Sunday, October 12, 2008

Warrior Training -- Sustain a STRRIDE

These Duke University cardiologists performed an RCT (randomized controlled trial) on exercise intensity and frequency and found that large big puffy HDLs are can be achieved with exercise and can be degraded by 'de-training'. They found "In conclusion, physical inactivity has profound negative effects on lipoprotein metabolism. Modest exercise prevented this. Moderate-intensity but not vigorous-intensity exercise resulted in sustained VLDL-triglyceride lowering. Thirty minutes per day of vigorous exercise, like jogging, has sustained beneficial effects on HDL metabolism."

Inactivity, exercise training and detraining, and plasma lipoproteins.

STRRIDE: a randomized, controlled study of exercise intensity and amount.
Slentz CA, Houmard JA, Johnson JL, Bateman LA, Tanner CJ, McCartney JS, Duscha BD, Kraus WE. J Appl Physiol. 2007 Aug;103(2):432-42.
Division of Cardiology, Duke Univ. Medical Center, Durham, NC 27710, USA.

Exercise has beneficial effects on lipoproteins. Little is known about how long the effects persist with detraining or whether the duration of benefit is effected by training intensity or amount.

METHOD OF MADNESS: Sedentary, overweight subjects (n = 240) were randomized to 6-mo control or one of three exercise groups:
  1. High-amount/vigorous-intensity exercise (equivalent to jogging 20 miles/wk (32.0 km) at 65-80% max effort -- approx 10,000 steps 4 days per week)
  2. Low-amount/vigorous-intensity exercise (equivalent to jogging 12 miles/wk at 65-80% of max effort)
  3. Low-amount/moderate-intensity exercise (equivalent to walking 12 miles/wk (19.2 km) at 40-55% of max effort) -- THIS IS THE TRACK YOUR PLAQUE MINIMUM. Remember...all things in moderation except love and laughs.

Training consisted of a gradual increase in amount of exercise followed by 6 mo of exercise at the prescribed level. Exercise included treadmill, elliptical trainer, and stationary bicycle. The number of minutes necessary to expend the prescribed kilocalories per week (14 kcal x kg body wt(-1) x wk(-1) for both low-amount groups; 23 kcal x kg body wt(-1) x wk(-1) for high-amount group) was calculated for each subject. Average adherence was 83-92% for the three groups; minutes per week were 207, 125, and 203 and sessions per week were 3.6, 2.9, and 3.5 for high-amount/vigorous-intensity, low-amount/vigorous intensity, and low-amount/moderate-intensity groups, respectively. Plasma was obtained at baseline, 24 h, 5 days, and 15 days after exercise cessation.

ROARING RESULTS: Continued INACTIVITY resulted in significant increases (bad) in the control group:
(Do you think plaque progressed? HEYYLLL Y E A H)
--low-density lipoprotein (LDL) particle number
--small dense LDL--LDL-cholesterol
--weight gain (1kg = 2.2 lbs)
--body fat increases (8.6% abdominal belly fat increase in 6mos)

A modest amount of exercise training prevented this deterioration (good).

Moderate-intensity but not vigorous-intensity exercise resulted in a sustained reduction in very-low-density lipoprotein (VLDL)-triglycerides over 15 days of detraining (P less than 0.05)

WOW. Yup not bad, eh? Moderate intensity was actually just as good the vigorous activity for reducing weight, in fact, was better for these untrained/sedentary individuals for de-training VLDL-TGs and body fat reducations. This is my experience as well -- I need long sustained, moderate intensity exercise to burn (stubborn) fat and maintain weight. Obviously the longer duration the better, and either intensities in the trial were better than nothing. Here the graph exemplifying the benefits of moderate intensity for belly fat reduction over vigorous intensity (see bottom bar graph). Low amounts of moderate produced a reduction of 1.2% subcutaneous belly fat compared with a 3.1% increase in the low amount vigorous group.

Here the authors report the precise changes in body fat in the STRRIDE study Kraus WE et al J Appl Physiol 2005 Oct;99(4):1613-8: HERE

