Exercise, Health and You: How Much Is Enough?
Jeff Novick, MS, RDN
While optimal health requires a certain level of activity, exercise and fitness, more exercise does not always equal greater health, and too much exercise can lead to less than optimal health.
While maintaining a certain level of adequate strength (and muscle) is important for a long disability-free life, there are things athletes do to maximize performance in the short-term that are counter productive to maximizing their health for the long-term. For example, they may have to engage in unhealthy dietary practices to meet their needs for extra calories. They also may have to spend unreasonable amounts of time training, which increases their risk for activity related injuries.
Optimal short-term sports and/or athletic performance does not always equate to optimal long-term health.
My approach to fitness is the same as to food: simple, common sense, safe and sane. Just as I do not encourage extreme forms of eating, I do not encourage extreme forms of exercise.
Let's put this in proper context and perspective...
Only 23% of Americans meet the minimum requirements for exercise (aerobic and resistance) (1) and, on any given day, only 5% of Americans engage in vigorous activity (2). Over half of Americans do not meet the minimum requirements of exercise and almost 30% are considered completely sedentary (3). This sedentary behavior and the lack of exercise contribute to many of our leading preventable causes of premature disability and death. That means that, for over 80% of the population, the most important goal is to be active enough to meet at least the minimum requirements. My goal is to get the 80% active enough to reap the health benefits, not to get them to become extreme athletes or body builders, or to engage in high-level competitive sports.
That is the message—not one of supplements, protein powders, gimmicks, gadgets, potions, pills, food industry trends, dietary fads, exercise gimmicks, extreme eating or extreme exercise—but a common sense diet and a common sense amount of activity each day with no extreme forms of eating or exercise.
How much is enough?
The best recommendations come from recognized, credible fitness/health organizations. Find their recommendations at the following links (and find a quick summary below):
American College of Sports Medicine
https://journals.lww.com/acsm-msse/Full ... ng.26.aspxCenters For Disease Control and Prevention
http://www.cdc.gov/physicalactivity/eve ... dults.htmlAmerican Heart Association
http://www.heart.org/HEARTORG/GettingHe ... rticle.jspWorld Health Organization
http://www.who.int/dietphysicalactivity ... adults/en/The U.S. Department of Health and Human Services (HHS)
https://www.hhs.gov/fitness/be-active/p ... index.htmlThe Office of Disease Prevention and Health Promotion
http://www.health.gov/paguidelines/guid ... pter4.aspxAmerican Council on Exercise
http://www.acefitness.org/acefit/fitnes ... cise-tips/National Health Services UK
http://www.nhs.uk/Livewell/fitness/Page ... dults.aspxUSDA 2015 Dietary Guidelines Exercise Recommendations
https://health.gov/dietaryguidelines/20 ... ppendix-1/American Institute of Cancer Research
http://www.aicr.org/reduce-your-cancer- ... -activity/You can sum this all up by simply saying: Aim for 30-60 minutes per day, most days of the week (4-6), which will depend on intensity, and will include both aerobic and resistance training. Another way to look at it is, 150 to 300 minutes per week. The inclusion of some balance and flexibility work is also recommended.
I do not know of any doctor in this field who recommends more than these guidelines as part of any of these programs.
Which is the best exercise? The one you will do.
For most of us, brisk walking along with some resistance training is more than enough. However, if you enjoy another form, just pick the one you enjoy and will do, regardless of whether it is walking, jogging, running, swimming, cycling, exercise classes, etc.
In Health,
Jeff
We can also look at the issue another way, which I have discussed many times before. Let us say we have two identical people.
- one maintains a BMI of 18.5 and does so through a very healthy diet. They exercise moderately about 30 minutes a day, 5x a week and burn a total of about 2000 calories per day. To maintain their BMI, they consume about 2000 calories per day.
- the other identical person also maintains a BMI of 18.5 and does so through a very healthy diet. However, they exercise vigorously about 1.5 - 2 hours a day (or more) and burn a total of about 3000-3500 calories per day. To maintain their BMI, they consume about 3000-3500 calories per day.
The studies in animals and the recent ones in humans show the first one will do much better and live longer and healthier.
