How can you improve your fitness?

This is the fourth column in the series about health and exercise.

First column discussed Darwin’s theory of “survival of the fittest”. Research supporting the concept of survival of the fittest is strong and compelling. There is plenty of evidence showing relation of fitness, physical activity and exercise to reduced mortality overall and from cardiovascular causes.

Second column was on the fundamentals of exercise. We need to exercise regularly to maintain tone in our muscles. If you do not use certain muscles on a regular basis then the muscles start to waste, become thin and weak. Our cardiac and skeletal muscles need regular exercise to keep them toned and strong.

Third column was on the importance of having a good exercise plan. An exercise plan should have three components – aerobic exercise, resistance training (weight lifting) and stretching. The plan should have two aims – to prevent disease and reduce mortality. A good exercise plan should prevent cardiovascular disease and prevent weakness of muscles, bones and joints .

Today, we will discuss the concept of physical fitness. A fitness program should train you to build strength, power, stamina, endurance, flexibility and balance.

To build strength, power and stamina, the best exercises are: swimming, basketball, bicycling, climbing stairs, dancing, hiking, and jogging.

To build flexibility, the best exercises are: swimming, basketball, dancing, tennis and yoga.

Except for swimming, none of the other exercises cater to all aspects of fitness. Therefore, you should combine more than one type of activity in your schedule to maximize your fitness.

To prevent boredom and monotony, you should change the exercise regime and goals every six to eight weeks. This keeps your mind and body working towards a new goal. A professional qualified trainer can help you achieve this. They know more about strength, power, stamina, endurance, flexibility and balance. This article is just an introduction to what you need to do to be fit and healthy.

Review of literature suggests swimming is excellent for all aspects of fitness. It probably fits the definition of a perfect or best exercise. When swimming, you can burn 12 calories per minute. Compare this to jogging 9.6 km. (six miles) an hour, cross-country skiing, squash and handball where you can burn 10 to 11 calories per minute.

Those people who are calorie conscious and want to shed some weight off their girth, thighs and gluteal areas would like to know what kind of exercise would do that. Here is some information on how to melt that unwanted fat.

You can lose two calories per minute by just standing or sitting at one place. You can lose up to four calories a minute by walking 3.2 km (two miles) an hour or bicycling eight km. (five miles) an hour.

You can lose up to seven calories a minute by indulging in sexual activity, shoveling dirt, skating or bicycling 16 km. (10 miles) and hour. Anyway, who would like to shovel dirt when you can burn calories by getting involved in a romantic activity?

Other examples are: housework burns five calories/minute; raking leaves burns six calories/minute; tennis, shoveling snow, downhill skiing, and water-skiing burn eight calories/minute; and basketball burns eight to 10 calories/minute.

What about golf? Golf is not a good activity to build stamina. It is good for flexibility. And has small effect on building strength. You can lose 250 calories per hour when you golf riding a cart.

A study done by Golf Digest showed a golfer who walks 18 holes while carrying his bag travels an average of 9.4 km. (5.9 miles) and burns 1811 calories. A rider with no cart path restrictions, surprisingly, walks an average of 3.7 km. (2.3 miles) and burns 859 calories.

So, keep moving. Remember, more is better and less is better than being a couch potato.

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An Exercise Plan Should Have Three Components

For a happy retirement, you need a good financial plan. For a healthy retirement, you need an exercise plan.

An exercise plan should have three components – aerobic exercise, resistance training (weight lifting) and stretching. The plan should have two aims – to prevent disease and reduce mortality. A good exercise plan should prevent cardiovascular disease and prevent weakness of muscles, bones and joints.

There is much evidence to show that a regular combination of moderate intensity aerobic and resistance exercises can help us achieve these goals. “…..simple, long walks are not the way to health, nor are six-pack abs and marathon running,” says Dr. Khursheed Jeejeebhoy, professor of medicine at the University of Toronto, in an article in the Medical Post. What we need is moderately intense physical exercise.

How do you define moderately intense physical exercise?

“Moderately intense physical exercise is that which results in mild shortness of breath and involves oxygen uptake that is approximately 50 per cent of the maximal level; an example of such exercise is brisk walking,” says an editorial in the New England Journal of Medicine.

