The 'new' Physical Activity Guidelines for Americans, and what they got wrong

Early this month, the Department of Health and Human Services released an update to the 2008 Physical Activity Guidelines for Americans. The recommended amount of physical activity needed to maintain good health really hasn't changed. Children should get 60 minutes of physical activity a day and most of it should be moderate to vigorous aerobic activity (i.e., increased heart rate, hard to carry on a conversation) and they need muscle strengthening exercises, too.  Little children, and their caregivers, should stay active throughout the day. That is subjective, but it means less screen time!

The amount of moderate to vigorous physical activity and strength training that adults need is still 150 to 300 minutes of aerobic activity a week, less if it's vigorous (like running at a 10 m/m pace or faster), and twice a week weight training. The Guidelines say that this amount of physical activity is beneficial, but to really improve health and prevent disease MORE is necessary. That goes for strength training (e.g., lift weights), too. The least amount Americans need to do is twice a week for 20 minutes. Older adults, say 50+ should consider weight training imperative, as it will slow age related muscle loss (i.e., sarcopenia). Read more from the DHHS here. And for an announcement on the changes from NPR, read here.

So what has me all riled up... so much so I am writing a blog post when I have pretty much stopped making time for them? Well, the Guidelines now claim that any large muscle motor activity/movement can count toward your aerobic goal. So if you walk from your car to a building and it takes 5 minutes, good for you!! Only 295 more to go. If you mop the floor for 10 minutes - you are AWESOME, 285 more to go. And so forth.

As I perceive it, that is not exercise. And here is why I think the DHHS wants to say it is. Because, as a nation, we have been woefully behind in meeting the PAGA (physical activity guidelines). According to the CDC, less than 1/4 (25%!) meet the combined aerobic and strength training minimum goal. But if the government says all those little things DO count, then when they ask people about meeting the per week aerobic goal, more can say yes. So the next time the CDC reports results form a survey, the percent of the population meeting the aerobic goal might jump from 50% to 75%, only because the definition has changed, not because people became more active. 

Imagine our trend lines - there could be a sudden spike in the number of Americans who meet the goals, but it won't be because people are exercising more, it will be because they are counting things that probably shouldn't count. Be wary when looking at trend data when the definition of the behavior being tracked or the question being asked, has changed.

I absolutely 100% believe we need to move more and sit less and that by doing so, we will be healthier, but come on.  If you get up and go to the toilet at night, can you count that too?!? Lowering the standards is not going to reduce chronic illnesses related to sedentary behavior.

Start the New Year Informed

Like many or most of you, I am preparing for the new year. What might be different is that to be healthy I simply (or not so simply) need to keep doing what I have been doing. Whereas, many others start every year pledging - resolving - to do things differently. With that in mind, I want so share some truths with you.

The most important things that any of us can do are these (listed, not necessarily, but maybe, in order of impact):

1. Do not smoke tobacco (don't start or do quit).
2. Exercise - everyday (30 to 60 minutes of activity that increases your heart rate).
3. Maintain a healthy weight (this is relative, but for most people it means losing weight).
4. Eat within a calorie appropriate (controlled) recommended dietary pattern, e.g., the Mediterranean Diet, which is plant based.
5. Get some sun, but not more than 10 minutes without protection (also relative to time of year, your skin pigmentation and where you live).
6. Avoid alcohol in excess (for some this means any alcohol, for others excess means more than 1 or 2 a day or 7 to 14 a week (never more than 3 or 4 in one day).
7. Get vaccinated according to the CDC recommendations for your sex and age (and take your children in for their shots).
8. Practice safer sex - i.e., use condoms and discretion.
9. For those suffering from any substance use disorder, SAMHSA can direct you to supportive services
10. Do not fall for diet and supplement scams - nutrition comes from food and weight control comes from balancing intake with expenditure. If whatever supplement or plan you are hearing about was as much of a break through as the ad says, we would NOT have an obesity epidemic. Please believe me.. there is NO pill for you. Reread numbers 1 - 9 above, this is the key to health.
11. Remember these final words of truth:
1. Non-GMO only means something does not contain genetically modified ingredients, not that its low calorie or necessarily good for you.
2. Organic means something has been raised according to specific standards, and so the plant or animal was not treated with chemicals or antibiotics. Organic foods are not scientifically better for you than conventional foods (though there IS concern about antibiotics in the food chain). Organic foods are not necessarily or ever lower in calories than similar non-organic foods.
3. All natural is finally being defined by the FDA - but stay tuned for the final rule and then years before companies have to comply.  Even if something is truly natural - not at all processed - that does not mean it is good for you, wont' hurt you, or is low in calories.
4. There are legal definitions for low calorie, low fat, low sodium, etc.. and 'lower' means something different than low.
5. Read the nutrition facts panels, think about serving sizes.. pay attention to calories (usually a lower calorie item will also be low in sugar). Hopefully, the added sugar declaration will be added to labels this year and that will lead manufacturers to reformulate their products.
6. Some fat is good for you! Especially consider adding omega 3 fatty acids from food, like salmon.
7. ONLY 1% of white people in the United States have CELIAC DISEASE, and even fewer people of other races/ethnicities do. That means, YOU probably don't need a gluten free diet.
8. Gluten free does NOT mean low in calories or good for you.
9. The health promoting property of olive oil is destroyed when you cook in it. To get the nutrition you are seeking, drizzle a teaspoon over your cooked veggies instead.
10. Get your fiber from plant based foods and whole grains, not mixes and pills.

