There is undeniable evidence showing that those who get regular exercise have better health and tend to live longer than those who don’t. More physically fit individuals have a better quality of life, particularly in the older years when many become frail and struggle with basic daily activities. No one can exercise for a patient — it is an investment in health which each of us has to do for ourselves. Those who devote the time and energy reap the benefits. If optimising health is your goal, some form of exercise simply must be part of your life. Remember that even a little exercise once in a while is much better than throwing in the towel and doing none at all.
For those who need assistance getting into an exercise routine an individualised plan, designed jointly by physician and patient, is usually best — figuring out what is feasible and sustainable is key. Re-evaluate regularly and make changes as required. There are four general categories patients can choose from, though doing some of each may be optimal.
1. Physical Activity
This refers to simply staying active. Many people reference their total daily “step count” as tracked by a smart-watch, phone or other such device. Trying to avoid long sedentary periods during the day is one helpful tactic. Try to get up from your chair or couch once every hour and walk around for a few minutes. Use stairs instead of elevators. Don’t stress too much to find the perfect close parking space — embrace the longer walk in the parking lot. On an afternoon find a safe place to take a stroll with family or friends — socialising while getting some steps in is much healthier than doing it on a smart-phone!
In terms of goals, some health experts suggest that 10,000 steps a day is ideal, but there is evidence that most of the health benefits can be gained from just 5,000 daily steps and that as little as 3,000 steps confers measurable benefits.
2. Zone 2 Exercise
This is typically what most people think of when they talk about doing “cardio”. The goal here is to get the heart rate up and keep it there for longer periods, so the intensity of exercise needs to be higher than a slow stroll but not so high that it can’t be maintained for 30 minutes or more. This is typically done with brisk walking (especially on hills), slow jogging or cycling. Even just one 30 minute session a week will show measurable benefits but those striving for more optimal health should aim to do three 45 minute sessions a week — this sounds like a lot but I advise each patient to accept that one hour a day is going to be devoted in some way to personal long-term health. Surely investing this time is a sacrifice worth making?
3. VO2 max training
VO2 max refers to cardio-respiratory fitness, essentially how much oxygen a person can consume at near maximal exercise, higher being better. This training is not quite as intense as high-intensity interval training (HIIT) but it may still not be for the faint of heart or those with heart failure or other severe heart conditions. It may also not be ideal for those with prior injuries or more prone to injury, such as older more frail folks. It refers to brief vigorous exercise followed by a rest and then a repeat. Each bout typically lasts 4 or more minutes with equal time for rest and is repeated 4 or 5 times. The idea is to get your heart rate up fairly close to maximum, keep it there for a few minutes, then ease off and catch your breath before repeating. These workouts are probably only needed once or twice a week and are optimal for increasing cardio-respiratory fitness.
VO2 max correlates strongly with health-span, longevity and cardiovascular health, so everyone should strive to get their VO2max as high as possible.
4. Resistance Training
Most people do not think of weight lifting as a heart healthy exercise. Doing resistance training simply means exercising the muscles against resistance using either free weights, resistance bands or exercise machines (such as those found in most gyms). Maintaining muscle strength and size helps stabilise joints to prevent injury, mitigates falls and injury from falls (particularly useful in older individuals and in those prone to falling) and has important implications for metabolic health. Muscle is a metabolically active organ which helps prevent spikes in blood sugar and can mitigate formation of harmful visceral fat. After the age of 40 most humans begin to slowly (often imperceptibly) lose muscle. Over decades this adds up and by age 70 can contribute to serious health issues. To slow this process resistance training (preferably 30 minutes to one hour at least twice a week) combined with adequate healthy daily protein intake is crucial. The recommended daily protein intake for those over 60 is now thought to be higher than previously advised — a target of 0.75g to 1g per pound of body weight divided between at least 3 meals may be ideal for those exercising regularly and wishing to mitigate the sarcopenia of ageing.
We are not talking about intense power-lifting or trying to look like a body builder! Using moderate loads in a medium repetition range will help prevent injury while stimulating the muscle to stay strong. Muscle strength correlates positively with health span and lifespan almost as strongly as VO2 max does.