Exercise

Why Exercise?

To Lose weight of course! And more…

In order to decrease:

  •   Body Fat
  •   Serum LDL Cholesterol
  •   Serum Triglycerides
  •   Severe Depression
  •   Risk for Heart Disease
  •   Risk for Diabetes
  •   Risk for Stroke

In order to increase:

  • Bone Density
  • Flexibility
  • Strength
  • Endurance
  • Power
  • Speed
  • Agility
  • Balance
  • Muscle, which burns fat
  • Metabolic rate
  • Cardiovascular Efficiency
  • Endocrine System Efficiency

 

Why stretch?

  1. Stretching increases flexibility.
  2. Flexibility is crucial for any proper exercise routine because it allows for full range of motion.
  3. Stretching can relieve joint stress.
  4. Stretching can correct muscle imbalances.
  5. Stretching can decrease the occurrence of overuse injuries.

 

References:
Clark, MA, Lucett, S, Corn, R, Cappuccio, R, Humphrey, R, Kraus, SJ, Titchanel, A, Robbins, P. NASM: Optimum Performance Training for the Health and Fitness Professional. National Academy of Sports Medicine. USA pp 9-10;198.
Babyak, M. A., Blumenthal, J. A., Herman, S., Khatri, P., Doraiswamy, P. M., Moore, K. A., Craighead, W. E., Baldewicz, T. T., & Krishnan, K. R. Exercise treatment for major depression: Maintenance of therapeutic benefit at 10 months. Psychosomatic Medicine, Vol. 62. pp. 633-638. 2000

 

Exercise and Weight Loss

According to a recent analysis by Marketdata Enterprise, Inc, Americans spent $60 billion on weight loss products in 2010.1  Plenty of marketing today focuses on fad diets, pills, fasting, detoxes, and quick fixes for weight loss.  Americans are bombarded with ads about Jenny CraigÒ or Weight WatchersÒ etc.  Trendy workout equipment and programs like the BowflexÒ, Beach Body InsanityÒ, P90xÒ are also spreading.  Nevertheless, the majority of adults in the US struggle to lose weight or at least maintain it.2  Despite the billions of dollars spent on weight loss products, obesity is increasing throughout America.  Obesity is mainly assessed using the body mass index or BMI value of 30 or above through an equation of weight in kilograms divided by height in meters squared.3  Current media often point out the main culprits behind obesity including sedentary work environments and fast food habits.

Healthcare practitioners, the media, and scientists, on the other hand, often spread the message of combating obesity through an active lifestyle and a balanced diet.  Still an estimated 55% of American adults do not exercise or do not regularly participate in physical activities.4  Weight is a balance between energy expenditure and food intake, so the most important factors in weight control and body composition are resting metabolic rate, energy expended through exercise, dietary intake, and the thermogenic effect of food.5  For this reason, both dietary and exercise approaches to weight loss can be effective.  If an individual expends 2000 calories per day but also eats 2000 calories per day, then he or she will not lose or gain weight.  However, weight is not the only determinant of good health.  Both weight status calculated using BMI and body fat levels are positively associated with an increase risk of death. In fact, the risk of death increases by 4% per unit of BMI while another model using fitness level has a 25% lower risk of death per unit MET (VO2 max=1.44 x minutes on treadmill +14.99).6  In terms of health hazards, the amount of body fat is not as important as the location of it.7  Large deposits of visceral fat stored in the abdominal area can damage health more than subcutaneous adipose tissue on the extremities.7

 

Weight loss

Using diet alone can induce weight loss and using exercise without changing diet can also induce weight loss.  Ross et al tested this idea when he randomized 52 obese men to a diet-induced weight loss, exercise induced weight loss, exercise without weight loss, or a control group.8  Both the diet and exercise weight loss groups improved though the exercise induced weight loss group experienced a two pound greater reduction in fat.  A total weight reduction did not occur in the exercise without weight loss group, but they had a decrease in abdominal and visceral fat.8  Perhaps, this group increased muscle mass to compensate for the fat loss.

