Category Archives: Exercise

Healthier Together Series: Cycle 1 B. Physical Activity — Workout bonus

lindsay-henwood-7_kRuX1hSXM-unsplashToday’s Physical Activity Notes:

First: I will often use the terms physical activity and workout interchangeably. When I use the terms “working out” & “workout,” I specifically refer to intentional physical activity that is planned for the purpose of being exercise. Working out is deliberately moving for health, fitness –> exercising. Physical activity is anything we do that moves our body and includes working out, exercising as well as other activities we do daily.

Good news: since we wake up in a mode burning our body’s stored fuels, whatever physical activity we do in the morning prior to eating or drinking calories, accelerates our fat burning by using up our muscles’ stores of glycogen (energy stored in muscles). This means that you get to drink or eat a bit more freely after being physically active in the morning. In fact, if you workout vigorously in the morning (if you used up all the glycogen in your muscles), you can add some unprocessed carbs to your meal within approximately 30-60 minutes & your body will put the extra blood sugar (the glucose from digesting the carbs) into your muscles and NOT into fat cells. HOW COOL IS THAT?

Remember, if you eat foods that spike your blood sugar (especially foods like processed carbohydrates including sugars), your insulin will spike and your body will store most of that extra blood sugar in your fat cells! So, your FAT stores will GROW BIGGER…and mostly around your middle. NOT your goal. So, that means if you want to eat/drink that higher carbohydrate food or drink & you don’t want to grow your fat, WORK OUT first! You get the biggest bang for your buck if you are physically active first thing in the morning before you eat or drink any calories (drinking water is better).

Remember, the “physical activity” can be:

1. Low intensity movement for a longer duration – like walking for 30-40+ minutes or an activity that is at a perceived exertion level of 5-7 or heart rate approximately 60% (+/-10%) of your personal maximum heart rate. *see previous blog about perceived exertion and heart rates for more info.

2. Spurts of higher intensity activity for a shorter duration (even 4 minutes counts!). This might mean boosting your perceived exertion closer to 8-10 or 80-90% of your maximum heart rate for very short spurts, no longer than 30-60 seconds, interspersed with 2-5 minutes of lower intensity such as level 5-6. Basically, you go hard for 30 seconds then easy for 2 minutes, & repeat a few times. I like 4 cycles. — Another option, look up the 7 minute workout online.

The key is to deplete or significantly lower your body’s storage of glycogen with exercise and voila! You now have created an empty space (your muscles and liver) where your body will put the extra sugars in your blood (from the carbs &/or sugars you have consumed) & it is NOT going into your fat cells for storage. It is getting burned up in your muscles immediately. If you have eaten protein & fat within a low carb “break-fast,” you will just continue to be burning fat.

Bottom line: If occasionally, you are craving extra berries or a sweetened cup of coffee or tea or other starchy carbohydrate with your breakfast, & you don’t want to worry about it increasing your weight, work out first thing in the morning! It’s a workout bonus!

Photo by Lindsay Henwood on Unsplash

Perceived Exertion & Heart Rates — How to use them

This doctor’s Perceived Exertion Scale

Scale of 1-10.
1 laying in bed or propped up
2 sitting up
3 standing
4 standing & / or jiggling
5 walking
6 brisk walk/slow jog – point of breaking a sweat, could keep doing this for hours; equivalent of 60% of max heart rate
7 sweating, still able to have a conversation; 70% of max heart rate
8 breathing faster through mouth, sweating more; 80% of max heart rate
9 not able to sustain for long time, breathing hard, conversation has to wait; 90 % max heart rate
10 hard as you can go, balls to the wall, takes concentration on working it…this is your personal maximum heart rate

Keep perceived exertion in mind…

I’m a fan of the heart rate monitor when I am working out. I like numbers. I use a polar heart rate monitor even though I don’t care to wear a chest strap. I have just found it is the most reliable and it is easy to use. If you work out at a gym, it will often “talk” to the motorized gym equipment like the treadmill, elliptical, stepper, stationary bike, etc.

