CHAPTER 8
Exercise
Exercise
Exercise
is a bad word to many people. It brings up memories of high school gym
class, and they remember how they hated it. They remember their coach
in school who made them do extra laps around the football field because
they misbehaved. It reminds them of the times they did push-ups in class
for the presidential fitness test and were not able to do as many as they
were asked to do, so they ended up feeling like a failure. Or they may
think of those times they tried to do chin-ups and could not even do one.
Oh, the internal pain that many felt! It’s no wonder that many people
dislike the thought of exercise, and will run as fast as they can away
from anything that even hints at the word.
The exercise
that we are talking about does not have to be painful and does not have
to include push-ups or chin-ups. There are no tests and you are not compared
to anyone--you only compare yourself to you. You need to be gentle with
yourself and if you start a program and fail to keep it up, remember that
you are not worthless because you stopped doing it for a while. Many times
we beat ourselves up over silly things. If you have stopped exercising
for whatever reason, realize that it is also your choice at some time
in the future to start up again. You have the right to start and to stop;
you have the right to make that choice for yourself and that is okay.
It is true that when we make a choice, we also have to be willing to live
with the consequences of that choice. So if you do not like the consequences
of your choice, then you need to re-consider the decision you made and
see if there is another option that would give you consequences that are
more acceptable.
Before you
start any kind of exercise program, you need to give it some thought.
If a physician is looking after you, then you need to discuss it with
him so he can give you his advice as to how much exercise may be appropriate
for you. For example, if you are a heart patient, your doctor may want
to do a treadmill test first to be certain that you can walk safely. If
you don’t have a physician then you need to use common sense. Listen
to your body. If you feel faint, week, nauseated, have chest pain, then
you need to stop and see a physician before you start back on your exercise
program. For those over 40 years of age, you may want to consider having
a treadmill test done before you begin an exercise program so that you
are certain to the best of anyone’s knowledge that your heart is
in good condition.
The advantage
of a treadmill test is that you will know how high you can safely push
your heart rate. When you walk on the treadmill, they will ask you to
keep going until your heart rate rises to a certain point. If you are
interested in knowing how high you can safely raise your heart rate, then
you may want to ask your physician if you can see how far you can go.
This will allow you to determine what your maximum heart rate is under
these conditions. This is important if you are going to be doing strenuous
exercise and not just burning fat. Many people just want to burn fat,
so they do not necessarily need to know the maximum heart rate they can
achieve in a controlled setting. When I did my treadmill, I wanted to
push it as long as I could; I wanted to know how high I could safely push
my heart rate. I wanted to be as certain as I could be that if I went
out for a run that I would not drop dead on the side of the road. They
let me continue on the treadmill after I had reached the magic number
that they were after so that I could see what I could do. We will talk
more about heart rate later.
What kind
of exercise should you do? That really depends on you and what your goals
are. I would like you to spend a few seconds and think about your goals
regarding exercise, then jot them down. Is the goal weight control? It
may be that you want to tone up muscles, bulk up, or just improve your
cardiovascular fitness. We will spend a little time talking about each
of these. Whatever your goal is, the goal needs to be for you. Don’t
do this for someone else. Don’t do it because I said to do it; do
it because you feel that this is what you want to do for you. If your
spouse or friends want you to exercise, and you don’t then it is
not going to happen, or if it does it will not last long. Don’t
do it because some of your friends are now going to the gym and you have
to be in the group; do it for you.
If you look
at most weight control programs, they include exercise. Why? Well, the
answer is very simple: if you can help people keep their total caloric
intake under control and maintain that in either in a weight-stable or
a weight-losing situation, then exercise can allow patients to lose weight
faster. Let me show you what I mean. Fat has 3,500 calories per pound;
if you are going to lose weight, for every pound of fat that you take
off, you are going to have to expend 3,500 calories more then you are
taking in. Let’s assume that you are burning up as many calories
as you are eating. Then your weight will stay stable. If you eat and burn
up 2000 calories a day, then you are not spending any of the 3500 calories
that you have in the bank (one pound of fat) that you want to spend. As
long as you continue to eat and burn up 2000 calories per day, the bank
will not be drawn upon, and the 3500 will stay. The good news is that
in this bank you do not earn interest!
