A recent analysis of 29 randomized clinical trials that evaluated the cognitive effects of aerobic exercise backs up your impression.  The combined results of 24 trials, all with at least a month-long program before evaluation of participants, found attention span and mental processing speed were improved by consistent aerobics.  Most of the exercise programs studied included 3 to 4 session per week of at least 30 minutes, with brisk walking, biking, or jogging the most common interventions.  Those who combined aerobic training with strength training got superior results regardless of age.

Nineteen studies assessed executive function, the ability to plan, make decisions and problem solve. Virtually all found improvements when comparing the groups randomized to exercise compared to those who were not physically active.  The combined estimate across all studies supports the benefits of aerobic training for everyone with the most benefit accruing to older participants.  Finally, memory – but not necessarily working memory (short term recall of items like lists of numbers) – was also enhanced in the 16 studies that measured effects on memory.

So remember, “a sound mind in a sound body” comes with scientific evidence to back it up.

References:

Smith, PJ and colleagues.  Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials.  Psychosomatic Medicine 2010(72):239-52.

K. Hartmann, MD, PhD

realfitmd@gmail.com

For first timers:

• Like to know exactly what to expect?  Check out bikes between classes and identify how to make adjustments.  Odds are good that one or more is already a good fit and you can note those settings.  Try it out – the knob below the handle bar on the frame sets resistance.
• Fine to just come early to class.  Instructors and other members will be happy to help you get oriented – it’s easy and quick to make adjustments.  Weekends are often small groups with relaxed time for great coaching in your first class.
• Bike shoes not required – moderate support trainers are comfortable.  Just pick a bike with toe cages on the pedals if you need.
• Adjust saddle height so knee is slightly bent when you push the pedal straight down and have your weight on ball of your foot with your heel down a bit.  (Saddle will be near hip standing by bike.)
• Set distance from saddle to handlebars so you can comfortably reach the main part of the handlebar grip (above where it inserts into the frame) leaning somewhat forward while staying in the saddle.  You should be able to reach out to the most distant grip comfortably with a flatter back.
• Higher handlebars reduce stress on the lower back.  Err on the side of higher until you are sure of your posture and comfort.  Never put lower than seat unless you’re Lance.
• Last, tighten toe cages so you can both push and pull the pedals.  Lifting the edge of the silver buckle closest to the frame will release; pulling the strap through the buckle (usually already threaded) tightens.  For the most muscle recruitment you want to work all 360 degrees.  Make it snug but don’t strangle your foot – you will be at this for an hour.
• Have a towel across the handlebars and water in the holder – you’re ready to go.

Classes are 45 to 60 minutes.  Instructors coach through the ride with easy to follow directions.  They’ll explain the duration of the interval, type of work (endurance, sprint, “flat road”, “climb”), target intensity (percent of maximum effort – achieved by adjusting resistance and cadence), and position (see below).  Familiarity with minimal jargon can make you feel more ready but is not essential since you have the instructor and the whole class to watch for cues.

• Hands “far” or 3:  stereotypical bike racer’s position; arms forward to outer grip, back flat, glutes back and up – lots of core at work with balanced push pull from quads and hamstrings.
• Hands “middle” or 2:  hands on middle grip position.  Keep weight over pedals; don’t need extreme lean, let shoulders relax, maintain light contact with handlebars, and enough bend in the knees and hips to fully engage quads and hamstrings.
• Hands “near” or 1:  most often for warm-ups/cool downs, hands on closest portion of handlebars, elbows gently bent – a relaxed neutral position.

Body positions relate to hands; near and middle hand positions are both used out of the saddle when in a standing “run”.  Middle and far are both used for sprinting or “climbing” in the saddle.

You may be saddle sore the first few classes.  Give it at least three.  Comfort level rises quickly; few members ride with cycling shorts with padding.  Gel seat covers are available if you’re feeling bruised, but likely won’t become part of your spin routine – they hold heat and don’t cool off quickly during out of the saddle work.  You will get comfortable as the ride become more natural.  Do pick close fitting work-out gear that won’t chafe or ride up; check shirt length in back if you don’t want to bare too much when you reach forward.  Music and coaching intensity vary widely by instructor.  Try them all and you’ll find a perfect fit or several great styles.  Regardless, a deluxe work-out will be within your control – so take if for a spin.

