Tag Archives: exercise

Just How Many Heartbeats Do We Get?

Talking recently about exercise and the heart, a really weird question came up. Sometimes those are the best questions, aren’t they?

Exercise makes the heart beat faster, so why doesn’t exercise wear the heart out faster? Why don’t you run out of heartbeats sooner if you spend a lot of time exercising? After all, the heart has a lot of moving parts – heart valves, blood vessels and muscle. These presumably wear out, like anything else, kind of like the 100,000-mile power train warranty on your car. After the warranty expires, you’re on your own …

So you Exercisers watch out, you might just shake something loose. Actually the heart is an absolute wonder of durable construction and last an astounding number of beats. Let’s play with some numbers.
How many beats do we get in a lifetime? If an individual averages 80 beats per minute, that’s 4,800 beats per hour, 115,200 beats per day, and more than 42 million per year, which calculates to roughly 3 billion if you live to age 72. When you think about them that way, heartbeats are the most precious commodity on the planet. Hate to waste ‘em.

Assume a really compulsive 40-year-old exerciser does something strenuous and aerobic five days a week for 30 minutes. He will drive his heart rate up to 160 beats per minute (220 – your age is maximum heart rate and we like to exercise at 65 to 85 percent of that).

The math works out to an extra 2,400 heartbeats per day on your exercise days. That is a 2 percent increase in heartbeats per day for those who are keeping count.

But exercisers have slow heart rates — not in the first week, but after a month or two. Let’s assume exercise brings your resting pulse down from 80 to 60 beats a minute, a pretty reasonable goal. The 72-year-old at the 60-pulse rate uses only 2.2 billion heartbeats. To put it another way, to use up 3 billion heart beats, at a pulse rate of 60, you have to live to age 95. Startling, isn’t it?

But lower pulse rate isn’t the whole story because your heart is living tissue, not a car. That’s a subtle distinction I know, but one that comes up every day in medical practice. A mechanic comes in with a cut hand that requires sutures. He thanks me for fixing it and I usually say, “you’re doing the hard part, I just got it pushed together. You are healing it.” A mechanic has to fix your car engine 100 percent or it won’t run properly. Cars can’t heal themselves, but people can.

Using your heart’s muscle makes it strong. You don’t wear tissue out by using it; you wear it out by not using it. So invest as little as 15 minutes a day in exercise and you will extend your warranty for more trouble-free years of body ownership. Get that pulse down to 50 and it takes 105 years to use up 3 billion heartbeats.

Take care

Dr B

10 Reasons Not to Exercise

I was a great exerciser for most of my life. Recently I seem better at making up excuses not to exercise than to actually exercise.

As a motivation tool for myself I have listed all my good reasons for not exercising. You may find a few of your favorites. Hopefully you will see my folly and get back on a program yourself. So after a little reflection, here are my favorites.

1. I am middle aged and don’t need to pretend I’m young.
2. I am too busy to exercise – work, child rearing, keeping the house livable doesn’t leave time for exercise.
3. I don’t get enough sleep as it is without getting up an hour earlier to exercise.
4. My back hurts. You may substitute knees, hips, or your big toe – pick your favorite, or least favorite, body part
5. It’s too hot to exercise (115 F in Phoenix as I write). Of course too cold, humid, windy, rainy or generally inclement works equally well. It could also be too light or too dark for that matter.
6. I have a big meeting tomorrow and I need to be well rested.
7. I’ve been married for 17 years and my wife still likes me (even without exercise).
8. My weight is good and I look like I exercise (I actually stole that one from my wife a decade ago).
9. No matter how much I exercise I still don’t look like Arnold (or Halle).
10. If I can’t do the exercise I want, why bother.

So use one excuse a week and it will be a long time before you exercise.

More seriously, most of these are easily swatted away and I have done that myself many times.

