOT USE THE BED FOR WORK, WATCHING TELEVISION, OR USING OTHER ELECTRONICS.
  9. ESTABLISH A PRE-SLEEP RITUAL AND USE RELAXATION TECHNIQUES BEFORE GOING TO BED IF NECESSARY.


For those with insomnia, we strengthen these behavioral recommendations (see here for more). Some individuals with more severe cases may benefit from pursuing Cognitive Behavioral Therapy for Insomnia (CBT-I).

We also frequently screen individuals for sleep-disordered breathing such as obstructive sleep apnea (OSA). It is commonly associated with snoring and carrying excess bodyweight. Specifically, neck circumference is correlated with an elevated risk of developing obstructive sleep apnea (greater than 17 inches / 43 cm in men, or 16 inches / 40 cm in women). It can cause fatigue, high blood pressure, and a number of other medical conditions.


In order to evaluate an individual’s risk for sleep-disordered breathing, we recommend using The Official STOP-BANG Questionnaire. With this information, you can speak with your doctor about the next steps of evaluation and potential treatment.


For clinicians, we recommend familiarizing yourself with the 2019 Clinical Practice Guidelines on the Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea.


Avoid smoking and the use or abuse of other addictive substances

Tobacco use has been disastrous for human health, with smoking being a particularly popular consumption method. According to the CDC, cigarette smoking is the leading cause of preventable disease and death in the United States, accounting for about 1 in 5 deaths every year. While cigarette smoking has been on the decline in the US, about 14% of adults still currently smoke cigarettes, meaning we still have a lot more work to do.


Quitting smoking can be difficult. It typically requires multiple attempts and a substantial degree of external support. There are a number of public resources to help people with quitting smoking, as well as medications available through a physician’s care that can increase the chances of success.


Close behind, alcohol has negative effects on almost every major system in the body, as well as negative effects on others due to injuries and violence. According to the CDC it is responsible for about 88,000 deaths annually in the U.S. While there are some data suggesting that moderate or occasional alcohol consumption is correlated with better health, there is no probable cause for this stemming from alcohol itself. Instead, other factors, such as social interaction and its positive effects may confound those seemingly-healthful results.


Similar to smoking, there are a number of public resources to help people with quitting alcohol, as well as medications available through a physician’s care that can increase the chances of success.


If you currently smoke or drink heavily, you are exposing yourself to harm that cannot be overcome through diet, exercise, or other medical interventions. The same can be said for other drugs that are commonly abused. Cessation, or reduction in use of these substances, can be very difficult, but is no less important because of that. As with tobacco and alcohol, resources are available for other substance use as well.


Routine, appropriate medical care


There are relatively few health screenings we recommend on a broad scale. Most important among these include:

  • BLOOD PRESSURE
  • BLOOD LIPIDS/CHOLESTEROL (GENERAL TARGET FOR THOSE WITHOUT KNOWN CARDIOVASCULAR DISEASE: NON-HDL-C LESS THAN 130 MG/DL
  • DEPRESSION


Beyond these, other recommended demographic-appropriate screenings can be found using the Electronic Preventive Services Selector (ePSS) tool, which reflect current guidelines from the US Preventive Services Task Force. We are extremely cognizant of the risks and harms of over-testing, over-diagnosis, and over-treatment and recommend only screening for conditions for which we have strong evidence of benefit, such as high blood pressure.


With this in mind, we DO NOT recommend any OTHER routine screening via laboratory, imaging, or other testing modalities for individuals who do not have symptoms. This includes things like vitamin/mineral testing (e.g., vitamin D), hormone testing (e.g., testosterone, thyroid, cortisol), stress tests, or other lab / imaging tests. While the idea of “early detection” sounds good in theory, it very often does not work out in the patient’s best interest. See our screening podcast and for more on the topic of screening and overdiagnosis.


A far more effective method than medical testing for reducing the risk of diseases and even certain types of cancer is immunization. We therefore strongly agree with the Advisory Committee on Immunization Practices (ACIP) immunization guidelines for all children and adults. Additional reliable, evidence-based information is available on every available vaccine through the CDC, for both routine immunization as well as recommendations for travelers visiting other countries. Among areas with decreasing vaccine uptake we routinely see large outbreaks of vaccine-preventable diseases, which can lead to permanent complications and death among those who are most vulnerable. So, while there is a substantial amount of public discourse and debate around immunizations, based on the available evidence there is no question that their benefits outweigh their risks.