Aerobic exercise involves continuous activity. It exercises your heart. It increases endurance and helps body use oxygen more effectively. It makes the lungs, heart and muscles strong. It is good for cardiovascular fitness. Examples of aerobic exercises are – swimming, brisk walking, running, bicycling, climbing stairs, cross country skiing, using stationary bike, elliptical machines, dance-based classes and similar exercises that significantly increase your heart rate.

Aerobic exercises train your lungs and cardiovascular system to process oxygen more efficiently. There is efficient delivery of blood and oxygen to distant parts of the body. Aerobic exercises burn calories and melt fat, reduce blood pressure, increase body metabolism and increase lung capacity.

Aerobic exercises reduce the risk of heart attack, diabetes, improve our immune system and provide relaxation and reduction of stress level. Aerobic exercises should be done three to five times a week for 20 to 60 minutes.

Resistance training involves exercises to increasing muscle strength. This is done by weight lifting or any physical or sporting activity that makes you flex muscles repetitively.

Resistance exercises help burn more calories even while at rest. These exercises make our bones strong, reduces incidence of osteoporosis and injury, joints are supported and protected by strong muscles, reduces arthritic pain, improves muscle mass and delays muscles wasting, reduces body fat, increases metabolism and improves glucose tolerance and insulin sensitivity, thus reducing the risk of diabetes.

Start with a weight that allows you to do eight repetitions. Once you can completer 12 reps increase the weight by five per cent and try to do eight reps and then 12 reps. You should do weight training at least once a week for strength maintenance. You can do it two to three times a week to increase strength and power. There are countless alternate approaches, depending on your focus – is it strength, endurance and/or power. You should consult a trainer to figure out how much and how often you should do resistance exercise.

A study involving Harvard runners showed that men who trained with weights for 30 minutes or more per week cut their risk of heart disease by 23 percent. In a study of nursing home residents, researchers found 45 minutes of resistance exercise three times a week over a 10-week period resulted in 35 to 40 per cent of previously chair-bound people gaining the strength to be able to climb stairs.

Stretching and warm-up are important part of an exercise and fitness program. You should warm-up before you exercise. There is no particular method to warm-ups. Every individual has his or her plan. Professional athletes spend a lot of time on stretching and warm-ups. There is a theory that muscles contract better after they have already been contracting. The idea is to get the muscles warmed and get them ready of action. Does it improve performance? There is a dearth of good research on whether it actually does.

There are low-intensity and high intensity warm-ups. One review paper concluded that warm-up was shown to improve performance in 79 per cent of the criterions examined. But most of the studies were poorly conducted. An exception is a study found that a seven-and-a-half-minute warm-up involving cardiovascular exercise, stretching and air swings – swinging a golf club without hitting a ball – can significantly improve a golfer’s performance. There you go. Some good news for struggling golfers.

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What are the fundamentals of regular exercise?

Exercise regularly or perish like a vegetable.

-Author Unknown

We need to exercise regularly to maintain tone in our muscles. If you do not use certain muscles on a regular basis then the muscles start to waste, become thin and weak. An immobilized muscle starts to lose tone within 24 hours. And it gets progressively worse. Our body was designed to keep moving. That is why we have muscles and joints. Lack of physical activity makes our muscles weak and joints stiff.

There are there are three types of muscles in the human body: cardiac, smooth and skeletal muscles.

Cardiac (heart) muscle is a very strong muscle because it has to pump blood forcefully to all parts of the body. The heart muscle needs regular exercise to keep it strong and make it stronger. In a physically fit person the resting heart rate goes down because a healthy strong heart has to work less to pump the blood to rest of the body.

Heart muscle is the hardest working muscle in the body. It pumps out 2 ounces (71 grams) of blood at every heartbeat. Every day, the heart pumps at least 2,500 gallons (9,450 liters) of blood. The heart has the ability to beat over 3 billion times in a person’s life. That is one more reason to keep the heart healthy and strong.

Smooth muscles make up the walls of the intestine, the uterus, blood vessels, and internal muscles of the eye. These muscles are under the control of autonomic nervous system and their strength is not dependent on exercise.

Skeletal muscles, in most parts, are attached to the bones. There are about 650 to 850 muscles in our skeletal system – these are the muscles responsible for most of our daily activities. Contraction and relaxation of the skeletal muscles helps limbs, joints and other body parts to move. Like the heart muscle, skeletal muscles require regular exercise to make them strong and keep them strong.