Here is how I use my heart rate monitor. First, I rate my perceived exertion at the level of exercise I am doing – & see what my heart rate is. This lets me know my own heart rate zones for different levels of perceived exertion so I know how vigorous any activity is for me. Then, I look at what my heart rate is when I am going 10/10 & note that as my personal maximum heart rate. Then, I can figure out my approximate heart rate which correlates with each level of perceived exertion. Now, I can see how I am doing.

What I find is that as my fitness improves, I can do more for the same heart rate response. For example, I can walk 3.6 mph at a 4 degree incline on my treadmill and I am at a level 6 that correlates with a heartrate in the 120’s. Previously, when I first started my current exercise program, that same setting on my treadmill felt more like an 8 on perceived exertion and my heart rate was in the 160’s.

Also, as the fitness level improves, the time it takes for your heart rate to come back down gets shorter. In other words, your recovery time gets shorter. Instead of 10 minutes to cool down, it only takes 1 minute.

Finally, when you know what your resting heart rate is, you can objectively see if your body is under more stress (ie. fighting a brutal cold) & adjust your workout accordingly. So, given my resting heart rate is in the 50’s, if I have a cold & my resting heart rate is in the 70’s or 80’s, I know I may not want to exert myself too much. In fact, I can just gently walk slowly & see my heart rate will rise quickly. OR I can just do some stretches or some gentle yoga and make sure I am getting my fluids and taking care of myself in other ways.

We are all scientists when it comes to our own bodies. It helps to learn of more ways to understand what it is telling us. I suggest keeping a log of your observations. In this case, write the date & time, write down your activity (including duration and settings) and your perceived exertion and heart rate. I include my average heart rate and my maximum heart rate also. Then I include some notes about how I was feeling. I always finish with a positive note & then I review what I will do next time. Numbers make it easier to follow your progress. It’s so fun to look back on all of the successes!

In a future blog, I will discuss how to use this information to organize your workout plan – how to evaluate your workout and how much time you will invest into working out.

