Let’s Get Physical! | By Dr. Mary Anne Pandy-Calimon

LET’S GET PHYSICAL!
By Dr. Mary Anne Pandy-Calimon

There is a lot you can tell about a society by what shoes are in at the time.  In 1960s, it was all about patent shoes in every conceivable color, 1970s was about comfort shoes and earthy sandals, 1980s was a time for sneakers especially Air Jordans, for the 1990s it was Doc Martens, early 2000s was more of mixed styles.  Nowadays, sport or athletic shoes are the “in” thing.

With health problems, such as obesity, diabetes and cardiovascular disease, becoming more common nowadays, people are becoming more and more health conscious.  A lot of diets that promote weight loss and healthy living have evolved through time but so did physical fitness.  Fitness just used to be a way of life during the primal times.  Over the years, it has become specialized, competitive and has developed into a thriving industry.  Even in the Philippines, you would find gyms and fitness centers popping up almost everywhere.  It would therefore not be uncommon to find patients asking us “what exercises would you recommend?”  To get health benefits from exercise, guidelines would recommend at least 150 minutes of moderate-intensity physical activity such as brisk walking per week1 or at least 20 minutes of vigorous aerobic activity at least 3 days per week or a combination of moderate- and vigorous-intensity activity and moderate- to high-intensity muscle strengthening at least 2 days per week.2

However, our patients often look for something more than these generalized guidelines.  They want specifics as well as the benefits that they would get from doing these exercises to be able to achieve their goals.  There are three main types of exercises, namely aerobic, resistance and flexibility exercises.  All-around fitness cannot be achieved by any single type of exercise and a combination of these three types is often recommended.  Below is a summary of these exercise types as well as the the benefits they provide.

AEROBIC EXERCISE

Definition: Physical activity that involves rhythmic, repetitive and continuous movements of the same large muscle group for at least 10 minutes at a time resulting in a substantial increase in the heart rate and energy expenditure.  Intensity may be moderate which increases the person’s maximum heart rate to 50-70% or vigorous intensity where >70% of the maximum heart rate is achieved.3

Types: Swimming, cycling, team sports, brisk walking, running, aerobics, etc.

Calories Burned: For most activities, calories burned depend on the weight and the intensity of the exercise. The more you weigh, the more calories will be burned. A person weighing 70kg will burn about 167 calories per 30 minutes of walking at 4mph but running at a pace of 6mph can burn as much as 372 calories.5

Benefits: Moderate to high levels of physical activity has been associated with a reduction in the morbidity and mortality in both men and women with type 1 and type 2 diabetes.3  Aerobic training has also been associated with a significant reduction in both body weight and fat mass particularly the visceral adipose tissue with a significant improvement in the metabolic syndrome score.4

RESISTANCE EXERCISE

Definition: Physical activity that is designed to improve muscle strength, power and endurance by doing exercises involving weights, weight machines, resistance bands or one’s own body weight with varying resistance, number of sets done and the rest interval provided between set .3

Types: Use of free weights such as dumbbells or barbells, weight machines or resistance bands; Use of body weight such as squats, push-ups, planks, etc.

Calories Burned: A 70 kg person will burn only 112 to 223 calories doing 30 minutes of moderate to vigorous resistance training.5 Although it doesn’t burn as many calories as doing aerobic exercises, resistance training builds more muscle and muscle burns more calories at rest.  Thus, doing weight-training increases the basal metabolic rate that remains elevated for up to 38 hours of weight training resulting in more calories burned for hours or days afterwards.

Benefits: Resistance training has been associated with an increase in lean muscle mass, strength and bone mineral density that eventually improved functional status and prevent osteoporosis.3  Although there is lack of body mass loss with resistance training, this was largely due to an increase in the lean body mass.  This increase in the lean muscle mass increases the resting metabolic rate that eventually results in a steady state increase in the total energy expenditure, hence a negative shift in energy balance.4  This concept suggests that doing resistance training can eventually result in changes in body mass or fat mass due to an increase in metabolism of overweight or obese sedentary adults.4 Furthermore, a meta-analysis of randomized trials showed that resistance exercises improved glycemic control (with a reduction in the glycated hemoglobin), reduction in insulin resistance, and improved muscle strength among adults with type 2 diabetes.3

FLEXIBILITY

Definition: Physical activity that enhances the ability of joints to move through their full range of motion.3

Types: Yoga, Tai chi, Pilates

Calories Burned: A 70kg individual doing 30 minutes of stretching and hatha yoga will burn about 149 calories.5

Benefits: Specific health benefits in doing flexibility exercises are still unclear.  In a systematic review that evaluated the efficacy of Tai chi among type 2 diabetic patients, it failed to show a significant reduction in the fasting blood sugar and glycated hemoglobin or improvement in the quality of life.6 While another meta-analysis evaluating the efficacy of yoga among diabetic patients showed significant glycemic and metabolic improvement.7

TAKE HOME MESSAGE:

Any form of physical activity is beneficial and should be encouraged.  One type of exercise is not necessarily better than the other.  Although doing aerobic exercises have been associated with better weight loss and reduction in cardiovascular disease, incorporating resistance training helps improve muscle mass and body composition, while adding flexibility exercises may enhance performance and muscular conditioning together with the reduction of injury risk.  Just as we tailor our medications to each of our patients, we must also tailor the exercise regimens to the limitations, needs and goals of each of our patients.

