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Exercise

Updated: Dec 25, 2023

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” - Hippocrates


Exercise defined.

“Exercise is a subset of physical activity that is planned, structured, and repetitive and has as a final or an intermediate objective for the improvement or maintenance of physical fitness [1].”

Exercise vs physical activity.

“Physical activity is defined as any bodily movement produced by skeletal muscles that result in energy expenditure [1].”

Exercise is a physical activity, but not all physical activity is exercise. I bring this up because in practice, when I begin encouraging exercise I hear a lot of “I have a physical job, I don’t need to exercise.” Exercise and work are both stressors on the body, but there are two different kinds of stress: eustress and distress. Generally speaking, eustress means good stress and distress means bad stress.

In an adequately designed exercise plan, there is a set duration, intensity, frequency, and recovery period. The adaptations that occur from exercise are usually positive, in the form of increased strength, endurance, and/or enhanced cardiovascular fitness. Thus the stress was good.

With work, physical activity tends to be repetitive, with no option to modify intensity, frequency, and no built-in recovery period. The adaptations that take place typically lead to overuse injuries such as tendonitis, bursitis, arthritis, and/or degenerative changes in general. The adaptations are negative, and thus work tends to be a bad stress.

If you have a sedentary job, and you're sitting or even standing stationary for most of the day, the need for exercise is obvious. The body was built for movement and only operates optimally if it gets an adequate amount of physical activity. The research here is pretty unanimous. If on the other hand, you have a physically demanding job, you need to exercise so that you can condition yourself to withstand the rigors of that job.

None of this is to say that increasing your non-exercise physical activity isn’t good for you [2]. It very much is. But letting the circumstances of day-to-day life dictate whether you can squeeze in some physical activity is not optimal. Don’t’ leave your exercise to chance. Instead, develop an exercise plan.

Benefits of exercise.

The benefits of exercise are too numerous to identify. It’s probable that every organ system in the body benefits [3-4].

  • Musculoskeletal system – increases capacity for work and exercise, reduces the risk of injury, improves range of motion, and maintenance of bone mass.

  • Cardiovascular – decreased risk of heart disease and stroke, decreased blood pressure.

  • Endocrine system – control of body weight, better insulin sensitivity and carbohydrate tolerance, better cholesterol profile.

  • Immune – less overall susceptibility to infections.

  • Psychologically exercise can enhance mood, self-esteem, and improve memory.


Detriments of immobility.

Reverse engineer the benefits of exercise and you’re left with the detriments of immobility. Consistent immobility has been coined in the medical literature as “disuse syndrome.” “The primary characteristics of disuse syndrome are cardiovascular vulnerability, obesity, musculoskeletal fragility, depression, and premature aging [5].”

What do the experts say?

The American College of Sports Medicine in conjunction with The American Heart Association has established physical activity guidelines for adults [6]. They are as follows:

  • 30 minutes of moderate-intensity aerobic exercise (brisk walk), 5 days a week for a total of 150 minutes. Or

  • 25 minutes of vigorous-intensity aerobic exercise (jogging), 3 days a week for a total of 75 minutes. Or

  • A combination of the two.

  • In addition, at least twice a week, perform a full-body resistance exercise routine (about 30 minutes each session).

Keep in mind that the recommendations above are considered the minimum amount of exercise you should do. These recommendations are guidelines and don’t need to be followed to the letter. They are, however, a good base on which to develop your own exercise regimen.

Fitness vs performance.

As stated above, exercise aims to advance some aspect of physical fitness, of which there are many. For someone that is trying to improve sports performance; agility, balance, coordination, speed, and power are important aspects of fitness that they may want to improve.

For the average person whose goal is to maintain or improve health, the focus should be placed on cardiorespiratory endurance, muscular strength, muscular endurance, flexibility, and body composition.

What type and how much?

Cardiorespiratory Endurance.

Cardiorespiratory endurance entails the ability to perform large-muscle, dynamic, moderate-to-high intensity exercise for prolonged periods [6]. Most of the known benefits of exercise come from research done on individuals performing cardiorespiratory exercise. Examples include: walking, running, swimming, jumping rope, cycling, elliptical training, rowing, boxing, etc… Cardiorespiratory endurance training (cardio) should be done for 20-60 mins. 3-5 days per week.

Muscular Strength and Muscular Endurance.

