Consistency is key to becoming the best healthy versions of ourselves
It’s 5 a.m. on a Wednesday morning and I am looking forward to leg day. First some espresso and yerba mate and some quiet time with the Lord. That always comes first, and it is the most important thing I do to start my day. I then make a high protein smoothie packed with fresh fruit and vegetables for a post-workout breakfast. I try to strength train each muscle group two times per week and sprinkle in some core exercises in between sets. Cardio is also a must on the off-days. By the timeI am dressed and off to the surgery center, my head is clear and my body feels strong.
The Basics
I know that when a lot of people hear the word exercise, they are immediately turned off by the thought of going to a sweaty gym or they think of some meathead pushing some ridiculous weight. However, there is much more to it, and the health benefits are far-reaching, improving both healthspan and lifespan. There are many ways to accomplish resistance training that is both fun and social. Also, when most people think about exercise it is in the context of weight loss. While this is a laudable goal (as close to 70% of Americans are either overweight or obese), there are many other tangible benefits. These include reduction in blood pressure and resting heart rate, improvement in cardiovascular function, better blood glucose control, improved sleep, improved mood, and reduction in depressive symptoms.
To see how exercise can manifest itself in the real world, I contacted, Dr. Jeff Stevens, a family medicine physician with Summit Medical Group in Maryville.
Like me, Jeff is personally invested in exercise and has made it a standard in his life to get in some form of exercise daily. We therefore had a lot to talk about, but truthfully, I was more interested in how he integrates it into his clinical practice. “It is integral to everything that I do. It is important for every age group, from young to old,” Jeff says. “Exercise is a critical component of a multi-modal approach to treating childhood obesity and anxiety and prevention of sarcopenia (loss of muscle mass) and dementia as we get older.”
To help understand the role of exercise and, more specifically, resistance training, it is important to understand a little bit about muscle physiology. I will try not to bore you with didactic science, but rather provide reasons instead of rules.
Resistance Training
Skeletal muscle is an endocrine organ which means that it secretes peptide hormones that have local and distant effects on other organs such as the brain. It is really the only endocrine organ over which we have voluntary control. Skeletal muscle will adapt to imposed demand meaning that the muscle cells will grow larger and stronger and will make more mitochondria when it is stimulated to do so through resistance training.
Skeletal muscle is composed of two basic cell types. Type I—or slow twitch muscle fibers—are smaller fibers filled with mitochondria and are concentrated in our postural muscles such as the paraspinal muscles in our backs. They are more consistently activated to keep us upright which is why they have more mitochondria to create the energy needed. Type II muscle fibers are the fast twitch larger fibers, found in greater concentration in the larger muscles of the arms and legs.
Let’s look at an example of how the muscle fibers work together with a simple biceps contraction. An electrical impulse travels from the brain through the spinal cord to a motor nerve that innervates the biceps. This one motor nerve will stimulate multiple muscle fibers to contract. The first are the slow twitch fibers and then with increasing load, the fast twitch fibers are recruited. This sequence is important to understand because as we age, we loose about 40% of our muscle mass from 25 to 80 years of age. The fast twitch Type II fibers are the first to go away. This can be mitigated by resistance training by placing loads that are enough to recruit those fibers. Resistance training is also one of the best ways to prevent osteoporosis as our bones respond to load by increasing mass.
Health Benefits
Increasing muscle mass and quality has many other positive health effects other than a better physique (however, that is nice as well). Muscle has a significant impact on your blood glucose control. Muscle has GLUT 4 receptors that are insulin independent and are activated by exercise. Almost all other cells require insulin to shuttle glucose across the cell membrane to be used or stored. Muscle, however, can reduce your blood glucose level without insulin. This decreases you insulin levels and insulin resistance which is a main cause of diabetes and metabolic syndrome.
Resistance training can also improve your cognition. As we activate our muscles, they secrete compounds called myokines which in turn stimulate brain derived neurotrophic factor which promote neuroplasticity. Neuroplasticity is the brain’s ability to learn and adapt to novel stimuli and create new connections. Research has shown that one of the most powerful ways to mitigate dementia is routine exercise.
Although exercise transiently elevates your heart rate and blood pressure, both are lowered through routine exercise. Nitric oxide is a molecule that dilates blood vessels which is increased via routine exercise. Your body also increases the number of capillaries to the muscles that are being worked.
Depression is more common than most of us realize. I see many of my patients on antidepressants and anxiolytics. As it turns out, multiple studies have evaluated the effects of exercise and have concluded that exercise (resistance training or aerobic training) are as effective as some antidepressants and that the effects are long-lasting. Multi-modal approaches which include exercise and medication have yielded great results in many patients.
Testosterone booster commercials are on all the time. One of the best ways to improve your testosterone and growth hormone levels is resistance training. Normal physiologic levels of testosterone and growth hormone improves your sleep and brain fog. With better sleep you will find an increase in energy and performance. It is important to check your testosterone and other hormone levels as low testosterone will make you feel like not going to the gym and will definitely affect mood, recovery, and performance.
Finally, increasing your muscle mass can increase your basal metabolic rate. Resistance training is mainly anaerobic meaning that you are burning glucose and glycogen stores in your muscles outside of the mitochondria. This muscle glycogen and intracellular glucose will need to be replenished and much of this is done by mobilizing fat stores and converting it to glucose. Additionally at-rest muscle burns fatty acids as a preferred fuel source. Therefore, resistance training will allow you to lose fat.
In Practice
So, with all these benefits, why do we have an obesity problem with 94% of the population having at least 3 of the metrics that define metabolic syndrome? Jeff says that it is compliance and patients buying into the process. He encourages patients to do three things: eat fruit and vegetables, consume lean meat, and exercise 30 minutes daily. Those patients that have persevered have reaped the benefits of weight reduction and even coming off of medication for blood pressure and diabetes.
Time is the biggest hurdle. We are all crunched for time. The reality with exercise is that you gain more energy and better performance throughout the day that will increase efficiency. More importantly the exercise will improve your healthspan and lifespan. It is more of an investment in yourself and your health.
There are so many ways to accomplish this resistance goal. The key is picking something that you like. Consistency beats intensity every time. If you abhor lifting weights in a gym, then don’t do it. You can use bands or weights at home or yoga with body weight resistance. Many people like joining groups either for accountability or simply for socialization. There are many groups that meet in local parks and other organizations like CrossFit and Orange Theory. The social part of working out with a group is very beneficial and increases serotonin and mood.
We have become a sedentary society with everything at our finger tips. My grandfather lived on a farm and was super fit. He had old man strength and was farmer strong. He didn’t have to go to a gym because life was a gym. Many of us now work indoors and in a chair. We have to carve out time to exercise. Our elevated standard of living requires that we make exercise a standard in our lives.
We have agency over our health through nutrition, exercising, sleeping well and nurturing our emotional connections. I would encourage you to find a friend or group and get started with something fun. Set reasonable and attainable goals and check your labs with your primary care doctor a couple times per year. The biggest thing is setting your mind to start the journey to better health.