A few to discuss:

No. 10 is a real struggle for many. I had two back surgeries that put a stop to my running and weightlifting. It took some pondering, but rollerblading is easy on the back and aerobic exercise. Aging and injuries do force you to lower the exercise bar, but throwing in the towel is not necessary. If you can only walk, do that. Almost anyone can swim for exercise, the weightlessness makes it joint friendly.

Looking like you exercise is not the point. Living longer and being able to participate is the point. Exercise can make some wheelchair bound people walk again. You can be fat, thin, short, tall, old or young and still make your life better with exercise.

Most studies show exercise helps joint pain. This is true even with relatively advance degenerative joint disease. It also helps you lose weight, lessening pain.

Hopefully, I will think of these counterpoints tomorrow morning when I wake up with an excuse at my lips.

I will recognize it for the excuse it is and move anyway. If doesn’t work, Sheba, my Siberian Husky, will remind me she needs exercise also and doesn’t take excuses.

Take Care.

Dr. Bucklin

Easing Into Your Exercise: The Warm Up

One thing that keeps you running, besides good shoes and the gumption to get out of bed, is a good warm up. The warm up is less exciting than shoe technology or finding your zone, but just as integral to your success as a runner.

The type of warm up you do is dependent on the type of activity you are about to embark upon. The warm up for a runner is different than for a tennis player. The primary goal of any warm up is injury prevention. You also get the benefit of less discomfort during the activity after a good warm up.

The first principle of warming up is a gradual increase in intensity of the activity. Walk before you run, if you will. There are a number of adaptations the body must make to go from its idling state to a higher performance level. The circulatory system must ramp up the blood supply. As your heart beats faster, blood supply is shifted to the working muscles and to the central circulation where it is used most efficiently.

The lungs, like the heart, increase both the rate of respiration and the depth of respiration, providing for increased oxygen needs.

All this activity is very good for your body and spirit. The hiccup is in going from a “body at rest” to “a body in motion.” That is perhaps not too surprising, as almost nobody starts their car on a cold morning, then “floors-it.” You would expect to see engine parts coming out your tailpipe. You would prefer not to have this happen to your body.

There is good evidence that a “cold” body is at greatest risk of injury. Studies have shown that back injuries occur more frequently when someone bends at the waist for the first time of the day. We all have experience with pulling a muscle simply doing a big stretch when yawning in the morning. Cold muscles injure easily.

The cardiovascular warm up is straightforward. For a runner it is as easy as a brisk walk for a block or two before running hard. If it’s cold out, some calisthenics indoors can get blood moving before charging outside for your run.

The stretching part of a warm up is much more controversial. More vigorous stretching to elongate muscles and stretch joint capsules has become much less popular among exercise physiologists as some studies show this increases injuries.

Static stretching – steadily reaching for your toes – gradually elongates muscles by continuous pressure. This type of stretching still is favored by many to prevent injuries.

Bounce stretching, colorfully named “ballistic stretching,” has totally fallen out of favor. This type of stretching is where you actively bounce against the limits of your range of motion, to increase it. The bouncing is more likely to hurt you.

Consider making an appropriate warm up part of your exercise routine. Your body will appreciate the few minutes of TLC while coming up to operating temperature. Your injuries will be fewer and your miles will be more enjoyable.

Stay well

Dr B (aka Dr Don Bucklin).

What to Sweat Over When It Comes to Sports Drinks

Every time I see a “Gatorade shower” after a sporting event, I ask myself if this is a waste of a great hydration resource or just a cheap replacement for champagne.

Gatorade was the original sports beverage, invented in 1965 by a “medical team” in Florida. That all sounds pretty impressive, but 1965 was practically the Middle Ages in the world of medicine. Sports drinks have proliferated in recent years; Gatorade, Power Aid, Sobe and Vitamin Water all compete for your attention and hydration dollar. Each comes in multiple flavors and special formulas. I have to admit that it wasn’t long ago that I expected a measurable and substantial increase in my performance due to the consumption of a sports beverage or bar. I thought of it as pouring rocket fuel into my ski legs. It even seemed to work.

