Go outside and play!

If you are like most people, you have probably spent much of the day indoors, probably sitting. In fact, this is likely how you spend most days. According to one survey, the average American may spend up to 15 hours per day sitting at work or at home. If you subtract sleeping, this accounts for nearly the entire day!

Prolonged sitting has been linked to negative health effects that are similar to those of not exercising. Even among people who do exercise, those who spend more time sitting tend to have more health problems than those who are more active during the day. Consider yourself lucky if you have a job that keeps you active.

The good news is that you can offset the health effects of sitting too much. Taking short breaks at work can improve attention and productivity. In fact, many time management and productivity techniques include periods of focused work separated by breaks. Using these breaks to get up and move is good for your body and your mind. The same is true at home—getting off the couch during TV commercials can have the same benefits.

Even greater benefits can be gained from dedicating more time to be active, especially regular exercise. A lower risk of weight gain, diabetes, heart disease, and some cancers are among a long list of positive health effects of physical activity. Lesser known benefits include improved mental health, cognitive function, and greater feelings of wellbeing.

Being active in a natural environment seems to have an even bigger impact on mental health. This is the topic of my Health & Fitness column in the Aiken Standard this week.

Indeed, activity outdoors leads to enhanced feelings of energy and diminished fatigue, anxiety, anger, and sadness compared to similar activity conducted indoors. Additionally, some research suggests that outdoor activity may improve attention in adults and children.

Another advantage of exercising outdoors is that you might get a better workout. This is mostly due to the fact that you will likely walk or run faster outdoors, but other factors like wind resistance add to your effort. Research shows that even though people tend to exercise at a higher intensity outside, they don’t necessarily feel it. In fact, ratings of effort are lower outdoors for the same exercise.

This because the pleasant visual stimuli outdoors distracts you from unpleasant sensations of effort during exercise. This is the same reason that listening to music makes exercise more enjoyable and why fitness centers have televisions on the walls or built into exercise equipment. Think of the outdoors as a really big TV screen!

Almost any indoor exercise can be moved outdoors. While walking, running, and cycling are most obvious, resistance training exercises using body weight and many high-intensity interval training workouts can be modified for outdoors. Yoga and aerobics classes in the park are also great ways to promote both the physical and psychological benefits of exercise.

Much of the psychological benefit of outdoor exercise occurs in the first five minutes, so even short bouts of activity are meaningful. It also means that going for a short walk outside when you have a break at work or walking instead of driving short distances can have positive effects. At home, taking the dog for a walk, playing outside with the kids, or doing yard work are good ways to be active and reap the benefits of being outdoors.

Every little bit of activity you do outdoors will have both physical and psychological benefits to help you become and feel healthier. So, go outside and play!

That’s NOT fruit!

Making healthy food choices is never easy. It is made more challenging by the fact that some foods that appear to be a smart choice may be less healthy than you think.

This is the topic of my Health & Fitness column in the Aiken Standard this week. It is a topic I have addressed in the past that is still relevant today. Specifically, regarding what my kids picked for breakfast this morning! This shouldn’t be a surprise, since many foods that look healthy, but aren’t are breakfast foods marketed to children.

Often, prepackaged fruits and vegetables contain added sugar, fat, or salt, making them less healthy than eating them fresh. Consumption these foods can also make it less likely that people—especially children—will eat fresh fruits and vegetables when they are available.

The problem is that these foods may look like fruit. They may even contain real fruit juice. But many drinks and snacks–especially for kids– that look like fruit are really candy in disguise.

Here are a couple of examples of foods that may appear to be healthy but, upon closer examination, turn out to be less nutritious than we might think.

Fruit snacks: These gummy fruit treats are a favorite among kids. If you check the package you will probably see that they contain real fruit or fruit juice, so they must be healthy, right? While there is variation among different brands, in most cases these snacks contain little, if any, actual fruit. If you read the ingredients you will see that they do contain lots of added sugar, meaning that many of these snacks are essentially candy. In fact, if you compare some brands of fruit snacks with something that is easily recognized as candy, such as gummy bears, you will see that they have a similar sugar content.

Fruit drinks: Not everything that looks like fruit juice is actually juice. Take Sunny D for example. This popular orange drink contains mostly sugar and water—and only 5% juice. By contrast, real orange juice contains fewer calories and more vitamins per serving. In fact, if you compare the ingredients and nutrition information, Sunny D is essentially orange soda without the bubbles!

There are two problems with this. First, some foods that appear to be healthy because they either claim to or actually do contain fruit are actually less healthy than we might believe. Considering that fruit snacks and fruit drinks are likely to be consumed as alternatives to real fruit juice or a piece of fruit as a snack, these foods could lead to poor nutrition. This is especially true in children.