On a sad note, the national vending and menu labeling law which is NOW set for compliance in May of 2017 is part of the Affordable Care Act - and may or may not survive the next presidency. That means that local and state laws could once again begin to populate which could be better for us and a nightmare for industry. Stay tuned

Lastly and sincerely,  I wish you the healthiest of New Years....remember, though I focus on food, physical activity is the sine qua non of health... make sure you get plenty this year... all year.

~ Deirdre

Exercise for Weight Loss?

No.
Exercise for exercise. Exercise for a long, healthy, active live.
Exercise for functional capacity, mood stability, improved attention and learning.
Exercise to prevent disease. Exercise to improve your quality of life.
Exercise because not exercising increases your risk of all causes of death and all disease states.

If you exercise only because you think it will help you lose weight, and exercise is your only weight loss strategy, chances are you won't lose weight. And then you will think exercise failed you. You will be wrong. Exercise is the sine qua non of health; it will never fail you. if you do it for the right reasons.  There are many reasons, see the first paragraph and the research studies below.

If you want to lose weight, change your eating patterns. Many people need to lose weight.
If you want to be healthy, exercise - daily.. Everyone, regardless of their weight status, needs to do this.

(NB. this was posted a few weeks later http://www.vox.com/2016/4/28/11518804/weight-loss-exercise-myth-burn-calories)

Janssen, I., & LeBlanc, A. G. (2010). Review Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. International Journal of Behavioral nutrition and physical activity, 7(40), 1-16.

Nocon, M., Hiemann, T., Müller-Riemenschneider, F., Thalau, F., Roll, S., & Willich, S. N. (2008). Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. European Journal of Cardiovascular Prevention & Rehabilitation, 15(3), 239-246.

Penedo, F. J., & Dahn, J. R. (2005a). Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Current opinion in psychiatry, 18(2), 189-193.

 Warburton, D. E., Nicol, C. W., & Bredin, S. S. (2006). Health benefits of physical activity: the evidence. Canadian medical association journal, 174(6), 801-809.

Prevent Obesity w/ More exercise - less fast food

Morales, Gordon-Larson and Guilkey (2014) conducted a simulation experiment where they statistically modeled several factors that are related to the probability of a person being obese in the future.  The model tested their assumptions by predicting who would become obese. You can read the study here .- Several statistical equations were used to simulate decisions about smoking, physical activity, starting a family, and fast food consumption.  In addition, the researchers added a neighborhood level factor.

The data used were real - information came from the National Study of Adolescent Health (USA) which contains several years of information following people from high school through young adult hood.  During those years, people in the study usually transition from a home environment chosen by their parents, to one they chose themselves.  The choice of environment is based on some unknown personal preferences or necessities of the person.  Since many researchers speculate that where a person lives has a direct impact on whether or not that person becomes obese, these researchers felt it important to capture neighborhood choice in their model predicting obesity.  In fact, Morales, et al knew exactly where the participants lived at all times and added the number of parks, complete streets and fast food restaurants in each persons neighborhood to their simulation model.

The results of the study are interesting and give public health advocates, researchers, policy makers and the general public some things to consider.  The researchers tracked people over time in their simulation model, too, so they carried forward things about the person that had been learned at the previous time point.  They found that the best or most powerful predictor of whether or not a person would be obese at time 2 or 3 or 4 was whether or not they were obese the time before that.  In fact, the researchers assert that the most important thing to do is prevent obesity in the first place, because a reversal just isn't seen.  In other words, if a person was obese at any of the previous times it is very unlikely that they will be normal weight at any point in the future.  I agree that prevention is the key.

Other findings that seemed important to me, include; the more fast foods a person consumed the more likely they were to be obese; and physical activity reduced the probability of obesity, but in a nuanced way.  The researchers found that at least 30 minutes of physical activity 5 days a week were needed to keep a person from becoming obese and that the greatest impact on weight - or the best chance of not being obese - came from maintaining that level of physical activity from adolescence (i.e., high school) throughout adulthood.

Neighborhood characteristics, a main focus of this study, did have an impact on the probability of being obese, but the magnitude of the effect was much smaller than physical activity and fast food consumption.