Their conclusions from this analysis: "The equivalent of 11 miles of exercise per week, at either intensity, prevented significant accumulation of visceral fat. Controls gained visceral fat (8.6% BF +/- 17.2%; P = 0.001) in 6 months. Significant gains in visceral fat over only 6 mo emphasize the HIGH COST OF CONTINUED INACTIVITY. A modest exercise program, consistent with recommendations from the Centers for Disease Control/American College of Sports Medicine (CDC/ACSM), prevented significant increases in visceral fat." The highest exercise group lost ~ 7% body fat in only 8 months. Roughly approx one inch off the inches measured at our belly button (umbilical) is equivalent to approx 1% body fat. My personal experience mirrors these experimental measures. At moderate intensity which is equivalent to ~ 60% of our peak oxygen output, we our maximally in our aerobic fat-burning mode. Our muscles' (including the heart muscles) preferred energy source is fatty acids -- these are the longest burning 'logs' that fuel moving muscles. Sustained moderate intensity movement draws from our fat reserves the most optimally. Now, with that said, we do require a little intensity in life. My trainer once told me at the end of the workout, push the intensity to 70-80% for 1-2 minutes for speed and power later. Adding strength training and weights potentiates strength and burns visceral fat further (toxic fat enclosing our viscera/offal/organs, livers/gallbladders/hearts/etc). So minimum 11 miles per week? And for maximum gluteus maximus, squats + walking 20 miles per week?

The high-amount group had significant improvements in ALL the benefits below that were sustained for 15 days after exercise stopped:
--high-density lipoprotein (HDL)-cholesterol
--HDL particle size
--large HDL levels

The more, the better the HDLs.

Modest WALKING 10,000 steps most days... INTENSE PLAQUE BUSTING POWER!
I like that. And the benefits can be sustained and uncompromised despite times when I can't get off my beautiful bum.

I really really really like T H A T .

Group Three is what we try to attain at the Track Your Plaque program at the mininum. But after conditioning and some practice, a moderate amount at moderate intensity is preferred for its lipoprotein-shifting, insulin-sensitizing, mood-elevating, stress-busting benefits.

Use a pedometer. Gradually work up to an ultimate goal of walking (not jogging) 10,000 steps per day. More details

Walk. Sustain a STRRIDE.

Sixty minutes at 60% of max effort for 6 days of the week. 60-60-6. Sound familiar? 60-60-60-60 Rules for Regression.

Is that devil-talk?

We are not talking 'elite' athlete training or even amateur-weekend-athlete training. We are talking from an untrained, sedentary, have-not-exercised-since-Reagan-was-in-office perspective.

Aim to start LOW and go SLOW.

Take time to build up tendons, ligaments, strengthen joints and condition the lungs and other apparatus. Always warm up for the minumum 10-20 min in order to prevent injury or pulling a hamstring (my Achilles -- this used to frequently happen to me and derail training for 3-4mos -- but not now with squat exercises *smile* luv em). With the weather cooling now, warming up consistently and regularly will be the key to sustaining a program without disturbing injuries which would undoubtedly halt any well-intended program.

If you have not embarked on an exercise program before, then start first by asking your physician/cardiologist for an exercise stress Thallium to first assess flow, ischemia and changes on EKG. It is prudent for even well-trained elite athletes to undergo this test as well (as many have done and reported at the TYP forum) to make sure no underlying asymptomatic pathologies exist.

FINAL CONCLUSIONS: In conclusion, physical inactivity has profound negative effects on lipoprotein metabolism. Modest exercise prevented this. Moderate-intensity but not vigorous-intensity exercise resulted in sustained VLDL-triglyceride lowering. Thirty minutes per day of vigorous exercise, like jogging, has sustained beneficial effects on HDL metabolism. PMID: 17395756


Andrew said...

Unfortunately for some of us, there is no such thing as "moderate" exercise. Heck, 20 miles per week at 65-80% oxygen consumption would be an exercise regime that I consider "very light."

It would be interesting to see the results of LDL and HDL levels for high performance athletes and not just overweight people.

Dr. B G said...

I agree -- couldn't find much! Would love to look at Lance Armstrong's NMR results :)

Their HDLs probably vary -- depending on overtraining v. not overtraining, genetics, fat intake, dietary cholesterol, carb intake. Elite athletes and power lifters who train 2-3 h/day often do show high Lp(a).

Here is one interesting article about athletes and hormonal adaptations to stress:
Stress adaptation -- depends on HDL, testosterone and cortisol


Anonymous said...

This ties in mincely with Mark Sisson's

"Move slowly a lot, run very fast occasionally, lift heavy things" mantra

All the components have different effects on the end results and all are neccessary.

Dr. B G said...

Hey Hawwwt GRRRLL,

Exactly yes -- we all call it different things. Mark doesn't call it cardio, he calls it 'play'.

Raising the heart rate is what animals are meant to do -- it's in our DNA...

You have a great blog!


Anonymous said...

"Hey Hawwwt GRRRLL"

Huh??? That's the ED and neuropathy, my willy didn't quite drop off yet but it's still there

"You have a great blog!"

I might have one day when I get it finished, only I spend most of my time reading rather than writing.

You can understand why doctors don't know any of this stuff. there's so much of it and so many sources. Easier just to accept Conventional Wisdom from pharma flyers.

Dr. B G said...

Hello Mr. Trinkwasser,

I need to catch up! I am so sorry about the mistaken gender!!