Ep 4: Exercise

Everyone knows that exercise is important. The problem is, there are so many different types - jogging, walking weights, aerobics, cycling, golf and the list goes on. But what kind of exercise do you really need to be doing and why? 

In this episode Dr Nick is in his wheelhouse. With a masters in Sports medicine, he is credentialed as being a team doctor for the Tottenam Hotspurs and has helped professional tennis players on their journey to success at Wimbledon.  In this episode he weeds out the truth from the trends. 

Transcript

Tempo: 120.0

SPEAKER_00 0:05

Hello and welcome to the Pillars of Health. I'm Dr. Nick Krasner. And I'm Ben Eshelby. What are we going to be talking about today, Ben? Today we're talking about exercise. Exercise. Fantastic.

SPEAKER_01 0:17

So is it good for us? Well, that's what we're going to find out. There's all different types of exercise, isn't there? And you know, we get told to run around the block and we get told to pump iron and we get told, you know, to do sit-ups and cross-training and cross-fit and all these other sorts of things. What do we need to do?

SPEAKER_00 0:34

Well, all of us need to get to be fit. And actually, the older you get, the more important it is to exercise. Obviously, exercise needs to be done in an extremely safe way, and it's a bit different for different age groups, but building muscle mass is probably the most important anti-aging thing you can do.

SPEAKER_01 0:50

Absolutely. I totally agree. And so there's also other things that it does for the body. So what are the complete effects that exercise has on the body? We're talking about weights, which is and it's important in anti-aging. But what about other aspects of health and that sort of thing?

SPEAKER_00 1:07

Well, I mean, looking at some studies, it's been shown that it can reduce cardiovascular disease like heart attacks by 30 to 35%, increase energy in the cell, help with things like diabetes, or help with brain function, neuroplasticity, hormone balance, increases your immune system, helps with anti-inflammatory effects. And then there's obviously the psychological effects. There's a reduction in depression. Some people have managed to come off antidepressants because of it, reduction in anxiety, general mood increases. So there's loads of those things. And I think we're going to be talking about one of your favorite things a little bit later. What does it do to the microbiome?

SPEAKER_01 1:44

That's it. So we're always going to talk about on these little podcasts. We're going to talk about the relationship of exercise to the human body.

SPEAKER_00 1:51

Yes.

SPEAKER_01 1:52

But also the other part of which we are the microbiome. And it also affects that as well.

SPEAKER_00 1:57

Wonderful. You're probably people, our listeners are probably really into the microbiome, realizing how more and more important it is. But going back, because you were talking about the different types of exercise, didn't you? That's it. Yeah. So so how would you, what what sort of different categories would you class exercise into? Yeah, well, I mean, obviously there's light exercise, just walking and keeping keeping busy. And actually, if you're busy at your job, like you're cleaning or gardening, those those could be excellent exercises. Then you're looking at exercises that some people call cardiovascular exercises, whereby you're trying to get your heart rate out and then be sort of running and playing sports and those kind of things at a sort of higher intensity. And then people talk about fat burning, whereby you're trying to have a general level where you're not completely out of breath, you're probably a little bit out of breath, but you can burn fat in that state. Uh, that's a general rule. I don't hold to it totally in the fact that actually a lot of people who train at very high intensity lose a lot of weight. But they're the general ones. And of course, the one that I love, and the one that's so anti-aging, weight training. If you can up your muscle mass, you will stay younger. And don't think because you're 80 you can't increase your muscle mass. There was a study done about 25 years ago. They did an MRI on patients in a nursing home. They hadn't done any exercise. They did resistance work with bands and things. They double their muscle mass in six months. And a lot of them who couldn't get out of a chair could get out of a chair. So we should be exercising in our 90s, hundreds, whatever.

SPEAKER_01 3:27

That's it. And there's also that really interesting correlation between lean muscle mass and life expectancy. So as lean muscle mass decreases, life expectancy decreases also.