For practical purposes, the combination of exercise and calorie restriction can produce timely results.  Using both methods makes sense taking into account the fact that one pound of fat consists of 3555 calories and about 87% lipid.9  A person could either decrease dietary intake by 100 calories per day or jog one mile daily to obtain a yearly weight loss of 10 pounds.9  Ideally, weight loss should not exceed two pounds per week to minimize risk of losing muscle mass and long term decreases in resting metabolic rate.9

 

Exercise Type

A common myth that clouds honest fitness efforts is the spot reduction method where people focus on exercising one area of the body in the hopes of reducing local fat stores.9  For example, many gym goers emphasize abdominal exercises like crunches and sit-ups in order to target belly fat.  These are calisthenic strength type exercises using body weight as resistance, which mainly increase strength and flexibility. While that kind of exercise benefits total fitness, it is not as effective for abdominal fat reduction as aerobic exercises.7  Italian scientists recently tested the difference between aerobic and resistance exercise routine in terms of weight loss wherein 47 patients were assigned to aerobic or a combination of aerobic plus resistance training in addition to a diet regime.10  Each exercise program lasted a total of three weeks.  The aerobic routine consisted of 15 minutes using the row ergometer machine and 15 minutes using the bicycle ergometer for a total of 30 minutes daily for five days a week.10  This routine was performed at 70% of the age-predicted max heart rate.  Combination routines consisted of similar cardio 30 minute portions plus 15 minutes of 9 resistance exercises for the upper body and lower body wherein loads were 40-50% of the one repetition max.10  Each resistance exercise contained one set, resting interval was less than one minute between sets and weights were adjusted as strength level increased.  This study concluded that aerobic training alone produces an equal increase in weight loss compared with the combination of exercises and is therefore more practical for adults with time constraints in daily life.10  In a similar study, Sarsan et al utilized a 12-week training period with aerobic or resistance exercise routines on 60 obese women.11  Both exercise groups lost a significant amount of weight.11

Duke University faculty compared the effects of aerobic and resistance training on body mass and fat mass in adults.12  119 sedentary overweight or obese participants were randomized to a resistance, aerobic, or combination group for eight months.  The resistance group engaged in three sets of 8-12 repetitions for each exercise on three days per week.12  The aerobic group completed the equivalent of 12 miles per week at 65-80% VO2.  The combination group did the same aerobic plus the same resistance exercises as the other two groups.  As a result, the aerobic and combination groups lost more weight and fat compared to the resistance group.  Conversely, the resistance and combination groups increased lean body mass more than the aerobic group.12

A more practical trial recently evaluated the difference between 30 minutes of resistance full body exercises with 25 sets at 10-repetition maximum level (reaching muscular failure at 10 repetitions) versus 30 minutes of aerobic exercise on a treadmill at 60% heart rate reserve.13  All participants exercised 3-5 times per week for 12 weeks total.  At the end of this trial, weight, body fat, and BMI were significantly lower in the combination and aerobic groups compared with the control and resistance groups.13

Clearly intensity and duration of the exercises are crucial to anthropometric changes.  An hour of exercise even at moderate intensity can be more prolific than half an hour as seen in the following study.  Researchers at a Turkish University recently analyzed the effects of an eight week pilates exercise routine on 58 previously sedentary obese women.14  Pilates is a calisthenic strength type exercise that uses body weight for resistance.  27 women were included in the control group and 34 were in the pilates group.  The pilates group engaged in one hour of exercise four days per week.14  Anthropometric measurements taken for this study included BMI, waist circumference, waist-hip ratio, body fat percentage, resting metabolic rate, and 4-site skinfold thickness.  This study concluded that the pilates exercise routine was effective for improving weight, BMI, lean body mass, waist-hip ratio, fat percentage, metabolic rate and flexibility.14

Indeed a large discrepancy exists between the benefits of different exercise routines.  Aerobic exercise outcomes vary from machine to machine and depend heavily on the intensity and duration of the routine.  For instance, at the same perceived exertion rate “somewhat hard” a person could expend 700 calories per hour on the treadmill versus 500 calories per hour using a cycle ergometer.15

Brown et al compared energy expenditure using a treadmill to that on an elliptical machine. They found that there was no significant difference in the energy expended during workouts.  However, participants using the elliptical burned a slightly larger amount than participants using the treadmill.16

 

Resting Metabolic Rate   

The largest proportion of a person’s daily energy expenditure, and therefore a major determinant of weight status, is the resting metabolic rate (RMR).17  This rate accounts for about 60-75% of the daily total energy expenditure depending on how much exercise the individual does.17  For sedentary people, the RMR is a prime determinant of weight status since they are not exercising regularly to expend more calories.  Even for the gym enthusiast, who jogs one mile per day burning around 100 calories of additional energy on an average day, the RMR is key.9  The 270 or even 300 calories burned during a 60 minute run at 65% VO2 max does not compare to the 1500 or 2000 calories expended via the RMR for a given woman or man.18  A 40-minute resistance interval workout can account for an average of 289 expended calories,19 which is still trivial in comparison to an RMR of nearly 2000 calories.  For weight loss purposes, one might aim to lose a pound per week and recall that a pound is roughly equal to the aforementioned 3555 calories.  This means an excess of 500 calories must be expended through exercise daily beyond the RMR if calorie intake remains stable.