Remember, a little is good, a little more may be a little better, but not that much and lots more is not good.
My recommendations are...
1) Follow the guidelines & principles as recommended in this forum, especially in the sticky
The Healthy Eating Placemat.
2) Follow the guidelines & principles for exercise/activity as recommended above, which include 150 minute to 300 minutes a week with a focus on aerobic & resistance with some stretching and flexibility.
3) If weight is an issue, or the regular program is not working, strictly follow the Maximum Weight Loss (MWL) program and if needed, the principles on how to fine tune the MWL.
4) In certain instances, (i.e., persistent symptoms, autoimmune disease, etc) an elimination diet may be required to eliminate any hidden triggers.
5) For those interested in "Calorie Restriction with Optimal Nutrition" (CR), use the above principles in point 1, 2 & 3 to maintain a BMI of 18.5-22
6) Get proper sleep, rest, relaxation, pure air, pure water, have a passion, surround yourself with loving relationships & most of all, relax & enjoy life.
In Health
Jeff
References:
(1) State Variation in Meeting the 2008 Federal Guidelines for Both Aerobic and Muscle-strengthening Activities Through Leisure-time Physical Activity Among Adults Aged 18–64: United States, 2010–2015. National Health Statistics Reports, Number 112, June 28, 2018
(2) Frequently Reported Activities by Intensity for U.S. Adults: The American Time Use Survey.
American Journal of Preventive Medicine Volume 39, Issue 4 , Pages e13-e20, October 2010
(3) Physical Activity Council. 2014 Participation Report.
On the problems with extreme exercise.
(if you only do one thing, watch the at the bottom of this post in point #7, which sums of most everything.)
1)
Extreme Workouts: When Exercise Does More Harm than Goodhttp://healthland.time.com/2012/06/04/e ... than-good/http://www.sciencedaily.com/releases/20 ... 093108.htm"recent research suggests that chronic training for, and competing in, extreme endurance exercise such as marathons, iron man distance triathlons, and very long distance bicycle races may cause structural changes to the heart and large arteries, leading to myocardial injury. A study in the June issue of Mayo Clinic Proceedingsreviews the literature and outlines in detail for the first time the mechanisms, pathophysiology, and clinical manifestations of cardiovascular injury from excessive endurance exercise."2) The results of 3 very large studies reviewed here in the NY Times.
http://well.blogs.nytimes.com/2012/06/0 ... -exercise/3) Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise. Mayo Clinic Proceedings. Volume 87, Issue 6 , Pages 587-595, June 2012
http://www.mayoclinicproceedings.org/ar ... 25-6196(12)00473-9/fulltext
Abstract
A routine of regular exercise is highly effective for prevention and treatment of many common chronic diseases and improves cardiovascular (CV) health and longevity. However, long-term excessive endurance exercise may induce pathologic structural remodeling of the heart and large arteries. Emerging data suggest that chronic training for and competing in extreme endurance events such as marathons, ultramarathons, ironman distance triathlons, and very long distance bicycle races, can cause transient acute volume overload of the atria and right ventricle, with transient reductions in right ventricular ejection fraction and elevations of cardiac biomarkers, all of which return to normal within 1 week. Over months to years of repetitive injury, this process, in some individuals, may lead to patchy myocardial fibrosis, particularly in the atria, interventricular septum, and right ventricle, creating a substrate for atrial and ventricular arrhythmias. Additionally, long-term excessive sustained exercise may be associated with coronary artery calcification, diastolic dysfunction, and large-artery wall stiffening. However, this concept is still hypothetical and there is some inconsistency in the reported findings. Furthermore, lifelong vigorous exercisers generally have low mortality rates and excellent functional capacity. Notwithstanding, the hypothesis that long-term excessive endurance exercise may induce adverse CV remodeling warrants further investigation to identify at-risk individuals and formulate physical fitness regimens for conferring optimal CV health and longevity.