Breaks in Sedentary Time

There are two, no three, disease or health related lifestyle factors that I pay the most attention to when scanning research updates: dietary intake, tobacco use and sedentary behavior.  Sedentary behavior is any activity that keeps the body relatively still, e.g., sitting  and- typing a blog post, watching TV, playing cards, reading a book, listening to an instructor/speaker, playing video games.  Past research has shown that the more a person sits the worse it is for their health, with health defined as all-cause mortality, chronic disease, metabolic dysfunction (high blood pressure, blood sugar, etc.).  I have already talked about the past studies, but to review (and I don’t recall who was in the sample studied, i.e., men, women, young, old, black, white), sitting for more than an hour without taking a break -getting up and moving - is associated with poor health outcomes and this is still true (with a weaker effect) if the person doing the uninterrupted sitting also exercises for an hour or so a day.  So physical activity is good, sedentary behavior is bad, and sedentary behavior is bad (deleterious) for inactive AND active people.

So that was old news.  This week I read another study about the benefits of breaking up sedentary time.  The study by Sardinha, Santos, Silva, Baptista, & Owen (2014) specifically focused on Portuguese adults between the ages of 65 and 94, but it is likely that the same metabolic processes happen in older adults of other races/nationalities though the effect may be higher or lower.  An example; if sedentary behavior increased the risk of all-cause mortality by 2% in one group, it would probably increase the risk in a similar group, but the increase (effect) might be 1% or 5% instead.  Sedentary behavior is still bad, just more or less so.

The current study was a little different from those that came before, and that is a good thing, because it makes the evidence stronger.  Here the researchers included measures specific to an older person’s physical activity level, physical functioning and physical independence.  The participants wore accelerometers on their hips during the day for four days.  The accelerators recorded information on movement that the researchers could turn into activity levels.  The researchers took several measures of physical functioning, including, how many times a person could sit and stand from a chair in 30sec, how many dumbbell curls they could do in 30sec, and how far they could walk in 6 minutes.  The researchers measured physical independence with a 12 item scale with a total of 0 to 24 points.  Items include questions about one’s ability to do an activity with or without assistance, e.g., bathe, do laundry, walk, etc.  I found an example of both tests, if you’d like to see them click here for the physical function test and here for independence test.

For the outcome of interest, Sardinha et al focused on differences in persons’ physical functioning abilities (e.g., the dumbbell activity) and a score that totaled all those physical function abilities. These measures matter because they are important indicators of successful vs usual aging.  Sardinha et al compared the functional measures, while controlling for persons’ physical activity levels (do they get the recommend 30 minutes a day of moderate to vigorous physical activity/ yes or no; based on the accelerometer data), independence test scores (described in the above paragraph), BMI, sex and some other things.  They wanted to see if peoples’ scores were different based on the amount of time they spent in sedentary behavior (sb) and whether or not that time is broken up; breaks in sedentary behavior (BST).

And of course, the scores were different.  In the analysis of the physical function components and the overall score, there were higher scores in the dumbbell curl, the chair test and the overall score, when people took breaks in their sedentary time. The researchers also looked at the direct and independent effect of moderate-vigorous physical activity (cycling, aerobics, running), sedentary time and breaks in sedentary time on the total physical function score and found that people who engage in at least 30 min of moderate to vigorous physical activity a day have higher scores, people who spend the most time in sedentary behavior have the lowest scores and those who take breaks have higher scores than those who do not.

I leave you with a quote from the authors’ conclusion section:

Therefore, PA [physical activity] guidelines for older adults might emphasize more strongly these two distinct behaviors to be considered together, such that even if a person were to comply with 30 min/d of MVPA, they should avoid too much sitting for the rest of the day. Periodic and small interruptions to SB [sedentary behavior] are likely to be of importance in preventing a decline in physical function.

Sardinha, L. B., Santos, D. A., Silva, A. M., Baptista, F., & Owen, N. (2014). Breaking-up Sedentary Time Is Associated With Physical Function in Older Adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, glu193.

Should smokers exercise?

   Smoking is an independent cause of heart disease.  One possible link between smoking and heart disease is that smokers’ arteries tend to be stiffer than the arteries of non-smokers, even when controlling for other factors that might lead to this condition, e.g., having a family hx of heart disease.  Physical activity is also independently related to heart disease - being active reduces the risk and sitting around increases it - to be clear - sitting around for extended periods of time (independent of how active you are otherwise) is associated with the risk of heart disease.

   New research from a small study of young men¹ suggests that smokers who engage in regular physical activity have less stiffness of large arteries than smokers who do not engage in regular physical activity.  However, the stiffness in active smokers was worse than that of active non-smokers, and clearly the best option is not to smoke.

   When I read the study conclusion, I wondered how they measured smoking?  For instance, did they say, ‘in the last month have you had at least one cigarette’ and then put all the yes's in the smoking group and the no's in the nonsmoking group?  If that were the case, I would discount the validity of the conclusion because a person who is physically active and otherwise healthy, might by chance, have had one cigarette in the last month, whereas a physically inactive smoker might have smoked 2 packs a day. That was not the case; the researchers categorized smokers as those who had at least 8 to 10 cigarettes every day during the past two years.  

   Unfortunately, there were other limitations of the study which give me pause, though they do not diminish my faith in the benefits of exercise.  In this small study, the inactive smokers were different in other ways that could lead to heart disease, i.e., they were older, had higher % body fat and smoked more cigarettes per day than the active smokers.  In addition, the average age of the participants in the study was 22 and artery stiffness and other markers of heart disease usually occur later - even those associated with smoking.