SPEAKER_00 3:39

Absolutely. Not only that, but also life interests. I mean, the ability to do things, aches and pains get bet. So it's really important to really work on this. It's why weight training or resistance training is so important. And everyone can resistance train, even if it's with those bands, they can be so useful. Of course, it may well be useful if you're not used to it to spend the money that you might have spent on a new car. Why don't you spend it on seeing personal trainers, excise physiologists, Pilates? It's hard to get into, isn't it? It's hard to get the routine going for a lot of people. It is, but it's amazing. Once people get into a routine, then the opposite's true. That's it. Uh people then can't handle not going to the gym or not doing that. So, like everything, it's just it's a whole change, a whole shift in personality and in person.

SPEAKER_01 4:25

Yeah. So yeah, so look, I guess some of the other ways that that people have defined exercise is uh low intensity, moderate intensity, and high intensity. Where would where would so walk around the block would be low intensity?

SPEAKER_00 4:38

Low to low to medium, depending on. I mean, obviously you can walk up a hill and you know you can walk quite fast, but generally it's going to be low to medium intensity. What would you what would you consider moderate intensity? Well, generally they would suggest moderate intensity sort of ends, moderate intensity ends where you're sweating a little bit and you're a little bit short of breath.

SPEAKER_01 4:57

So that could be sort of a faster pace or doing moderate little light, lightish sort of weights, resistance training.

SPEAKER_00 5:04

Yeah, I mean, scientists would say you sort of they talk about VO2 max, in other words, you know, what percentage of your maximum heart rate can you do? And they would say about 60% is the end of moderate, and then you start to go into, you know, obviously more severe exercise levels.

SPEAKER_01 5:19

And then, yeah, the the the high intensity, it can be heavy weights just when you're out of breath and yeah.

SPEAKER_00 5:25

Absolutely. So people think weight training is not necessarily cardiovascular. Actually, if you're doing weights well and at some people do it at certain speeds, it can be very cardiovascular as well as weight training. And we'll talk in a minute about weight training, all the good things you can do, and actually the things you need to be careful and how to do it properly.

SPEAKER_01 5:40

That's it. I think I think a lot of people are scared of weight training because there's so many injuries that can potentially happen. And you just see, you know, people often think, oh, my back, it's gonna if I lift something up off the ground, I'm gonna throw something out. I think if the technique is fine, it's so critical to get that right and start light, get a technique and then then kind of develop from there.

SPEAKER_00 6:00

Technique is absolutely key, much better to do it, much lower weight properly than a higher weight, highly. And also, of course, as you build up muscle mass, you're actually gonna decrease your risk of injuring things. But you're right, one of the most main important things is get the technique right. As I said, if you can afford to get somebody who knows what they're doing, do it. It's worth a session or two sessions or three sessions. The important things about weight training, first of all, is you need to breathe. Some you can increase your power by holding your breath and lifting a heavy weight. Believe it or not, that can increase your blood pressure to up to 400 millimetres of mercury. And I have known people that have actually had a carniochidal fall off their heart because they've done that, and obviously that can kill somebody. So it's really important as you lift a heavy weight, you blow out. So working on your breathing as well as your lifting technique is very important. It's also really important to get a full range of movement of you know of that movement. So you're not just doing a short movement because your tendons will tighten up. You want a full range of movement. The other thing that's really important is that when you're working one side, you work the other. What we would call the agonist and the antagonist. In other words, if you're doing your biceps, do your triceps. If you're doing your chest, do your back. Make sure you do both because balance is really important. I've actually had footballers who've worked really hard on their front and had very weak back muscles, and they've actually dislocated their shoulders quite regularly because everything's being pulled in the wrong direction. So balance is key.