4) Three articles at this link
http://www.msma.org/docs/communications ... dicine.pdfA) Increased Coronary Artery Plaque Volume Among Male Marathon Runners
Missouri Medicine | March/April 2014 | 111:2 | 85
Abstract
Background
Long-term marathon running improves many cardiovascular risk factors, and is presumed to protect against coronary artery plaque formation. This hypothesis, that long-term marathon running is protective against coronary atherosclerosis, was
tested by quantitatively assessing coronary artery plaque using high resolution coronary computed tomographic angiography (CCTA) in veteran marathon runners compared to sedentary control subjects.
Methods
Men in the study completed at least one marathon yearly for 25 consecutive years. All study subjects underwent CCTA, 12-lead electrocardiogram, measurement of blood pressure, heart rate, and lipid panel. A sedentary matched group was derived from a contemporaneous CCTA database of asymptomatic healthy individuals. CCTAs were analyzed using validated plaque characterization software.
Results
Male marathon runners (n = 50) as compared with sedentary male controls (n = 23) had increased total plaque volume (200 vs. 126 mm3, p < 0.01), calcified plaque volume (84 vs. 44 mm3, p < 0.0001), and non-calcified plaque volume (116 vs. 82 mm3, p = 0.04). Lesion area and length, number of lesions per subject, and diameter stenosis did not reach statistical significance.
Conclusion
Long-term male marathon runners may have paradoxically increased coronary artery plaque volume.
B) Coronary Artery Plaque and Cardiotoxicity as a Result of Extreme Endurance Exercise
Missouri Medicine | March/April 2014 | 111:2 | 91
C) Pheidippides’ Final Words:“My Feet Are Killing Me!”
by John C. Hagan, III, MD
"In the long run, you may end up with a broken heart:
Missouri Medicine | March/April 2014 | 111:2 | 95
5) There May Be Such a Thing as 'Too Much Exercise'
Research suggests that moderate activity might be best for people with pre-existing heart disease
By Robert Preidt
http://www.webmd.com/fitness-exercise/n ... h-exerciseWEDNESDAY, May 14, 2014 (HealthDay News) -- Is there a limit to the benefits of exercise? Two studies suggest that, for certain people, keeping to a moderate physical activity regimen may be best for heart health.
One study found that a schedule of intense workouts actually boosted the risk of death from heart attack or stroke in older people with pre-existing heart disease, while the other found that young men who did a lot of endurance exercise were at higher risk for heart rhythm problems later in life.
However, one expert unconnected to the studies stressed that, on the whole, exercise is good medicine.
"Folks with heart disease should continue to engage in some form of daily physical activity," urged Barbara George, director of The Center for Cardiovascular Lifestyle Medicine at Winthrop-University Hospital in Mineola, N.Y. But she said moderation is key.
"You shouldn't feel you have to become a marathon runner to reap the benefits," George said.
The first study was led by Dr. Ute Mons of the German Cancer Research Center in Heidelberg, Germany, and included more than 1,000 people. Most of the participants were in their 60s, had stable heart disease and were tracked for 10 years. About 40 percent exercised two to four times a week, 30 percent worked out more often, and 30 percent exercised less often.
Compared to those who got regular exercise, the most inactive people were about twice as likely to have a heart attack or stroke, and were about four times more likely to die of heart disease and all causes, the researchers said.
However, Mons' team also found that those who did the most strenuous daily exercise were more than twice as likely to die of a heart attack compared to those who exercised more moderately.
The second study was led by Dr. Nikola Drca of the Karolinska Institute in Stockholm, Sweden, and included more than 44,000 Swedish men, aged 45 to 79. All of the men were asked about their physical activity levels at ages 15, 30, 50 and during the previous year. Their heart health was then tracked for an average of 12 years.
Those who had done intensive exercise for more than five hours a week when they were younger were 19 percent more likely to have developed a heart rhythm disorder called atrial fibrillation by age 60 than those who exercised for less than an hour a week.
That risk increased to 49 percent among those who did more than five hours of exercise at age 30 but did less than an hour a week by the time they were 60. Participants who cycled or walked briskly for an hour or more a day at age 60 were 13 percent less likely to develop atrial fibrillation.
The studies were published online May 14 in the journal Heart.
Another expert said the findings shouldn't alter standard recommendations.