REFERENCE:

  • Knowler WC, Barrett-Connor E, Fowler SE, et al.; Diabetes Prevention Program Research Group Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393-403.
  • American Heart Association. Physical Activity and Public Health: Update Recommendations for Adults from the American College of Sports Medicine and the American Heart Association. Circulation 2007; 116:1081-1093.
  • Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Clinical Practice Guidelines: Physical Activity and Diabetes. Can J Diabetes 2013; 37:S40-44.
  • 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. Journal of Applied Physiology 2012; 113 (12): 1831-1837.
  • Calories burned in 30 minutes for people of different weights. July 2004 issue of the Harvard Heart Letter. Retrieved from https://www.health.harvard.edu/diet-and-weight-loss/calories-burned-in-30-minutes-of-leisure-and-routine-activities
  • Lee MS, Choi TY, Lim HJ, et al. Tai chi for the management of type 2 diabetes mellitus: a systematic review. Chin J Integr Med 2011; 17(10): 789-93.
  • Thind H, Lantini R, Balletto BL, et al. The effects of yoga among adults with type 2 diabetes: a systematic review and metaanalysis (Abstract). Preventive Medicine. 2017; 105:116-126.

 

FITNESS TRENDS OR FADS?

Despite the economic uncertainties, the fitness industry is one of the few that continues to grow and thrive. With waistlines growing exponentially everywhere, it is no wonder people come up with all sorts of fitness regimens. Some come and go.

The American College of Sports Medicine yearly conducts surveys to identify the latest fitness trends and they defined trend as “a general development or a change in situation or in the way that people are behaving” while fad was defined as “a fashion that is taken up with a great enthusiasm for a brief period.”1 Below is a discussion of the latest craze in fitness.

  1. HIIT (High Intensity Interval Training)

This method of training involves alternating periods of high intensity exercise with periods of low-intensity recovery.2 The goal is to recover just enough to be able to perform maximum effort for the next interval.  This usually lasts for about 30 minutes or less and may burn 8-12 calories per minute giving a total of 261-374 calories burned in 30 minutes.  HIIT workouts are designed to be high intensity.  It is not surprising that a lot of people are doing this training since it is an efficient and effective of incorporating aerobic exercises and at the same time burning a lot of calories without requiring a lot of time.

A minimum duration of 12 weeks showed improvement in the fasting glucose, HDL-C and anthropometric measurements of overweight and obese individuals.2

  1. Crossfit

Crossfit is a fitness regimen developed and trademarked by Greg Glassman.  The regimen is comprised of varied functional movements and reflect the best aspects of weightlifting, gymnastics, running and others.  This involves high intensity performance that is designed to maximize work over time.  In essence, the more the work, the less the time, the more intense is the effort.  During a 20-minute workout, exercisers are said to burn as much as 260calories.  This is roughly equivalent to running 2.6miles (4kilometers) in 20minutes.

Scientific data regarding crossfit training is still sparse.  Although in one systematic review, it did not show any significant change in the body composition including the fat mass, lean mass and waist circumference, it showed improvement in the satisfaction and motivation during training.3

  1. Wearable technology

Technology has made it easier for people to incorporate fitness into their daily activities.  With the use of activity trackers, heart rate monitors and smartwatches, it is easier to monitor the number of steps, hours of sleep, standing time and burned calories daily. Use of these tools have revolutionized health care, fitness and nutrition.

Other fitness trends also include bodybuilding, yoga, group classes such as Zumba and having a personal trainer.  These fitness trends somehow allow an individual incorporate their activities into their daily lives.  Indeed, there is a vast array of possibilities in fitness.  Our patients don’t need to try all of these trends but rather they should find the type of trend that will work for them to improve their health and well-being.

1 Thompson WR. Worldwide survey of fitness trends for 2018- The CREP Edition. ACSM’s Health & Fitness Journal. 2017.

2 Kessler HS, Sisson SB, Short KR. The potential for high-intensity interval training to reduce cardiometabolic disease risk. Sports Med 2012;42:489–509

3 Claudino JG, Gabbett TJ, Bourgeois F, et al. CrossFit Overview: Systematic Review and Meta-analysis. Sports Med Open. 2018; 4 (11).