Photo by Markus Spiske/Unsplash

Overcoming 17 Exercise Barriers

Have you had a hard time getting started with exercise or continuing to exercise? You are not alone. Though this is a common concern, there are many different reasons. The good news is, there is help out there. I have included some of the most common challenges I have come across. See if any of the below relate to you…
Common Barriers to Exercise:
1. Don’t know where to start or what to do.
–First off, remember you do NOT have to be a “jock” or workout like crazy for it to count as exercise. The MAJORITY of people do NOT want to do that or need to that. In fact, there are many ways to improve your health and well-being with physical activity. Yes, some people like hard core structured workouts at the gym or with videos or specialized equipment. Still, others prefer more gentle movements or they prefer natural activities such as walking or gardening or social dancing or jumping waves on the beach.
–Try wearing a pedometer and counting your daily steps. If you are active at work, you can see it on the pedometer & pat yourself on the back – get credit for working out while working! Otherwise, see how many steps you take in a “normal day” and increase a little either in distance or speed once a week . Maybe walk the dog a little farther or faster.
–Getting up & down from a stable chair or the side of a bed is great for the legs and your core. It is also helpful in decreasing the risk of falls as we get older.
–Dance to your favorite music or do some crunches during TV commercials. In other words, make your time work double for you.
–Find some books, DVD’s, online videos & blogs. Look up body weight exercises if you do not want any special equipment. There are various levels of exercise options.
–Also, there are always the trainers either at the gym or who make house calls that can help put a program together for you. Find a trainer that understands your goals — or you may find yourself being pushed harder than necessary for your health benefit goals.
–If you like to workout with others, you may want a workout partner, a class or a gym membership. You may even find someone at the gym or at school or work that already works out and really knows what they are doing. They are often happy to help you.
–Bottom line, pick something you want to try & just go for it. You will find what works for you eventually. The fun part is trying different things that sound interesting to you & moving forward closer to your fitness & health goals.
2. Injury early on.
–This is especially common in people who used to workout or be physically fit in the past and then had a period of time where they were deconditioned. It is NOT because you are getting older most of the time. It is because your muscles have memory and regain their strength quickly on return to exercise, however your joints do not suddenly get younger and smoother. Your muscles “beg” you to increase their workout rapidly. Your joints need a slower ramp up to catch up to what your muscles can do. That is why you should increase your exercise training no more than 10 percent total intensity in a week. Otherwise, you run the risk of joint injury, feeling “old” and having to interrupt your workout plans.
–The other group with injury early on are often doing a workout that is not right for them or that is being done incorrectly. This is a good time to seek out help. For example, schedule to meet with a physical therapist, work with a personal trainer, exercise physiologist, or a physician with additional training (physician specializing in Physical Medicine & Rehab, Sports Medicine or any physician with a strong history & interest in exercise training). Find out what you are doing wrong & fix it.
–Recommend early intervention.
3. Previous joint injury.
–Again, as in #2, seek out help. Make sure you know what exercises are right for you, and learn how to do them correctly and how to progress forward. If you need surgical intervention, find out now.
–Do move it. Blood circulation helps healing. Make sure you continue to move forward. Your joints will get stiff & crusty if you don’t keep moving forward.
–As you move your joints, you smooth out the roughened surfaces if there is some arthritis. Worst case, your need for a joint replacement or surgical intervention may still be necessary, but best case, you rehab your joint & defer or eliminate the need for a joint replacement or surgical intervention.
4. Boredom.
–Find friends, blogs, DVD’s, classes, clubs, groups that are doing different things and try them out.
–Schedule & plan for variety in your plan. For example, schedule a workout plan or trial period of 2 weeks and then assess & then plan the next 2 weeks.
–Get a workout buddy you like to spend time with. Being with someone, feeling good about yourselves together, is VERY motivating and powerful!
5. Burnt out.
–You may have advanced your workouts too quickly or started with too much. Take your time. You have your whole life to continue to improve.
–You should feel energized after your workout and look forward to your next workout. If you are dreading your workout or drained after your workout, that is a sign of burn out.
6. Not enough time.
–We all have enough hours in a day. IF a president can work out, we can probably find the time. MOST high powered executives and professionals also workout. People who workout tend to make more money than those who don’t.
–Often, because we have to schedule in the workout, we find we have more time in the day because we plan our time better.