Now what happens
if you decide to start a walking program? When you start this program,
you have to begin with what you can do. If you can only walk to the mailbox
and back, that is fine. Tomorrow you may be able to do it twice. What
you have to do is increase it in a systematic way so that you start walking
more. If you can get up to 1 mile a day, then you will be burning off
approximately 120 calories a day more then you were before. If you are
able to keep your intake the same, then you now have the ability to withdraw
3600 calories a month by walking 1 mile a day. In effect, you will lose
1 pound a month for every mile you walk on a daily basis. It also does
not really matter if you walk the mile or run the mile: you will still
burn off approximately 120 calories per mile. If that is the case, then
why would anyone run? The answer is simple: if you are going to do a marathon
or run a race, you have to practice by running it. The only reason to
run is to train for a race, or to build up your cardiovascular (or heart)
conditioning.
If your goal
is to burn fat and lose weight, then you want to try to get your heart
rate into the fat burning rage. For most adults between 40 and 60 years
of age that means a heart rate of 95 to 108, for adults between 60 and
80 it is 84 and 95 beats per minute. How did we calculate that? What you
do is to take 220 and subtract your age, you then take that number and
multiply it by 60% and you will get a number that is in the fat burning
zone. In this zone you are suppose to burn more fat than carbohydrates.
People who are overweight need to burn calories and using fat is good.
You will find that to get into this range you will not have to walk very
fast.
So how do
you know fast your heart is beating? The best way is to use a heart rate
monitor. They cost about as much as a good pair of sneakers. You can find
them at sports stores, or in sports catalogues. Most of the monitors have
a strap that goes around your chest and a wristwatch; the heart rate then
appears on the wristwatch continuously. This is your coach and it will
tell you when to speed up and when to slow down. Some treadmills also
have the technology built into them, so that all you have to do is to
hold onto the metal strips and it will tell you what your heart rate is.
This technology continues to develop and you can get the monitors for
as little as $40, on to up to several hundred dollars. Some models will
download the information onto your computer. If you are planning on being
in the Olympics or a competitive athlete then you may want the expensive
system. For the rest of us, the less expensive system will work great.
For those
who do not want to buy the heart rate monitor, then you need to learn
to feel your pulse either in your wrist or your neck and count it for
6 seconds and multiply the number by 10. This is not as accurate as counting
for an entire minute but when you are walking it is hard to count your
pulse and walk. It is easier to stop and count and then start walking
again. Most people will also notice that their heart rate seems to change
some when you count it, especially if you are at rest. The heart rate
seems to increase. When I am exercising, there is only one organ that
I am really interested in and that is my heart. I don’t care if
my legs or arms feel bad but I do care if my heart gets into trouble.
For me it is worth the $40 to buy a heart rate monitor and to wear it.
I wear my heart rate monitor every time I exercise.
What if your
goal is to tone up? There is a big difference between toning up and getting
“ripped.” If your goal is to improve the tone of your muscles,
that is great; you will have more strength and you will be able to be
more active. But generally it will not result in weight loss. You might
wonder why? The answer is fairly simple: you don’t burn a lot of
calories if you are just trying to tone up. If you want to tone up your
arms, you can do this at home; what you need to do is to take a can of
soup and use it like a weight. Use different muscles just like you would
at a gym. This could serve as the poor man’s free weights. You don’t
have to invest a lot of money to tone your muscles. You can increase the
tone of your muscles regardless of your age. Many people think that if
you are over 70 or 80 that there is not much you can do. They think that
it is all downhill and that you are destined to get weaker and weaker.
Well, if you don’t tone your muscles, that is true. If you take
care of yourself then that is not true. Recently, for example, in the
same year a 91-year-old man finished the New York Marathon and an 81-year
old man completed the Hawaiian Ironman (2.5-mile swim, 112-mile bike ride,
and a 26.2-mile run). People say “But they must have been training
all their lives.” That’s not necessarily so. You can become
fit in a fairly short period of time if you choose to.