Nevertheless, water has been the hydration “beverage of choice” for more than 200,000 years, and that was without the benefit of research, television or advertising. You have to admire the audacity of the “medical team” that sought to improve on water. They started with the simple discovery that sweat is salty. This is something that any of us non-scientists could have explained after mowing the lawn on a summer afternoon in Florida.

This what my dad spends money onphoto © 2008 Zac Zellers | more info (via: Wylio)Sports beverages, first and foremost, provide hydration. Their claim to fame is the provision of electrolytes (salt) and carbohydrate for muscle energy. This salt and carb combo is touted to be an improvement on water for sustained performance.

The whole point of sports drinks is to replace sweat. So what is sweat? It’s salt water, more or less. To make comparisons of saltiness, we use milligrams per liter (mg/l). This is handy because sport drinks come in roughly liter bottles (a little more than a quart).

Sweat is about 97% water. Sodium, the next most common element in sweat, weighs in at a whopping 900mg/l. Potassium is next at 200mg/l. There are many other elements in small amounts, but sodium and potassium are the main ones. We can sweat a liter per hour during heavy exertion, mostly as a way to dissipate the heat of muscle use.

When sports drinks talk electrolytes, they are talking sodium. Sodium is a plentiful element in human beings. There is a lot of it in sweat (900mg/l), but even more in the blood (3100 mg/l). So looking at electrolytes in sports drinks, it is obvious that the amount of sodium in them (100 mg/l) is trivial compared to the sodium in sweat or blood. Drinking a sports drink will replace about 3% of the electrolytes you lose in sweat.

So there may be good reasons for drinking sports drinks, but electrolyte replacement isn’t one of them.

Carbohydrates, and specifically glycogen, are the preferred fuel of working muscles. Your internal store of this sugar molecule is in the muscles and the liver. You have a couple of hours worth of fuel stored before turning to the much-less-efficient fat metabolism. The carbohydrate in a sports beverage provides 15 to 20 grams of sugar, something like 5 teaspoons which supplies 60 fuel calories. Strenuous physical activity burns about 300-400 calories per hour. Again, the sports beverage provides fuel, but only a very minor amount.

So there may be good reasons for drinking sports beverages, but fuel replacement isn’t one of them.

Which brings me back to the true strength of sports beverages. Most people would rather drink Gatorade than water. It just tastes better. Hydration is absolutely crucial to maintain during exercise. This not only helps maintain performance, but also prevents exhaustion, shock and even death. Many studies of exercise show people drink more sports beverages than water.

So bring what you’ll drink to your next session of strenuous exercise. Your drink will sustain you whether it is the highest tech beverage or very old school H2O.

For those on budget: a little orange juice mixed with a lot of water ends up being pretty close to the sports beverage formulae – not to mention, cheap and palatable.

Keep drinking and take care,

Dr. B

Debunking 3 Weight Management Myths

Overweight? You have lots of company. It is one of the greatest public health issues of the last 20 years. Let’s discuss a few myths, as well as a few ideas.

Myth: Eat three meals a day.
Not so! Three meals a day is a modern concept. Historically there never was enough food for the average person to eat three meals a day. In many parts of the world, that is still true. If you eat three “reasonable” meals a day, you will be overweight.

Chinese Food Macro 12-6-08 7photo © 2008 Steven Depolo | more info (via: Wylio)

Myth: The kind of food you eat dramatically affects your weight.
That also is more myth than science. Your body needs somewhere in the neighborhood of 2,500 calories per day. If you take in more calories, you gain weight; taking in less means you lose weight. If you eat 4,000 calories of carrots per day, you will gain weight (and turn orange – I’m not kidding). The body happily converts protein, carbohydrates and fat in your diet to whatever the body needs. Carbohydrates are not the great Satan, nor are fats. Fats do happen to be twice as calorie-rich per weight as everything else. So you can only eat half as much fat. On that thought, it really is too bad that the body stores extra calories as fat (4,100 calories per pound). If it stored excess as carbohydrate or protein, it would only take 1,800 calories to burn a pound.