K. Hartmann, MD, PhD

realfitmd@gmail.com

Restricting calories consumed and spending calories in exercise are not equivalent in the body’s economy.  Even though in the bank, $400 saved (in our example, let’s say 400 calories not consumed as Alfredo sauce) are the same as $400 earned (400 calories of Stairmaster work), the body is a more sophisticated banker.  If your goal is to lose weight or maintain a stable weight, investments in balancing calorie intake and calorie expenditure in exercise are both required for optimal results.  You have to have a diversified portfolio.

Why? Restricting calories alone turns the body into a miser – if sustained over time the rate at which your body uses calories slows.  In other words your metabolism compensates to match what is perceived as a shortage making each subsequent increment of weight loss harder to achieve by calorie restriction alone.  This situation makes inevitable slip-ups more dangerous because binges or over-eating will result in more rapid weigh gain than before you started dieting if you focus on calorie restriction alone.  In general, cutting back on calories as the major approach to weight management gives you slower metabolism; and calorie restriction make you feel accurately that you have less energy for normal activities.  The result of feeling more sluggish is that people who sustain calorie restriction over long periods of time (months to years) do less physical activity of all types and burn fewer calories even when they engage in activities like walking that aren’t demanding.  These factors set up a no-win vicious cycle that popular culture knows as “yo-yo dieting”.

In contrast to isolated calories restriction, every episode of exercise has a halo effect or net positive return on investment – after the calories are burned, depending on the intensity of the workout, the background metabolic rate can be boosted for minutes to hours beyond the actual exercise, prolonging the benefits of the time spent on exercise.  For optimal results you want to balance three goals: 1) build muscle (and drop fat) so that your body needs more calories in a day; 2) consume a balance diet with a healthy calorie goal; and 3) get aerobic exercise – moderate to high intensity exertion – regularly, at least five times a week or to the total energy expenditure goal that you know reliably gets you the results you want.  That approach will keep the ledger balanced no matter what your age or current fitness level ultimately providing big pay offs.

K. Hartmann, MD, PhD

realfitmd@gmail.com

Balanced information, rooted in high quality scientific evidence, is as rare as hype of the next super food is common.  In this encyclopedia style book, Bowden serves up clear summaries of the dietary value of 150 food items that made the shopping lists of more than a dozen expert nutritionist, physicians, health and fitness authors, and meshed with his own reading of the nutrition and health literature.  These top picks are grouped in 14 categories that cover everything on your shopping list from vegetables, grains, dairy, meat, and poultry, to specialty foods, beverages, condiments, and sweeteners.

The brief summaries of individual foods blend descriptions of reliable research data about benefits with notes and explanations about instances when commonly cited benefits fall short of proof (“royal jelly may be overrated”).  At times Bowden relies on animal studies or nutritional content analyses in isolation; however, overall where data from research in humans is available he has featured and explained it well.  The smart conversational tone and the practical tips interspersed throughout make this book easy reading.  Introductory sections for each category provide key insights into understanding food sources and jargon (“free range” does not yet have an official definition for labeling).  Scattered throughout are relevant cautions for individuals with specific conditions ranging from pregnancy to diabetes and Wilson’s disease; as well as the individual top ten lists of the contributing experts.  The glossary and indexing are top-notch – helping you graze topics from ACE inhibitors to zingerone.

Bowden accomplishes this information feast with a tone that is blissfully free of the dogmatism that plagues much of contemporary diet and nutrition publishing.  The thoughtful exposition engages the reader in ways that help inform and support your choices.  This book will leave you hungry for more intelligent straight-talk.  And it may inspire you to add some of the 150 to your routine.

K. Hartmann, MD, PhD

realfitmd@gmail.com

In studies with precise measures of muscle protein synthesis, researchers find that healthy, fit volunteers can make efficient use of 20 to 30 grams of protein at a time, the equivalent of 10 grams of essential amino acids, if it is consumed, digested, and available close in time to demands on the muscle.  Few studies have directly compared time frames – within 30 minutes vs. two hours – but closer to exercise is likely superior.

