Physical Activity and Exercise Part 2

Welcome to Part 2 of the Physical Activity and Exercise series! This article is a continuation of Physical Activity and Exercise - Part 1 released in November.

Physical Activity and Exercise - Part 1

Start the new year with healthier habits! Learn about aerobic and anaerobic exercise benefits for diabetes, hypertension, and overall well-being in this week’s article.

RxTeachMichael Forst, PharmD

Given that the end of the year is associated with new beginnings and resolutions, I wanted to discuss physical activity and exercise to coincide with New Year’s resolutions. As stated in Part 1, 80% of adults do not meet the guidelines for both aerobic and anaerobic exercise.¹ The lack of physical activity is linked to about $117 billion in annual healthcare costs and about 10% of premature mortality.¹

Important Reminder - AHA Physical Activity Recommendation Based on Age

1. 18 years and older: Get at least 150 minutes per week of moderate-intensity aerobic activity, or 75 minutes per week of vigorous aerobic activity, or a combination of both. preferably spread throughout the week.
2. 6-17 years: Get at least 60 minutes per day of moderate- to vigorous-intensity physical activity, mostly aerobic.
3. 3-5 years: Be as physically active as possible and have plenty of opportunities to move throughout the day.

Important Definitions:

1. Aerobic Physical Activity: activity in which the body’s large muscles move in a rhythmic manner for a sustained period of time.¹ Also called endurance or cardio activity.
2. Anaerobic Physical Activity: intense physical activity of very short duration, fueled by the energy sources within the contracting muscles and independent of the use of inhaled oxygen as an energy source.²

Aerobic vs Anaerobic

Think of aerobic exercise as continuous, rhythmic movements that utilize large muscle groups. Aerobic exercise relies on aerobic metabolism to extract ATP from amino acids, carbohydrates, and fatty acids for energy.⁴ The cardiorespiratory system supplies oxygen, and the skeletal muscles utilize oxygen.⁴ Examples include brisk walking, jogging, long-distance running, swimming, bicycling, dancing, and hiking.^1,4

Think of anaerobic exercise as intense physical activity for short durations that are characterized by muscle contractions. Anaerobic exercise relies on cells forming ATP via glycolysis and fermentation because these exercises do not utilize inhaled oxygen as an energy source.⁴ Examples include calisthenics, weight lifting, sprinting, high-intensity interval training, and plyometrics.^3,4 Anaerobic exercise is known for its characteristic increase in lactate and metabolic acidosis, which contributes to sore muscles. 

The association between aerobic activity and health benefits has been studied for many decades and continues to enhance our understanding of the importance of physical activity and exercise. Included below is a short list of benefits for aerobic and anaerobic physical activity:

• Aerobic
  • Reduction in total cholesterol and triglycerides in children, adolescents, and adults.⁴
  • Reduction in levels of endothelin-1, a vasoconstrictor and correlated with increased risk of atherosclerosis.^4,5
• Anaerobic
  • Increase in C-type natriuretic peptide, a peptide that contributes to vasodilation and prevention of cardiac aging.^4,6
  • Increase in bone-specific alkaline phosphate and osteocalcin, which contributes to increased bone density and reduced risk of osteoporosis.^4,7
• Both aerobic and anaerobic
  • Increased HDL cholesterol, improved adipose tissue distribution, increased insulin sensitivity, improved cognitive function, increased metabolism, reduced incidence of cardiovascular disease and stroke.⁴

Below are two graphics to help guide further research on exercise and support talking points of exercise benefits to patients, friends, family, etc. Figure 1 illustrates a handful of physiological benefits of exercise. Figure 2 provides a visual of the Office of Disease Prevention and Health Promotion, ODPHP, guidelines for moderate- and vigorous-intensity exercise via its Move Your Way initiative. The initiative aims to promote movement and physical activity in all individuals regardless of their physical ability.

Figure 1: Summary of Effect of Exercise on Cardiovascular Risk Factors

Figure 2: Implementation of Physical Activity Guidelines - Move Your Way Initiative

Exercise Examples

This next section discusses exercises to consider and some I enjoy implementing in my routine. One of the most important tasks to complete before and after a workout routine is stretching to keep your muscles loose and activated to reduce injury risk. I have linked two stretching routines from the National Academy of Sports Medicine and the Arthritis Foundation - Upper Body and Lower Body.

Table 1 highlights aerobic exercises that can be implemented into weekly and monthly exercise routines. These exercises can be done at home or at a gym. With each exercise, gradually increase your pace and duration to meet and set new goals. As always, stretch before and after!

Table 1 Examples of Aerobic Exercise Routines

Important considerations for the above exercises include the following:

• Proceed at a comfortable pace to reach and maintain target heart rate.
• With each exercise session, aim to gradually increase duration and pace of each set and total exercise time.
• For walking, aim for at least 10,000 steps daily. Start with your base, the current amount you walk each day, and slowly increase your daily step count. Increase your daily steps by 500 to 1,000 every 1-2 weeks until goal is met. Increase step goal after previous goal is met.
• For beginner runners, run for 20 to 30 minutes twice a week. Consider alternating between 5 minutes of running and 1 minute of walking to start if needed.
• For any aerobic exercise, add 5 minutes to your Total Time of Workout Session each week to increase exercise duration.