SPEAKER_01 7:29

Now, if it's still all these sorts of things I guess go through people's head when they're when they're trying to do weights. As a young, as a young bloke, I would have just ripped out and tried to do something really heavy, and you know, you injure yourself, and two days later you're back on your feet again. But as you get older, you start to become a bit more mindful of these sorts of things, and the body doesn't quite repair like it used to. So technique is absolutely important. Now, one of the things that we've noticed when we do a lot of functional medicine around, you know, longevity medicine and that sort of thing is people do everything right and they sort of go to the point where they're having all of their hormones restored, and that's men and women. So, you know, it's quite popular these days for you know men over the age of you know 40 and 50 to be taking light doses of testosterone replacement. Women obviously on HRT. But the thing is, like, what isn't told is you know, things like HRT for men and women will increase muscle density and muscle mass. And where I often see people going wrong is they're scared of going to the gym and lifting weights. Uh and and so you know, you sort of ask them what they're doing for exercise, and they'll say, Well, look, I I do three, three or four walks a day. Now, the problem with that of just walking or running or jogging or whatever it is, it doesn't actually build muscle at all, it actually strips it away. And so, for an anti-aging type, or I guess a uh longevity type perspective, it it the cardiovascular aspects of you know walking and running are important, but if you solely focus on that, you can actually have the reverse effects. Now, for people who are scared and like of of doing weights, and it becomes an issue when you're older, who do they normally talk? Like, who is the person in the medical industry that's specialized in that? It's it's exercise physiologists, isn't it? It is.

SPEAKER_00 9:20

I mean, some GPs will talk to you. I mean, I do sports medicine, so obviously that's really important. Uh, and there are some trainers at the gym. Trainers can go from the brilliant to the awful. So the exercise physiologists obviously spend a lot more time. I think they have a three to four-year course, whereas some personal trainers have only done I think it's three months, six months. My apologies, I don't know the exact amount. So the exercise physiologists will have in mind injuries and illnesses and issues that they'll they'll take into consideration. So I think it's really important. Uh, and it's money really well spent. You know, people will spend a hundred quid on uh, you know, certain creams and things to make themselves feel better, you know, spend it on an exercise physiologist, even if they're just showing you what to do. And that's really, really important. The other thing with weight training, I mean, the weight loss is great. I call it the treble bubble. I know people call it the double bubble. But if you're weight training, obviously you lose fat because you're exercising. Then because when you weight train, your muscles actually tear a little bit and then have to repair. And people get DOMS, like, which is a delayed onset of muscle, muscle pains. And that's the muscle healing itself again, and that uses energy. And the third thing is once you've increased the muscle mass, the muscle just sits there and fasciculates like twitches, and that uses a lot of energy as well. So weight training is a great way of getting sort of the abdominal circumference down as well.

SPEAKER_01 10:43

And you're talking about um putting on muscle and and hypertrophy. What once those muscles are injured, I guess that they need to repair. And that's where diet becomes really important.

SPEAKER_00 10:53

It is very important, and that's why I mean a lot of people at the gyms are very clear. You know, your muscles are made from amino acids. So amino acids are really, really important. So a lot of people take protein powder. Obviously, you want lots of energy in the cell, so a lot of people take a little bit of creatine, which not only gives energy to the cell, but also holds a lot of water, so it gives water to the cell. Things like magnesium and the B vitamins can be really important for that as well. Uh it's important to have rest days as well. So, you know, normally weight train say three days a week, but make sure the rest is allowing your body to heal. It it is it is a balance that you need to do.

SPEAKER_01 11:28

And what about what about all these high protein diets? You know, you go carnivore because it's high protein, or do you take powders and supplements?

SPEAKER_00 11:35

And yeah, I think it's very important to look at what you're doing and how you you know how you're doing it. It can be very good. Obviously, reducing carbohydrates is a really good thing, but one has to realise you do need all your sort of essential vitamins and minerals and stuff. I know a lot of people add like essential greens and those things to their smoothies. Uh but fresh vegetables, you know, a little bit of fruit, really important. Yeah.