Does that mean anyone interested in building defined muscles should be pumping designer protein supplements too?  No, sources like skim milk, egg whites, lean fish and meat, beans, and soy provide high quality protein.  But convenience may kick in.  Protein powder and bars can be an easy option to speed amino acid delivery to muscle immediately after exercise.  Based on speed of bioavailability, whey protein (derived from milk) tops the list of protein sources for muscle building; followed by soy protein; with casein (also a milk protein) coming in last in research designed to determine amino acid uptake into muscle after a work-out.  Among amino acids, leucine provides the strongest dietary signals for muscle protein synthesis.  Gram for gram, whey protein provides the largest proportion of leucine adding to the appeal of whey protein as a post-exercise source.

To favor muscle protein synthesis over time, aim for a total of 1.4 to 2.0 grams of protein each day per kilogram of body weight distributed throughout the day.  Adequate calorie intake, so your body doesn’t steal from muscle resources, and steady availability of protein are the key to keeping muscle cells encouraged to manufacture rather than breakdown proteins.  Meals and snacks with relatively “slower” proteins like those from plant sources and lean meats are ideal for this purpose.  Overnight the balance tips towards muscle protein breakdown.  Breaking your fast with ≥10 gms of protein, like that in low-fat Greek yogurt or protein supplemented cereals, provides enough stimulus to stop turnover and await the post-work-out boost or full meal.

Philipps, SM.  Physiologic and molecular bases of muscle hypertrophy and atrophy: impact of resistance exercise on human skeletal muscle (protein and dose effects), in Applied Physiology, Nutrition, and Metabolism 2009(34):403-10.

Tang JE and colleagues.  Maximizing muscle protein anabolism: the role of protein quality, in Current Opinion in Clinical Nutrition and Metabolism Care 2009(12):66-71.

Tang JE and colleagues. Ingestion of whey hydrolysate, casein, or soy protein isolate: effects on muscle protein synthesis at rest and following resistance exercise in young men, in Journal of Applied Physiology 2009(107):987-992.

K. Hartmann, MD, PhD

realfitmd@gmail.com

Weight loss advantage in the group of research participants who drank eight ounces of low sodium vegetable juice each day compared to those on the same diet for 12 weeks who didn’t.

Shenoy et al. in Nutrition Journal 2010; 9:8.

25 percent

Amount by which morning exercisers outstrip their afternoon peers in regularity of work-outs.

Data from Mollen Clinic, a preventive medicine and wellness center, in Scottsdale Arizona (2009).

7.9 METs

Maximal aerobic capacity above which adults achieve reductions in annual risk of death.  At age 50 this corresponds roughly to tolerance for continuous walking at 4mph in men and 3 mph in women. Greater fitness yields greater protection.

Kodama et al in JAMA 2009;(19):2024-2035.

10 to 40 kcal

Energy expenditure of 10 to 15 minutes of genuine laughter.

Buchowski et al. in International Journal of Obesity 2007;31(1):131-7.

431 kcal

Reduction in basal total daily energy expenditure including sleeping metabolic rate at 3 months among adults restricting calories for weight loss without exercise.  Those who added exercise five days a week with the same restriction in calories had no decrease in basal energy expenditure.

Redman et al. in PLoS ONE; 2009;4(2):e4377.

10 to 15 percent

Boost in metabolism that persist for several hours after exercise when you hit the high intensity zone.

Arthur Weltman, Director Exercise Physiology, University of Virginia.

4.5cm

Advantage in reducing waist circumference among women who did high intensity training compared to low intensity training five days a week with the same total caloric expenditure of 400kcalper day for 16 weeks.

Irving et al. in Medicine and Science in Sports and Exercise 2008;40(11):1863-72.

60 percent

Reduction in gum disease risk from daily yogurt intake compared to only other dairy intake like cheese or milk. Lactobacilli in yogurt make lactic acid and can help keep harmful oral flora in check.

Shimazaki et al. in Journal of Periodontology 2008;79(1):131-7.

