Never too late to get fit

I talk with numerous patients daily about starting fitness regimens, whether it be for managing a medical issue or simply as a core element of general wellness.  There is irrefutable evidence that an active lifestyle is beneficial and that an inactive lifestyle is detrimental to one’s health.   Such a change in lifestyle is important at any age, so says a recent report from a meeting on Health and Fitness by the American College of Sports Medicine (ACSM).

I know that many individuals are bothered by the seemingly impossible task of getting in shape after having let themselves go for so long.  No doubt, it must feel like “Mission: Impossible” to fix a 40-inch waist and 100-lb excess, especially when there are associated health problems (like arthritis or heart disease) or other stresses (time, stress, family demands).  Add to that, the feeling that many individuals have regarding futility of effort towards their fitness goals as they age.  At some point, it seems like a lost cause – why work so hard when you may not live that much longer.

Inertia affects our interest in physical activity, just as it affects all objects.  Little did Newton know that his First Law of Motion would describe humans so well.  But, an increase in one’s activity level may improve one’s quality of life immensely.  It’s just getting over that inertia that is the hard point.

Bottom line: it’s never too late to make healthy lifestyle changes.

What is required to get in shape?

Something got me thinking about fitness and lifestyle changes today. I was trying to pin down what exactly is the difference between individuals who are able to make significant lifestyle changes and/or transformations from those who continue doing the same self-destructive things that led them to their current state of affairs. So I started thinking about what is required to get fit.

Time? Absolutely

But, you may notice that there is not necessarily a correlation between how much free time someone has and how fit they are. In fact, I might even argue that I normally see the opposite effect (Time on the hands goes wasted – or certainly not to fitness pursuits). For example, I work more in a typical week than 98-99% of my patients do, and yet I manage to find time for my workouts. My days start early and end late, but I still get one (often two) workouts fit in to a typical day. There’s gotta be something more . . .

Resources? Not really

There is no cost associated with walking/running or even lifting most weights. I could find a thousand things in my house that I could use for hand weights. Instead, I chose to invest in a set of weights with barbells and dumbbells with a much-used weight bench for the sake of convenience. I stock it with weight plates that I buy on sale from the cheapest place in town I could find. Despite what some people might contend, just because I’m a physician, I am by no means living in the lap of luxury (my student loans alone could buy many a house – Uncle Sam has a chokehold on my finances).

Energy? Definitely

Having the energy to get through an exercise regimen is highly dependent on nutrition and a decent foundation of well-being (i.e. no major medical complications). But plenty of people have all sorts of energy to work every day, go out on nights and /or weekends, travel, etc. and they still don’t manage to exercise. So what is the all-important factor?

Discipline! This requirement is perhaps the most important.

Any of the other requirements can be directed to other ventures and not get one any closer to their goals if not used properly. For example, how many stories have you heard about treadmills sitting in someone’s basement holding laundry? The resources are available and there is likely time and energy to do at least some exercise, but it never gets attention. I’ve encountered hundreds (maybe thousands) of people who have ridiculous amounts of time on their hands and plenty of desire to “get in shape”, but give up on a fitness plan for any number of reasons. This phenomenon happens predictably every year.

For me, in order to make the changes that I have made so far, I had to set aside the comfortable alternative of “doing nothing”. Believe me, it’s far easier to sleep in every morning, grab quick and fatty foods, eat to my content, and sit around watching TV when I come home from work. I absolutely wish that life were that easy. Unfortunately, there’s no substitution for a disciplined approach to fitness.

I’ve learned what it takes to keep my body in a healthy state. After letting it go for a few years, I’ve had to work harder to get back on track, but now I’ve learned some lifelong habits that will maintain a good level of fitness.

Getting started on a diet

For those struggling with how to go about creating a healthy diet, take a look at this other site I came across.  It gives detailed analysis of foods, including glycemic index, nutrient content, ability to track foods, etc.

http://www.nutritiondata.com/

I haven’t had a chance to navigate the site much, but it looks like a useful tool.