For clinicians, we recommend familiarizing yourself with the US Preventive Service Taskforce Guidelines.


Learn about pain self-management


Pain is a normal human experience that is a part of life. However, it can be extremely distressing and disabling, particularly when it persists without a clear reason. Learning how to self-manage your own aches and pains is an invaluable skill that can help to reduce unnecessary fear, disability, and the harms of over-medicalization.


Low back pain is extremely common, and we discuss this at length here (part 1, part 2) as well as on our podcast. Other aches and pains commonly arise in the course of life and exercise as well, and good introductory resources on the topic can be found at: Pain in Training: What do? and Pain Science – Guiding the Path.

For clinicians, we recommend familiarizing yourself with the 2018 Lancet Low Back Pain Series, as well as Lin et al.’s best practice care for musculoskeletal pain.


Develop and maintain meaningful social connections with others

This will be the most indefinite of our recommendations because “meaningful” in this context cannot be easily quantified. There will be significant variation among individuals in the frequency and nature of connections that are made and sustained. However, humans are social creatures and benefit greatly from healthy interactions with others. Positive support from family and friends is important when attempting to change behaviors. Similarly, lack of support can hamstring those efforts and is implicated in increased risk for substance abuse and depression.

Individuals do not need to reside in a state of uninterrupted bliss, nor is this even possible. Further, we do not have a minimum number of friends to recommend. What is clear is that feeling alone and cut off from peers represents an unfavorable environment for good health.


While mentioned in the previous section about routine, appropriate medical care, depression puts you at risk for multiple adverse health outcomes. If you suspect that you are depressed, or are suffering from undue emotional distress, seeking professional treatment is highly recommended.


We hope that this overview is helpful in guiding your priorities in the pursuit of health. Please help us disseminate this information to others who are in need of guidance, who are struggling with their own health, or to those who are confused in a world full of controversy and disinformation.

Aerobic vs anaerobic exercise training effects on the cardiovascular system

Harsh Patel, Hassan Alkhawam, Raef Madanieh, Niel Shah, Constantine E Kosmas, and Timothy J Vittorio

2017 Feb 26; 9(2): 134–138.

Abstract

Physical exercise is one of the most effective methods to help prevent cardiovascular (CV) disease and to promote CV health. Aerobic and anaerobic exercises are two types of exercise that differ based on the intensity, interval and types of muscle fibers incorporated. In this article, we aim to further elaborate on these two categories of physical exercise and to help decipher which provides the most effective means of promoting CV health.

Keywords: Cardiovascular, Exercise, Training, Aerobic, Anaerobic

Core tip: As the association between physical inactivity and the increased risk of cardiovascular morbidity solidified, further data and studies supported the advantages of exercise on physical well-being. Anaerobic and aerobic exercise have a favorable effect on lipid metabolism, anaerobic exercises have been shown to have a positive influence on the lipid profile.

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INTRODUCTION

More than 250000 yearly deaths in the United States are attributed to cardiovascular (CV) disease resulting from a lack of physical activity. On the other hand, physical inactivity is estimated to cause 30% of ischemic heart disease[1]. The association between physical inactivity and CV disease gained a foothold in the medical community in 1996, when the American Heart Association (AHA) published information advocating the benefit of physical exercise in regards to improvements in hemodynamic, hormonal, metabolic, neurological and respiratory function[2]. As the association between physical inactivity and the increased risk of CV morbidity solidified, further data and studies supported the advantages of exercise on physical well-being. The 2010 recommendations by the World Health Organization (WHO) provided activity recommendations based on three different age groups: Ages 5-17, 18-64, and > 64 years of age. In the age group of 5-17 years, individuals should accrue at least 60 min of moderate activity daily. Those in the group of 18-64 years should perform at least 150 min of moderate activity or at least 75 min of vigorous activity throughout the week. Finally, individuals above the age of 65 years are recommended similar length and intensity exercise programs as the prior group, but with a focus on activities to help enhance balance and to prevent falls[3].