   Still: Physical Activity is the sine qua non of health and experts recommend it for EVERYONE.  Smoking is the sine qua non of disease and experts recommend it for NO ONE.  I pride myself in being pro exercise and anti-smoking; but I am not anti-smoker and so I got my dander up when I read the following facebook post of one of my acquaintances.  

Just saw the most bizarre thing ever. Two older ladies walking through (x) Park at a decent pace (clearly here for exercise) then one of them lights up a cigarette and they keep on walking. Why bother exercising?!? At least she can enjoy her death stick in some pretty scenery I guess

   First,  I one hundred percent agree that the park should be tobacco free and I would be furious and loud mouthed about someone smoking near me as I walked, ran or cycled, but that is not what this facebooker was venting.

   The person who started the post, and most of the people who commented on it, wanted to know why the smoker was bothering to exercise - the people speaking on the thread were clearly anti-smoker - if we followed their line of reasoning that a smoker shouldn’t bother to exercise (because they were killing themselves with the cigarettes), then smokers should also stop wearing seat belts or looking both ways when crossing the street.  Ridiculous, judgmental, nonfactual discourse.

   For goodness sakes - EVERYONE should exercise and not all smokers die from smoking related diseases…. maybe because they are otherwise healthy or genetically protected – still, it is not smart to smoke, but it is even less smart to do all the other reckless things on top of it.

Now, put those cigarettes down and go take a walk.

¹ Park, W., Miyachi, M., & Tanaka, H. (2014). Does Aerobic Exercise Mitigatethe Effects of Cigarette Smoking on Arterial Stiffness? The Journal ofClinical Hypertension.

What keeps us healthy doesn't involve self loathing.

There are several diseases and poor health outcomes that may be related to weight gain and having excess adipose tissue (fat).  Research suggests an association among weight gain, diabetes, heart disease, and some cancers (see e.g., The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity.)  There is reason to believe that the increase risk in heart disease is related to inflammation caused by fat tissue (Berg & Scherer, 2005) and that belly fat specifically, increases the risk for diabetes (Chan, Rimm, Colditz, Stampfer, & Willett, 1994).  Being overweight is also associated with joint problems (Anderson & Felson, 1988) .  The studies that I have referenced here do not show cause and effect, but many scientists, myself included, agree that excess body fat is detrimental to health.

Disease and poor health may also be the result of sitting around too much, of being still. Researchers have found that people who spend continuous hours of time doing sedentary activities, like sitting at one’s desk, sitting and playing cards, sitting and watching TV, sitting and reading, etc, regardless of how physically active they are at other times, are at risk of premature death from any cause (Katzmarzyk, Church, Craig, & Bouchard, 2009).  Sedentary activity also increases the risk of metabolic syndrome (Bankoski et al., 2011), which is often seen as a precursor to diabetes or heart disease.

A lack of regular, consistent physical activity (exercise) is another risk factor for disease and early death. The Physical Activity Guidelines for Americans and several independent research studies have shown numerous health benefits of daily exercise.  For example, men and women who spend more time engaging in leisure time physical activity have less heart attacks and less heart attack deaths than men and women who engage in little or no leisure time physical activity, i.e., exercise (Leon, Connett, Jacobs, & Rauramaa, 1987; Oguma & Shinoda-Tagawa, 2004).   Lack of exercise is also related to incidence of diabetes, cancer, hypertension, obesity, depression and osteoporosis (Warburton, Nicol, & Bredin, 2006).

So, these things are clear to me and maybe to you as well:
· achieving and maintaining a weight that is considered low risk by waist to hip ratio, waist circumference and/or BMI -indicating normal levels of fat tissue, especially in the abdomen- is smart (i.e., it promotes health and reduces risk of disease and early death);
· limiting the amount of time spent in activities that require you to be still is also smart; and,
· engaging in physical activity for prolonged bouts - 20 to 60 minutes at a time, at least once a day is again, smart.

All of these lifestyle behaviors, which we have some or total control over, are good for us.  We are wise to be mindful of our dietary intake (what and how much), wise to sit for only short periods of time (< 1 hour), and wise to exercise every day.  We should do what we have the power to do to keep our bodies from becoming overfat and deconditioned.  I believe this and I promote it, but I believe something else just as vehemently.

I believe we have weight stigma in the USA and this stigma may be responsible for adverse health outcomes (Puhl & Heuer, 2010).  I find that the worst part of the stigma and the discrimination it promotes is its internalization: people turn the stigma onto themselves and become self-loathing. 

Please click on this link to read a story and watch a video about the hatred many women feel about their own bodies.  Being overfat is bad for health.  I will continue to say it, and continue to push back against body acceptance when body acceptance is a justification for poor dietary habits and a lack of exercise.  But let me be clear, hating oneself is more than bad for health; it is bad for the soul. Obesity researchers, myself included, must be ever mindful of the very difficult and complex process of weight loss and not let our work imply that obesity is a chosen disease, it is not. Weight loss is not easy, if it were easy, two out of three US adults wouldn't be overweight.  Please watch that video.