Diet and high blood pressure

 It’s hard to know where to begin with one’s diet when starting on a plan to lose weight, reduce high blood pressure (hypertension), etc.  The typical American diet is, frankly, lousy – too much fat, too many processed foods, excess red meats, inadequate fruits/vegetables. 

The medical community has established a Dietary Advice to Stop Hypertension (DASH) diet as a general set of guidelines, obviously aimed at hypertension, but certainly an improvement on typical American diets to achieve any goal.  I do not particularly agree with the distribution of calories as outlined in the DASH diet, but it’s a good start and it certainly depends on your ultimate goal.  I’ll elaborate more on my ideal nutrition goals in further posts.

DASH Diet Meal Plan

Nutrient goals:

• daily nutrient goals (for a 2,100 kilocalorie diet)
  • total fat 27% of kilocalories
  • saturated fat 6% of kilocalories
  • protein 18% of kilocalories
  • carbohydrate 55% of kilocalories
  • dietary fiber 30 g
  • dietary cholesterol 150 mg
  • sodium 1,500-2,300 mg
  • potassium 4,700 mg
  • calcium 1,250 mg
  • magnesium 500 mg
• Reference – National Heart, Lung, and Blood Institute (Lowering Your Blood Pressure with DASH PDF)

Sample eating plan:

• DASH eating plan for 2,000 kilocalorie/day diet
  • 6-8 servings/day of grains; whole grains recommended for most grain servings (1 serving = 1 slice bread; 1 ounce dry cereal; 1/2 cup cooked rice, pasta, or cereal)
  • 4-5 servings/day of vegetables (1 serving = 1 cup raw leafy vegetables, 1/2 cup cut-up raw or cooked vegetables, 1/2 cup vegetable juice)
  • 4-5 servings/day of fruits (1 serving = 1 medium piece of fruit; 1/4 cup dried fruit; 1/2 cup fresh, frozen or canned fruit; 1/2 cup fruit juice)
  • 2-3 servings/day of fat-free or low-fat milk and milk products (1 serving = 1 cup milk or yogurt, 1 1/2 ounces cheese)
  • 6 servings or less/day of lean meats, poultry, fish or eggs (1 serving = 1 ounce cooked meats, poultry or fish; 1 whole egg)
  • 4-5 servings/week of nuts, seeds and legumes (1 serving = 1/3 cup or 1 1/2 ounces nuts; 2 tablespoons peanut butter; 2 Tablespoons or 1/2 ounce seeds; 1/2 cup cooked legumes [dry beans and peas])
  • 2-3 servings/day of fats and oils (1 serving = 1 teaspoon soft margarine, 1 teaspoon vegetable oil, 1 tablespoon mayonnaise, 2 tablespoons salad dressing
  • 5 servings or less/week of sweets and added sugars (1 serving = 1 tablespoon sugar, jelly or jam; 1/2 cup sorbet, gelatin; 1 cup lemonade

Target Heart Rate

A reader (age 43) asked:

My heart rate is around 155-160 when I’m running a typical mile on treadmill. Should I slow down? My Dr. recommends HR of 130 till I can tolerate 170 6-9 months from now.

This is a common, though not very straight-forward issue. There are several contributing factors to what an individual’s target heart rate should be. For example, the traditional method of calculating Target Heart Rate is 60-90% of your Maximum Heart Rate. Maximum Heart Rate is calculated as 220 minus your age:

220 – age (in years)

for age 43 – 220 – 43 = 177

for age 31 – 220 – 31 = 189

for age 65 -220 – 65 = 155

Where does the calculation for Maximum Heart Rate come from? Good question – I had to look it up. There is a somewhat linear relationship between intensity of exercise and heart rate (i.e. the more intense you exercise, the faster your heart will beat) as established in a research study years ago. At some point, however, the heart rate is unable to continue increasing with increases in exertion – that point is deemed the Maximum Heart Rate. Rather than measuring that point in individuals, the above equation was derived in 1971 to provide a rough estimate of Maximum Heart Rate across all populations.