What if we could increase RMR?  This seems likely since RMR is directly influenced by fat free mass or lean tissue.17  Another relevant questions is “What kind of exercise could change RMR?”  Aerobic exercise performed 3-4 days a week for 6 months at 70-85% maximal heart rate for 45-60 minutes per session does not affect RMR despite improvements in weight, body fat and BMI.17  In contrast, according to the International Journal of Sport Nutrition and Exercise Metabolism, RMR in a few young women increased by 4.2% in two days after 100 minutes of acute strenuous resistance exercise.20  Eight weeks of resistance training (three times a week) alone can increase lean tissue by 7.7 lb and reduce body fat by 4.4%, though the same amount of training plus a daily intake of 20 grams of green tea powder can increase lean body mass by 14 lb and reduce body fat by 10.3%.21  This combination of resistance training and tea powder intake results in a significant increase in RMR as well.21  Unfortunately, the increase in RMR that occurs after resistance training can be counteracted by a decrease in metabolic rate that occurs with weight loss.  In fact, weight loss can even affect how many calories are burned during a workout.  A new study in the Netherlands showed that the effect of weight loss can lower energy expenditure during exercise by 143 calories per day.22  In other words the person might have to jog an extra mile and a half or walk for two hours per day to make up for how many calories they are not able to burn compared to before the weight loss.22  Most importantly though, a decrease in RMR is correlated with weight loss and the decrease may be greater than expected or disproportional.22

Consequently, one must seriously consider the importance of hypertrophy, the increase of muscle mass, and plenty of scientific support (including the green tea study mentioned in this article) suggests that resistance training can promote hypertrophic adaptations, which result in increased skeletal muscle mass.23  Ten weeks of resistance training can increase muscle mass by three pounds and subsequently increase RMR by 7%.24  On the other end of the spectrum, even intense aerobic exercises such as distance running and marathon running, despite extensive muscular endurance adaptations, may not result in leg muscle hypertrophy.25

 

Discussion

Undoubtedly the epidemic of obesity in America, and now in most developed nations, is a devastating predicament.  Much controversy exists over the solution to this issue among experts and laymen.  To this end, the media often asks or attempts to answer the following questions “Is it diet? Is it exercise? What kind of diet? What kind of exercise?” Research has answered these questions using a number of methods.

The aforementioned 3555 calories for a pound of fat is a rough estimate that can help elucidate how much food and exercise one should reduce or increase, respectively.  If a gym enthusiast runs for one hour daily Monday through Sunday while keeping their diet the same, then they might lose a little over one pound per week.  If this same person skipped the gym and reduced their daily food intake by 500 calories per day (which is a bad idea if they are not obtaining adequate nutrition), then they could still lose about one pound per week.  Putting these ideas into perspective, one can see why combining exercise and a healthy low calorie diet can be effective for weight loss.

Frequent and moderately intense aerobic exercise is a timely and efficient method for reductions in body fat as well as weight loss if one maintains or decreases calorie intake.  Exercising on a treadmill with a perceived exertion of “somewhat hard” or a 13 on a scale of 1 to 20, in which 1 is the easiest and 20 is the hardest, can account for expending 700 calories per hour.  On the other hand, moderate intensity resistance training for 40 minutes accounts for about 289 calories.  Indeed aerobic training expends more calories compared with resistance training.  This is probably why most women at a typical gym are in the cardio room or on some kind of cardio equipment.

There is one major problem with that, however, resting metabolic rate decreases significantly when a person loses a large amount of weight. For example, he or she can go from burning 2000 calories per day when he or she weighed 200 lb to only burning 1500 calories when he or she lost 60 lb.  So if this individual was eating 2000 calories before the weight loss, but they expended 500 calories per day through exercise, then it would take them over one year to lose 60 lb. Once they achieved this weight loss and their RMR was 1500, they would have to continue expending the 500 calories per day (which would take more effort or time because activity energy expenditure decreases with weight loss)22 simply to maintain their current weight.  For these reasons, many people end up regaining weight after several months or years.  This is where resistance training becomes essential for weight maintenance.

Although exercise and diet can dramatically change weight status, resting metabolic rate (RMR) is usually the prime determinant of energy expenditure.  Running on the treadmill for two and a half hours daily might come close to devouring the same proportion of metabolic energy as RMR.  Most people, however, do not exercise enough to expend 1500 calories or more per day.  So what is the solution to weight loss maintenance?

