Chill out! Why less stress is essential for good health.

Chronic stress can have serious emotional, psychological, and physiological effects that contribute to or exacerbate many health problems. In fact, the negative health effects of chronic stress are like those of eating a poor diet or not getting enough physical activity. That said, managing stress, including getting enough sleep, is often overlooked as a key component of good health.

The effects of stress and the importance of stress management is the topic of my Health & Fitness column in the Aiken Standard this week.

stress


The word “stress” is typically used to indicate both the feeling of being “under a lot of stress” as well as the things that cause that feeling. The events and situations that cause stress are properly called stressors, which lead to a stress response that includes consequences we feel as well as physiological changes we may not notice.

The immediate effect of a stressor is called the “fight or flight” response since it prepares the body to deal with a dangerous situation. A classic example of this is a caveman who encounters a saber-toothed tiger, clearly a stress-inducing event.

The sympathetic nervous system is immediately activated, which raises heart rate and blood pressure to pump more blood to the muscles. Additionally, stored fat and carbohydrate fuels are broken down as fuel for the muscles. The adrenal glands release catecholamines (adrenaline) and cortisol (the stress hormone) to prolong and enhance this effect. This coordinated response makes sure the caveman’s body is ready for action. After the danger passes, everything returns to normal.

This physiological response is appropriate for major events like saber-toothed tiger encounters, but not for less perilous stressors like being stuck in traffic, pressure at work or home, and other personal and family issues. But the body responds with the same increase in blood pressure and hormones to them all. Unlike a rare saber-toothed tiger encounter, these stressors tend to occur on a daily basis, leading to continuous stress response.

The increase in hormones can lead to high blood pressure, obesity, type 2 diabetes, and other chronic diseases. This is partly due to elevated levels of cortisol, a hormone that plays a role in storing fat and increasing appetite. While elevated cortisol during exercise (including running away from a saber-toothed tiger) is normal, chronic overproduction can have negative effects.

While it is impossible to avoid all stress in life, minimizing stressors and managing the way you respond to stress can have important benefits. To the extent that it is possible, avoiding stressful situations through better time management, setting realistic expectations for ourselves and with others, and learning to say “no” are common recommendations.

Learning how to deal with stressors to avoid the negative effects of stress is also important. Techniques that can be implemented in the heat of a stressful moment include taking a break from the situation, listening to calming music, and progressive relaxation. Even taking a deep breath can help.

Exercise has long been recognized as beneficial for reducing stress and the long-term effects of stress on your health. This includes doing something active during a stressful situation and exercising regularly to improve the way your body responds to stress. While all forms of exercise seem to work, much research and practice has focused on specific types of exercise including yoga and Tai Chi.

Other effective strategies traditionally include meditation and relaxation exercises. More and more research shows that getting enough sleep is also critical for reducing stress and the impact it has on your health. Eating a healthy diet can reduce the effects of stress as well.

The bottom line is that a healthy lifestyle includes stress management as well as a good diet and regular activity. Since all three are essential for good health, it would be wise to eat smart, move more, and chill out!


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Get fit (and stay cool) in the pool

It’s hot! Whether you are swimming laps or splashing in a lake, swimming is a great way to stay cool. Swimming is also an excellent exercise to get in shape, build muscle, and to help you lose (and maintain) weight. Lap swimming is about as aerobically demanding and burns as many calories as land-based exercise such as walking or jogging. The benefits of swimming is the topic of my Health & Fitness column in the Aiken Standard this week.

Swimmer


There is nothing that feels better on a hot summer day than going for a swim. But beyond being a fun way to cool down, swimming is a great way to get in shape. Swimming is also an excellent exercise for injury rehabilitation or for people with conditions like arthritis.

The fitness benefits of swimming are well established. Since swimming is a whole-body exercise it uses all of your major muscle groups, building strength, endurance, and aerobic fitness. Highly trained swimmers have VO2max values, considered the best measure of aerobic fitness, that are similar to runners and cyclists. If you have doubts about the fitness benefits of swimming, think about how muscular and lean Olympic swimmers are.

Depending on the stroke and speed, swimming ranges between 5 to 10 METs. (METs are units used to measure the intensity of activity; one MET is equivalent to sitting at rest) For example, doing the backstroke at a moderate speed is about 5 METs while swimming laps freestyle with vigorous effort is about 10 METs.