Second, sweetness is one of the most important tastes we respond to. Consuming food and beverages that are flavored like fruit but are actually much sweeter may make real fruit less palatable. Again, this is especially true for children who may develop an expectation that strawberries should taste like strawberry-flavored fruit snacks or that orange juice should taste as sweet as Sunny D. These kids are likely to prefer the sugar-sweetened version over the real fruit. Since these sugar-sweetened “fruits” tend to be higher in calories, consumption of these foods is one contributor to childhood obesity.

This isn’t just the case with fruit. Adding salt and sauces to vegetables makes them more flavorful, to the point that many of us don’t eat plain vegetables very often. The majority of potatoes are consumed in the form of French fries, loaded with both fat and salt. This has changed how we expect potatoes to taste so that now we typically eat baked potatoes “loaded” with butter, sour cream, cheese or bacon. When was the last time you ate a plain baked potato?

But there are some simple steps you can take to get back to eating real fruit and vegetables. Look for 100% fruit juice or, better yet, a piece of fruit instead of fruit-flavored drinks. Instead of sugar-sweetened fruit snacks, try dehydrated fruit. Cut back on the salt, butter, and other toppings you add to vegetables or purchase frozen vegetables without added sauces.

HIIT me, again!

The next time you are at the gym sweating through an hour on the elliptical machine or going for a long run to improve your fitness, think about this: you may be able to get the same benefits with just a few minutes of exercise. It’s not as easy as it sounds, though. The exercise has to done at a very high intensity, often in short intervals.

This type of exercise is called high-intensity interval training (HIIT), which involves multiple bouts of very intense exercise separated by periods of rest or light exercise. I have written about this type of training previously, but new research and the popularity of HIIT training programs warrant revisiting this topic in my Health & Fitness column in the Aiken Standard this week. And although high-intensity training is effective for improving fitness and burning calories, it may not be right for you.

Exercise to improve cardiorespiratory fitness typically involves 20–60 minutes of moderate to vigorous exercise done 3–5 days per week. This type of exercise is common for people who are training for an event like a 10k run since it leads to improvements in maximal exercise capacity (called VO2max) and endurance by increasing heart function and promoting changes in the muscle. This type of training is also followed by most people who are interested in losing weight or getting in shape, even if they don’t plan to compete in a race.

Research and practical experience have shown that shorter HIIT sessions can be effective, too. The length and intensity of the intervals vary both in the research and in practice. For example, in one study these intervals were as short as 30 seconds of all-out, maximal exercise separated by rest periods, for a total of just six minutes of exercise per day. Other studies employ slightly less intense (still 90% of maximal heart rate) intervals for a total of 20 minutes of exercise per session. The results show that HIIT leads to adaptations in the muscle and improvements in VO2max that are greater than that of more traditional, lower intensity exercise.

A study published last month showed that even one bout of high-intensity exercise can promote changes in the muscle that lead to improved endurance. This study compared the effect of four 30-second bursts of very intense exercise separated by four minutes of recovery with a single 4-minute bout of vigorous exercise. Both promoted a similar effect on blood and muscle markers that lead to improvements in fitness. This suggests that both sustained and interval exercise can be effective, as long as the intensity is high enough.

Does this mean that high-intensity training is right for you? It depends on several factors. First, the risk of injury during intense exercise is greater than during more moderate exercise. At the very least, exercise of this intensity is likely to be uncomfortable. Second, exercising at a high intensity may not be a good idea if you are not already in good shape or have other health problems like diabetes or high blood pressure. Third, HIIT may not be the best way for you to meet your exercise goals. If you exercise to lose weight your emphasis should be on duration, not intensity, to burn calories. If you are trying to build endurance for a marathon or long distance bike ride, you really do need to focus on longer duration exercise.

For most people, there is little harm in trying some higher-intensity exercise, even just one day per week. In fact, many group exercise classes are designed to be a high-intensity workout, so this might be a good way to add more intense training sessions to your exercise routine.


Physical activity at school in two infographics

This week I came across two infographics explaining the benefits of including physical activity in the school day and ways kids can be active at school.

Having opportunities to be active throughout the day benefits children in many ways, from improving their health, helping them maintain a healthy weight, and promoting learning. In fact, physical activity through recess, structured PE class, and other unstructured activities is absent at many schools. This represents a missed opportunity to teach children about the importance of being active.

According to these infographics, though, engineering activity into the school doesn’t have to be difficult. And including physical activity in the school day makes children believe it is important (which it is) and helps develop habits that will last into adulthood.


The Role of Schools in Promoting Physical Activity | via Active Living Research


Screen Shot 2014-03-06 at 8.14.35 PM

Get 60 Minutes | via Institute of Medicine


Now if we could just do something about the quality of school lunches!