Subsequent research revealed that this equation is fraught with error, as there is incredible variety between individuals of the same age. I know I’ve been able to take my heart rate higher than my calculated Maximum HR. Revised formulas have been suggested:

205.8 – 0.685 (age)

for age 43 = 176

for age 31 = 184.5

for age 65 = 161

or

208 – 0.7(age)

for age 43 = 178

for age 31 = 186

for age 65 = 162.5

Though there’s not great disparity between these calculations, there may still be significant variation between seemingly similar individuals. Thus, it’s recommended to design exercise regimens to focus on other measurements of intensity rather than heart rate alone. For example, “perceived effort” is one option, though quite subjective. When I do HIIT on the elliptical, I just aim to give it almost all I can, aiming for 90-100% effort during the high-intensity intervals, then falling to roughly 50% effort between intervals.

A Target HR of 60-90% of Maximum Heart Rate is the standard recommendation for exercise intensity. Traditionally, a Target HR of 60-70% of Maximum HR has been suggested as optimal for fat-burning, but that is simply not true. As you will learn from my HIIT post, exercise of higher intensity is better for fat loss, but a beginner will not be able to handle that regimen right off the bat.

When starting out on a new exercise regimen from a relatively inactive lifestyle, it certainly makes sense to start out low and gradually ramp up the intensity. I recommend that you not get hung-up on the numbers so much as just doing the exercise. Work hard, and it will pay off over time. If you want to monitor your heart rate, that’s okay, but I don’t think it’s necessary let off the intensity of your workout just because you have exceeded your Target HR, unless you are pacing yourself for an endurance workout.

Body transformation – Who needs a New Year’s Resolution?

As much as I hate the cliche’ nature of New Year’s Resolutions, I am setting myself up for one. I have been off my workout regimen for several weeks, thanks to recent illnesses, demands of work, and just plain lack of motivation. I have no doubt as to whether or not I will make a change. When I put my mind to it, I will do it. Unfortunately, I am suffering from that “inertia” of inactivity right now, and it’s killing me. I have been plotting my next round of my “transformation” but have been reluctant to put it into action, especially knowing that I’ll probably be a bit naughty on New Year’s Eve (Who doesn’t want to be?).

Too bad. No more excuses. I am starting now.

I will get my butt out of bed by 6:00 AM no matter how lazy I am feeling.

I will take a ‘before’ photo in the morning.

I will kick my ass on the elliptical with Blue October blaring throughout the house.

I will eat ‘clean’.

I will lift weights in the evening.

Most importantly, I will not give up.

Stay tuned . . .

New Year’s Fitness Resolutions

It’s that time of year again – to re-focus our efforts on what we feel are priorities.  I think it’s safe to say that health/fitness is among the most oft-repeated resolutions.  I’m not sure what their source is, but our official US government website has a list of the “most popular” resolutions.  Of the 13 resolutions mentioned, 5 are directly related to fitness issues.  No surprise there.  But, as mentioned in my “False Hope Syndrome” post, there’s a reason for the same resolution showing up on the list year after year. 

Go ahead and eat those cookies and sweets leftover from the big Christmas party, go have fun at your New Year’s Eve party, watch all the college football bowl games you can handle . . . as long as you commit to making a change in your lifestyle once you get all of this badness out of your system.  You don’t have to give up all your indulgences once you commit to a healthier lifestyle – you simply make them rare indulgences. 

In fact, the majority of people in bodybuilding, high levels of fitness, etc. hold onto a regular “cheat meal” as part of their training plan.  They have recognized that sticking to an ultra-healthy diet can be tiring and counter-productive.  Whether it’s once a week or once a month, allow yourself to splurge on a favorite food once in a while.  Then you can refocus your efforts on your fitness plan and not feel imprisoned.

Your New Year’s Resolution should be reasonable – few will succeed with an overly dramatic resolution, such as “I will not eat any more sweets” or “I will exercise every day”.  Your body may demand a gradual change, rather than an abrupt change.  Be satisfied that you’re starting in the right direction at first, then worry about perfecting things. 

Good Luck!