Increasing RMR is possible through the increase of lean tissue also known as muscle tissue.  The addition of three pounds of muscle is equivalent to about a 7% increase in RMR.25  In the above example, a baseline RMR of 1500 calories per day can change to about 1600 calories per day as a result of the three pound muscle increase.  That may not seem like a big change but over a one-week period this amounts to 700 additional calories that a person can expend without long hours of extra exercise.  This example then begs the question “What about increasing muscle mass by six pounds or even nine pounds?”

If a 7% increase in RMR correlates to the addition of three pounds of muscle, then adding nine pounds of muscle might correlate to a 21% increase in RMR.  Using the  same example baseline RMR of 1500 calories per day could change to 1815 calories per day.  This new RMR would result in an expended 2205 calories per week in surplus of the baseline 1500 calories per day.  This kind of change would allow a person to remain on a very similar diet to the one he or she had before the 60 lb weight loss mentioned in a previous example. He or she could maintain his or her weight as long as the muscle mass is kept constant and the calorie intake remained close to 1800 calories per day.

In summary, the most sensible and rapid approach to initial weight loss is a daily combination of intense (or starting with moderate and gradually increasing intensity) aerobic exercise and a well-balanced healthy calorie restricted diet.  Once a significant amount of weight and body fat loss is achieved, one should begin to incorporate moderate resistance training at least 3-4 times per week.  The resistance training should progress in intensity and duration until the addition of 3-9 pounds of muscle mass is achieved, depending on the goal maintenance weight and calorie intake.  Once this increase of lean tissue is obtained, the individual can adjust workout routines to lower frequency of aerobic exercises and maintain an adequate amount of resistance training to ward of any muscle atrophy.  By maintaining a significant amount of lean tissue, the individual can be assured that RMR will stay relatively stable and calorie intake can go back close to normal to compensate for the resulting changes in RMR.

 

References:

  1. LaRosa John. US weight loss market worth $60 billion: 80% of dieters now do it themselves, highest level ever. 2011. http://www.prweb.com/releases/2011/5/prweb8393658.htm  [Accessed April 24 2013]
  2. Serdula MK, et al. Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999;282:1359.
  3. Bray GA. Pathophysiology of obesity. Am J Clin Nutr 1992;55:488s.
  4. Mokdad AH, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA 2001;86:1195.
  5. Schoeller DA, et al. The importance of clinical research: the role of thermogenesis in human obesity. Am J Clin Nutr 2001;73:511.
  6. Church TS, Cheng YJ, Gibbons LW, et al. Exercise capacity and body composition as predictors of mortality among men with diabetes.  Diabetes Care 2004;27(1):83-88.
  7. Ismail I, Keating SE, Baker MK, et al.  A systematic review and meta-analysis of the effect of aerobic vs resistance exercise training on visceral fat. Obes Rev 2011;13:68-91.
  8. Ross R, Dagnone D, Jones PJH, et al. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men: a randomized controlled trial. Ann Intern Med 2000; 133(2):92-103.
  9. McArdle WD, Katch FL, Katch VL. Sports and Exercise Nutrition 3rd Ed. Lippincott Williams & Wilkins 2009:463-477.

10. Lucotti P, Monti LD, Setola E, et al. Aerobic and resistance training effects compared to aerobic training alone in obese type 2 diabetic patients on diet treatment. Diabetes Res Clin Prac 2011;94(3):395-403.

11. Sarsan A, Fusun A, Ozgen M, et al. The effects of aerobic and resistance exercises in obese women. Clin Rehab 2006;20:773-782.

12. Willis LH, Slentz CA, Bateman LA, et al. Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults. J Appl Physiol 2012;113:1831-1837.

13. Ho SS, Dhaliwal SS, Hills AP, Pal Sebely. The effects of 12 weeks of aerobic, resistance or combination exercise training on cardiovascular risk factors in the overweight and obese in a randomized trial. BMC Public Health 2012;12:704.

14. Cakmakci O. The effect of 8 week pilates exercise on body composition in obese women. 2011;35(4):1045-1050.

15. Zeni A, Martin D, Hoffman MD, et al. Energy expenditure with indoor exercise machines. JAMA 1996;275(18):1424-1427.

16. Brown GA, Cook CM, Krueger RD, Heelan KA. Comparison of energy expenditure on a treadmill vs. elliptical device at a sel-selected exercise intensity. J Strength Cond Res 2010;24(6):1643-1649.