Subway’s identity problem (and why it matters).

If you are looking for a healthy place to eat lunch, chances are you will think of Subway. More than any other fast food restaurant, Subway has developed a reputation for being a healthy choice, consistent with losing weight and an active lifestyle. While you can get healthy food at Subway, you may end up eating a meal that is similar to traditional fast food in terms of calories, fat, and sodium.

This “identity problem” — Is it a healthy option to regular fast food? Or just an alternative to fast food? —  is the topic of my Health & Fitness column in the Aiken Standard this week.  This matters, of course, because you may well be fooling yourself into thinking you are making healthy choices when you aren’t.

Subway has long been thought of a healthy alternative to traditional fast food. This is largely due to a menu that has fresh-looking sandwiches rather than burgers and fries. Food at Subway looks healthy. This image is enhanced by a marketing strategy that associates Subway with health and wellness, something they seem to do better than any other fast food chain. Advertisements featuring former Olympians were abundant during the winter Olympics television broadcasts and the continuing association with Jared Fogle, who lost nearly 250 pounds by drastically changing his diet—including eating at Subway—and becoming more active strengthen this image.

The Subway menu does include several sandwiches designated as Fresh Fit choices that are low in fat and calories and could contain a full serving of vegetables. If you read the fine print you will see that this is true if you order a 6-inch sandwich on plain bread with meat and veggies, but no condiments or cheese. Adding mayo, sauces, and cheese or substituting another bread will increase the calories and fat in the sandwich. But, if you make smart choices, select a healthy side such as apple slices, and have water, unsweet tea, or another calorie-free drink, you can get a healthy, low-calorie meal.

However, that does not mean that all of the sandwiches at Subway are good choices if you want limit calories or fat. One of the sandwiches featured currently is the Fritos chicken enchilada sandwich, which is served exactly as it sounds: shredded chicken topped with enchilada sauce and Fritos chips. But if it comes from Subway it must be healthy, right?

Wrong! If you look at the nutrition information you will find that this sandwich has 580 calories, 26 grams of fat (which account for 40% of the calories), and 1170 milligrams of sodium (nearly half of what you should get in a whole day). The best traditional fast food comparison is the Big Mac at McDonald’s, which has 550 calories, 29 grams of fat, and 970 milligrams of sodium. Considering that many people eat at Subway in an effort to avoid the fat and calories of fast food, this would not be a good choice.

The point is that while you can get a healthy meal at Subway, many menus items are as high in fat, calories, and sodium as food at other fast food restaurants. The image that Subway has carefully cultivated likely conceals this fact, leading people to think they are eating a healthy meal when, in reality, they are not. It is also possible to get a meal at McDonald’s and many other fast food restaurants that is nutritionally similar to the healthier sandwiches at Subway.

This is a good lesson, since menus at many restaurants include a “healthy choices” section. Keep in mind that food that appears to be healthy may not be and that a restaurant typically thought of as a poor choice may have healthy menu items. The trick is to check out the nutrition information and make smart choices.

Sports Science at the Winter Olympics

So, the 2014 Winter Olympics wrapped up with the closing ceremony yesterday. If you have been watching the Olympics you have seen some incredible performances. The competitors are among the fittest and most highly trained athletes in the world, both in terms of laboratory measures of fitness and in subjective evaluations of skill. Competing in the Olympics requires years of focused, intense training and some good luck.

In my Health & Fitness column in the Aiken Standard this week I take a look at the  physiology that goes in to training for and competing in the Olympics.

First, let’s look at the fitness. This is most evident in the endurance events like cross-country skiing and speed skating. The key to performance in long-duration events like these is for the muscle to contract repeatedly and forcefully without fatigue. In order to do so, the muscle must have a steady supply of oxygen and nutrients. These nutrients are delivered through the blood, which is pumped to the muscle by the heart. The muscle takes up and uses these nutrients to produce ATP, the form of energy used by the muscle.

After months and years of endurance training the heart gets bigger 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 sustain a higher intensity (skiing speed, for example) for a longer time without fatigue.

How fit are these athletes? In the laboratory we measure VO2max, the maximal rate at which oxygen can be used by the muscle to power exercise, during intense exercise. While we don’t have test data on most Olympic athletes, cross-country skiers tend to have the highest VO2max values, followed closely by distance runners and cyclists.

While all Olympic athletes are all very physically fit, other events rely more heavily on skill including figure skating and freestyle snow boarding. For example, in figure skating completing a triple axel involves leaping into the air, spinning three and a half times, and landing backwards. On a 4 mm wide blade. On ice. Or think about the triple cork 1440, a snowboarding trick that involves flipping three times in the air while doing four 360-degree turns.