What is a calorie anyway? The calorie is a certain amount of energy that is contained in food. It can be thought of as “stored work.” You use it when you exercise or to keep your heart beating. Calories are good stuff, in moderation.

Myth: Exercise absolves you of food sin.
Unfortunately, there is no absolution. You need to exercise, and it is one of the most important health habits you can have. Exercise will burn 200-500 calories per session. That will help you lose weight or keep you trim. Keep in mind that 200-500 calories isn’t even a candy bar’s worth of calories. So exercise alone won’t do the job.

Now I would like to suggest the concept of dining for enjoyment vs. for fuel. I define fuel as calories I take in only to keep going. These are not tasted, savored or enjoyed. They are simply thrown down my throat hastily. Here is the important thing, in my opinion: if I am not going to savor and enjoy a meal, I might as well throw down something good for me (a protein or yogurt drink). If I have time to sit down and really enjoy a meal, I might as well eat something tasty, even if it’s not that great for me.

So get some exercise and don’t throw down bad food without enjoying it. If you are trim, it will help you stay that way, and if not, you will make steadily progress toward a lesser you.

Stay well,

Dr. B

The Proper Care and Feeding of Your Heart

Why should you invest a few precious heartbeats in learning something about your ticker?

Because of atherosclerosis and heart attacks – and because heart disease is still the No. 1 cause of death in this country.

Heart anatomyphoto © 2009 K Sandberg | more info (via: Wylio)

Most of us think the heart is the most important organ in your body. While this might spark a heated philosophical debate, the heart has a certain anatomic primacy based on the simple fact you can’t live without it, even for a few minutes. And few things will ruin your day more.

Most of the important organs in your body are designed with a certain redundancy, like airplanes having two spark plugs per cylinder. You have two kidneys, but can get by on one. You can lose more than half of your liver, just as much of your intestines, blood or lungs, and live, although not with all of that occurring simultaneously. Running on 50 percent function of most organs will leave you alive to fight again.

Ah, but the heart – there can be only one.

Conceptually, the heart is simple enough. It’s a variable speed pump. The faster it beats, the faster the blood goes round and round. It is actually kind of a double pump – one side pumps blood to the lungs, the other to the body. You have to be impressed by the build quality. Most hearts are good for 70+ years and more than 50 million cycles. Very few other things in the world, either living or inanimate, last 50 million cycles.

The heart is a lot like other pumps you know. Pumps, in general, don’t run on what they pump. Think about it – the oil pump in your car uses electricity to pump oil, and a pool pump uses the same to pump water. Similarly, the heart is not nourished by the blood inside the pump; rather, it is powered by the blood in vessels on the outside, namely the coronary arteries.

Given the coronary arteries’ well known propensity to plug up, perhaps the heart might have been better designed to get its nourishment from the blood inside.

But there are sound mechanical reasons why this can’t be. The first involves the heart’s thick muscular walls. There is no way for oxygen to passively diffuse across dense heart muscles in enough concentration to keep the heart alive, let alone beating.

Then there is the problem inherent in that whole beating thing. Blood leaves the heart in an intermittent flow (squirt-stop-squirt-stop). Most tissues, including the heart, don’t tolerate this type of flow. They need continuous flow. Getting this flow smoothed out is the job of the major arteries. These arteries have muscular walls that act as shock absorbers. They expand to absorb a slug of blood and then steadily contract to keep it moving. This works much like a water reservoir supplying water continuously to a town, even though rain is episodic.

Ah, but a heart is so much more than simple plumbing.

A heart’s got rhythm. Heart cells are a type of muscle cell, and like muscles everywhere, they contract. A specialized group of heart cells is a built-in pacemaker. This supplies the tempo. Everybody has to contract at once to get anything done. When they don’t, the heart sort of quivers and stops pumping, and that’s bad.

