Working Out With Bob, Erik, and (of course) Tony

Anyone who reads this blog knows that I am a huge fan of P90X.  I first learned about the program from a Sunday morning infomercial on TV, bought the DVDs in September of 2009, and wasn’t sure I would ever be able to do the whole thing. I started interspersing some of the workouts with ones I was currently doing.  Eventually I did P90X Lean, the slightly scaled back version, all the way through. Last year I advanced to Classic, the main version, and did that all the way through twice. 

This year, when I started on my third round of P90X it occurred to me that I wasn’t getting as much out of some of the workouts as I had previously. One of the ideas behind the program is that muscle confusion prevents you from getting to a plateau so you keep making progress indefinitely. A survey of the reviews of P90X on Amazon l tells me that this is wishful thinking. With any resistance workout, no matter how intense and varied, sooner or later you reach a point of diminishing returns. (Cardio workouts are different: the body doesn’t seem to care whether you’re running, swimming, or on a machine. As long as you keep your heart rate up high enough, long enough, at the right intervals, you’ll keep your condition.)

I would like to have done P90X2, but it requires more space for exercising and for storing additional equipment than I have in my house. I looked at Insanity, another Beachbody program, but the amount of high impact activity seemed like a bad idea for my 67-year-old knees. I finally settled on two workouts by Bob Harper, who is one of the coaches on “The Biggest Loser,” and Rushfit, a six-DVD series featuring Canadian martial arts champion Georges St. Pierre and led by trainer Erik Owings, who created the program.  All of these are great workouts and each has its advantages and drawbacks.

So I’m now doing a combination of all three programs, trying to keep a variety of different types of exercise (as in P90X), while increasing the intensity. Each new workout you try uncovers unsuspected weak areas in your body that can be made stronger. Each one changes different parts of the body.  From P90X I’ve kept the four upper body routines plus Ab Ripper X. Upper body is really Tony Horton’s strongest area and you can tell that by looking at him. I also do Yoga X and Plyo X, which I alternate with the corresponding workouts in Rushfit.  “Balance & Agility” and “Stretching for Flexibility” are two bonus workouts in Rushfit that cover some of the same territory as Yoga X. “Explosive Power Training” is shorter than Plyo X but some of the moves are harder.

In the P90X workouts you are working out with Tony and a group of his friends. The mood ranges from serious to playful with Tony’s background in mime and standup comedy on full display. Tony seems genuinely interested in how each person in the class is doing and he introduces them all by name. He also does most of the workouts himself. In Rushfit you are being invited to share a workout that Georges St. Pierre is doing with trainer Erik Owings. The workouts all use the same warm-up and cool-down and all are based on a five-round cycle with short breaks in between, like a championship fight. As in P90X, the instructions are clear and there is a lot of attention given to correct form. I especially like Rushfit’s emphasis on fluid range of movement; "functional training" is the term Erik Owings uses to describe this approach. At one point he sits cross-legged on the ground, lifts himself onto his hands, and swings his legs back into a plank - very impressive! Since I started these workouts I have seen improvement in my flexibility and my mid-section is looking better too.

The hardest workout I do is Bob Harper’s Total Body Transformation, a full hour of non-stop action.  There isn’t much of a warm-up but the first quarter of the workout is not too hard.  This part features a lot of work for shoulders – great for the often-weak rotator cuff areas.  The rest of the workout is more about legs and core, including a fair number of isometric moves using planks and squats.  It’s a good workout but a bit unrealistic; toward the end, even the people in the class are starting to lose their form. I alternate this with Bob Harper’s Totally Ripped Core, which is supposed to be mainly for abs.  With these two workouts the main change I have seen has been in the backs and sides of my legs. My quads are naturally strong but these workouts have helped my hamstrings and abductors especially.  I can now lift my top leg while doing a side plank, which I couldn’t do before.

I do at least one of these workouts six days a week.  Twice a week I also have to do 30+ minutes of cardio because none of these workouts gets my heart rate much above 120 bpm and I need to get into the low 130’s to maintain condition.