The athletes who are able to successfully complete these maneuvers have practiced for years to develop the skill and confidence needed to perform them consistently in competition. These are some of the most obvious displays of athletic skill, but all events require good technique. The development of skill in addition to fitness is the main reason why athletes specialize in one area and you don’t see people competing in both downhill skiing and speed skating, for example.

Of course, there is a psychological aspect to Olympic performances. The motivation to put in the training time alone is remarkable. Even more impressive is the ability to focus on an event despite the distractions of the crowds, media, and pressure of competition. This combination of physical and mental preparation is rare—as rare as Olympic gold medalists!

The training and preparation followed by bobsledders provides a good model for what goes into creating an Olympic athlete.

But is training alone sufficient for Olympic-level performance? Could anyone who trains enough make it to the Olympics? The answer is no, because there is another important factor in athletic performance—luck. Luck refers to genetics, which determine potential for attributes like heart size and muscle characteristics. As much as 50% of performance in some events is attributed to genetics. One sports physiologist famously answered the question, “How do I become an Olympic champion?” with “pick the right parents!”

There is more that I am missing (on purpose, because I have a word limit in my column). One additional key factor is nutrition. Despite what Subway would have you believe, Olympic athletes don’t really eat a lot of sandwiches with Fritos on them. In fact, this is a good overview of what US Olympians eat to fuel their training and competition.

Even though most of us will never become Olympic champions we can still experience many of the same benefits of training. All athletes train to develop strength, endurance, and flexibility, which is exactly what we should do, too. And those attributes will help us perform better at work (and play) and help us live a longer healthier life. It will also help us appreciate the training, dedication, and good luck that the athletes bring to the Olympic games.

Reducing your risk of heart disease

February is Heart Month, an ideal time to assess your risk of heart disease and take steps to improve your health. This is important because heart disease, sometimes called coronary artery disease, is the leading cause of death among adults in the United States. It is responsible for nearly 600,000 deaths each year, mostly from heart attacks. Millions more are at increased risk because of certain biological and behavioral risk factors.

Identifying your personal risk for heart disease and making efforts to improve your heart health is the topic of my Health & Fitness column in the Aiken Standard this week.

Some of these risk factors cannot be changed, such as age, sex, and family history, while others can be altered to reduce risk. These modifiable risk factors include smoking, high blood pressure, high cholesterol, diabetes, obesity, and physical inactivity. While your doctor can play an important role in treating these conditions, there is much you can do on your own to improve your heart health.

The first step is to get a good assessment of your heart health. If you haven’t done so recently, you should see your doctor to have your risk factors evaluated. This includes tests for blood glucose and blood lipids (including total, LDL, and HDL cholesterol and triglycerides), measurement of your blood pressure and body weight, and an assessment of other health factors such as your family history, whether you smoke, and your level of physical activity.

The next step is to treat the risk factors that you have. Depending on the severity and your own personal health history your doctor may prescribe medications to lower your blood pressure, blood glucose, or blood lipids. These medications are most effective when combined with lifestyle changes including good nutrition, exercise, and weight loss. In some cases, poor diet and lack of activity can counteract the beneficial effects of these drugs. Furthermore, these healthy habits may help you reduce the dosage, and limiting the side effects, or stop taking the medications altogether.

The other risk factors—obesity, inactivity, and smoking—really must be treated through lifestyle management. While there are medications that can help with smoking cessation and weight loss, being successful requires making lasting behavior changes. These habits can be difficult to change, and many people have tried before without success. Keep in mind, though, that everyone who is successful at quitting smoking, losing weight, or sticking to an exercise program has experienced his or her share of difficulty. The difference is that those people kept trying until they were successful. You can be successful, too.

Even small changes can have a big impact. Take exercise, for example. The benefits of as little as 30 minutes of physical activity per day are well established and impact heart disease risk in a multitude of ways. Physical activity helps with weight control, lowers blood pressure, improves blood lipids, and prevents and treats diabetes. Think of this as a great health “deal.” By modifying one risk factor—inactivity—you can also promote beneficial changes in four others—obesity, hypertension, high cholesterol, and diabetes. There is no other treatment, drugs included, which can have such a broad impact on reducing heart disease risk!

Of course, there are steps you can take beyond becoming more physically active to reduce your risk of heart disease. The list of beneficial changes you can make to improve your heart health is long, but keep in mind that even small changes can add up to a big benefit. 

Knowing which risk factors are most concerning can help you and your doctor make effective treatment decisions. Quitting smoking, increasing your physical activity (and reducing sedentary time), and eating a healthier diet can lead to improvements in heart disease risk factors and reduced heart attack risk. The best news is that these same changes can also reduce your risk of other serious health problems including many types of cancer, stroke, and lung disease.