What if you
want to bulk up your muscles? Then you need to start a serious workout
program that includes weight lifting or isometric strengthening of the
muscles. You will probably need to consider getting a trainer to help
you get started so that you can learn what exercises you need to do to
bulk up where you want to. A good trainer will also help you learn how
to do it safely. If you use weights incorrectly, you can injure yourself
and that may take a long time to heal. A good trainer in this setting
can be worth his or her weight in gold. You may not want to use a trainer
all the time, but it’s very important when you first get started
to do it correctly with the proper form. Do you want a “6 pack,”
as it is called? Do you want to compete for Mr. or Ms. body builder? Well,
the answer for most of us is NO! If that is important to you, then you
need to learn and read about the process so that you can do it without
getting hurt.
People have
been told they only need to exercise 3 times a week; well, that is true
if your only goal is cardiovascular fitness. If you walk 1 mile only three
times a week, then it will take you two and a half months to lose one
pound. I believe that if you eat every day then you probably need to walk
every day. Walking is like brushing your teeth or taking a bath; once
it becomes a habit it is easy. You need to take time for you. There are
168 hrs in a week. Can you spare 7 of those hours for yourself? The average
person watches 3 to 4 hours of TV a day. That is 21 to 28 hours a week
or 1052 to 1456 hrs a year; that is equal to 45 to 60 days of your life
every year just sitting in front of a TV set. Do you really want to spend
that much time just sitting in front of the TV set? If you gave up one
hour a day of television that would equal 2 weeks every year of time that
you would have for you. When you decide that you are important enough,
you will choose to spend the time on yourself. People will come up with
all kinds of excuses, such as “You do not know my schedule”;
“I get to work before sunrise and don’t get home until after
dark”; or “My neighborhood is not a good place to walk.”
The reality is that we can all find excuses if we don’t want to
do something. You could go to a large store or shopping mall and walk
there; that should be safe. To win this war, you have to get “can’t”
out of your vocabulary.
Working out
three times a week is a good program if your goal is cardiovascular fitness.
For many Americans that in itself is an important goal. They have heart
disease and their doctor has told them that they need to work out at least
3 times a week for thirty minutes at a time. Many people hear the three
times a week and miss the “at least” part of the statement.
So many feel that all they need to do is go for walks three times a week.
They are correct this will help the heart stay fit, and improve your cardiovascular
fitness. This is an important goal; the reason they want you to do this
is so that if you have another heart attack, you will be more likely to
survive it and stay functional. By being functional, I mean that you will
be able to get around the house and do the things that are important to
you. The goal of the cardiologist is to keep you healthy if and when you
have another heart attack. This goal is not a bad goal. However, it may
or may not be your goal. Hopefully you have already determined what your
goals are. If not now is the time to think about the issues and decide
what goals are appropriate for you.
What are the
other reasons to consider adding an exercise program to your life? I expect
that you know some of them, but may not realize the others. The nurses’
health study is a study that has followed 200,000 US women since 1976
prospectively collecting data to study the impact of diet, physical exercise,
and smoking on health, was done, demonstrating that when nurses walk 4
miles a day they can decrease their risk of a heart attack by 50%. To
walk four miles a day will take most people about one hour once they get
into walking. Most are able to walk at about four miles an hour; to start
with people may walk slower but with time most people can get up to that
rate. So one hour a day can decrease your risk of a heart attack by 50%.
The question is, are you worth it? To be honest, we don’t have any
drugs that will lower your risk of a heart attack by 50%. Our drugs are
good and we can help people to diminish their risk but not by 50%. People
like “natural” things; well, nothing is more natural than
walking. Many people want something natural but they want it to be a pill,
not something as natural as walking.
Many people
also have hypertension, or elevated blood pressure. It has been shown
in medical studies that walking will decrease your blood pressure by 15
to 25 points on the systolic number or the “top number”. This
is significant. Most of the medicines that we use only give us this amount
of change. For some people a simple walking program will allow them to
lower their blood pressure and possibly come off some of their medicine.
What you have to do is start the walking program, monitor your blood pressure,
and talk with your physicians. Let them know what you are doing and what
you want to gain from doing it. Let them know that you hope to come off
some of your medicine. This will allow them to focus on what you are on,
and as your pressure gets better, they will be willing to discuss the
options of reducing some of the medicines. If they know that you have
started this program with that goal in mind, then they will probably be
very willing to work with you on your goal. The more medicines you are
able to stop using, the more money you can save at the pharmacy
Walking will
also help diabetics keep their blood sugar under better control. You might
wonder how walking will help diabetics. Well, it turns out that walking
will allow the muscles to utilize the sugar that is in the blood more
efficiently; insulin in the body becomes more effective and therefore,
the blood sugar drops and is under better control. Many endocrinologists
try to get their diabetics to walk for 1 hour a day--approximately 4 miles.
