Exercise in a Pill

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Why most people do not exercise?
When people are asked why they do not exercise 85% of those questioned state that they have no time. The fact is that exercise should take no more than 2-3 hours per week. You will gain the time back in terms of increased energy, brain power, stress reduction and well being.

The trick is not to enroll in a gym that is too far. Proximity counts for a lot. Getting there is half the battle.

If you have no access to a gym close by, then you need to invest in some simple equipment at home. Exercise should not take much more than 30-50 minutes from your day: 10 minutes for warm-up and stretching, 10 minutes to lift weights and build muscle, 15-20 minutes on the bicycle or treadmill to strengthen the lungs and the heart and 10 minutes to get there and take a quick shower afterward. Ideally, you need to keep this routine 3-5 times a week.

Saying that you are too overweight to exercise is like saying you are too skinny to eat. Start small: walk five minutes a day, and increase by two minutes every two to three days.

When choosing the right weight for a specific exercise, pick up any weight and do the exercise. If you cannot do 12 repetitions, the weight you picked is too heavy for you. If you far exceed 12 reps, the weight is too light for you.

You get most of the benefit of exercising any group of muscles with the first 12 repetitions. Do not waste time doing much more. Make sure your movements with the dumb-bell are slow and that you are not moving the weight too quickly. You need to use deliberate resistance and not momentum. If you are a woman with normal hormone levels, you need not worry about developing a masculine physique, no matter how heavy the weight you work with. Do not use your upper body or weights during walking or cycling as this goes beyond normal body limits and places undue strain on your spine or shoulders.

You are not tired at the end of the day because you get too much exercise; you are tired because you do not get enough exercise. Your body is mentally, physically and emotionally drained from being sedentary. The reality is that our sedentary life is so full of misdirected mental energy that we cannot afford not to exercise. Of course you will be physically tired in the first months as you get back in shape. Do not over do it; take it slowly for a few weeks until you get in touch with what feels good and what hurts.

It is tough to keep up the motivation to exercise when life is crowded with obligations and stress, so rely on structure for discipline more than motivation.

Carve out time to exercise, make it "protected time" and guard it fiercely against intrusion. It makes sense to think of exercise as a job because once you pass the age of 40, exercise should no longer be optional.

With each year after 40 your metabolism slows. Even with no change in your diet, this will result in a newfound difficulty keeping weight off. Increased weight and lack of exercise accelerates the aging process. We should not wake up and think about whether or not to go to the gym every day, anymore than we wake up and think whether or not to go to work. Do not leave it up to your mood; make it a habit that will eventually govern your mood. Reserve a time on your schedule and commit to it. Once you drag yourself to work or to the gym it is much harder not to do what you are there for!

Open-heart surgery is hugely popular these days, apparently because so many people prefer it to the work involved in watching their diet, exercising or quitting smoking. The surgery is not really that risky anymore. All the surgeons have to do is cut open your chest with an electric saw, and then crack your sternum like the shell of a lobster with a huge pair of shears - snip, snip, snip... Then the team - don't worry they've done this a thousand times - pry the bones back so the doctor can reach in.

I was, for years, a cardiac anesthesiologist. I have seen the black lungs of smokers when they should have been pink. I have also seen thousands of heart vessels clogged, and the resulting cottage cheese-like plaques being removed. Believe me, none of this is pretty and what is sad is that 80% of it could have been avoided with the proverbial “ounce of prevention”.

If you do not care for going to the gym, choose anything you enjoy doing regularly, such as brisk walking, tennis, volleyball, basketball, soccer, rope jumping or belly dancing. What counts is to get your entire body moving instead of limiting movement to those muscles involved in chewing, or those in your fingertips needed to operate the TV remote control or your computer mouse or BlackBerry.

The key to overriding the decay code that the brain sends to the different parts of the body, and the shut-down mode triggered by decreasing muscle mass is to have daily exercise. Emotional commitment, reasonable nutrition, and real engagement with living can help, but none to the extent of regular exercise. Working out stimulates the production of endorphins which give the brain a feeling of calm and wellbeing and counters the damaging effects of the stress hormone cortisol. Exercise can increase the size of the hippocampus, the main center of memory.

But what about people who are so out of shape they cannot enjoy the benefits of exercise without the extreme pain of exertion. It turns out that we have two types of muscle fibers: type 1 fibers are rich with mitochondria, the tiny organelles that generate the cell energy, and are therefore resistant to fatigue. Type 2 fibers have poor mitochondria and therefore tire easily. Athletes have lots of type one fibers and obese patients’ lots of type two fibers. Researchers at the Salk Institute in San Diego are busy working on a dream pill that can trick the body into thinking as if it has plenty of type one fibers.

Aicar is a drug under investigation that may fit the bill. The closest we have to “workout-in-a-pill” medicine is testosterone replacement for selected patients who become nothing but skin, fat and bone as they age, a condition called sarcopenia. Exercise of course makes these drugs, including testosterone, work that much better. In Feb 2008 the prestigious Journal of The American Medical association or JAMA reported that sarcopenia is one of the most reliable indicators of accelerated aging and quality of life in men and women.