Anderson, J. J., & Felson, D. T. (1988). Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I) evidence for an association with overweight, race, and physical demands of work. American journal of epidemiology, 128(1), 179-189.

Bankoski, A., Harris, T. B., McClain, J. J., Brychta, R. J., Caserotti, P., Chen, K. Y., . . . Koster, A. (2011). Sedentary activity associated with metabolic syndrome independent of physical activity. Diabetes care, 34(2), 497-503.

Berg, A. H., & Scherer, P. E. (2005). Adipose tissue, inflammation, and cardiovascular disease. Circulation research, 96(9), 939-949.

Chan, J. M., Rimm, E. B., Colditz, G. A., Stampfer, M. J., & Willett, W. C. (1994). Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes care, 17(9), 961-969.

Katzmarzyk, P. T., Church, T. S., Craig, C. L., & Bouchard, C. (2009). Sitting time and mortality from all causes, cardiovascular disease, and cancer. Medicine & Science in Sports & Exercise, 41(5), 998-1005. doi: 10.1249/MSS.0b013e3181930355

Leon, A. S., Connett, J., Jacobs, D. R., &; Rauramaa, R. (1987). Leisure-time physical activity levels and risk of coronary heart disease and death: the Multiple Risk Factor Intervention Trial. Jama, 258(17), 2388-2395.

Oguma, Y., & Shinoda-Tagawa, T. (2004). Physical activity decreases cardiovascular disease risk in women: review and meta-analysis. American journal of preventive medicine, 26(5), 407-418.

Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public health. American journal of public health, 100(6).

Warburton, D. E., Nicol, C. W., & Bredin, S. S. (2006). Health benefits of physical activity: the evidence. Canadian medical association journal, 174(6), 801-809.

Fat in food vs Fat on your body

    I was frustrated by the research study on M&Ms. I was frustrated because it is 2013 and I thought we had learned that low fat is not the answer to our collective weight problem.
   Studies that continue to focus on promoting low fat choices add to the confusion.
As someone who has expertise in public health nutrition, health education and health promotion, I must try to clear this up. 
   Fat in food does not equal fat on your body.
   Too many calories from any source does. When a person regularly consumes more calories than their body needs, the extra is stored as body fat.  (Note: Over indulging every weekend is regularly consuming too much.)  There are ways to increase your intake to build lean body mass but that is not the focus here.

YES it is true that there are more calories in a gram of fat than there are in a gram of carbohydrate, protein or alcohol.   (9,4,4,7)  
YES it is true that some foods are more nutritious than other foods.  It is recommended that we fill our plates with nutrient dense, not energy dense, foods 
    Foods that are especially important are complex carbohydrates (vegetables and many fruits), whole grains and so called 'healthy' oils or fats (like those in olive oils and salmon).
Complex carbohydrates contain phytochemicals, flavinoids, and antioxidants.  These substances have been associated with reduced risk of many chronic diseases.
And YES it is true that refined or simple carbs, like sugar, white flour (rice, pasta, bread) baked goods, sugary or starchy fruits with little fiber, and all sugar sweetened beverages have more calories than they do nutrients.
AND Yes, it is true that some sources of fat just like some sources of carbs are believed to be harmful. (e.g., red and processed meats are associated with colon cancer).
   The reason some foods are calorically (energy) dense is because they are full of sugar or fried in grease.  
   Too many calories from either  = fat storage. 
********************
    And because its politically palatable to promote, physical activity as a solution to the country's obesity 'problem,'  I have to address that too.  Initiatives to build more parks and alert people to "take the stairs" are only going to work (for weight control) if two things happen.  TWO things.

1) people actually start using the stairs and parks, and
2) they stop eating too much

It does not matter how many stairs a person climbs (Mayor Bloomberg), if he or she eats more calories than needed - weight loss will not occur if 'we' keep eating too much.

There are people (fewer than the drug/genetic companies would have us think) who fall outside these generalities.  In other words, some people do not gain weight no matter how much they eat and others do not lose weight not matter how much they restrict.  These are very unusual people and I suspect you are not one of them. 

Disclaimer: I am not a nutritionist or a dietitian who can give individual diet advice.   I share information based on research and public health recommendations.

What's your plan B?

**** post note.  I have been working on my 12 mile bicycle ride. (I am riding a mountain bike on the street -  they aren't fast on the street).  See how I my speed increased almost every time!   This is a fun, challenging way to survive a vacation from running.  Look at the column on the right, and start at the bottom.  I started at 12 mph and increased to 13 mph.

**original blog post:
No, not for birth control... your exercise plan B.
What do YOU do if you can't do what you planned to do?  What do YOU do if you can't do your planned exercise for one day?  What if you can't do it for weeks or months?