–That being said, working out does take time. However, good news is that workouts don’t have to take a lot of time. There is a 7 minute workout that has been scientifically proven to be as effective as the traditional longer workouts, working strength for the whole body & cardio. There are short yoga sequences & exercise programs on DVD, online and on smartphone apps.
7. Haven’t found an activity that is pleasurable.
–See #4.
–Find a workout buddy or online community and workout together, share ideas. The human body is made to move. That is why we have muscles and joints. There is something out there that you will enjoy. It’s like dating…there is someone for everyone, and there are enjoyable exercise options for everyone.
8. Can’t afford it, ie. gym membership or equipment cost.
–Look at garage sales/yard sales, online auctions or Craig’sList for equipment.
–Get a job at a gym part-time.
–Find exercises that don’t require equipment. Again, the 7 minute workout does not require equipment. Modify the exercises to your level of fitness (I never step up & down from a chair, but use a step).
–Share the cost of equipment or DVD’s with a workout buddy or group of buddies.
–Borrow workout DVDs from the video store or from your local library.
9. Scared of injury.
–Get a trainer, workout with someone.
–Take your time learning the proper techniques.
–Advance your workout slowly.
10. Embarrassed to be seen.
–Remember, this often changes when you see other people just like you.
–You can also choose to start out at home or go to the gym during off hours.
–Really, in a gym, everyone is usually pretty positive about everyone at the gym because when we work out, the endorphins (feel good chemicals in our bodies) are surging through our systems.
11. Schedule is erratic. Can’t get into a regular regimen, traveling frequently, in a new relationship interfering with usual workout time.
–If possible, find something that is regular in your schedule, ie. you brush your teeth every night. Plan your exercise to be linked to that. For example, I brush my teeth in the morning when my alarm goes off & hop in the shower, so I will plan to schedule a workout at the same time. If my workout is 35 minutes, I will set the alarm 35 minutes prior to my usual waking time. To compensate, I will move my bedtime up by 35 minutes the night before or make sure I can fit in a nap or make up sleep time by going to bed earlier the next night.
12. Too tired.
–Make sure there is no medical reason you are too tired, such as anemia, thyroid disorder, etc.
–This may also be a sign of depression or excessive stress. Both may improve with exercise.
–This also more commonly is due to not enough hours of sleep, deconditioning (which means you should be working out), &/or too many carbohydrates in your diet.
13. No babysitter.
–Find a gym with a free babysitting service.
–See if another parent you trust would trade workout times with you: you watch their kid(s) while they workout and they watch your kid(s) while you work out.
–Work out before the kids wake up or after they go to sleep or during their naps if they have regular naps.
–Incorporate your children into your workout: ie. jogger stroller, babycarrier.
–Find a reliable teenager to watch your kid(s) while you workout at home or outside the home.
14. Active at work or running around after kids.
–If you are really that active, get credit for it. Wear a pedometer or accelerometer or even a heart rate monitor.
–If you are walking 10,000 steps daily or more, you should pat yourself on the back, you really are running around alot! Great job!
15. Gym is not convenient: doesn’t open early enough, closes too early or is too far away.
–Sounds like that is not the right place for you to be signed up. Find a way to make it a part of your routine to go out that way or shift your time to exercise. If not, find another gym or another way to exercise.
16. Need to shower after, doesn’t fit in my day.
–Again, this is about scheduling. Either not enough time or no shower avail. This is commonly noted when people plan to workout over their lunch break. If you will need to shower after & you are not comfortable with a sponging off over a sink or you don’t have enough time, then find your alternative. I like the early morning because it means I only need to shower once for the day. I workout & shower & get ready for work & off I go.
17. “Don’t feel like it.”
–Well, it’s usually because of one of the above reasons. If you are social, you need other people or you need to find a way that the workout time does not take away from time with other people. If you are more private, you may want to workout at home or when & where there are fewer people around or workout only with a single workout buddy. If you like being outdoors or being in nature, find outdoor activities. If you like music, find exercises that you can do with music or that require music. If you like lists or calendars, put your workout on the list/calendar so that you will do it & cross it off – it feels so good to cross off a ‘to do.”
Finally, I can tell you that the majority of people feel better when they are regularly moving their bodies. Your movement helps circulate body fluids, keeping you “younger” longer and often reversing signs of aging such as arthritis. Your mood is better & you can accomplish more. Give it at least 4 weeks to really see obvious benefits and body changes. There is nothing quite like being successful and doing something so profoundly good for you. Remember, this is for your lifetime. Enjoy the process.

