Exercise

In the 1980s, the Soviet empire was falling apart. This led to shortages of food and fuel on the island of Cuba. People grew gardens and switched from driving to walking and biking. From 1991 to 1995, daily food intake dropped from 2,899 to 1,863 calories. And the percentage of physically-active adults increased from 30% to 67%.

Health benefits were dramatic. The average Cuban lost 10 pounds. Deaths dropped by 18% thanks to declines in heart disease, diabetes, and stroke.

The doctor of the future will give no medicine, but instead will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.

-Thomas Edison

Importance of exercise

Here are life-changing benefits:

Healthier

• 50% lower risk of diabetes

• 30% lower risk of heart disease

• 20% lower risk of stroke

• 10–30% lower risk of breast, colon, and liver cancer

• Live 3 years longer or more

Smarter

• 40% lower risk of Alzheimer’s disease

• 10–20% better memory, attention, and concentration

Happier

• 20% less depression

• 15% less anxiety

Attractive

• Prevent erectile dysfunction

• Men with medium-sized muscles can gain 3 points on a 10-point scale

Physical activity—even if you don’t lose an ounce, you’ll live longer, feel healthier, and be less likely to get cancer, heart disease, stroke, and arthritis. It’s the closest thing we have to a wonder drug.

-Tom Frieden

How to exercise

Exercise 30 minutes every day

• 10 minutes of aerobic training

• 10 minutes of resistance training

• 10 minutes of balance/flexibility training

Aerobic training

• To get a good workout in 10 minutes, do interval training that alternates high-intensity exercise to elevate your heart rate with low-intensity exercise to recover

  • • e.g., 30 seconds of sprinting then 2 minutes of walking

• To learn to run properly, read Chi Running: A Revolutionary Approach to Effortless, Injury-Free Running by Danny Dreyer

Resistance training

• Exercise major muscle groups twice per week: chest, arms, back, shoulders, legs

  • • e.g., push-ups, pull-ups, squats

• Rest at least 2 days before exercising the same muscle group

• Lifting to failure builds the most muscle

  • • e.g., many repetitions of low weight or fewer repetitions of high weight

• Eat protein immediately after exercising to build muscle

• If you don’t have access to a gym, do high-intensity circuit training using body weight

  • • e.g., search YouTube for “7-minute scientific workout”

Balance/flexibility training

• Do 10 minutes of yoga or tai chi

  • • e.g., search YouTube for a 10-minute yoga class

• Hold stretches for 30 seconds to get the best stretch

The best exercises are the ones you are willing to do.

-Scott Adams

How to start today

About 75% of Americans do not exercise enough. But you can with this 3-week plan:

• Week 1: jog for 10 minutes every morning

  • • Put a cue in a highly-visible place, like running shoes by your bed

• Week 2: add 10 minutes of yoga after jogging

• Week 3: add 10 minutes of resistance training after yoga

When I want to get something done, I start with a ridiculously small first step. If the step is small enough, there is no expected pain to stop you. Want to start running? Put on a pair of shoes. Want to start building muscles? Do one push-up.

-Karl-Mikael Syding

Personal notes

I do yoga every morning for 10 minutes. I like the first 12 of 26 postures for Bikram Yoga because they force me to be present or fall over. I hold each posture for 30 seconds. Also, I work at a desk and yoga prevents stiffness in my neck, shoulders, and lower back.

After yoga, I do resistance training for 15 minutes. I have a 3-day rotation that alternates bicep and tricep curls, push-ups, and pull-ups. I do 6 sets until failure and rest 60 seconds between sets.

After exercising, I eat oatmeal with peanut butter, blueberries, and banana. These foods have a low glycemic index, which means they release glucose slowly into my bloodstream. Protein in peanut butter builds muscle and keeps me full longer.

For aerobic exercise, I walk briskly at least 30 minutes per day.

I find it easiest to exercise first thing in the morning. My workout wakes me up and I often get ideas and insights.

Typically, people who exercise start eating better and becoming more productive at work. They smoke less and show more patience with colleagues and family. They use their credit cards less frequently and say they feel less stressed. Exercise is a keystone habit that triggers widespread change.

-Charles Duhigg

References

Franco M et al. (2007). Impact of energy intake, physical activity, and population-wide weight loss on cardiovascular disease and diabetes mortality in Cuba, 1980–2005. Am J Epidemiol. 166(12): 1374–1380.