Do You Take Supplements? Use Generic Drugs? Check Out ConsumerLab.

There is so much information out there about supplements – which ones we should take and how much of each, whether we should take them at all – that it can be different to sort out the facts from the rhetoric and self-promotion. If you want to know what the science says, check out ConsumerLab. Founded in 1999, this organization tests supplements to determine whether they actually contain what the label says and not too much or too little of it, that they aren’t contaminated by toxins such as heavy metals (found in some calcium supplements), and that they can be absorbed by the body. Tod Cooperman, MD, president of ConsumerLab, appeared on Dr. Oz on 4/9/2013 discussing the mission of ConsumerLab and some recent findings. A follow-up article by Dr. Cooperman appears on the Dr. Oz web site.

The same program included a discussion of generic drugs, an area where I’ve had some personal experience. Dr. Cooperman pointed out that the FDA does not test generics for efficacy and safety; in fact it doesn’t test them at all. Manufacturers of generic drugs themselves test their products to ensure that they include approximately the same amount of active ingredient as the original drug.  "Approximately" in this case is defined as 80%-125%. Different manufacturers of generics may contain different percentages of the active ingredient so if you got generics from one place one month and another the next your dosage could vary by as much as 45%! This gets you into trouble with medications where it is important to stay within the same narrow range. Dr. Cooperman listed the following groups of drugs:

1.       Blood pressure

2.       Thyroid

3.       Anti-seizure

4.       Asthma

5.       Blood thinners

6.       Immunosuppressants

7.       Anti-depressants

In these cases generics should be used with caution. The same is true for extended release medications because the pills may differ in technology.  

Dr. Cooperman also recommended identifying the manufacturer of your generic by checking the label and trying to get the same kind each time. He also suggested asking whether there is an authorized generic for your medication. Authorized generics are made by the same company that originally produced the drug but after it has gone off patent. If you switch from a medication to a generic, he said, you should monitor yourself for a month to be sure that nothing has changed.

In my own case, it took years to get my thyroid level stabilized.  A couple of times I was put on generics instead of Synthroid and the results were bad.  These days I have a note in my doctor’s folder for me saying “Do Not Substitute.”

Update: Recent Bloomberg article about people's experiences with generics, https://bloom.bg/2HwQK0w

From Sharon Begley on Twitter

I follow science writer Sharon Begley on twitter and picked up references to a couple of recent articles on health care.  

Tuesday’s USA Today carried a long article:  “DoctorsPerform Thousands of Unnecessary Surgeries” by Peter Eisler and Barbara Hansen.  One man had his dreams of a career in professional baseball and the military shattered after he had a pacemaker installed.  It turned out that all he really needed was blood pressure medication.

On the website ModernHealthcare.com Jason Shafrin interviews author and economics professor  Douglas Hough about his recent book on irrational behavior of patients, providers, and stakeholders.

Better Feet, Stronger Bones

“I’m starting to get a nasty twinge across my kneecap.”  I wrote this in a note to my podiatrist Dr. Hoffman and taped it to my left-side orthotic.  These days I rarely see Dr. Hoffman in person; most of the time I write a note describing the pain I’m having, attach it to the orthotic, and leave it with the receptionist.  A few hours to a day later she calls me and I come and pick it up.  Usually he gets it right the first time and there’s no pain for several months.  Sometimes I have to bring it back to have it tweaked.  The average person doesn’t need to get their orthotics adjusted that often but I exercise eight or nine hours a week and that means that my body is constantly changing.

In “Respect the Feet,” 10/1/2011, I recounted the history of my dealings with Dr. Hoffman.  I got orthotics when I was in my late 40’s or early 50’s and started exercising more.  Dr. Hoffman would adjust my orthotics by adding pieces of cork to the bottoms.  If I started feeling pain, I would tape pieces of cardboard on to see whether it would go away.  Sometimes I would get such huge wads of cardboard that he would say, “I don’t see how you can walk on those things.”  Keeping the pain away, protecting my ankles, knees, hips, and lower back from inflammation, has allowed me to do harder and harder workouts and to get into the best shape of my life, at the age of 66.