SPEAKER_01 11:58

So I guess that leads us to the to the final part of what we were going to talk about, and that's the microbiome.

SPEAKER_00 12:03

A study in 2018 showed that elite athletes have a lot more diversity of the microbiome, which is good, uh, increased beneficial bacteria, increased short-chain fatty acids, which you all know is very good, reduced gut inflammation, has positive effects on the gut brain access, improves metabolism. The one thing it did say is that if you stop exercising, the microbiome can go back to the way it was.

SPEAKER_01 12:26

That's exactly right. So, so we've talked in earlier podcasts about what happens when the body is stressed. Now, we are more bacterial cells than we are human cells. And the microbiome is designed to save us and protect us. Now, when the human gets stressed, and I'll rehash a little bit, when the human gets stressed, what happens is the gut microbiome changes and the diversity decreases. And what this means is we start to put on weight, we start to get inflammation, we start to get sluggish, we're not as optimistic, it's kind of a bit of a downer on the mood, and all of these sorts of things, which are kind of the opposite of exercise. Now, what happens is when you exercise, you can actually change the gut microbiome back to a healthy state. Now that increases microbial diversity. And once again, if you remember to the earlier podcasts that we've done, the beneficial bacteria in your gut make things called short-chain fatty acids, which increase metabolism, they decrease inflammation, they increase brain function, they increase heart function, they increase lung function, they increase bone density. So all these things that are kind of we're attributing to exercise are kind of helped along by the gut microbiome. Now, when when you exercise, or when you don't exercise, you can actually precipitate the same gut that you have when your body is stressed. And so when you don't exercise, the body almost goes into a state of stress. So all of a sudden, you stop exercising, you start sitting in a chair, you start putting on weight, you feel less like going out to the gym. When you do go to the gym, you're going to be really sore because you've got extra inflammation. So all your short-chain fatty acids start to decrease. On the flip side of the coin, if you over-train, then what can happen is you can actually start to get the opposite effect again. So then your body becomes stressed, you over-train, you lose your motivation, you become inflamed, you get injuries, you stop performing at an efficient level. And so there's a happy medium of exercise that everyone should do. So elite sports people are now starting to look at the role of the gut to see whether they're over-training or not, because it's it's quite a useful little tool. For an average human being, what has kind of been identified as the ideal zone is about 150 minutes a week of moderate exercise. Now, that's not 150 minutes of walking, that's 150 minutes of moderate exercise. So a couple of classes a week at least of you know going to the gym or something like that. You can do walking around that just to keep sort of general fat burning and whatnot going, as an upper limit around 300 minutes a week of moderate exercise. But any less than that 150, and you'll find that your gut microbiome starts to decrease in diversity again, and you can potentially start to go backwards. So it's a massive, I guess it's a massive influence over health once again from the aspect of exercise.

SPEAKER_00 15:28

Yeah, very important, very important to realize that I'm finding your balance. And one thing that you said, which is really true, is you know, you may start off with a vicious cycle of you put on weight, you don't want to eat, you don't want to exercise. It's a real big vicious circle of one bad thing leads to another. But I think with there's also what I like to call the circle of grace, one good thing can lead to another. So you start eating healthier, you do more exercise, you want to eat less, you want to drink more fluids, you're a bit more awake, so you can do more exercise. The other exercise that can be really useful as well is interval training. And interval training for like six minutes has been shown to be as important as 40 minutes to an hour in the gym. And in fact, if you start training over 40 minutes, you might find that you're burning off your muscle. So it's very important to sort of find that moderation that's perfect for you. Uh, and I think that is probably quite a lot we've done today. I think so. I'm ready to go and hit the gym right now. I think so. Well, I was at the gym at six this morning just showing off, but only because I've got a personal trainer and he has to go with me if I didn't turn up. So that's us from me. I've been Dr. Nick. And I'm Ben. And we will see you again soon on the Pillars of Health. See you next time. Bye.