• From 1991 to 1995, daily food intake dropped from 2,899 to 1,863 calories, and proportion of physically-active adults increased from 30% to 67%

• From 1997 to 2002, prevalence of obesity declined from 14% to 7%, and there were declines in deaths attributed to diabetes (51%), coronary heart disease (35%), stroke (20%), and all causes (18%)

Moskow A. (1999). Havana’s self-provision gardens. Envir Urban. 11(2): 127–134.

• During the food and fuel shortage in the 1990s, it is estimated that Havana had over 26,000 self-provision gardens, and more than 1 in 10 people received food from them

Healthier

Laaksonen DE et al. (2005). Physical activity in the prevention of type 2 diabetes: the Finnish diabetes prevention study. Diabetes. 54(1): 158–165.

• A 4-year study of 487 individuals found that moderate-to-vigorous exercise reduced risk of diabetes by 49%

Davenport MH et al. (2018). Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Br J Sports Med. 52(21): 1367–1375.

• A meta-analysis of 106 studies with 273,182 individuals found that exercise reduced risk of gestational diabetes by 38%

Cheng W et al. (2018). Associations of leisure-time physical activity with cardiovascular mortality: A systematic review and meta-analysis of 44 prospective cohort studies. Eur J Prev Cardiol. 25(17): 1864–1872. 

• A meta-analysis of 44 studies with 1,584,181 individuals found that risk of cardiovascular death was reduced by moderate exercise (23%) and high exercise (27%)

Li J, Siegrist J. (2012). Physical activity and risk of cardiovascular disease--a meta-analysis of prospective cohort studies. Int J Environ Res Public Health. 9(2): 391–407.

• A meta-analysis of 21 prospective studies with over 650,000 adults found that exercise reduced risk of stroke by 20%

Moore SC et al. (2016). Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med. 176(6): 816–825.

• An analysis of 12 cohort studies with 1.44 million participants found that high vs. low exercise reduced risks of 13 cancers: esophageal adenocarcinoma (42%), liver (27%), lung (26%), kidney (23%), gastric cardia (22%), endometrial (21%), myeloid leukemia (20%), myeloma (17%), colon (16%), head and neck (15%), rectal (13%), bladder (13%), and breast (10%)

Reimers CD, Knapp G, Reimers AK. (2012). Does physical activity increase life expectancy? A review of the literature. J Aging Res. 2012: 243958. 

• A review of 13 studies found that exercising increased life expectancy by a minimum of 2–4 years

Ekelund U et al. (2016). Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. 388(10051): 1302–1310.

• A meta-analysis of 16 studies with 1,005,791 individuals found that sitting >8 hours/day and exercising <1 hour/week increased risk of death by 59%

• 60–75 minutes/day of moderate exercise eliminated increased risk of death

Khera AV et al. (2016). Genetic risk, adherence to a healthy lifestyle, and coronary disease. N Engl J Med. 375(24): 2349–2358.

• A genetic study of 51,425 individuals found that the top quintile had a 91% higher risk of coronary events, but this could be lowered by 46% with exercise, healthy diet, and no smoking

Arem H et al. (2015). Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med. 175(6): 959–967.

• An analysis of 6 studies with 661,137 men and women found that exercising for 30 minutes/day lowered risk of death by 31% over 14 years

Swift DL et al. (2014). The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis. 56(4): 441–447.

• A review of studies found that exercise only had a 2-kg effect on weight loss

Wroblewski AP et al. (2011). Chronic exercise preserves lean muscle mass in masters athletes. Phys Sportsmed. 39(3): 172–178.

• A study of 40 high-level recreational athletes aged 40 to 81 who exercised 4–5 times/week found they did not experience age-related muscle loss

Puterman E et al. (2010). The power of exercise: buffering the effect of chronic stress on telomere length. PLoS One. 5(5): e10837.

• A study of 63 post-menopausal women found that exercise buffered effect of high stress on telomere length

Wu T et al. (2009). Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis. Obes Rev. 10(3): 313–323.

• A meta-analysis of 18 studies found that diet plus exercise resulted in weight loss of 3.34 kg vs. 1.38 kg for exercise alone

Smarter

Erickson KI et al. (2019). Physical activity, cognition, and brain outcomes: A review of the 2018 physical activity guidelines. Med Sci Sports Exerc. 51(6): 1242–1251.