By now, you should be convinced that exercise is not something you do because you want to lose a few pounds (though it sure helps) but something you do to prevent disease, boost your mood and to age successfully (not normally - successfully).  In other words, exercise is not meant to be temporary.  It benefits you for as long as you do it (like healthy eating).

So if you have plans for a walk at the park and it rains, what is your plan B?  If you planned to swim, but a thunderstorm or faulty equipment closes the pool, what do you do instead?  Do you have a list of options for your plan B?

What if the activity you prefer, for me its running, is one you have to rest from?  IF you like to swim and tear a muscle in your shoulder that will take months to heal, what will you do for your exercise?

It is best to have more than one exercise - not just for plan B days, but in general.  This is because the body acclimates and what was once challenging can become ineffective.  The body needs variety  - could be little things like tempo, speed and terrain - and big things like alternating biking, swimming, running, walking, aerobics, sports, etc .

My usual routine is 5 days of running (with changes in place and pace) and two days of swimming (w/ 2 routines) and 2 days of weight training.  YES, that IS nine days.  You are very astute.  I swim and weight train on the same day.

Cycling is my plan B as is 'extra' swimming and step aerobics.  On a recent walk date, my friend and I got rained out, so we went to the mall and WALKED.  Corny, but effective. 

When the pool closes unexpectedly, I go to another pool, or I cycle or do some indoor cardio activity at the gym.  Sometimes I lift weights at home if the gym is closed on a weight train day.  ETC

Something else you might consider - especially if you are using exercise for weight control or perhaps, stress control, and you have to stop your high intensity exercise.  How do you handle the change in calorie burn that comes from decreased intensity?

You have a few options.  You can switch to low impact activities and do them longer, sometimes twice as long.  You can work on making that low impact activity, like cycling, walking or swimming happen FASTER. You can do the lower impact/low burn activity for the same time that you did your favored higher burn activity and choose to eat less - or you can do the low burn activity for the same duration and accept that you'll gain a few pounds.   (For me, I don't have more time to spend - but if I choose a 12 mile cycling routine, I can try to do it faster (even a few seconds) each time.  I would not be increasing distance, just pace.  For swimming, I could stick with my time limit, 50 minutes and try to get in more laps -so more distance)

 MOST important take home message - YOU DECIDE.  Take control and be ready with your plan B list.  You decide how you'll adapt to the change and you decide that this adaption does not include quitting.

The Perfect Mix for a BEST DAY

   One day last week and again yesterday, I was able to run before class, lift weights after class -go to a meeting, then go swimming after the meeting and then do some studying.  In other words, my three big cognitive or mental activities were split up with exercise, not just physical activity (walking from one to the other would be physical activity).  Instead, I set time aside to systematically increase my heart rate and tone my body, lungs and heart.
   This is my ideal type of day.  I will as often as possible break my mental activities up with little walks or some activity.  Because of the mix it up routine I feel confident saying that I am at the 95th percentile of productivity. By this I mean, if you assessed 100 people on level of productivity, only five of them would be more productive than me (and maybe less!).

MOVE more LIVE longer

   After writing a recent post regarding calorie intake and limits, I made a note to myself to come back and remind people about the benefits of exercise.  Sometimes when I am talking about weight control I give the impression that I do not appreciate exercise.  That could not be further from the truth.  Not only do I appreciate it, I engage in it on a daily basis.  Daily - meaning each and every day (with rare exceptions). 
   I have dedicated many posts to this subject.  You can use the search feature on the right side of the blog on the blogsite to find them.  
  The Physical Activity Guidelines for Americans can be read in full at the CDC website here.  The guidelines give the type of exercise, the duration and the frequency that is necessary for optimal health. The countless benefits of physical activity are also noted in the document.
   It is important to engage in activities that increase your heart rate such as walking, cycling, swimming, running, and playing sports on a regular basis.  One should strive for daily exercise but vary the amount of time spent and the type of activity.  For example, exercise seven days a week, but on some days ride a bike, others swim, golf or walk etc.  Some days you might exercise for an hour and others for only 30 minutes.  The weekly goals are provided on the CDC website.  The second recommendation is strength training - activities that build, condition or strengthen your muscles (e.g.,  weight lifting, resistance training and power yoga).  Balance and core work is also important.  Simply practicing standing on one foot for 30 seconds a few times a week will work.  If that's so easy you could do it all day, try it with your eyes closed or raise your leg higher.
    Research has shown that exercise - being physically active - is associated with improved health, both physical and mental, and a decrease in disease, cancer, the effects of aging, and all cause mortality.  Physical activity also improves mood, agility and assists in weight control.  
   I especially like this post that shows the different levels of expenditure based on exercise types.  And this one that talks about motivation to exercise. 
    Lastly a little clarification about different terms you might hear.  Even though we often use physical activity and exercise to mean the same thing, they are actually different.
   Physical activity is any kind of moving about with your whole body - big movements that you do throughout the day count. Exercise is always physical activity but physical activity is not always exercise!  For example, you are being physically active doing your chores, reaching, bending, carrying - but that is not exercise.  It is still GOOD - better than being still.  Much better.
   Exercise is planned action you take to increase your heart rate for a predetermined amount of time.  If you decide to go for a 30 minute walk or jog, you have decided to exercise.
   Sedentary behavior is the opposite of exercise and physical activity.  It is what you want to avoid because it is associated with metabolic (under the skin) changes that can make you more likely to get a disease (e.g., diabetes, hypertension).  Sitting around is sedentary behavior - as is lying about - try not to sit for more than an hour without doing some moving around ( aka physical activity!).