The inherent advantages of physical exercise stem from an increase in the cardiac output and an enhancement of the innate ability of muscles to extract and to utilize oxygen from the blood. This benefit is further compounded by the benefit physical exercise has on high-density lipoprotein cholesterol (HDL-C)[4], adipose tissue distribution[5], increased insulin sensitivity[6], improved cognitive function[7], enhanced response to psychosocial stressors[8], as well as determent of depression[9]. With the benefit of physical exercise well established, the question remains which type of exercise provides the most effective and efficient means to help deter CV disease.

A recent meta-analysis published showed a decrease in the risk of all CV outcomes and diabetes mellitus incidence with increasing levels of physical activities[10]. Another meta-analysis suggested that high level of leisure time physical activity had a beneficial effect on CV health by reducing the overall risk of incident CHD and stroke among men and women by 20% to 30%, while moderate level of occupational physical activity might reduce 10% to 20% risk of CVD[11].

Furthermore, cardiac rehabilitation, which is physical exercise based, is a promising field which showed a favorable outcome among patients with heart failure and post-CVD events[12,13].

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AEROBIC EXERCISE

The American College of Sports Medicine (ACSM) defines aerobic exercise as any activity that uses large muscle groups, can be maintained continuously and is rhythmic in nature[10]. As the name implies, muscle groups activated by this type of exercise rely on aerobic metabolism to extract energy in the form of adenosine triphosphate (ATP) from amino acids, carbohydrates and fatty acids. Examples of aerobic exercise include cycling, dancing, hiking, jogging/long distance running, swimming and walking. These activities can best be accessed via the aerobic capacity, which is defined by the ACSM as the product of the capacity of the cardiorespiratory system to supply oxygen and the capacity of the skeletal muscles to utilize oxygen[14]. The criterion measure for aerobic capacity is the peak oxygen consumption (VO2), which can be measured either through graded exercise ergometry or treadmill protocols with an oxygen consumption analyzer or via mathematical formulas. The value of peak VO2 can be appreciated by a study performed by Vaitkevicius et al[15], in which the VO2max was calculated along with other dimensions, to conclude that higher physical conditioning status was directly correlated with reduced arterial stiffness.

Various studies have been published that prove the advantages of aerobic exercise in reversing and preventing CV disease. In 2002, Wisløff et al[16] were the first to show the benefit of aerobic training in the myocardium after an ischemic event. Their study was performed on adult female Sprague-Dawley rats, which were placed into groups categorized based on induced myocardial infarctions (MI) with and without exercise and controls with and without exercise. Their results showed a 15% reduction in the left ventricle (LV) hypertrophy post-infarction, as well as 12% and 20% decreases in myocyte length and width, respectively, with aerobic exercise. Furthermore, a 60% improvement was noted in myocardial contractility in subjects with a MI who were assigned to the training group, suggesting enhanced myocardial Ca2+ sensitivity. They were able to conclude the beneficial effects of aerobic training on cardiac remodeling and myocardial contractility[16].

The effect of aerobic exercise were confirmed in human subjects when Wisløff et al[17] published another study five years later, which incorporated human subjects with post-MI heart failure. Subjects were enrolled in aerobic interval training (AIT), moderate continuous training (MCT) or a control group. The AIT group showed a 46% increase in peak VO2, which correlated with a 60% increase in the maximal rate of Ca2+ reuptake in the sarcoplasmic reticulum in the skeletal muscles. Additionally, cardiac remodeling was evident in humans, much like the rat subjects in the previous study, as LV diameters declined and LV volumes increased in both the diastolic and systolic phases. Moreover, systolic function was noted to increase by 35% in the AIT group[17], thereby further strengthening the advantages of aerobic exercise.

Furthermore, aerobic exercise has been shown to have a positive impact on other dimensions of CV health. Several studies have shown that aerobic exercise improves the lipid profile, particularly increasing the HDL-C[18]. In an Australian study, aerobic exercise led to a small but statistically significant reduction in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) ranging in a span of 0.08 mmol/L to 0.10 mmol/L. They also showed an increase in HDL-C with their aerobic exercise program of about 0.05 mmol/L[19]. Similar results have been documented in children and adolescents, as well[20]. In a meta-analysis conducted by Kelley et al[21], it was concluded that aerobic exercises contributed to a statistically significant 9% increase in HDL-C and an 11% decline in TG, but no statistically significant changes in TC and LDL-C.