• A review of 76 studies found moderate evidence from randomized controlled trials for moderate-to-vigorous exercise improving processing speed, memory, and executive function

• A meta-analysis of 15 prospective studies with 33,000 individuals found that greater amounts of exercise reduced risk of cognitive decline by 38%

• A meta-analysis of 10 prospective studies with >20,000 individuals found that greater amounts of exercise reduced risk of developing Alzheimer’s disease by 40%

Hamer M, Chida Y. (2009). Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence. Psychol Med. 39(1): 3–11. 

• A meta-analysis of 16 prospective studies with 163,797 non-demented participants found that exercise reduced risks of developing Alzheimer’s disease (45%) and Parkinson’s disease (18%)

Sanders LMJ et al. (2019). Dose-response relationship between exercise and cognitive function in older adults with and without cognitive impairment: A systematic review and meta-analysis. PLoS One. 14(1): e0210036.

• A meta-analysis of 37 studies found that exercise improved executive function (effect size = 0.27) and memory (effect size = 0.24)

• In older adults with cognitive impairments, exercise improved global cognition (effect size = 0.37)

Oaten M, Cheng K. (2006). Longitudinal gains in self-regulation from regular physical exercise. Br J Health Psychol. 11(Pt 4): 717–733.

• A study of 24 students who started exercising 3–4 times/week for 2 months showed they significantly increased self-control for behaviors such as smoking, drinking alcohol and coffee, eating junk food, healthy habits, over-spending, losing temper, missing appointments, and not studying

Happier

Rebar AL et al. (2015). A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations. Health Psychol Rev. 9(3): 366–378.

• A meta-meta-analysis of 92 studies with 4,310 participants found that exercise reduced depression (effect size = 0.50)

• A meta-meta-analysis of 306 studies with 10,755 participants found that exercise reduced anxiety (effect size = 0.38)

Zhang J, Chen W. (2019). A systematic review of the relationship between physical activity and happiness. J Happiness Stud. 20(4): 1305–1322.

• A review of 23 studies found that as little as 10 minutes of exercise per week significantly increased odds of being happy

• There was no difference in happiness levels between individuals exercising 150–300 minutes vs. >300 minutes/week

Pritchett RV, Daley AJ, Jolly K. (2017). Does aerobic exercise reduce postpartum depressive symptoms? a systematic review and meta-analysis. Br J Gen Pract. 67(663): e684–e691.

• A meta-analysis of 13 randomized controlled trials with 1,734 individuals found that exercise reduced postpartum depressive symptoms by 44%

Attractive

Gerbild H et al. (2018). Physical activity to improve erectile function: A systematic review of intervention studies. Sex Med. 6(2): 75–89.

• The leading cause of erectile dysfunction is arterial dysfunction, which is linked to cardiovascular disease

• A review of 10 studies found that exercise improved erectile dysfunction by 14–86%

• Moderate-to-vigorous exercise for 40 minutes, 4 times/week is recommended to treat erectile dysfunction

Frederick DA, Haselton MG. (2007). Why is muscularity sexy? Tests of the fitness indicator hypothesis. Pers Soc Psychol Bull. 33(8): 1167–1183.

• 286 female students rated silhouettes of men

• On a 9-point scale, average ratings were: non-muscular: 3, muscular: 6, and extremely muscular: 2

Crane JD et al. (2015). Exercise-stimulated interleukin-15 is controlled by AMPK and regulates skin metabolism and aging. Aging Cell. 14(4): 625–634.

• A study of 10 sedentary elderly adults found that 12 weeks of endurance exercise training reversed indicators of skin aging by 10–15%

Exercise guidelines

Garber CE et al. (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 43(7): 1334–1359.

• Aerobic exercise: At least 150 minutes of moderate-intensity exercise per week

  • • e.g., 5 days/week of 30–60 minutes of moderate-intensity exercise

    • e.g., 3 days/week of 20–60 minutes of vigorous-intensity exercise

• Resistance exercise: Train each major muscle group 2–3 days per week

  • • 2–4 sets with 8–12 reps improve strength and power

    • Wait at least 48 hours between training sessions

• Flexibility exercise: At least 2–3 days per week to improve range of motion

  • • Each stretch should be held for 10–30 seconds

    • Repeat each stretch 2–4 times

• Neuromotor exercise: 2–3 days per week

  • • e.g., yoga, tai chi

Rogers MA et al. (1990). Effect of 10 days of physical inactivity on glucose tolerance in master athletes. J Appl Physiol. 68(5): 1833–1837.

• A study of 14 male master athletes aged 59 to 63 found that stopping exercise for 10 days resulted in 29% developing impaired glucose tolerance

Aerobic training

Lee D et al. (2014). Leisure-time running reduces all-cause and cardiovascular mortality risk. J Am Coll Cardiol. 64(5): 472–481.