The Best Way to Lose Weight

I want to be sure that I didn't  mislead or confuse you, by referring to this old NHIS question in the last post.

In your opinion which of these are the 2 best ways to lose weight

 Eat fewer calories
 Take diet pills
 Increase physical activity
 Eat NO fat
 Don't eat at bedtime
 Eat grapefruit with each meal

My point was to draw your attention to how things have changed in the last 40 years and what we know today.

In the above list and in any list, the best way to lose weight is to reduce the number of calories consumed.  You must eat less to lose weight - and not because you took a diet pill or because there was grapefruit on your plate.  Limiting saturated fat is a good idea, avoiding trans fat is important. Including healthy oils from plant and fish sources is essential.  The only right answer in that list was related to calories.  BTW, the body doesn't know what time you eat.

 But about the physical activity:

A person who is physically active is less likely to become overweight than a person who is inactive.  A person who is physically active is more likely to keep lost weight from returning than someone who does not engage in physical activity.
A person who meets the recommended levels of physical activity is less likely to die from any cause (over a set time period) than those who do not.  People who exercise regularly are also less likely to become ill from heart disease and some cancers.

Heat, Hydration and Exercise Amounts

Heat, Hydration and Muscles  This goes into the “learned the hard way” category.  Maybe you can learn from my experience.  As you may recall, I had some pain in my calf a few weeks ago.  Both the physical therapist and later the MD asked me if I had been running when it was very hot.  I had.  It was when NC was having the high heat index days and I was blogging about code red air quality.  The PT said that I was probably tired and hot leading my muscles to cramp and stay sort of knotted up.  I kept trying to run – thinking – well surely those knots will let go.  Instead, it got worse and Monday a week ago, the pain was intense enough to send stress fracture alarm bells ringing and I have not run since (sad me).  I saw the sports medicine doctor on Thursday.  He told his assistant, “It’s the heat.  Remember all the runners that have been coming in with pulled muscles?  They get dehydrated and injured.”  So dehydration was the cause.  Dehydration (when you sweat out more than you drink in) impairs muscle functioning.  The muscles have less blood flowing to them, are not as flexible and elastic as usual and are prone to stresses.  This makes the muscles weaker, increases cramping, and injury risk.  As I recall, I may have run over a root on a trail on one of those super hot days. The muscles that stabilize the ankle couldn’t handle the contraction needed to balance me.  I did not feel any sharp pains – I only felt tightness the next day.  My doctor used an ultrasound to evaluate my injury and found some tears in the perineum – one of the many calf muscles. I do not have a stress fracture and all my joints and muscles are strong. I did learn that the muscles most susceptible to injury during dehydration are the hamstrings, quadriceps and calf.  I thought I was prepared for the.  I wore a fuel belt with electrolyte water , but I guess I needed two bottles not one.  BAH.  Well – I am unhappy but as you’ll see in the exercise chart below – I am NOT sedentary. 

Exercise Amounts

I have added totals to the excel sheet that I use to make my chart. When considering my weekly total,  I should not count the 80 minutes of cycling for transportation.  It does not really meet the definition of exercise. That leaves me with a total of 678 minutes for the week.  Within that total is my time spent on resistance or strength (weights) training.  The PAG (physical activity guidelines) specify time for resistance workouts (at least 20 min 2x a week) apart from the recommendations for aerobic activity.  So I should also subtract my 60 minutes of weight training form the 678 total. That leaves me with 618 minutes spent on walking, running, swimming or cycling in seven days.  I averaged almost an hour and a half each day.  Believe it or not, the PAG suggest that the more one exercises the better the benefit.

My change due to injury is somewhat noticable in the chart below and will be more so next week.  I have added more cycling for fitness (including dirt trails) and and extra day of swimming.  For the extra day of swimming (oh my gosh I used to hate one and now its three!) I am doing pool running with a jog belt.  If you are interested in that, Google has some video links.

Remember you can make your own chart by modifying the excel document I made.  It is available here. link to scribd 

 

 Are you still reading?  Great.  Let me add that I understand that the majority of people have trouble meeting the 150 minutes of aerobic activity per week, none the less 300 minutes.  But it is true, the more you do the better off you'll be (for most people).  Below is the statement from the PAG document itself.  You can check out the guidelines in full here.  There are special sections for people who are disabled or over the age of 65.  However, no one gets away with being sedentary!

The benefits continue to increase when a person does more than the equivalent of 300 minutes a week of moderate-intensity aerobic activity. For example, a person who does 420 minutes (7 hours) a week has an even lower risk of premature death than a person who does 150 to 300 minutes a week. Current science does not allow identifying an upper limit of total activity above which there are no additional health benefits.