FROM THE SOURCE

“The magnitude of muscular hypertrophy did not statistically differ between morning and afternoon training times.  From a practical point of view, strength training in the morning and afternoon can be similarly efficient when aiming for muscle hypertrophy…”

Sedliak et al. in Journal of Strength and Conditioning Research 2009;23(9):2451-7.

K. Hartmann, MD, PhD

realfitmd@gmail.com

Lack of regular and predictable ovulation is the leading cause of female infertility in the US.  For many women lifestyle changes can be the solution.  Function of the ovaries depends on inter-related metabolic factors including normal ability to respond to insulin.  The body releases insulin in response to carbohydrates in food.  Insulin signals cells to take up and use glucose as energy.  However, the higher the BMI and the more carbohydrate loaded the diet, the more prone we are to under-respond to the insulin signal, developing impaired sensitivity to insulin.  This sets up a vicious cycle of storing more of the energy in our food as fat and “listening” less and less to normal metabolic commands.  These metabolic commands influence brain-ovary control mechanisms.  When out of tune, this disrupts hormone balance required for high-quality ovulation.

How do lifestyle changes interrupt this cycle?  Aerobic activity reduces total body fat improving the body’s ability to respond to insulin.  This drives use of glucose and reduces storage as fat.  Strength training builds muscle mass and proportionately increases the body’s steady demand for and use of glucose.  A low glycemic index diet, supplies fewer simple sugars requiring less insulin in response.  Low fat intake improves circulating lipid levels.  Combined, these steps restore ability to listen to metabolic signals and stay “in tune”.

What’s the evidence?  Women with infrequent or absent ovulation from overweight or even Type II Diabetes or Polycystic Ovarian Syndrome, do not need to attain normal BMI to restore ovulation.  Modest amounts of weight loss and increased physical activity reset the system of metabolic and hormonal controls on menstrual cycles.  Clinical trials have shown resumed ovulation with modest weight loss (5 to 10% of initial) and conception rates that are superior to oral fertility medications.  Infertility treatment guidelines, based on research, cite physical activity, weight loss, and nutrition as the first line treatment for infertility that results from failed ovulation in women with elevated BMI.  However, the majority of women will be offered medications to spur ovulation, without getting enough information to understand how investing in their health can enhance their fertility.

References:

Karimzadeh MA, Javedani M.  An assessment of lifestyle modification versus medical treatment with clomiphene citrate, metformin, and clomiphene citrate-metformin in patients with polycystic ovary syndrome. Fertil Steril. 2009 May 20. [Epub ahead of print]

Pasquali R, Gambineri A. Treatment of the polycystic ovary syndrome with lifestyle intervention. Curr Opin Endocrinol Metab 2002;9:459–68.

Zain MM, Norman RJ.  Impact of obesity on female fertility and fertility treatment. Women’s Health (Lond Engl). 2008 Mar;4(2):183-94. Review.

K. Hartmann, MD, PhD

realfitmd@gmail.com

1)     Start from the ground up.  Not sure if your work-out shoes can go the distance?  Get a consult at a local sporting goods store staffed by real trainers.  Explain you’ll be putting in 10 to 14 hours in cross-training each week and share information about any prior injuries or recurrent strains.  Consider adding inserts as stiffer insoles can reduce joint strain – too much cushioning can stress joints by requiring constant compensation for the padding.  Make sure your toes have room and take advice to go up a half size if it applies to assuring room.

2)     Pedicures ladies and gentleman.  See item #1 – you’ll be logging hours in motion on your feet.  Pressure on the nail bed, bruising under the nail, and loss of toenails can happen.  Prevention starts with a short trim.  Well-cared for feet will take you a long way towards comfort.

3)     Get familiar with a heart rate monitor.  Polar brand has staying power; high ratings in comparisons; and most models are pool worthy.  Get the basic settings programmed and play with the features – you’ll come to love the daily and weekly summaries of heart rate range, total time, and total energy expenditure.  While not the most user friendly software interface, the cradle that allows up-load to the web is a bonus for tech junkies who will appreciate the graphs and ability to manipulate and compile work-out data.