Each muscle or group of muscles performs specific activity. The size and strength of the muscles depend on the kind of activity they do. Strongest muscles in our body are masseter (muscles of mastication), gluteus maximus (muscles of the buttocks) and quadriceps femoris (muscles of the thigh).

Masseter, with all muscles of the jaw working together, can close the teeth with a force as great as 55 pounds (25 kilograms) on the incisors or 200 pounds (90.7 kilograms) on the molars.

The gluteus maximus is the largest muscle in the human body. It is large and powerful because it has the job of keeping the trunk of the body in an erect posture. It is the chief antigravity muscle that aids in walking up stairs.

To be healthy and physically strong, we need to keep our heart muscle strong and strengthen our two large and strong skeletal muscle groups (quadriceps and gluteal muscles) by doing aerobic exercises, squats, leg presses, stairs climbing and lunges. More about this in the future columns.

Doing regular exercise is a lifelong commitment. Exercise must become one of those things that you do without question, like bathing and brushing your teeth. It should not be taken lightly. Unless you are convinced of the benefits of fitness and the risks of unfitness, you will not succeed. Be patient and do it at your own pace, but keep doing it. (The President’s Council on Physical Fitness and Sports: http://www.fitness.gov/home_about.htm)

As they say, more is better and less is better than nothing.

In the next few columns we will discuss different kinds of exercises and their health benefits. So stay tuned.

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Survival of the fittest – are you fit and healthy?

We are what we repeatedly do.

-Aristotle, Greek philosopher (384 BC – 322 BC)

On July 1, we proudly celebrated Canada’s 143rd birthday. My brief research tells me that the first settlers came to Canada over 400 years ago. I also discovered that First Nations have inhabited this beautiful land for over 2000 years. In all this nostalgia, on July 1, my wife and I quietly celebrated our 25th anniversary of our settlement in Medicine Hat. This is the longest I have lived in one city. This says a lot about the wonderful people of Medicine Hat and surrounding areas.

In the last 25 years, much water has flown through the South Saskatchewan River. We are now 25 years older and our family has grown from two to four. My children say I am getting shorter as I get older. I guess this may be true or it may be relative as these days most children are taller than their parents. But one thing for certain is that as I get older I find my abdominal girth gets bigger. My struggle to stay fit and healthy is an ongoing battle. It becomes harder as I get older. And this may be true for most people who care about their health.

There are many things I do to stay fit and healthy. Two basic foundations are healthy diet and regular exercise. For the next few columns, I hope to do a lot of research on various aspects of exercise and share that information with you. I think that is going to be an interesting exercise in itself – pun intended! I will see if I can get my abdominal girth to where I want. That is a good challenge.

As we get older, we are going to face two major health hazards – cardiovascular diseases and physical weakness. Our looks will change. We will be overweight, walking around with some difficulty carrying extra 20 to 100 pounds on us. That will be no good for our morale, nor for our backs, hips, knees, ankles and feet.

For the most part, our survival depends on how fit we are. I have an editorial piece from New England Journal of Medicine (NEJM 2002) titled, Survival of the Fittest – More Evidence, which recounts Charles Darwin’s 1859 published theory of evolution as an incessant struggle among individuals with different degrees of fitness within a species. Now, after almost 160 years later, research supporting the concept of survival of the fittest are strong and compelling, says NEJM editorial.

There is plenty of evidence, unequivocal and robust, showing relation of fitness, physical activity and exercise to reduced mortality overall and from cardiovascular causes and reduced cardiovascular risk, says the NEJM editorial.

It is obvious that healthier people, that are people who have no physical or mental illness, are physically fit and live longer. What is exciting is that there is evidence to show a person with or without cardiovascular disease who is less fit or less active, can improve his/her survival if the person increase the level of fitness or physical activity. A program of regular exercise can improve fitness by 15 to 30 per cent within three to six months. Isn’t that exciting?

This begs us to ask the next question: what is the dose (total energy expended per week) and at what intensity (the energy requirements per unit of time for a given activity) I should exercise to achieve a specific health benefit? We will look into that and many more questions in the future columns. For now, generally speaking, it is recommended that all people adopt a physically active lifestyle and, specifically, that all adults engage in moderately intense physical activity for at least 30 minutes on most – and preferably all – days of the week, says the NEJM editorial.

Stay tuned for more exciting information on this subject next week.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!