For anaerobic exercises, I want to start by providing resources for calisthenics that can be implemented into weekly and monthly exercise routines. Calisthenics are exercises that utilize body weight for resistance to improve strength. They are great for everyone but especially helpful for beginner exercisers. These exercises can be done at home or at a gym. Men's Health and NASM provide comprehensive, visual examples to craft a regimen that is easy to follow. Both programs involve 9-10 exercises that are effective for muscle growth. I chose these two routines because they ensure that the upper body, lower body, and abdominals are targeted. Begin at a comfortable pace, and increase your pace over time. This will result in a gradual increase in the number of reps per set for each exercise session. Target 30-90 seconds of rest between each exercise.

For advanced, or seasoned, exercisers, I have included a 21-day circuit training regimen from Gymaholic. I chose this regimen because it targets different body areas each day with a recovery day on Day 4 and a rest day on Day 7 for each of the three weeks. The program also includes a cardiovascular warmup and three different levels of rest between each circuit. It is also helpful for those looking for a guided, multi-week workout plan. It can be repeated after 21 days.

For those interested in weightlifting for the first time, please consult with a physical trainer. Understanding proper form and safety precautions is extremely, and I mean extremely, important before beginning your weightlifting journey. I am more than happy to answer any questions and/or direct those with questions to helpful resources! I utilize weight lifting and strength training as a time to decompress after work. It is where I enter a very relaxed mindset each day, so I look forward to this time to keep my muscles engaged and active. A common regimen includes a push day (focuses on chest and triceps), a pull day (focuses on back and bicep), and a leg and shoulder day. Note: I purposefully linked these three days to different websites to expand the resource network for readers as well as to illustrate that there is an endless amount of resources available on the internet. My hope is that a writer, organization, or website appeals to you to formulate your workout regimens or take your current regimen to the next level. Similar to the Gymaholic article above, my routine consists of days dedicated to specific areas: chest, back, legs, shoulders, and arms. I previously followed a push-and-pull day program and now prefer the five-day regimen simply to switch things up and dedicate a day to targeting arms.

I cannot emphasize enough that safety is extremely important when participating in strength training. Three tenets that I learned back when I started and carry with me are:

• Form: Maintaining proper form is crucial to prevent injuries, especially during explosive movements.
• Progression: Start with a lower weight and gradually increasing as your fitness level improves.
• Listen to Your Body: Take breaks when needed and adjust weight or repetitions based on how you feel.

These are simple, yet effective, statements that are gentle reminders to be safe with all mediums of exercise. This will avoid injury and aid in reaching your goals. To reiterate from Part 1 of this series, physical activity is the gift that keeps on giving. You will continuously achieve progress and see results. As we close on 2024, I hope that the new year brings abundance to all facets of your life. May this season mark a time of warmth, good health, accomplishment, and excitement for new beginnings and continued success. Wishing you and yours a very Merry Christmas, Happy Hanukkah, and Happy Kwanzaa!

References:

1. Piercy KL, et al. Office of Disease Prevention and Health Promotion. The Physical Activity Guidelines for Americans. JAMA. 2018;320(19):2020-2028. doi: 10.1001/jama.2018.14854.
2. Thompson PD, et al. American College of Sports Medicine. ACSM's New Preparticipation Health Screening Recommendations from ACSM's Guidelines for Exercise Testing and Prescription, Ninth Edition. Curr Sports Med Rep. 2013;12(4):215-7. doi: 10.1249/JSR.0b013e31829a68cf.
3. Ferguson B, American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription 9th Ed. 2014. J Can Chiropr Assoc. 2014;58(3):328.
4. Patel H, et al. Aerobic vs anaerobic exercise training effects on the cardiovascular system. World J Cardiol. 2017;9(2):134-138. doi: 10.4330/wjc.v9.i2.134.
5. Maeda S, et al. Aerobic exercise training reduces plasma endothelin-1 concentration in older women. J Appl Physiol. 2003;95(1):336-341. doi: 10.1152/japplphysiol.01016.2002.
6. Sangaralingham SJ, et al. The aging heart, myocardial fibrosis, and its relationship to circulating C-type natriuretic Peptide. Hypertension. 2011;57(2):201-7. doi: 10.1161/HYPERTENSIONAHA.110.160796.
7. Chang X, et al. Regulation of Bone Health Through Physical Exercise: Mechanisms and Types. Front Endocrinol. 2022;13:1029475. doi: 10.3389/fendo.2022.1029475.

*Information presented on RxTeach does not represent the opinion of any specific company, organization, or team other than the authors themselves. No patient-provider relationship is created.