A positive correlation between biochemical signal markers, such as endothelin-I (ET-1) and aerobic exercise was recently speculated by several studies. Vascular endothelial cells produce ET-1, which functions as a vasoconstrictor[22] and promoter of atherosclerosis[23]. Maeda et al[24] were able to demonstrate a statistically significant positive linear correlation of increasing age with rising levels of ET-1. They were also able to exhibit a visible reduction in ET-1 levels after a 3 mo aerobic exercise regimen[24].

While aerobic exercise appears to have some beneficial effects, its contribution is limited on frequency and quantity. A very recent publication by a Danish group was able to represent what they called a “U shaped association” between aerobic exercise and mortality. Their research quantified 1 to 2.4 h of exercise over 2 to 3 times per week as the optimal quantity and frequency standard of aerobic exercise to promote improved health. Interestingly, they quantified any amount above that standard as being indifferent to the mortality risk, as that of sedentary individuals[25].

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ANAEROBIC EXERCISE

Anaerobic exercise has been defined by the ACSM as intense physical activity of very short duration, fueled by the energy sources within the contracting muscles and independent of the use of inhaled oxygen as an energy source[14]. Without the use of oxygen, our cells revert to the formation of ATP via glycolysis and fermentation. This process produces significantly less ATP than its aerobic counterpart and leads to the build-up of lactic acid. Exercises typically thought of as anaerobic consist of fast twitch muscles and include sprinting, high-intensity interval training (HIIT), power-lifting, etc. Sustained anaerobic metabolism, in other words, anaerobic exercise, causes a sustained increase in lactate and metabolic acidosis and this transition point is referred to anaerobic threshold (AT)[26]. AT can be directly measured via frequent blood samples measuring the blood lactate level during a graded-exercise regimen. Once the blood lactate values are plotted, the point at which the curve makes a sudden sharp incline represents the AT. Other methods include portal lactate analyzers and mathematical formulas involving heart rate (HR).

Similar to aerobic exercise, anaerobic exercise may exert a potentially beneficial influence on the CV system. In a Turkish study completed by Akseki Temür et al[27], the effects of anaerobic exercise were evaluated with a member of the natriuretic peptide family, known as C-type natriuretic peptide (CNP). CNP is synthesized by the endothelium and offers a protective effect through its effects on the vascular tone of blood vessels, as well as exerting antifibrotic and antiproliferative properties. It produces a hyperpolarization effect on the smooth muscle layer of blood vessels, which causes vasodilatation[28]. CNP has also been reported to exert its nonproliferative effects on cardiac fibroblasts to help prevent cardiac aging through LV fibrosis via the cyclic guanosine monophosphate (cGMP) pathway[29]. In this study, twelve healthy young male subjects were divided into two groups based on their previous history of exercise. Once categorized into groups, the subjects were asked to participate in a thirty second high intensity exercise program, which encompassed the anaerobic exercise factor. Blood samples were obtained from the subjects before exercise and then one minute, five minutes and thirty minutes after exercise and were tested for the levels of aminoterminal proCNP (NT-proCNP), a biologically inactive peptide of CNP. The results showed a statistically significant increase of NT-proCNP level in the five minute mark post-exercise in the physically active group after anaerobic exercise.

Similar to aerobic exercise and their favorable effect on lipid metabolism, anaerobic exercises have been shown to have a positive influence on the lipid profile. A small European study composed of 16 obese subjects was able to show the increased benefits of an aerobic workout followed by anaerobic training, as compared to aerobic training alone. Subjects who underwent core training with both aerobic and anaerobic exercises showed a larger reduction in non-esterified fatty acids. The same group was also found to have the greatest reduction in their body mass index (BMI)[30].

There are speculations about disadvantages of such an exercise program. One such shortcoming was brought to light by an Iranian study published by Manshouri et al[31], which concluded that anaerobic training led to a significant reduction in human growth hormone (HGH). It has long been theorized that long-standing HGH deficiencies can attribute to CV morbidity and mortality through the development of premature arthrosclerosis. HGH deficiency has been shown to result in higher BMI and TG, lower concentrations of HDL-C, as well as the development of hypertension (HTN)[32]. Furthermore, cardiac structure is affected in HGH deficient subjects, as manifested by reduced LV posterior wall thickness, smaller LV mass index and compromised LV ejection fraction (LVEF)[33]. The exact mechanism of action for such changes remains to be determined.