Patients with borderline diabetes can often completely correct the problem
if they start a walking program. For patients who already have adult-onset
diabetes, you can usually decrease the amount of medicine to treat the
diabetes if they start walking; and if they also lose weight, you may
be able to get them off all their diabetic medicines. It all depends on
how motivated the patient is. This can result in a lot of money saved
for the patient; they are not buying as much food because they are not
eating as much; and they are not buying as many medicines from the drug
store—such as strips, lances, and alcohol wipes--because their diabetes
is under good control.
Walking has
also been shown to decrease a person’s cholesterol. It also increases
the good cholesterol, or HDL form. That may be part of the reason that
walking helps to decrease the incidence of heart attacks. Walking and
exercise can lower some people’s cholesterol by as much as 50 to
60 points and also raise the good cholesterol by 10 points or more. We
have medicines that can work this well, but if you can do it naturally
without medicines, why add a pill? Pills are expensive, have side effects,
have to be monitored with blood work and you can waste a lot of money.
If you are on medicines, then it is possible with exercise that you may
be able to switch to a lower dose of the medicine or come off the cholesterol-lowering
drugs with the help of walking. This will need to be done with the help
of your physician so that he or she can monitor your progress.
Beyond that,
patients who walk or exercise on a regular basis have an improved quality
of life. They just feel better. They have more energy; they can do more;
they feel more alive. The ultimate goal in life is to enjoy the time that
you have been given. In order to enjoy it you have to feel good. In order
to feel your best, you have to exercise not only your body but your mind
and your spirit.
Many people
say they “can’t” walk or exercise. For some that is
true. For most it is not true. As long as “can’t” is
in your vocabulary then you will never be able to do the things that you
want to do. You need to get “can’t” out of the vocabulary
and replace it with “can.” There is an old saying that if
you think you can do something or you think you can’t do it, you
are probably right. Most of us are limited by what goes on between our
ears. It is important to remember that the mind is very tricky organ and
you need to be careful not let it talk you out of doing what you need
to do to stay healthy. I agree that there are some things that we can’t
do. I will not be able to be the fastest runner of a marathon, because
there are people who are born with the ability to run faster than me.
I will still be able to finish a marathon even if I have to walk it. I
will not be able to be an Olympic athlete because I am too old. But I
can still enjoy the sports they play, and participate in them at different
levels.
Walking has
also been shown to improve mental function. In one study, scientists put
one group of rats on a treadmill, while another group was sedentary. When
they dissected the animals, they found that the rats on the treadmill
had an increased number of brain cells. This is something that we were
taught in medical school could not happen. You only have so many brain
cells and as you age, they begin to die off; but this old theory may not
be correct. In another study, researchers took an older group of adults,
half of whom started on a walking program, while the other half remained
sedentary. The group that walked had improvement in mental function, suggesting
that walking and exercise may help improve mental ability and perhaps
retard the senility that may occur with age.
Another beneficial
effect of walking or exercise is that your bowels will work more regularly.
Runners have known this for years. If you are a runner, then many of us
need to be sure that we have used the bathroom before we go out for a
run, if we don’t want to have a surprise half way through. Some
runners get runner’s diarrhea, and plan their runs according to
where they know the bathrooms are located. Walking also increases the
intestinal motility and allows those who have a more sluggish bowel system
to be more regular. Many people as they get older have problems with constipation,
and this may be a simple way to help keep them regular without taking
a lot of medicines.
Well, what
else can walking do for you? It sounds like the greatest gift to mankind.
It is one of the greatest gifts that we have been given. Walking will
also help you sleep better at night. The use of the muscles, the pumping
of the blood through the circulation, the stimulation of the body may
very well help people sleep better. This is not unusual. This may allow
patients to get a better night’s sleep without taking medicines.