Sometime in 2009 I bought an agility ladder and started doing plyo or jump training. Later that year I started working my way into P90X, which includes jumping jacks and more plyo.  In April of 2012 I went to have my orthotics adjusted and instead of adding to them, Dr. Hoffman started filing them down.  Somehow my muscles and bones were rebuilding themselves in the direction of greater stability so that I no longer needed as much support from the orthotics.  In “My Feet Are Changing!” 4/14/2012, I speculated about possible causes for this improvement – the P90X Legs and Back routine? more protein in my diet? This process has continued, the orthotics are getting thinner and thinner, but I now think that it may be the plyo that is helping.

In the sports medicine community plyo is attracting more attention.  A number of studies have shown that sprinting, hopping, and jumping routines can improve bone density in younger people.  Even more intriguing is a Danish study in which women ages 20-47 and men ages 20-40 played soccer two or three times per week over a period of several months.  These individuals saw improvement not only in bone density but also in muscle strength and balance.  It would be interesting to see research on even older adults.   

I have to confess that I don’t love doing plyo.  Vigorous, explosive movement takes a lot of energy, especially for someone like me who is better at endurance exercise.  Plyo isn’t for everyone.  People who already have knee, hip, or back injuries should consult a doctor before trying jump training­­ – but for those who can use it, this seems to be a promising, low cost way to maintain bone strength in old age.

4/2013

 

10/2011

 

Important Article on Breast Cancer

In the cover article for the Sunday New York Times Magazine Peggy Orenstein surveys past and present thinking about breast cancer in light of her own experience.  In "Our Feel-Good War on Breast Cancer" she shows that women are  pressured into being treated for a DCIS, a condition that might not harm them until years later - or at all.  Women treated unnecessarily vastly outnumber those whose lives are actually saved by treatment.  The Komen Foundation lionizes cancer survivors while marginalizing women with untreatable cancer as though they had somehow failed.

In a recent blog post Orenstein adds other important material that did not make it into the article, notably the brave but unsung deeds of Rose Kushner.

My own experience with non-cancer was described in this blog post.

Michael Mosley's Exercise, My Exercise

After watching “The Truth About Exercise” I wanted to find out more about Michael Mosley.  He is a writer, doctor, and producer and presenter of TV programs and he has been interested in getting into better shape for several years.  About five years ago, after turning fifty and assessing his situation, he tried a restricted calorie diet and human growth hormone shots.  Neither approach was a success.  “The Truth About Exercise” chronicled more recent efforts and this year there is a book, The Fast Diet, that recommends eating your typical diet five days per week and one-quarter that number of calories (about 500 or 600) two days per week.  Apparently this worked for Mosley, as we will be able to see on an upcoming three part series on PBS.

In “The Truth About Exercise” Mosley applied new ideas about exercise to his own situation.  While watching the show, I mentally compared his experience with what has happened to me as I have tried to lose weight and improve my fitness over the years.  Michael Mosley and I have some things in common: we both like wine, chocolate, and good food.  Neither of us is especially fond of exercise.  In other ways, though, we are opposites.  Mosley is a toffee.  He looks lean but he has visceral fat around his internal organs.  I have never looked lean (and probably never will because I’m so muscular) but my visceral fat is not high, 9 or 10 on the Tanita Ironman’s scale of 1-60.  

When Mosley visits Dr. Emma Ross he learns that his brain is actually keeping him from exercising as much as he is physically capable of doing.  Something like this happened to me about four years ago.  I had been doing interval training and working up to faster speeds on the cross trainer but I was starting to feel that it was too much, getting a little tired and light-headed, especially on hot days during the summer.  What got me past this obstacle was the metabolic training program I did with Greg and Susan Simmons. 