Before exercising, prevent injury by performing 10 minutes of warm-up and stretching:
1. Warm up: consists of slow, deliberate, rhythmic movements such as very gentle bends for waist, arms, shoulders, pelvis, upper and lower legs and feet. Focus on range of motion.

2. Stretching: do not rush. Spend 5 to 10 minutes. Do not bounce. Stretch and hold the stretch for 30 seconds. Stop at the point that is just before the pain.

Always do the warm up before the stretching. Even if you do not work out every day, take a few minutes to warm up and stretch. The expression, “no pain no gain” has probably done more to promote exercise injuries than any other. Pain is the body’s way of telling you to lessen or stop the cause of aggravation. Pain can often be alleviated by warming up and stretching. Never continue agitating a body part that is in pain. Listen to your body when your body talks to you.

Everyone knows that exercise is good for you. Very few realize how good exercise is for you:

Exercise is essential in preventing anxiety, depression, constipation, insomnia, Alzheimer’s, chronic fatigue, stress, osteoporosis, decreased libido, back pain, in addition to decreasing cardiovascular disease, diabetes, stroke and high blood pressure. Exercise also stimulates the immune system, which can detect and kill cancer cells that your body accidentally creates.

Sooner or later you will struggle with your spiraling weight unless exercise is part of your life.

Yes you can have “too much of a good thing”. Many people simply get addicted to exercise — addicted because it makes them feel good. I frequently see what happens to those whose knees, shoulders and hips take constant pounding from running, throwing, skiing and playing professional tennis. I also see in my Pain Clinic too many torn anterior cruciate ligaments (ACL) in the knees of soccer players who concentrate on improving their running stamina with the treadmill without paying enough attention to building muscles through weight training. Knees are especially vulnerable, and surgical methods of repairing them despite all the recent advances are less than ideal. When you are older you can do a lot of swimming and cycling to get your cardiovascular exercise without stressing your joints. Walking is also a super form of exercise, but most people don’t walk fast enough to elevate their heart rates sufficiently.

If you are a smoker, suffer from abdominal obesity, or are over forty and out of shape do check with a good physician before beginning regular or vigourous exercise. As I was writing this book, a Canadian urologist working at the American Hospital in Dubai dropped dead while running on the treadmill.

The biggest gambler is the unfit dad who gets suddenly excited about joining his kids for a weekend soccer or basketball game. I saw many patients who moved from an active outdoor life to a hot and humid Dubai summer get busy with relocating and getting settled in this great city and forget to go to the gym. Then after they start gaining weight, they suddenly decide to hit the racket ball court where they suffer a massive heart attack. They do not realize that they need time to get back to their back home routine.

When you give up exercise for several months your heart fibers become a bit like a rubber band that was left to dry up for a long time on your desk. If you abruptly pull on it, it would break. But if you gradually loosen it up, it progressively regains its flexibility. Start slowly and increase your routine over several weeks. It is OK to get a bit winded while on a tread mill, but you should not get so short of breath that you cannot maintain a conversation.

Most studies published on the benefits of exercise for the heart were done on patients who, while never reaching the maximum heart rate for their age, exhibited great benefit from consistent moderate exercise. Sometimes less is more.

Men in their twenties and thirties frequently get hurt by engaging in contact sports while men in their fifties often exercise randomly or engage in start-stop sports such as tennis, soccer, or hand-ball which place an even greater risk on their basically sedentary hearts. An important secret for living better longer is to be aware of your risky behavior whether it is unsafe sex, aggressive driving, or taking financial risks that you cannot afford. Similarly, your exercise behavior should also match your aging body.

You should leave the gym rejuvenated. If you leave feeling worn out, cut back until you do. If you are above fifty check your testosterone and consider correcting sub-optimal levels. To summarize, take exercise as seriously as if your doctor had prescribed chemotherapy or kidney dialysis - make exercise life-sustaining; make it urgent.

Some athletes load up on protein supplements rich in glutamate as a means to enhance the body’s ability to build muscles. There is mounting evidence that excessive glutamate intake contributes to neurotoxicity leading later in life to Parkinson’s or Alzheimer’s fitting the stereotype of some “dumb and hunky” athletes. It is best to eat a meal rich in complex carbs within thirty minutes of exercise to prevent the body from destroying muscles to be used as fuel.

The Power Plate is a new technology that is backed by plenty of science which is very beneficial in preventing osteoporosis and in getting much more exercise benefit for less time spent in the gym. I have one in my bedroom; the problem is with its expensive price tag. Perhaps being fit enough to travel independently in the future may dictate spending money today on something that will improve your health, rather than on a cruise, new bedroom furniture, or a bigger high definition television. Sometimes you have to give a little to gain a lot. However, as with rowing machines, stationary bicycles, and treadmills, many of which ultimately become clothes trees or dust collectors, the key to whether it is worth the money comes from using it!

A good multi-mineral containing at least 300 mg of mixed magnesium is essential for athletes who perspire a lot.

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