4)     Double up.  Have two of everything.  When you are tired or running late is when you’ll misplace or need replacements for key items.  An extra pair of shoes, work-out clothes, water bottle, and heart monitor transmitter batteries and strap in the car trunk will get used.  Duplicates of all your usual grooming products in your gym bag makes it easier to feel like you’ve had a normal start to the day.  Duplication also assures you don’t end up with favorite shaving gear or lipstick left in the locker room or the bag in the back of the car when you wish it was in the house or with you.  Cutting the hassle factor makes the real demands of Boot more manageable.

5) Identify your supply line. You’ll be hunting down healthy food, protein sources, and options for quality on the fly.  How it all fits your plan will vary with time and tuning.  No need to buy cases of anything.  Your needs and preferences will change.  But this is a good time to figure out among the fresh fruit; low fat string, cottage, and ricotta cheese; high protein bars; nut butter; steel cut oats; flavored whey protein, and Greek yogurt brands what has appeal.  Pre-boot is also a good time to figure out your favorite no or low-fat egg and egg-white; vegetable; fish, lean pork and beef; and salad recipes.  Practice making it portable by finding small portions (mini-raisin boxes; single serving tuna; instant oatmeal); stocking up on re-usable containers; and pre-packaging from bulk to smaller sizes (almonds, high-protein cereals) for briefcase or purse.

6)     Pack your tunes. You’ll stay at it longer and harder with music that keeps you in the flow.  Make or find mixes that keep the beat at 120bpm and above and you’ll set a pace worth keeping.  Refreshing your music as well-as your work-out breaks boredom and maximizes intensity.

7)     Hang time. If you’ve got weeks before Boot consider ramping up with a strength trainer two to three times a week.  Add a graduated increase in target calories burned in aerobic activity and you can amplify your results.  For even more preparation talk about adding DeltaTrac for both diet and nutrition planning in the run-up to Boot.

K. Hartmann, MD, PhD

realfitmd@gmail.com

Muscle throughout the body requires essential amino acids in the diet from protein sources, these are building blocks that cannot be manufactured by our bodies and must be consumed.  Protein intake is also key because it has no glycemic load, provides calories that can prevent spikes and dips in blood sugar, and contributes to moderation of appetite.  These factors have made diets that emphasize protein consumption with relative exclusion of carbohydrates popular.  But a more physiologic reason to assure good protein intake relates to maintaining muscle.

If you are aiming at lean, you want to maintain and even build muscle.  Muscle, including the long, tapered subtle kind, is metabolically active – it burns calories all day and night.  Each additional pound of muscle demands 100 or more calories a day for “upkeep”.  As body fat falls and muscle is built or maintained, having more muscle often makes tight calorie restriction unnecessary when you are stable at your goal weight and remain active.  So don’t deprive your muscle; provide protein after work-outs and throughout the day to encourage muscle protein synthesis and repair.  Look after your muscle so it can give you the freedom that is only delivered by weight loss with conditioning and not by calorie restriction alone.

K. Hartmann, MD, PhD

realfitmd@gmail.com

Illustrations by Sharon Ellis

Few things are as intricately beautiful as the body at work.  This author-illustrator team pairs more than 150 exactingly correct and fascinating drawings with clear, focused text about the anatomy of 65 yoga poses.  Whether or not you include yoga in your fitness routine, this compact volume provides new visual insights into muscle origins, insertions, and joint actions in ways that will inform and inspire your training.

Each pose is classified by level of difficulty and accompanied by a description of joint actions, the “working” components of the pose, notes on breathing, and pointers about overcoming common obstacles.  The drawings were painstakingly created beginning with photographs of models in each of the asanas including some from “impossible” angles achieved by photographing up through plexiglass and down from the studio ceiling.  From Child’s Pose and the Plow, to Crane Pose and The Great Seal, this innovation provides vantage points on the base of support, proper orientation, and joint and muscle action that are both fascinating and helpful.

Kaminoff is the co-founder and head instructor of the Breathing Project in New York City; his collaborators include Amy Matthews a Certified Laban Movement Analyst, who is also a martial artist who blends karate and yoga, and Sharon Ellis, an award winning medical illustrator.  Pick up this book and be amazed by seeing inside the complexity of what the body can achieve.

K. Hartmann, MD, PhD

realfitmd@gmail.com