I exercised with a mask over my face that allowed Greg and Susan to monitor how my body was burning carbs and fat.  Based on my (very slow) metabolism, they designed an exercise program that would increase my aerobic base so that my body would become better at burning fat.  After that, we worked to increase my anaerobic threshold so that I could exercise at a higher intensity.  The workouts for this program were long and boring at first but I ended up being able to do a shorter, harder workout without feeling overstressed.  These days the aerobic part of my workout consists of a 33-minute series of intervals with heart rate averaging in the low 130’s, about 85% of maximum heart rate for me.  I do this routine twice a week. As part of the program Greg and Susan tested my VO₂max, a measure of cardiovascular fitness.  It was a not-bad 39 and got up to 42.9 the last time they tested it.  Mosley’s was a not-bad 37 but didn’t change at all as a result of the HIT training he did.

Michael Mosley seems especially interested in reaching the 80% of people who never go to the gym.  The segment with Dr. James Levine emphasizes the importance of non-exercise activity thermogenesis (NEAT) and encourages people to walk, ride a bike, and take the stairs in order to burn more calories during the day.  For people who rarely get up and move around during the day this approach may really help, but for people who are already somewhat active it may not make enough of a difference.  At our house we doing our own cooking, cleaning, laundry, and most of the yard work but we still have to watch what we eat and go to the Y in order to keep from putting on weight!

Interval training has been the subject of a lot of research lately.  It seems to be pretty well established that interval workouts are more efficient and effective that long, steady cardio sessions.  What is less clear is exactly how the intervals should be done and whether this is the same for everyone.  HIT, per Professor Jamie Timmons, involves very short intervals of 20-30 seconds.  I tried short-interval workouts for a while and saw no improvement at all; I didn’t lose weight and my fitness didn’t improve.  I was in decent shape so my resting heart rate was low (50 bpm or so).  To raise my heart rate to the point where I was actually working (at least 120) took more than 20 seconds – the interval was over before it had even started.  When I did the resting part my heart rate would go right back down to 70 or so and still not get much above 120 on the next round.  For my present regimen, I warm up for five minutes to get my heart rate to the mid-120’s, which is a good starting point.  I then alternate intervals of four and three minutes at 125-130 bpm and 135-140 bpm, respectively, for an overall average of about 132 bpm.  The 33-minute workout I do burns 300 calories or less, according to my Polar heart rate monitor.  For my body, a 12-minute workout would probably have no effect at all.  

It’s great that HIT improved Mosley’s insulin sensitivity but I sometimes felt that both he and Timmons verged on saying that the 12-minute routine might be all the exercise a person needs.  Leaving aside the issue of what cardio is right for each person, there are many types of exercise that can improve the body in many different areas, including strength, agility, quickness, flexibility, and balance.  While encouraging non-exercisers to exercise is a thoroughly admirable goal, it is also important to encourage those who do a little to try to expand the range of what they can do and improve their condition even more.  

I wish the segments about HIT had included information about Mosley’s resting heart rate and whether that changed as a result of the HIT training.  Resting heart rate is an important index of fitness.  I try to keep mine in the 45-50 bpm range and I do the cardio intervals mostly for that purpose.  If I go on a trip and don’t work out for a couple of weeks it tends to creep back up but after a few workouts it comes right back down.  A recent Danish study showing that healthy men with a resting heart rate of 51-80 bpm had a 40-50% greater risk of death than those at or below 50 bpm.  At 81-90 bpm the risk was doubled and above 90 bpm it was tripled!

Michael Mosley's "The Truth About Exercise"

This week I watched a fascinating show dealing with recent research on exercise.  “The Truth About Exercise,” which originally aired last year on the BBC, takes host Michael Mosley on a series of visits around the UK to learn about the new ideas and how they may be applicable to his own situation. 

The first stop is Loughborough University, where many UK Olympic hopefuls train, including hurdler Will Sharman.  Mosley asks the athlete whether he enjoys training and Sharman replies “There are some things within my training components that are grueling and I don’t enjoy them at the time.  It’s horrible.”  This corresponds pretty closely to Mosley’s own attitude toward exercise but he challenges Sharman to a race anyway.  During a practice run he pulls a muscle and falls down.  This event introduces the first truth about exercise, “You can easily hurt yourself if you’re not prepared.”