This range is similar to walking at 4 mph up to jogging at a 9 minute per mile pace. What if you are just spending time in the pool or lake rather than swimming laps? Swimming leisurely is 6 METs, still a decent workout.

Swimming is a great way to burn calories, too. Even at a moderate pace, swimming laps for 30 minutes can burn over 200 calories. The exact energy expenditure depends on the stroke (butterfly is highest, backstroke is lowest) and the speed, but for most people swimming will burn as many calories as spending the same amount of time exercising on land.

There are two major reasons for this. First, water is more dense than air, so you need to expend more energy to move your body through the water. Second, swimming is a whole-body exercise which requires more muscle activity compared to walking or jogging which mostly involve the legs.

You may be surprised to learn that novice swimmers expend more energy per lap than elite swimmers. For example, one study showed that competitive swimmers expend only 280 calories to swim a mile, while less experienced swimmers burn about 440 calories to cover the same distance. The reason for this is that experienced swimmers are more efficient, so they expend less energy.

Aquatic exercise is popular for both therapeutic and fitness purposes, especially for people who don’t tolerate exercise on land well. When you are submerged up to your waist, 50% of your weight is supported; when you are up to your chest, about 75% is supported. This reduces the impact of exercise in the water, perfect for people who have arthritis, osteoporosis, fibromyalgia, severe obesity, or who are recovering from injuries.

Exercise in the water doesn’t have to mean swimming laps. Water aerobics, aqua walking or jogging, and resistance training using foam “weights” or webbed gloves offer safe ways to increase strength and endurance for almost everyone. Most fitness facilities that have a pool offer group aquatic exercise classes and you can find instructions online for exercises that you can do in your own pool. If you are interested in using the pool for exercise, you can find information about aquatic exercise in general here and links to suggested exercises here.

The hot summer weather makes swimming and other water exercise appealing. But even if you don’t use the time for exercise, spending time playing in the pool or lake can still burn as many calories as going for a walk and is a great way to have fun and cool down!


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Get fit in just minutes per day!

We are cautioned to be skeptical of claims that you can lose weight while eating everything you want or that you can get in shape without spending hours at the gym. For good reason, too. These claims are essentially the equivalent of a get rich quick scheme, with the same expected results.

But there are some popular exercise programs that aim to increase your endurance, build muscle, and improve your health in less than 10 minutes per day. One is a popular seven minute workout that was published in a fitness journal and received much media attention. There is even an app for your phone that will guide you through the workout. If seven minutes seems like too much, there is even a four minute version! But is less than 10 minutes of exercise per day enough? This is the topic of my Health & Fitness column in the Aiken Standard this week.

Stopwatch


Current guidelines call for all adults to participate in moderate intensity physical activity for 2 hours and 30 minutes per week or vigorous activity for 1 hour and 15 minutes per week. You can meet this recommendation by going for a brisk walk for 30 minutes on 5 days each week, running for 25 minutes on 3 days per week, or some combination of the two. In addition, you should do strengthening and flexibility exercise at least two days of the week.

For many people, these recommendations seem daunting. In order to make it easier to meet these goals, the exercise time can be divided into shorter sessions. For example, three 10 minute walks are a substitute for walking 30 minutes at once. But some people may still find doing enough exercise to get in shape a challenge, which is why the seven minute exercise program became so popular. And for many, an effective way to improve their fitness.

The effect of exercise on health and fitness is determined by the dose—the combination of intensity and duration. Improvements in aerobic fitness and strength are more related to the intensity of the exercise. As little as a few minutes per day of high-intensity training can be enough to improve fitness, which is why these programs include a combination of vigorous aerobic and strength exercises. In fact, bouts as short as one minute of very intense exercise can improve strength and aerobic fitness better than lower intensity exercise done for a longer time.

Because these programs tend to be intense means that you have to be fit to even get started. A very short program may not be a good choice for people who are not already in shape or who are new to exercise. There may be a greater risk of injury in people who are unfit and start exercising at a high intensity. At the very least, muscle soreness is likely and may impact your ability—and motivation—to repeat that exercise the next day. It is smart to start slowly and gradually increase exercise duration and intensity as your fitness improves.

If you are interested in starting a 10 minute per day routine you may want to start with an app or video that leads you through daily workouts. These may involve using your own body weight for resistance or may require using minimal equipment like dumbbells or resistance bands. If you are more of an expert, you could create your own routine using exercises you are familiar with. You should also warm up before and cool down after each session, something that may not be included in the 10 minute program.