17. Santa-clara H, Szymanski L, Ordille T, Fernhall B. Effects of exercise training on resting metabolic rate in postmenopausal African American and Caucasian women. Metabolism 2006;55(10):1358-1364.

18. Mojock CD, Kim JS, Eccles DW, Panton LB. The effects of static stretching on running economy and endurance performance in female distance runners during treadmill running. J Strength Cond Res 2011;25(8):2170-2176.

19. Lagally KM, Cordero J, Good J, et al. Physiologic and metabolic responses to a continuous functional resistance exercise workout.  J Strength Cond Res 2009;23(2):373-379.

20. Osterburg KL, Melby CL. Effect of acute resistance exercise on postexercise oxygen consumption and resting metabolic rate in young women. Intl J Sport Nutr Exerc Metab 2000;10(1):71-81.

21. Cardoso GA, Salgado JM, Cesar MC, et al. The effects of green tea consumption and resistance training on body composition and resting metabolic rate in overweight or obese women. J Med Food 2013;16(2):120-127.

22. Bonomi AG, Soenen S, Goris AH, Westerterp KR. Weight-loss induced changes in physical activity and activity energy expenditure in overweight and obese subjects before and after energy restriction. Plos One 2013;8(3):e59641. [Accessed April 25 2013] http://www.ncbi.nlm.nih.gov/pubmed/23555733

23. Schoenfeld B. Post-exercise hypertrophic adaptations: A re-examination of the hormone hypothesis and its applicability to resistance training program design. J Strength Cond Res 2013. [Accessed April 25 2013] http://www.ncbi.nlm.nih.gov/pubmed/23442269

24. Westcott WL. Resistance training is medicine: effects of strength training on health. Curr Sports Med Rep 2012;11(4):209-216.

Ozaki H, Loenneke JP, Thiebaud RS, Stager JM, Abe T. Possibility of leg muscle hypertrophy by ambulation in older adults: a brief review. Clin Interv Aging 2013;8:369-375.

Bodybuilding

Thinking about bulking up and changing your diet to compensate?   You might not want to overload on animal protein.  A high intake of processed meats and red meats like beef, lamb, and pork, are linked to an increase in colorectal, colon, and rectal cancer.1  Using dairy protein and red meat can also increase your risk of prostate cancer.2  Some healthy sources of protein include legumes (beans), nuts, seeds, low-fat fish, organic egg whites, organic lean poultry, and vegetarian meat alternatives.

A bodybuilding diet should not differ immensely from the balanced diet recommended for non-athletes.  Fruits, vegetables, whole grains, legumes, and nuts are still important foods that should have a place in the diet of athletes and non-athletes alike.  However, the off-season and pre-contest bodybuilder’s diet should consist of 55-60% carbohydrate, 25-30% protein and 15-20% fat.  The off-season diet should have a 15% increase in calories and the pre-contest phase should have a 15% decrease in calories to help burn body fat.3

Creatine

Creatine is an effective supplement for individuals with low initial total free creatine, such as vegetarians. Those with diets high in meats will not see a major difference since the food they eat already contains a significant amount.  As a result, some people may not respond as well as others.  Increased free creatine and creatine phosphate are likely to provide more short term energy and increased rate of resynthesis during rest with a side effect of increased body mass from water retention or protein synthesis.4  Many individuals feel that creatine gives them a “bloated” look rather than a defined look because of the water retention.  Also keep in mind that supplements are not regulated the way food is regulated by the FDA and therefore supplements may not contain exactly what they claim to contain.

References:

  1. Chan, Doris; Lau, Rosa; Aune, Dagfinn; Vieira, Rui; Greenwood, Darren; Kampman, Ellen; Norat, Teresa. Red and Processed Meat and Colorectal Cancer Incidence: Meta-Analysis of Prospective Studies. PloS One: 2011; 6(6):e20456.

  2. Wright, Jonathan L; Neuhouser, Marian L; Lin, Daniel W; Kwon, Erika M; Feng, Ziding; Ostrander, Elaine A; Stanford, Janet. AMACR polymorphisms, dietary intake of red meat and dairy and prostate cancer risk. The Prostate, Vol 71, Issue 5, p 498-506. April 2011

  3. Lambert CP, Frank LL, Evans WJ. Macronutrient considerations for the sport of bodybuilding. Sports Medicine, Vol 34, Number 5, 2004, pp 317-327 (11).

    4. Demant TW, Rhodes EC. Effects of Creatine Supplementation on Exercise Performance. Sports Medicine, Vol 28, Number 1.