If you exercise strenuously then you may have to take a short nap. I know
that if I do a 3 or 4-hour workout, then I need to plan on a one-hour
nap. It’s okay to nap.
What kinds
of exercise can you do? The mind is very ingenious and you will be able
to think of a lot of different types of exercises that you could do. We
have talked a lot about walking. It is a great form of exercise. Some
people have trouble with their hips and knees and therefore have more
trouble walking, so they may want to do something different. For 95% of
the population, walking will work just fine. With walking, you need to
find a pace that you can handle and eventually you want to work with your
heart rate monitor to get the rate into the fat burning zone so that you
will burn more fat. Using the heart rate monitor as your coach can be
very helpful. It is good when you have a non-biased coach giving you advice.
My heart rate monitor tells me when to speed up and when to slow down
based on where I want my heart rate.
For the patients
who have knee and hip problems, as you lose weight your hips and knees
will no longer be hurting as much and you will be able to start a walking
program as well. When you walk, we have what is known as “impact
loading” on the knees, so that your knees feel three times your
weight with each step. Therefore, if you weigh 300 pounds your knees will
feel a weight of 900 pounds with each step. The good news is that as you
lose weight you will see a lot of improvement. If you lose only 30 pounds,
that is 90 pounds off the knees with each step. I have had patients who
were going to have their knees replaced who decided to loose 30 to 40
pounds first. What they found out was that their knees no longer hurt
and they canceled the surgery. Unfortunately, most patients will not lose
weight and so they end up having surgery.
For people
with hip and knee problems, water aerobics is also an excellent form of
exercise. When you are in the water, you do not have as much pressure
on your hips and knees or ankles. We also see that when runners get injured
and need to maintain their cardiovascular fitness, they jog in the deep
end of the pool. This allows them to exercise without injuring their legs
and allows the injury to heal. Water aerobics will help tone up muscles,
but unless you have a sustained elevated heart rate in the fat burning
zone, you may not burn a lot of calories. You can wear most heart rate
monitors in the pool; this way, you will know how you are doing.
Should you
buy a treadmill or an exercise machine? That depends on your commitment.
Most of the machines that are sold today are used to hang clothes on or
to collect dust. Some people I know have almost every device that has
ever been made. For me I do not use it at home. I am one of those people
that has to go to the gym to work out. I had a treadmill at home but never
use it so I gave it to my son. Some people will use it. Whether or not
you should buy it will depend on you and your makeup. I recommend that
you first try to buy or borrow a used one from a friend that is not using
theirs to see if you are going to use it. If you are like most of us,
it will just take up space. If you are one of the motivated and do use
it, then my hat is off to you.
Exercise can
be as simple as playing a CD and having a couple cans of soup in your
hands and dancing to it. Move your arms and legs to work the muscles.
You can sit in a chair and have a can of soup and lift it up and down,
straighten out your legs and relax them. Anything that uses your muscles
will help to tone them up.
Why don’t
we exercise then? There are thousands of excuses that we all use. You
know them all because you have already used them yourself. The excuses
range from “I have only so many heartbeats in my life and I don’t
want to waste any of them on exercise,” to “The elephant took
my sneakers and I don’t know where they are.” Really, the
hardest thing about going for a walk is to put on the sneakers or walking
shoes. Once they are on the rest is easy. The walk is fun; people say,
“I wish I did that more often.”
So what are
your goals? I hope that you have thought about it. I want you to jot them
down. You can also change them later. You have the right to change them,
since they are your goals.
My goals are:
1.
2.
3.
I will exercise _____ days a week and I will exercise ____ hours
a day to reach my goals.
Energy
I
don’t know anyone who ever complains of having too much energy.
So if you are having a problem, then it must be too little energy. Some
people don’t think much about it; they feel fine and the energy
that they have is good. But when you don’t have the energy that
you feel you should have, then it is a very important problem. So let’s
look at some of the causes of a lack of energy.
If your energy
is low, one thing that you need to do is to talk with your physician and
see if there is anything physical that could be wrong. There are many
medical problems that can cause people to have a lack of energy such as
anemia, thyroid disease, depression, viral and bacterial infections, and
cancers--just to name a few. So if you are without energy then get their
opinion. One thing that you need to know is that you can not be objective
about yourself, so don’t spend a lot of time surfing the Internet
trying to figure out what is wrong; just go and get checked up. You might
like to think that you can figure it out for yourself, but odds are you
will miss it by a long shot.