Deficits and Disorders

   A deficit is not the same thing as a disorder and you can have one without having the other.  Today's post regards a term that I first read in a publication from the American College of Sport's Medicine.  I do not know who coined it, or where it originated, but I am very uncomfortable with it.  The acronym is EDD and I will get to that in a moment.

   First. How do we define the two words.  What do they mean?  Deficit.  Deficiency.  Before one can be deficient in a "thing" a standard must exist.  The standard is usually an amount of a substance or attribute that is necessary for a system to function.  A system could be a body, a business, the economy and even the food supply.  (I hear there is going to be a corn deficiency)

   For the body, it has been established that a certain level of iron is needed to prevent anemia.  Vitamin C protects against scurvy and vitamin D, scurvy.  In the current year (2012), very few persons who live in developed countries suffer from any of the above deficiencies.  We get enough protein and iron, Vitamins C and D.  A greater percentage of persons are low in Vitamin D putting them at risk for bone weakening, but it is still less than a majority of persons.  It is now normal to have adequate levels of iron, D and C.  Normal because most people are sufficient.  The average person does not have a deficiency.

   I bring up this normal and average business because I consider a disorder to be something that is NOT the norm/average. I.e. it is 'out of the usual' order.  Dis = "the absence of" order (normal). 

  This brings me to the term I have dis taste for - Exercise Deficiency Disorder (EDD).  Sounds too much like a disease that someone will try to medicate.  Exercise in a pill.  The ACSM article encouraged exercise specialists to identify children who did not meet the daily requirements (standard) for physical activity.  

   Children should be engaged in moderate to vigorous exercise for 60 minutes a day.  Clearly I believe that exercise is necessary for health - as I said yesterday, the sine qua non.  I fully support the recommendations for 30-60 m a day.  I agree 100% that the majority of adults and children, worldwide, are deficient in meeting this goal.  However, if the majority of us are not doing it - then the norm is the deficiency.  It is normal.  It is tragic.  We need to do something about it.  But exercise deficiency is not a disorder.  Let's leave the labels for our restaurant menus and not add another diagnostic code with which to label our children.

Exercise - the comfort of a PLAN

It has not been that long since I posted my exercise plan with the hopes of swimming 2x a week through August, etc.

The past two weeks were challenging.  I was able to keep things as planned  when I had the day long classes the week before last.  I only had to shift times, not days or actions.

This week I had one all day event that interrupted my running time on Wednesday, but worse - or in addition, the fitness center was only open on Monday and Friday and the pool was closed all week. 

The fall schedule is now posted for the center and the pool and I know my class schedule (though not my "work hours").
First I will explain how I did my work-around this week and then I will share my plan for (oh my gosh)the whole fall.  YIKES.  Can I commit?
Sigh - well - it gives me leverage with my walking buddy.

Oh yes, let us start there.  The real deviance began last weekend. My pal called (before my alarm was due to go off - dang it) to say that she and her son's dog (pet sitting) had been attacked by yellow jackets.  Her hand was hurt and she worried over the dog so we postponed.  It began to rain and rained most of the day.  Instead of an hour long walk, I did an hour of step aerobics (in my living room to a DVD).
Sunday my friend's hand had swollen badly.  She went to Prime Care where she received a shot.  I took a run around my neighborhood because I figured the trail would be too muddy to navigate, but I still ran.

Monday the pool was closed so I cycled about 12 miles and then later did my weight training - in the PM - not AM.
My Tuesday went as planned. Wednesday I had to be somewhere early and did not run first.  I felt bad all day so I decided to run that night - it helped.  I ran Thursday too because the gym was closed.

Today I cycled another 12, and I had company :).  I went to do my weights at 1:30 and that is where I decided that I was going to blog about this tonight.  (oh and since I did not run today I will run tomorrow.  This weekend we will walk on Sunday instead - just so I can end the week as off schedule as I started!)

School is back in session and the younger students are back.  I have been lifting weights at 9:30 am all summer and even during school, I bet that time will be less crowded.  I was NOT intimidated by all the boys/men in the weight room today - as I was one year ago.  Still, it was crowded.

The advice I want to offer you - besides mapping out your weekly exercise routine- is to plan the weight training you will do before you walk in the door. It is far less daunting if you know exactly what machine and or free weights that you will use and in what order.  Just walk in with a mission, do your thing, and get out :)

So the schedule is up and I have just committed myself to continue swimming twice a week.  I made recurring appointments on my Google calendar for weight training Mon and Thurs at 9:30 and swim Monday at 12 and Thursday at 4 (after my class).  I was frustrated last fall/spring because the swim schedule is inconsistent - but with a plan in place, I think I can do this.

HA - this picture is at least 5 years old and at yet another gym!

I will try my running and walking on the other days as has been.  X fingers and welcome Fall Semester.  I am SO thrilled to be in this comfortable place with a general understanding of the expected course work.  It is so much better than a year ago!