While a 10 minute exercise program can improve your fitness, it shouldn’t be the only physical activity you get. Optimal health and fitness benefits are realized by combining daily physical activity with regular exercise. The best advice is to be as active as possible every day by limiting the time you spend sitting and looking for opportunities to move. Walking instead of driving, using the stairs, and taking the dog for a walk are good ways to increase your activity. You should also dedicate time for exercise to improve your strength and aerobic fitness at least 2–3 days per week. A very short exercise routine may make it easier for you to meet this goal.


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FITT-SPF: How to exercise safely in the sun this summer.

People who exercise are probably familiar with FITT—frequency, intensity, time, and type—the basic principle behind almost all fitness programs. The FITT principle applies to everything from running to weightlifting to yoga. For people who exercise outdoors there are three more letters that are important to know, especially in the summer: SPF. This is the topic of my Health & Fitness column in the Aiken Standard this week.

woman running on beach


First, a bit more about FITT. Exercise prescriptions are based on four key concepts that allow training to be tailored to meet individual goals. Frequency refers to how often you are training, usually expressed as days per week. Intensity is how hard you are working, which could be running or walking speed or the amount of weight you are lifting. Time is simply how long you are exercising per session. Type is the specific type of training you are doing, which we typically think of as endurance (like walking), resistance (lifting weights), or flexibility (stretching).

Keep in mind that there is interaction between these components. Less intense exercise like walking is typically done for longer than more intense exercise such as interval training can be done in shorter sessions. Some people focus on one type of training at a time, as in weight lifting to increase strength or yoga to enhance flexibility, while others do exercise that includes some endurance, resistance, and flexibility training in the same session. Many group exercise classes and programs like CrossFit are examples of combining multiple aspects of fitness in one session. Since everyone has a different starting fitness level and goals, FITT can be manipulated to meet a variety of needs.

Many types of exercise, especially endurance or aerobic training, can easily be done outdoors. Walking, running, cycling, and water sports like stand-up paddle boarding and kayaking, are popular outdoor activities, especially in the summer. Being active outdoors in nature improves health and wellbeing beyond the fitness benefits of the exercise itself, so “going green” with your workouts is a great idea! Some sun exposure is necessary for your body to produce vitamin D, an essential nutrient. But excessive sun exposure can increase the risk of skin cancer, the most commonly diagnosed form of cancer.

Excessive sun exposure is a real risk of exercising outdoors, especially for prolonged periods of time. Cycling, running, water sports, and skiing have been identified as sports that increase the risk of some types of skin cancer. Unfortunately, sunscreen use among outdoor athletes is low. According to survey results, at least half of college athletes never apply sunscreen before games and practices and those who report using sunscreen don’t use it regularly.

Marathoners, who can accumulate 1,000 or more hours of sun exposure during training per year, are more likely to be diagnosed with skin cancer than non-runners, but only about half use sunscreen, according to one study. Regular sunscreen use is even lower in the general population—about 30% of women and 15% of men—so even if you aren’t an athlete it is likely you are still at risk.

The good news is that there is much you can do to reduce your risk of skin cancer while you are active outdoors. First and foremost, properly applying (and reapplying every two hours) a broad-spectrum sunscreen with an SPF of 30 or higher is the best way to protect exposed skin. Some sunscreens are more water and sweat resistant, but still need to be reapplied regularly.

Second, covering exposed skin with light-colored clothing, a hat, and sunglasses is smart. Some clothing is more resistant to UV rays than others, so look for a higher ultraviolet protection factor (UPF). Obviously, you need to find a balance between protecting your skin and allowing sweat and heat loss to keep you cool.

Third, try to exercise outdoors in the early in the morning or later in the day when the sun’s rays are less direct. Keep in mind that you should still use sunscreen on cloudy days as UV rays can penetrate clouds. This also tends to be when temperatures are lower, too, so exercise may be more comfortable.

The bottom line is that summer is a great time to be active outdoors. By taking a few precautions you can do it safely, especially when it comes to reducing your risk of skin cancer from excessive sun exposure. You can learn more about skin cancer risk and prevention from the American Cancer Society and the American Academy of Dermatology.


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Sports physiology in the Tour de France

 

This week marks the start of the 2017 Tour de France. This year the race covers 2200 miles in 21 days of racing, comprised of team and individual time trials as well as stages through cities, countryside, and mountains of France. The Tour de France is interesting to me because it provides an excellent opportunity for a short lesson in sports physiology. Which I did in my Health & Fitness column in the Aiken Standard this week.