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CONCLUSION

With the high incidence of CV disease worldwide, it is an irrefutable notion that exercise helps deter CV morbidity and mortality. Both aerobic and anaerobic exercises have unique and collective positive correlations towards improved CV health. Despite all the research, further studies are still warranted to delve further into the impact that both aerobic and anaerobic exercise may have on human physiology to unequivocally determine if there is superiority of one type of exercise over another.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329739/

Quarantine Home Exercise Program

March 15, 2020

With gyms closing around the globe, many folks are faced with the challenge of training at home. With that in mind, we thought it might be useful to create a template for building a program that can be done at home with minimal to no equipment. Here's the general idea of what to do in the meantime:


First up, let's talk equipment. It would be great if everyone had access to some sort of resistance and a pull-up bar. For resistance, implements like dumbbells, kettlebells, or resistance bands would obviously work, but you can also great creative to add some resistance to exercises. For example, stuff some books in a backpack and now you can do weighted squats, lunges, push-ups, upright rows, etc. On the other hand, I'm not sure I have a creative way to MacGyver a pull-up bar so...let's just work with what you've got.


Second, let's talk reps and sets. If you have access to some resistance, you'll have more options given that can make the exercise harder or easier by adding or subtracting load. On the other hand, we can also use just your bodyweight to get a decent workout in. The idea is that each set should be fairly difficult, e.g. you should be within about 5 reps of voluntary failure. If you have access to resistance, you can achieve this in variety of rep ranges depending on the exercise and the amount of weight you have on hand. If you're working with your bodyweight only, you'll have to do more reps to get to that target "< 5 reps left" zone. An additional strategy that will either keep you close to that zone or get you there in the first place would be to pair a number of exercises together in a circuit and go through them one-by-one with minimal rest between.


Here's an sample template:


Repeat the following circuit 3-5 times. Rest 1-3 minutes between rounds based on tolerance, goals, and current fitness levels.


Leg exercise x 8-30 reps

Upper Body exercise x 8 -30 reps

Upper Body exercise x 8- 30 reps

Trunk exercise x near-failure effort*

Conditioning exercise x near failure effort*


*The near-failure effort means that you would do whatever trunk or conditioning exercise you choose to near failure, e.g. within 5 reps of voluntary failure or within ~20 seconds of you having to stop


The rep ranges are wide to allow for a variety of different exercises based on your preferences and a range of different loading. Here are some sample exercises for each group:


Leg Exercises w/o Equipment

Squat

Split Squat

Lunge

Reverse Lunge

Cossack Squats

One Legged Bird Squats

Nordic Hamstring Curl

Reverse Nordics

Glute Bridge


Upper Body Exercises w/o Equipment

Push-Up, standard grip (tempo, paused, etc.)

Push-Up, narrow grip

Push-Up, Wide grip

Frog Push-ups

Deficit Push-ups (hands on books or elevated surface)

Decline Push-ups(feet up on elevated surface)

Superman with Y,T, or I shoulder raise

Press-up from forearms


Core Exercises w/o Equipment

V-sit

V-up

Plank

Side Plank

Hollow Rocks

Sit-ups

Conditioning w/o Equipment

Running/jogging

Walking

Jumping Jacks

High knees

Running Planks/Mountain Climbers

Burpees


And here is a sample of how to put it all together using stuff from around the house, where applicable:


4 rounds of:

  • Squats with book bag + a few heavy books - max reps in 30 seconds. Rest 15 seconds.
  • Pushups, normal grip with book bag - max reps in 30 seconds. Rest 15 seconds.
  • Superman with I - 20 reps
  • Situps- max reps in 30 seconds. Rest 15 seconds.
  • High Knees x 30 seconds.
  • Rest 1 minute.

Obviously, the combinations are endless and there are a lot of bodyweight exercises to do, especially if you have access to a few toys (read: weights) at home. For more workouts and ideas, please contact us about our monthly online coaching availability.


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