There can be either blood flow problems, rhythm problems or both from similar things. Atherosclerosis, or plugged coronary arteries, starves the heart cells. Sometimes these cells curl up and die. Sometimes they go electrically haywire and a rhythm disturbance occurs.

So the most important care and feeding of your heart are keeping good freshly oxygenated blood flowing through your coronary arteries. You have been prewired for this to happen. All you have to do is not screw it up. To do this simply means don’t do the stuff that clogs arteries.

• Do control your blood pressure
• Do control you weight
• Do control your cholesterol
• Do control your sugar if you have diabetes
• Do control your stress
• Do not smoke
• Do laugh as often as possible; it helps immunize against stress
• Do drink some red wine – it’s good for your heart and might also help with stress
• Do get some exercise, and for heaven’s sake, don’t suffer for it. If you do, the stress might cancel the benefit of the exercise.

So while hearts may continue to be a mystery to young lovers, you now have the necessary information to understand what makes them tick.

Take care,

Dr. B

Walking for Exercise

Walking for exercise is one of the most effective, inexpensive, enjoyable and safest activities you can do to stay healthy. Other than some comfortable footwear, you do not need any special equipment or nine other people to do it.

Trailnet-Walk-05photo © 2007 Trailnet | more info (via: Wylio)

Walking is so accessible – it can be right outside your front door or on a lunch break at work. You can go to other venues for a change of scenery, none of which adds any cost to the price of beneficial exercise.

And numerous studies demonstrate the enormous benefits of walking to people of all ages. The benefits are physical, mental and emotional.

As a physical exercise, it’s easier on the joints compared to high-impact sports or jogging. The speed is not as important as the duration of the activity. The cardiovascular benefit is most dependent on getting the heart rate up a little, but still in a safe range and sustaining that pace for 15 to 20 minutes. Actually, aerobic exercise can be very effective even in small installments. If you only have 5-10 minutes to walk several times a day, the cumulative benefit is comparable to the same sustained activity for 30 continuous minutes.

Research has shown that Americans walk less than people do in other countries. Studies have also shown that use of a pedometer or other movement-measuring device can be very helpful in measuring and stimulating people to be more active when they pay closer attention to the amount of their daily activity. Inexpensive pedometers ($25-50) or the more expensive motion sensors ($100) are fun tools to measure and track your progress.

The more you walk, the more calories that are burned and the easier it is to maintain weight. Toning the muscles provides overall stamina and significant cardiovascular benefits.

What may surprise some is the appetite suppressant effect of regular exercise. For serious dieters, the more active you are burning calories, the less restrictive with food you need to be. If the feeling of being deprived can be avoided, then staying with your food plan is more likely.

A regimen of regular walking can be a great stress reducer and relaxation tool. As any aerobic exercise burns calories, the increased circulation to the brain helps prevent memory loss, and it relieves physical and emotional tension. With relaxation, we can be more mindful and clear thinking about all things.

Since the evidence is overwhelming that walking helps so many aspects of your health, what are you waiting for? Let’s get moving!

– Dr. Bruce Kaler

‘Air goes in and out, blood goes round and round, and urine runs downhill’

Thus began one of my more entertaining lectures in medical school. At the time I was about half-way through medical school, so I just barely knew enough to know that this was a bit of an oversimplification. I laughed hard at the time, as did my classmates, but this got me thinking. There was a simple elegance to this concept, almost Zen-like. The human body was put together with a series of conceptually simple functional systems.

On that same note, here are some oversimplified health beliefs and the truth to them:

Air Goes In and Out
The lungs are in many ways like a tree. The trunk is the windpipe, the branches the bronchial tubes, and the leaves the alveoli. The leaves are where a tree goes about breathing. The trunk and branches are of little use without leaves. The leaves are the most sensitive parts of the system; serious tree diseases usually affect the leaves. In the body, we absolutely depend on free exchange of gases at the alveoli. Put toxin into them, and they are the first to go. The tree will eventually die.