"It is not standard practice to recommend strenuous activity to individuals with coronary heart disease," said Dr. Nieca Goldberg, director of the Tisch Center for Women's Health at NYU Langone Medical Center, New York City. "This study, although interesting, does not change current recommendations for moderate physical activity in coronary patients."
For her part, George said it's clear that a moderate exercise program can provide real benefit for everyone.
"A large body of scientific research has consistently shown that a sedentary lifestyle is one of the risk factors for cardiovascular disease, which includes heart disease, and that becoming more physically active can decrease your risk by as much as 50 percent," she said.
Current American Heart Association guidelines advise 30 minutes of moderate-intensity aerobic exercise most days a week or 20 minutes of vigorous activity three days a week, George added.
And in a journal editorial, a team led by Dr. Lluis Mont of the Hospital Clinic of Barcelona, Spain, agreed with the two U.S. experts.
"The benefits of exercise are definitely not to be questioned; on the contrary, they should be reinforced," the team wrote. But studies like the two published in Heart are fine-tuning recommendations for exercise, to "maximize benefits obtained by regular exercise while preventing undesirable effects -- just like all other drugs and therapies," the editorialists said.
6) A reverse J-shaped association of leisure time physical activity with prognosis in patients with stable coronary heart disease: evidence from a large cohort with repeated measurements.
Heart. 2014 May 14. pii: heartjnl-2013-305242. doi: 10.1136/heartjnl-2013-305242. [Epub ahead of print]
http://heart.bmj.com/content/early/2014 ... 2.abstractAbstract
OBJECTIVE: To study the association of self-reported physical activity level with prognosis in a cohort of patients with coronary heart disease (CHD), with a special focus on the dose-response relationship with different levels of physical activity.
METHODS: Data were drawn from a prospective cohort of 1038 subjects with stable CHD in which frequency of strenuous leisure time physical activity was assessed repeatedly over 10 years of follow-up. Multiple Cox proportional hazards regression models were used to assess the association of physical activity level with different outcomes of prognosis (major cardiovascular events, cardiovascular mortality, all-cause mortality), with different sets of adjustments for potential confounders and taking into account time-dependence of frequency of physical activity.
RESULTS: A decline in engagement in physical activity over follow-up was observed. For all outcomes, the highest hazards were consistently found in the least active patient group, with a roughly twofold risk for major cardiovascular events and a roughly fourfold risk for both cardiovascular and all-cause mortality in comparison to the reference group of moderately frequent active patients. Furthermore, when taking time-dependence of physical activity into account, our data indicated reverse J-shaped associations of physical activity level with cardiovascular mortality, with the most frequently active patients also having increased hazards (2.36, 95% CI 1.05 to 5.34).
CONCLUSIONS: This study substantiated previous findings on the increased risks for adverse outcomes in physically inactive CHD patients. In addition, we also found evidence of increased cardiovascular mortality in patients with daily strenuous physical activity, which warrants further investigation.
7) Run for your life! At a comfortable pace, and not too far:
James O'Keefe at TEDxUMKC
http://youtu.be/Y6U728AZnV0"The fitness patterns for conferring longevity and robust lifelong cardiovascular health are distinctly different from the patterns that develop peak performance and marathon/superhuman endurance. Extreme endurance training and racing can take a toll on your long-term cardiovascular health. For the daily workout, it may be best to have more fun endure less suffering in order to attain ideal heart health."
Dr. James O'Keefe Jr. is the director of Preventative Cardiology Fellowship Program and the Director of Preventative Cardiology at Cardiovascular Consultants at the Saint Luke's Mid America Heart Institute, a large cardiology practice in Kansas City. He is the co-author of four bestselling books including The Forever Young Diet & Lifestyle (Andrews McMeel Publishing LLC, 2005). In 1989, he became a professor of medicine at the University of Missouri - Kansas City and has contributed to over 200 articles in medical literature. He is also the chief medical officer and founder of Cardiotabs, a company that creates nutritional supplements to aid in a healthy lifestyle.
8 ) There is also an increase in activity related risks. In regard to running, excessive and improper running can cause injuries. However, light running (running in moderation, at an eight- to 10-minute mile pace, for about 40 minutes a few days a week) can be beneficial.
http://www.npr.org/2011/03/28/134861448 ... your-knees