Tour de France


All the riders in the Tour are exceptionally fit since their bodies have adapted to years of dedicated, intense training. Endurance sports like cycling are dependent on the delivery of oxygenated blood to the muscle to produce ATP, the energy needed to sustain exercise. The riders have large, strong hearts, resulting in the ejection of more blood to the muscle. Within the muscle there is an increase in the number of capillaries, the small blood vessels that deliver blood to the muscle, and mitochondria, the part of the cell that produces most of the ATP. Together, these adaptations allow the muscle to produce more ATP without fatigue, allowing the athlete to exercise at a higher intensity for a longer time.

But training isn’t the only reason these athletes can sustain such intense exercise for so long. Proper nutrition, especially what the athletes eat and drink before, during, and after each stage, also plays an important role. Intense endurance exercise like cycling relies on carbohydrates, in particular, muscle glycogen, as a fuel. Muscle glycogen is a storage form of glucose, sugar that the muscle converts into energy. During prolonged exercise that lasts several hours, muscle glycogen levels can be severely depleted.

Eating carbohydrates before exercise can boost muscle glycogen levels, so cyclists eat carbohydrate-rich foods for breakfast before each stage. They also consume carbohydrates in the form of sports drinks (think Gatorade) and energy bars prior to starting. In fact, they start replenishing their muscle glycogen immediately after finishing the previous day’s ride. This usually begins with a recovery beverage, which may contain some protein for more rapid muscle glycogen synthesis, and extends through carbohydrate-rich meals and snacks that afternoon and evening.

During exercise it is crucial to maintain adequate blood glucose levels, which tend to drop since the muscle is using so much as a fuel. Failure to replenish blood glucose results in what cyclists call “hitting the wall” or “bonking,” which is like your car running out of gas. To prevent this, glucose must be replenished, typically with sports drinks, energy bars, or a sugary mixture called goo.

Prolonged, intense exercise, especially in the heat, results in a high sweat rate which can lead to dehydration. Sweat loss of several liters per hour is not uncommon during cycling, so fluid intake is essential. This means that cyclists spend a lot of time drinking water while they ride. Sports drinks are also commonly used since they contain carbohydrates and electrolytes in addition to water.

Endurance events like cycling, especially multi-stage events like the Tour de France, highlight important concepts of sports physiology. Even though you may never compete at that level, understanding how training can improve your endurance is relevant if you cycle—or run, walk, or swim—for exercise. Knowing how proper nutrition before, during, and after exercise can improve performance can help you make better decision about what to eat. Hopefully, it also gives you a greater appreciation for the science that goes into a performance like the Tour de France.


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From Worse to Bad: Moving in the right direction even if your health habits aren’t perfect

Recently, someone told me that her sister was quitting smoking by switching to e-cigarettes. “Isn’t that bad?” she asked. I told her that, sure, smoking e-cigarettes was bad but that smoking tobacco cigarettes was worse, so she was making a positive (and hopefully temporary) change. The benefits of making changes to health habits, even if they aren’t perfect, is the topic of my Health & Fitness column in the Aiken Standard this week.

cigarette vs e-cig

It is no secret that smoking has serious negative health effects. Cigarette smoking more than doubles the risk of heart disease and stroke, is by far the leading cause of lung cancer and other lung diseases, and is responsible for nearly 500,000 deaths per year. If you smoke, quitting now is probably the most important step you can take to improve your health.

But quitting smoking is difficult. Obviously, there is the addictive nature of nicotine that makes smoking cessation challenging. Beyond the drug effect, smoking also has a behavioral component. This includes what a smoker does first thing in the morning, after a meal, or on a work break as well as the act of holding a cigarette in his or her hand. Add to that the social aspects of smoking, including the influence of friends and family members, and it is easy to understand why it is a difficult habit to break.

Nicotine replacement therapy in the form of gum, lozenges, and patches as well as prescription medications can help with withdrawal symptoms. Nowadays, many smokers are turning to electronic cigarettes (e-cigarettes) to help them quit. The research on the effectiveness of using e-cigarettes to quit smoking is mixed, with some studies showing a benefit, some showing no real effect, and others suggesting that e-cigarettes actually lower the quit rate.