Blood Goes Round and Round
Blood needs to circulate. If it doesn’t, stuff dies. If the blood that supplies the heart doesn’t go round and round, we call it a heart attack. In the brain, this is a stroke. We should do everything in our power to avoid blockages like these. Blockages are caused by excess: too much blood pressure or cholesterol, too much eating or smoking, too much weight or sugar, even too much work. It’s all about balance in life.

What Goes In Must Come Out
The first association that comes to mind is the digestive system. This, most simply, is a long tube where food goes in one end and waste comes out the other. A certain balance is implied – too much in and not enough out, and trouble will ensue. We also might use this to consider nutrition – good food in, good heath comes out. Calories also go in and must come out, otherwise you get bigger.

Use It or Lose It
This has application to almost every system. Our muscles must be used or they deteriorate. Spend a month in bed and even simple walking is a great effort. You must stay active if you wish to continue a vital life.

Our immune system is also a fan of this rule. Kids raised in too clean an environment have unstimulated immune systems that don’t work well. Two dogs keep a house dirty enough for proper development of the immune system. Asthma is rare in kids from two-dog households.

We are even finding mental exercise prevents deterioration of the mind. Risk for Alzheimer’s is lower the higher a person’s education level.

It is very easy to get caught in the details of “pop health talk” – the vitamin of the week, the micro nutrient of the moment, or a single exercise that will change your life. Maintaining good heath is actually rather simple and something you can do on your own without these fads: keep moving, keep breathing and strive for balance in your habits.

Take care,

Dr. B

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Getting Back on the Healthy Horse

In this country, we tend to lean toward the extremes. We over eat, over drink, over spend and even over exercise. A little is good, a lot is better, so give me all.

If you ask normal people to divvy up the people around them into health groups, they assign most to minimal exercise and a few to heroic levels of exercise. The healthy among us are assumed by the others to be absolute exercise machines, to have wills of steel and unwavering commitment.

Ah, if only it were so…

I will let you in on a dirty little secret of the exercise cult. We’re just like you. We like to sleep in, procrastinate and eat too much. We have only one thing that you don’t have – and it’s what I call “get-back-on-the-horse-ness.” I don’t mean to channel the Wizard of Oz here, but the image is there. Everyone you see that exercises has quit exercising countless times. They have been discouraged, lazy, too busy or too tired like everyone else. The only difference is that we are better at getting back on a program.

A corollary of the culture of excess is high expectations, even for health. “I’m going to start tomorrow and exercise 2 hours a day and lose 5 pounds a week.” The unspoken part is: “If I can’t do the whole program, I won’t do anything.” Let’s be a little less absolutist here. It might be a bit unrealistic to expect that kind of commitment out of yourself. Maybe you don’t have 2 hours a day to exercise. You can probably swing getting up 15 minutes early and walking briskly around the block. Park a little further away, take the stairs. Small steps are OK.

We see this absolutist behavior in other health habits, good and bad. How often does someone go 2 months or 2 years without smoking, have one cigarette and jump right back up to a pack a day. One cigarette in two years is a remarkable victory. So you had one weak moment and had one cigarette? That one cigarette has zero health consequences. Smoke the darn thing, and get back on the horse.

Drinking is the same way. People with problematic alcohol consumption have a single drink after years of abstinence and immediately go on a two-week binge. Have the one drink, stop and then get back on the wagon.

I’ve had my own experience in moderating my previously extreme exercise tendencies. I had 2 low back surgeries in 3 months. I was initially quite upset because I couldn’t run or lift weights (probably not worth mentioning that the weights had something to do with the back surgery). But I found out I could rollerblade. When rollerblades became a problem, I could still walk briskly. If walking slowly is all I can do, I will do it.

So go ahead – set a low bar and surprise yourself.

Dr. B

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