Muscular strength is the highest amount of effort exerted by the muscles of the body in order to overcome the most resistance in a single effort.” Muscular endurance is the muscle’s ability to repeat a contraction for a longer period of time before it becomes exhausted. [7]

Muscular endurance and muscular strength are both improved with resistance training.

That resistance can take the form of free weights, elastic bands, or exercise machines at the gym. You can also do Pilates, yoga, calisthenics, etc… where your body weight is your resistance. You can also flip tires, lift logs and carry heavy stones. Whatever you like. Exercise most major muscle groups of the body, 30-60 minutes, 2-3 days per week.


Pick cardiovascular and resistance training exercises you find enjoyable, not what someone says is the best exercise. If you find exercise enjoyable, you’ll stick with it, and if you stick with it, you will reap the rewards of your efforts.

If you have no idea how to perform lifts or if you have a health condition that may prevent you from exercising, hire a certified personal trainer. Even if it's just long enough to learn how to perform each exercise that you choose to do safely. For information regarding common chronic diseases and exercise prescription, take a look at the ‘RX for Health Series’ developed by the American College of Sports Medicine, which can be found here: https://www.exerciseismedicine.org/eim-in-action/health-care/resources/rx-for-health-series/

Flexibility

Flexibility is the ability to move a joint through its complete, intended range of motion. Static stretching (stretch-and-hold) is the easiest and safest way to maintain or increase your flexibility.

There are about 600 muscles in the human body; you don’t need to stretch them all. For a cheat sheet on which muscles likely need to be stretched, you can check out Vladimir Janda’s work on upper cross and lower cross syndromes. Dr. Janda discovered during his work that certain muscles in the human body tend to become tight and need to be stretched, versus other muscles that tend to be weak and need to be strengthened. You can save time and just stretch the major muscle groups that tend to be tight (calf muscles, hamstrings, hip flexors, piriformis, low back, upper traps, and chest). More information about Janda’s work can be found here.

Stretches should be held for a minimum of 30 seconds, at 2-4 repetitions. You could hold stretches longer, up to around 2 minutes, after which you run into the law of diminishing returns. Stretch most days of the week.

Body Composition.

Body Composition is the amount of fat and lean body mass that makes up an individual's total body weight. Although body composition may not be a traditional measure of fitness, with regard to health, it’s very important.

There are different ways to measure body composition.

  • Obviously, weighing yourself gives you your total body weight.

  • You can calculate your body mass index (BMI) = [weight (lbs.) / height (in.)² x 703]. A calculator can be found here. BMI is a bit outdated, and doesn’t necessarily do a good job of determining a person’s present or future health status, but could be used as a quick screening tool for physicians. [8-9]

  • You can ascertain your body fat percentage using a variety of tools (calipers, bioelectrical impedance, DXA scan, hydrostatic weighing). I find the bioelectrical impedance scans best. Not because they are super accurate, but because they are cheap, non-invasive, easy to use, and accurate enough.

  • Waist circumference - Measuring waist circumference helps screen for possible health risks. To perform, use a flexible tape measure and measure the midway point between the bottom of your ribs, and the top of your hips. This appears to be an important measurement for men. [10-12]. You can measure your waist in a couple of different ways. I don’t believe one is necessarily better than the other, just be consistent with your measurements each time you record them. See examples here.

  • Waist-to-hip ratio (WHR) – “WHR is calculated by measuring the smallest circumference of the natural waist dividing by the hip circumference at its widest part.” [13] The waist-to-hip ratio may be the most useful body measurement with regard to health. “On the basis of the worldwide epidemiologic information, WHR has been found to be a more efficient predictor of mortality than WC or BMI.” [14] This is likely since not only does it capture an increased belly fat, but also a decreased gluteofemoral muscle mass, both of which are risk factors for mortality.


In reality, research is back and forth as to which measurement is most important with regard to health [8-9]. Recording and tracking a combination of measurements is best.

Using exercise as the only tool for body recomposition is not ideal. Combining exercise and diet to achieve more muscle and less fat is a much more effective approach.

Build your plan.

Now that we have a basic idea of what type of exercise to do and how much of it, it’s time to build an exercise routine. This is your plan, not mine. What’s offered above are only guidelines, supported by research. You get to pick what you want to do based on your goals. Those goals may be to improve heart health, control blood sugar, or look good naked. Doesn’t matter, they’re your goals. Develop your exercise plan and stick with it for 3-4 months. Keep what you like and what works for you, discard what doesn’t. Adjust your exercise plan accordingly. Repeat. It’s that simple.