Parts of an e-cigarette

Even though most smoking restrictions also apply to e-cigarettes, this form of smoking seems to be more socially acceptable than tobacco cigarettes. This is largely due to the fact that e-cigarettes are thought to be less dangerous to the smoker and to people around the smoker. While there isn’t much conclusive evidence on the health effects of e-cigarettes, a conservative interpretation is that e-cigarettes are better than smoking tobacco cigarettes but worse than not smoking at all.

So, switching from smoking cigarettes to e-cigarettes is making a move in the right direction, from worse to bad. And if using e-cigarettes helps a smoker start the quitting process it is probably a good idea. Obviously, not smoking at all is the goal, but this may not be reasonable for everyone, especially in the beginning. When it comes to improving your health, doing something is better than doing nothing, even if it isn’t perfect.

This obsession with being perfect extends beyond smoking cessation. There is a perception that if the diet or exercise program aren’t the “best,” they won’t be effective. So, many people struggle to find the perfect diet before trying to lose weight or wait to identify the best workout before starting an exercise program. This can lead people who need to become more active or change the way they eat to delay starting the process. And it is almost always a long process.

There are very few people who can change difficult habits quickly and easily. Even the people who make it look easy will tell you that developing a healthy lifestyle is a series of steps and missteps and that positive changes accumulate over time. The lesson is that getting started on improving your health now is more important than achieving the perfect outcome right away.  Just like switching from tobacco cigarettes to e-cigarettes isn’t the ultimate goal, making positive changes to your diet and exercise habits can have benefits now and give you a foundation from which to make more significant changes later.

For example, drinking water instead of sweet tea or soda when you eat lunch at a fast food restaurant is a good start. Obviously, the goal would be not to eat fast food meals, but modifying those meals will cut out some unhealthy choices. Similarly, going for a 10 minute walk after dinner instead of watching television is a step (literally!) toward a goal of less sedentary time longer exercise sessions. Neither are perfect, but you should recognize both as positive changes that move you away from behaviors that are worse.


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Obesity: It’s in your jeans. And your genes.

Have you ever noticed that some people struggle to lose weight while others seem to have no trouble maintaining a healthy body weight? Why is it that some people lack the motivation to exercise while others are can’t seem to stop moving? What about people who appear to have no interest in desserts while others have a “sweet tooth”? Why do overweight parents tend to have children who are also overweight?

The traditional answer is that some people lack willpower which makes it more difficult for them to make healthier eating and activity choices. While motivation and dedicated effort are essential for making healthy choices, genetic research has resulted in the identification of a host of genes that appear to affect physical activity and eating habits, food preferences, and responses to a diet or exercise program.

obese jeans


The link between genetics and obesity is not new. Decades ago researchers found that obesity tends to cluster in families. But is this due to shared genes or a shared environment? The answer is both, but heredity plays an important role. Studies of siblings raised apart show that their body weight and fatness more closely resembled each other than the families they lived with. Other studies show wide variation in body weight among relatives, where some are obese but others are at a healthy weight. This suggests that although genes can predispose people to being overweight, personal behavior can modify this risk.

Genetic variations also explains why people respond to exercise training differently. Much of this knowledge comes from the Heritage Family Study which examined body fatness, fitness, and other health factors in over 700 individuals from 130 families. After completing the same exercise program, some people improved their fitness significantly while others experienced only a minor improvement. The prevailing explanation was that varying degrees of compliance accounted for these differences, but the Heritage study showed that genetic factors were at responsible for 40–50% of the variation in both initial fitness and improvement in fitness.

Your genes can also influence what you eat. Eating habits, including how much you eat as well as food preferences, are at least partly under the control of certain genes. Two separate genes that regulate appetite and the type of food people eat, have been identified. This might explain why some people say they always feel hungry while others are satisfied after a small meal or why  some people crave foods that are high in sugar and fat while others do not. Of course, what you eat is a behavior that you can control—you are putting the food in your own mouth, right?—but it is interesting to know that there are genetic factors that make these decisions more challenging for some.

Does this mean that healthy behaviors including eating and exercise are out of your control? Does it give you an excuse for being unhealthy? Absolutely not! Your genes may predispose you to certain health conditions, meaning you are at higher risk, but they do not predetermine your health. The expression of these genes is modifiable by your environment and your behavior. Even though you may be at higher risk for obesity, you still need to eat too much and not be active enough to gain weight. Be aware that “too much” varies greatly among people, so there is no single eating and activity pattern that applies to everyone. But knowing that you have a family history should give you even more motivation to eat a healthy diet and get regular exercise.


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