12 Rules to Finding the Perfect Workout Program For You

gesina-kunkel-gRNcA7jFIeg-unsplashElements to look for in a week of an excellent workout program for you:

  1. It is fun or sounds like fun to you.
  2. Easy to learn the moves and the routine. It’s hard to get started when the routine or the moves are so complicated you have trouble following or remembering how to do them. Once you are in the routine of working out, you can add in or advance to more complicated routines and moves, but by then, you will be in the groove and it will be hard NOT to work out because you feel so good when you do. When starting out, keep it simple. Make it hard to make mistakes or to get discouraged.
  3. It can be done easily. For example, you have the equipment at home, your gym is convenient to get to, it is NOT a nuisance to set up or get ready to do, no too long. What you DO NOT want: I’m talking about the treadmill that folds up & fits under that bed in the cluttered room or the exercise bike that has become an extension of your closet, or the room that will need to be cleaned of clutter on the floor so you have space to do your workout DVD? Who wants to do laundry or clean up clutter & pull out & set up the heavy treadmill prior to each workout? Or is your gym is 30 minutes away, close to where you used to live or work or go to school? You want to add an hour commute to the time in the gym to squeeze in your work out? No. Make it easy to exercise.
  4. It should have enough routine to make it a habit, but enough variety to keep your body progressing forward over time.
  5. Rest days have to be built into it. One day per week should be completely off of strength training. If you can’t stand it, do some yoga or go for a nice walk on your day off. Also, I recommend a plan to allow at least 24-48 hours between strength workouts of the same body areas. This means, do NOT do the same strength training routine 2 days in a row. For example, ideally, schedule a minimum of 1-2 days between chest workouts. Work out each muscle group at least once per week, depending on your program and your goals.
  6. Your program should allow slow but steady progress forward and that progress should be apparent to you. Progress is motivating. Plan ahead for progress and stages of progression. For example, scheduling the week with increasing number of reps or increasing weight in a planned manner makes it very easy to see the progress and know how to progress. I suggest writing down what you are planning to do, and then what you ACTUALLY do. Do not do more than what you planned, but if you cannot increase as planned, don’t force it, That is where you are moving towards. Just adjust your plan accordingly.
  7. It should include strength training, often called anaerobic exercise. Strength training is important in keeping us independent longer. It includes exercises where your muscles push or pull against resistance. This can be done in many ways such as with weights, machines, bands, medicine ball, or even your own body weight and gravity. Some people also use a stationary surface to push against. If you are new to strength training, have someone teach you the proper ways to do the moves or find some reputable DVDs or online instructional videos to see how to do exercises properly. **Just a note about the importance of strength training for men & women of ALL ages…It can help keep us more physically independent for longer. I am in no rush to lose my independence & move into a nursing home so I will continue to make sure my muscles stay strong. This will help prevent falls and other injuries that are common with poor strength. If something happens to me, it will allow me the best chances for optimal recovery and also speed up my recovery. The patients that defy what the doctors predicted for their outcome after an illness or injury, AND end up doing remarkably much better than predicted, are usually the ones who were physically stronger prior to hospitalization. They have more reserve. Also, I want to be able to continue to walk on my own. I’m going to work on NOT needing assistive devices to walk. Can you tell, being independent and maintaining my mobility are a VERY high priority for me?
  8. It must include core training. This is often known as the “ab workout.” As we get older, spend more time sitting and/or we gain weight, our abdominal muscles and core muscles get weaker. This can cause lower back problems which can also lead to other joint problems. Core training treats and prevents back injury. It also improves posture and makes everyone look more attractive.
  9. It should work the heart. This is often called cardio or aerobic exercise. I am a fan of high intensity interval training (HIIT) using perceived exertion as my measure of intensity (I plan to discuss this further in a future post). This allows me to work out for a shorter duration while improving my power, strength & endurance. Given the short duration of intervals, the time flies by. And if you wear a heart rate monitor, recovery to baseline heart rate is a great measure of your cardiovascular fitness. If you are deconditioned (out of shape), it takes longer for your heart rate to go back to the usual after a workout. When you are fit, your heart rate returns to your usual much faster. Over time, as you continue to exercise, your heart rate will come down much faster after you finish your workouts. You recover faster after your workout. This means you have improved your fitness!
  10. It should include some stretching. I like yoga, passive and/or active stretching. This is the portion of the workout where you classically slow down and listen to your body. This is also important to allow our lymphatics and circulation to flow and to open up the joints. Certain stretches and yoga moves are particularly good for keeping the spine healthy and improve arthritic pains. A single sequence of sun salutations (yoga) takes 90 seconds and is a great way to start your day as you get out of bed.
  11. Limited or ideally, NO risk of injury. Learn proper form, advance SLOWLY & don’t do exercises that have high risk of injury to you.
  12. At the end of your exercise, you should feel energized and look forward to your next workout. I log my workouts and jot down a few notes. In a future post, I will go more into detail about the workout log. Meanwhile, enjoy the process. Make each day be a day you move forward and feel good about yourself.

Photo by Gesina Kunkel on Unsplash

The Freedom to Choose

Today, on our nation’s birthday, I do not have to go to work. I appreciate my day is full of free choices. Every day, we make choices to move forward or to move backwards. Nothing ever stays the same. I choose today, to make choices that help me move forward.