After this ignominious beginning, Mosley meets with Dr. Keith Tolfrey and goes for a jog around an outdoor track.  He wears a face mask that allows the scientist to measure how much oxygen and carbon dioxide he is using and calculate how many calories he is burning at his current pace.  At the rate of 16 calories per minute, Tolfrey tells him, it would take 55 minutes to burn off a cappuccino, a banana, and a blueberry muffin.  The moral? “If you really want to lose weight and keep it off, you have to control what you eat as well.”  On the other hand, even when exercise does not result in weight loss, it confers other benefits, like reducing the amount of fat circulating in the bloodstream.

In order to learn how this works, Mosley travels to his second destination, the University of Glasgow, where Dr. Jason Gill treats him to a huge Scottish breakfast, with fat equivalent to what most people eat in a day.  A comparison of blood samples from before and four hours after breakfast shows that the amount of fat in Mosley’s blood has doubled as a result of the meal.  This fat will end up as fatty deposits on the walls of the blood vessels and in other parts of the body.  The most dangerous scenario is that it may become visceral fat and surround internal organs such as the liver.  From a previous medical test, Mosley knows that he has too much visceral fat.  Also, his father was diabetic.  Dr. Gill then instructs Mosley to go for a long walk.   

The next day Mosley is served the same lavish breakfast but the walking has triggered an enzyme that offsets the effects of the meal.  When his blood is tested again four hours later, the amount of fat is one-third less than it was after the previous day’s breakfast.  The drawback is that the walk took 90 minutes, too much time to fit in on a regular basis.

Mosley’s third stop is the University of Nottingham, where Prof. Jamie Timmons is working to find ways to get more people to exercise.  Previous research by Timmons has shown that people respond to exercise in very different ways.  Based on a four-year study, Timmons and his colleagues determined that out of 1000 people 15% were over-responders to exercise, while 20% were non-responders who did not improve their fitness by exercising.  Eleven genes determine the category for any given individual.  Timmons also measures Mosley’s insulin sensitivity (a predictor of diabetes) and VO₂max (an index of overall fitness).  Timmons then has Mosley do a HIT (high intensity training) routine in which he pedals as fast as he can on a stationary bike for 20 seconds, then rests, then repeats the process twice more for a total of one minute of exercise.  Mosley is instructed to repeat this sequence three times per week, three minutes of exercise in all.

At the fourth destination the focus shifts from intense exercise to non-exercise.  Dr. James Levine discusses NEAT (non-exercise activity thermogenesis), which is the miscellany of up-walking-around movement that each person does each day.  Mosley and two other people are equipped with special underwear that measures how active they are and Mosley turns out to be very sedentary.  Over the next 24 hours he makes a conscious effort to be more active, walking, riding a bike, and taking the stairs rather than the elevator.  With very little effort he burns an additional 500 calories compared with the previous day.  According to Levine, new studies show that being sedentary is very destructive to the body.  He says, “There should never be an hour when you’re sitting down.”  Even people who go to the gym may not be doing enough if they are sitting for most of the day.

In order to learn about the influence of the subconscious brain on exercise Mosley makes his fifth journey, to visit Dr. Emma Ross at the University of Brighton.  There he exercises in a low-oxygen chamber and discovers that the brain can be like an overly cautious parent influencing a person to work less hard than he is actually capable of doing.  With additional sessions he finds that he is able to do more than he could at first. 

Mosley has now been following the 12-minutes-per-week HIT routine for one month and he returns to Jamie Timmons to learn whether the program has affected his fitness.  The good news is that his overall insulin sensitivity has improved by 23%, a welcome surprise given his family history of diabetes.  On the other hand, his VO₂max, a measure of aerobic fitness, has not improved at all.  As Timmons already knew based on the blood test, Mosley is a non-responder.  Timmons sums up the experience with these words: “The truth about exercise is that it should be tailored to the individual.”  In Mosley’s case this means that he intends to continue the HIT routine, keep trying to increase his NEAT, and remember that “The chair is a killer.”