• A prospective 15-year cohort study of 55,137 adults found that runners had a lower risk of death (30%) and cardiovascular death (45%), and increased life expectancy of 3 years

• Running as little as 5–10 min/day and at slow speeds (<6 miles/hour) lowered risk of death by 28%

Gillen JB et al. (2016). Twelve weeks of sprint interval training improves indices of cardiometabolic health similar to traditional endurance training despite a five-fold lower exercise volume and time commitment. PLoS One. 11(4): e0154075. 

• A study of 25 men found that 5 minutes of sprint interval training (SIT) was equivalent to 45 minutes of moderate-intensity continuous training (MICT)

• SIT consisted of 3 sets of 20-second “all-out” cycle sprints interspersed with 2 minutes of slow cycling

• MICT consisted of 45 minutes of continuous cycling at 70% of maximum heart rate

Resistance training

Morton RW et al. (2016). Neither load nor systemic hormones determine resistance training-mediated hypertrophy or strength gains in resistance-trained young men. J Appl Physiol. 121(1): 129–138.

• A study of 49 healthy young men found that lifting to failure built maximal muscle

• Equivalent muscle was built with many repetitions of low weight or fewer repetitions of high weight

Moore DR et al. (2009). Ingested protein dose response of muscle and albumin protein synthesis after resistance exercise in young men. Am J Clin Nutr. 89(1): 161–168.

• A study of 6 healthy young men found that eating 20 g of protein after exercise stimulated maximum muscle growth

Klika B, Jordan C. (2013). High-intensity circuit training using body weight: Maximum results with minimal investment. ACSM Health Fit J. 17(3): 8–13.

• High-intensity circuit training (HCIT) combines aerobic and resistance training into a single exercise circuit lasting 7 minutes

• Since body weight is used for resistance, the regimen can be performed anywhere

• Exercises are performed for 30 seconds, with 10 seconds of transition time between exercises

• The circuit includes jumping jacks, wall sit, push-up, abdominal crunch, step-up onto chair, squat, triceps dip on chair, plank, high knees/running in place, lunge, push-up and rotation, and side plank

Melov S et al. (2007). Resistance exercise reverses aging in human skeletal muscle. PLoS ONE. 2(5): e465.

• A study of 14 older adults found that 6 months of resistance training reversed aging in skeletal muscle

Neuromotor exercise for balance and coordination

Zoogman S et al. (2019). Effect of yoga-based interventions for anxiety symptoms: A meta-analysis of randomized controlled trials. Spirituality Clinical Practice. 6(4): 256–278.

• A meta-analysis of 38 randomized controlled trials with 2,295 participants found that yoga reduced anxiety (effect size = 0.80)

Huang Z-G et al. (2017). Systematic review and meta-analysis: Tai Chi for preventing falls in older adults. BMJ Open. 7: e013661.

• A meta-analysis of 18 trials with 3,824 participants found that tai chi for older adults reduced risk of falling (20%) and rate of falls (31%)

Holtzman S, Beggs RT. (2013). Yoga for chronic low back pain: A meta-analysis of randomized controlled trials. Pain Res Manag. 18(5): 267–272.

• A meta-analysis of 8 randomized controlled trials with 743 patients found that yoga reduced functional disability (effect size = 0.65) and low back pain (effect size = 0.62)

Decoster LC et al. (2005). The effects of hamstring stretching on range of motion: a systematic literature review. J Orthop Sports Phys Ther. 35(6): 377–387.

• A review of 28 studies with 1,338 participants found that ideal stretch duration was 30 seconds

How to start today

Blackwell DL, Clarke TC. (2018). State variation in meeting the 2008 federal guidelines for both aerobic and muscle-strengthening activities through leisure-time physical activity among adults aged 18-64: United States, 2010-2015. Natl Health Stat Report. 112: 1–22.

• A study of 155,134 adults found that 22.9% met exercise guidelines for aerobic and muscle-strengthening activities

Personal notes

Jenkins EM et al. (2019). Do stair climbing exercise “snacks” improve cardiorespiratory fitness? Appl Physiol Nutr Metab. 44(6): 681–684.

• 24 young sedentary adults were randomly assigned to quickly climb a 3-flight stairwell (60 steps), 3 times/day, with 1–4 hours of recovery between each climb, and repeat this for 3 days/week for 6 weeks

• Stairwell climbers improved maximum aerobic capacity by 5%

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