I started my day choosing to wake up to my favorite alarm clock app. (It wakes me up when I am in my lighter sleep cycle in the 30 minutes prior to my goal wake up time. This makes wake up significantly much easier for me (as I am NOT traditionally a morning person).) Then, I threw on my workout gear & headed to the basement, my home gym. As I grabbed my water bottle, put on my heart rate monitor & started my music, I was already in such a good mood! I was awake to do something good for me and I have the ability to move my body. What a gift!

After warming up my muscles, I started lifting weights and enjoyed the quiet in the rest of the house while I was able to focus on my body and my health. I had time to notice how much easier some of the sets were, how my muscles were ever so slightly more defined; my mind felt clear and optimistic about the day and I thought of the many patients in the past few weeks who had talked to me about their health. Specifically, I thought of the patients who mentioned joint pain during their office visit. There were 3 groups of responses to joint pain.

Some patients stated they had joint pains and stated they could not exercise and were very limited in their lives because of it. Often, they had been told they had arthritis or some other joint issue that would never be fully better or would require an invasive intervention to “improve it.” They had somehow been convinced that it was never going to get any better. They were focused on the pain & had become a victim to the pain. Often, they would ask for a “band-aid”- like pain medication. They had given up on getting better, they just wanted to mask the pain, even if it meant creating new problems like constipation, nausea, dependence on medications, drowsiness, etc. Unintentionally, they were moving backwards, getting “worse.”

Several patients had joint pains and they were grateful that because they were doing some form of movement/exercise, it was not getting worse. They were grateful they COULD still move. They wanted to learn what else they could do.  They wanted their list of choices to move forward. They were focused on staying independent and working towards higher quality function from their bodies. They came for guidance & were eager to comply. If they were given a home exercise program, they would do it. If they were sent for physical therapy, they would do it. If they were sent to see a specialist, they would do it.  They knew they could make choices that could help them. They listened to their bodies and trusted they could make themselves better if they were given the right plan.

The third group of patients had joint pains and found that by choosing exercise (including yoga, home exercises, physical therapy, individual workout programs, working with a trainer, etc.), they had healed themselves or improved their pains. They felt grateful and powerful. They wanted to know what choices they could make, what they could do, to continue to stay healthy- how to improve their bodies even more. They were empowered and living life to their fullest.

As I moved onto my interval training, I considered it interesting that in my practice, these three different kinds of responses to joint pains were not correlated to the amount or duration of the pain. They were all about attitude and faith (or loss of faith) in their bodies. And of course, it’s about seeing they have choices and choosing to move forward, or backwards, every day.

As I increased and decreased the intensity of my interval training workout, I wondered how each of my patients would respond to the questions: Do you trust your body to take care of you? Do you listen to your body, understand the cues and respond appropriately? If not, do you just need to help learning? Do you believe your body knows how to repair itself and get better? Do you allow your body to recover, improve or heal by providing it what it needs- proper nourishment (what we put into our bodies), relaxation (such as meditation, journaling, emotional intimacy with another person(s))  and circulation of fluids (movement)? If not, do you want to learn what you don’t know?

If my patients have taught me anything, I have learned that we can make choices that move us forward or that cause us to slip backwards. I like forward movement better. I want that for my patients. My patients come to me because they know that, and they want help in seeing and making the choices to move forward.

In my practice, I show my patients their choices (if they do not already know them) and help them to see which ones will most likely allow them to move forward. I spend time teaching them ways to best nourish their bodies with nutrition and medication, if necessary. I have relaxation training sessions and I counsel on ways to safely circulate fluids and move our bodies. I try to give my patients more ways they can choose to move forward.

As I cooled down and stretched, I appreciated that we all have choices. We live in a country that cherishes our freedom to make choices and we have lots to choose from. Every day, we make choices about our health. We have the bodies we were given. Some were luckier than others. But we all can choose what to do with it at any moment. We can choose to trust our body will do the best that it can for us, if we give it what it asks for and needs. We have the freedom to choose every day.  As a physician, I recommend making choices that move you forward.