I’m
no different. I tell my patients all the time that my pointer finger on
my right hand was hurting at the furthest knuckle for six weeks. Well,
I had figured that it would go away and it didn’t, so being an oncologist,
I figured it was cancer. I went and had an X-ray, and once I heard the
click of the X-ray machine the pain went away; the X-ray was normal. As
I tell my patients, “Do you know how many people I’ve seen
in my life time with cancer in that joint?” The answer is none.
I was going to be the first? I don’t think so; as you can see, it
is hard for anyone to be objective about himself or herself. That is why
physicians should not act as their own or their families’ physician,
and why attorneys should not represent themselves in court. So if your
energy is low, get a physical if you have not had one recently and make
sure that it is not just a simple medical problem that can be corrected
with some medicine.
Well, you
had your physical; what else can affect your energy level? Nutrition is
high on the list of culprits. If your diet is filled with junk food, then
you will have problems with your energy level. Your engines will not run
well if you do not take care of them and put proper fuel into them. If
your diet is full of empty calories then don’t be surprised if you
have trouble with energy. Your diet needs to be balanced. You need protein,
fat, carbohydrates, vitamins, fruits and fiber in your diet. If you just
eat one to the exclusion of the rest then you will feel bad. As you continue
on the journey that you are on, take a look at what you are eating, keep
up with it, and see how you feel when you eat certain foods. I know that
when you overeat, that you will feel sluggish for 3 to 4 hours after the
meal. Your energy will be quite low. All you will want to do is to sleep,
which is normal. What you choose to eat will have an effect on your energy
level. If you live on snack bars, nutritional supplements, and junk food
you may find that your body is craving something else, and you need to
listen.
Exercise is
very important when it comes to energy level. Patients will tell me I
don’t have the energy to go out and walk. I can’t do it. If
you think that you can’t, then your mindset is already such that
you can’t. When patients come back to me and tell me they are walking,
I ask them if they are up to six miles a day. I ask all my cancer patients
to walk six miles a day; of course, very few do it. They smile and chuckle
a little and say no. Those that do walk will tell you very quickly that
they have a lot more energy then they did before they started walking.
When I see patients who used to walk but fell off the wagon, so to speak,
they will always tell me that they felt better when they used to walk.
I ask them what made them stop and they always have an excuse; we humans
are great at coming up with them. Many will start walking again so they
have the energy that they want. My goal for my patients is for them to
have the energy that they want, and to be able to do the things that they
want to do, and enjoy the life that they have been given until it is time
to die.
Obesity is
another cause of low energy. You already know that if I gave you a 50
or 100 pound bag of potatoes to carry around that you would feel tired
and not able to do as much as you would like. When I see people who have
lost even 30 pounds, they all tell me that their energy level is better.
I was talking with a person recently who had lost almost 70 pounds and
his energy level was better then it had been in 20 years. Not only do
you have to lift the extra weight when you try to get out of the chair
but you have to carry it every step that you take. Stairs become a huge
burden, as does shopping; everyday acts of living become a challenge.
As the weight comes off, the problem begins to subside and your energy
returns.
So from a
diet perspective, begin to look at what you are eating. What kinds of
foods do you eat, and is it balanced or not? Are you getting too many
carbs or too much protein? Are you snacking on things that really don’t
help you at all--like beer, soft drinks, and candy--or are you trying
to get in some of all the different food groups that exist? Are you consuming
fiber and fruit? Are you exercising or have you put that off for tomorrow?
As Marcus Aurelius said, “You deserve where you are; you could have
done it today, but you put it off for tomorrow.” It is your energy
that we are talking about, not mine; this is not about me, it is about
you. Your choices will determine the outcomes. If you choose not to exercise,
then you will also choose to have lower energy then you could have had.
As you get your weight under control, then that will also allow you to
have the energy that you want. Don’t neglect any of the three if
you find that your energy is low. If your muscles are not in shape then
they will not work, and if you do not give them the right fuel then will
not work as well, and if you make them carry too much weight they will
struggle under the load that they have to carry.
Chapter 9 >
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