Exercise: How Much Is Enough?

Two of my favorite physician bloggers have both weighed in on a heavy topic and I wanted to discuss it myself.  One of the physicians who supervises Biggest Loser contestants on the shows presented some research on some of the contestants and determined that intensive exercise programs, like Biggest Loser, can actually reverse disease like diabetes, hypertension and improve other health markers.

• Dr. John M - Did you Hear Any Real World Messages from Biggest Loser Science
• Yoni Freedhoff - Biggest Loser MD, Deluded, Unethical or Clueless

This study confirms what I've come to believe from observation of many people with heart disease.  You hear those miracle stories of people who stop taking their diabetes medications because they have started running or signed on to some bootcamp program.  As Dr. M says, this study confirms that exercise CAN improve health markers.  In my personal experience, it doesn't have to be quite as intensive as "The Biggest Loser."  People can hardly find four hours a day to exercise.  If it has to be four hours a day, we're all in big trouble.

I think the problem with some people and exercise is intensity.  Dr. M hits on this.  I was watching Dr. Oz the other day and he was saying that things as simple as parking at the back of the parking lot can cure obesity.  There's also the book 10,000 Steps a Day to Your Optimal Weight, which says taking small steps, like Dr. Oz speaks of, will end in your ultimate goal weight.

My personal opinion of this low intensity exercise is that it doesn't produce results if you're already diseased, though little steps like that may be part of an overall picture that will prevent disease.  If you're diseased, it takes more.  Just the other day someone was telling me, "I've been walking on the treadmill 20 minutes a day like my cardiologist said for months.  I haven't lost any weight.  I give up."  It's hard to convince someone about the benefits of exercise when they don't see results.  When I queried this person further, I found out he walks, but not enough to really sweat.  He does a very low intensity walk because he says it's uncomfortable, not painful, to go any faster.

Sometimes I think our bodies are out to get out us.  Mine seems to love sitting on the couch and eating Doritos.  It seems happy when I do this, but my brain knows the end results.  I'm a distance runner.  Whenever I push it, I can feel it.  My body says, "Whoa, slow down.  Don't go this far."  The human body has perfected homeostasis.  It wants to stay the same.  We have to fight that.  That's why exercise is "uncomfortable." 

That being said, exercise shouldn't be painful.  If you have chest pain or pain while exercising, of course don't push it.  "No pain, no gain" is a myth.  Muscle aches after exercising are normal, but real pain tends leads to injury.  Injury leads to giving up exercise.  How do you know how hard to push?  How do you find that limit between uncomfortable and pain?  That will be different for every person and every medical condition.  Listen to your body and your physician and make the decision. 

Back to the study. Obviously, I think moderate or intense exercise is important.  Do I really think four hours a day is needed?  I've seen results from much less.  I think consistency is more important than duration.  Thirty minutes to an hour three times a week is what is recommended currently and, for most people, 30 minutes of moderate to intense activity is enough to see results in my anecdotal experience.

Let's be clear: most Biggest Losers contestants are more diseased than most of us.  We are a fat nation, but contestants on that show are outliers.  They are morbidly obese. Maybe they do need the intense intervention. Maybe there's a point where you can damage your body so much it won't ever bounce back to "normal."  I would like to see what happens to the Biggest Losers when they get back to the real world.  Do they still exercise four hours a day?  How much does it take once the weight is off? I have a feeling we'd find that it takes much less.

The rest of us?  I doubt it takes four hours.  In my experience what fits into your schedule is most important.  I've seen people lose lots of weight with intense programs (not as intense as Biggest Loser), only to put it back on when they couldn't keep up with it.  When they can't keep up, they just quit.  Would they have still put the weight back on if they'd modified their schedule? Maybe instead of a daily 2 hour bootcamp, a daily 30 minute workout?  I've found that keeping it up over time is the most important factor.

Keeping it up means always pushing your limits.  Like I said before, your body likes to stay the same. You have to keep pushing because your body adapts.  Pretty soon, you won't feel uncomfortable anymore, and we'll be in the same spot.