Resources


Getting started with exercise? Free resources available at: https://www.nerdfitness.com/free-resources/



NIH, Exercise and Physical Activity Tracking Tools: https://www.nia.nih.gov/health/exercise-and-physical-activity-tracking-tools

Glossary

Sedentary: doing or involving a lot of sitting: not doing or involving much physical activity

Repetition: the performance of the exercise one time. For example, bending and straightening the elbow is one repetition.

Set: The performance of all the prescribed repetitions one time. For example, if the exercise needs 10 repetitions of bending the elbow, this would be one set. If instructions say three sets, this means do ten repetitions, rest, and do another ten repetitions, rest, and then another ten repetitions.



Works Cited


1. Blair, S, and D Jacobs. Physical Activity, Exercise, and Physical Fitness: Definitions and Distinctions for Health-Related Research. , 1985.


2. Woodcock, J., et al. “Non-Vigorous Physical Activity and All-Cause Mortality: Systematic Review and Meta-Analysis of Cohort Studies.” International Journal of Epidemiology, vol. 40, no. 1, 14 July 2010, pp. 121–138, 10.1093/ije/dyq104. Accessed 6 Aug. 2021.


3. ABC of Sports Medicine BENEFITS of EXERCISE in HEALTH and DISEASE P H Fentem the Claim That Individual Participation in Adequate Amounts of Regular Physical Activity.


4. Anderson, Elizabeth, and J. Larry Durstine. “Physical Activity, Exercise, and Chronic Diseases: A Brief Review.” Sports Medicine and Health Science, vol. 1, no. 1, Dec. 2019, pp. 3–10, 10.1016/j.smhs.2019.08.006. Accessed 6 Aug. 2021.


5. Bortz, Walter, et al. Commentary the Disuse Syndrome. , Nov. 1984.


6. American Council on Exercise. The Professional’s Guide to Health and Wellness Coaching. 1 Jan. 2019.


7. “What Is the Definition of Muscular Strength?” Reference, 2019, www.reference.com/science/definition-muscular-strength-c3cdc41064c118b3.


8. Bosy‐Westphal, Anja, and Manfred J. Müller. “Diagnosis of Obesity Based on Body Composition‐Associated Health Risks—Time for a Change in Paradigm.” Obesity Reviews, vol. 22, no. S2, 21 Jan. 2021, 10.1111/obr.13190. Accessed 26 Aug. 2021.


9. Michels, K. B., et al. “Does Body Mass Index Adequately Capture the Relation of Body Composition and Body Size to Health Outcomes?” American Journal of Epidemiology, vol. 147, no. 2, 15 Jan. 1998, pp. 167–172, 10.1093/oxfordjournals.aje.a009430. Accessed 26 Aug. 2021.


10. Visscher, TLS, et al. “A Comparison of Body Mass Index, Waist–Hip Ratio and Waist Circumference as Predictors of All-Cause Mortality among the Elderly: The Rotterdam Study.” International Journal of Obesity, vol. 25, no. 11, Nov. 2001, pp. 1730–1735, 10.1038/sj.ijo.0801787. Accessed 30 Aug. 2021.


11. Despres, J.-P. “Treatment of Obesity: Need to Focus on High Risk Abdominally Obese Patients.” BMJ, vol. 322, no. 7288, 24 Mar. 2001, pp. 716–720, 10.1136/bmj.322.7288.716. Accessed 30 Aug. 2021.


12. Mousavi, S V, et al. “Changes in Body Mass Index, Waist and Hip Circumferences, Waist to Hip Ratio and Risk of All-Cause Mortality in Men.” European Journal of Clinical Nutrition, vol. 69, no. 8, 5 Nov. 2014, pp. 927–932, 10.1038/ejcn.2014.235. Accessed 30 Aug. 2021.


13. “Encyclopedia of Body Image and Human Appearance.” Choice Reviews Online, vol. 50, no. 10, 22 May 2013, pp. 50–535950–5359, 10.5860/choice.50-5359. Accessed 9 Nov. 2019.


14. Mousavi, S V, et al. “Changes in Body Mass Index, Waist and Hip Circumferences, Waist to Hip Ratio and Risk of All-Cause Mortality in Men.” European Journal of Clinical Nutrition, vol. 69, no. 8, 5 Nov. 2014, pp. 927–932, 10.1038/ejcn.2014.235. Accessed 30 Aug. 2021.



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