Welcome to another episode of the fresh focus podcast. Today we will be discussing the spectrum of exercise in relation to cardiac health. From zero to the extreme.

Please note that this podcast is not a substitute for talking to your doctor or cardiac rehab professional. It’s important to ensure you are medically stable, and ready for a progressive, structured exercise program. And your provider will also be able to give you specific guidance towards an exercise prescription that’s tailored to your needs.

And as with any exercise program, for any individual, you should start in a slow, controlled manner. Remember, you can always progress and advance, but we must allow the body time to go through the appropriate adaptive process. The body can do great things, but we need to give it time to do so.

o If you are exercising, be sure to be mindful of any warning signs that should prompt you to stop the activity, and possibly seek medical care. I’m going to list some of these things out, so bear with me. Some examples could be:
 Pain, tightness, pressure, burning or discomfort in your chest, neck, shoulder, arm, back, or jaw
 Severe shortness of breath
 Cold sweats
 Severe nausea or vomiting
 Muscle cramps
 Sudden weakness or changes in feeling in your arms and/or legs
 Sudden Severe Fatigue
 Trouble swallowing, talking, or seeing
 Severe headache, dizziness, or light-headedness
 Severe joint pain
 We also want to avoid any issues related to vitals, such as low blood sugar, abnormally low or elevated blood pressure, and an oxygen level dropping below 80% (if you also have a pulmonary condition that requires you to monitor your oxygen levels)
 If symptoms don’t go away after a few minutes, that’s when it may be a good idea to seek out medical assistance.
o As always, we want people to be able to exercise and invest in their functional independence, but we also have to be mindful of safety. If we end up having a serious medical event, or injury, due to trying to do too much too quickly, that’s just more lost time that could be spent investing in our health and overall freedom.
• Now that we’ve covered all of that, let’s move on to the fun stuff. The purpose of today’s topic, is to discuss the full spectrum of exercise volume when it comes to the effects on cardiac health. And when I say exercise volume, I am generally referring to the total amount of exercise completed on a regular basis, such as from week to week. So we will briefly touch on everything from no exercise all the way to extreme levels of exercise, as well as what lies in between.
• No activity/ exercise
o General focus: No activity = negative effects. Any movement is beneficial. Importance of activity/exercise, in general.
o First, let’s start at the ground level. And I want to lead off with this phrase: “The human body is meant to move.” Unfortunately, we live in an era characterized by convenience and sedentary lifestyles due to technological advancement. In our hunter/gatherer days, we wouldn’t need advice on activity and exercise (or nutrition for that matter). We’d be hunting, foraging, building shelter, etc., and our lives would characterized by regular activity and sporadic, moderate to high intensity movement, such as sprinting and lifting heavy things.
o Nowadays, things are a bit different. We have to intentionally strive to include regular activity and exercise into our lives.
o But what if we don’t? Unfortunately, for many, a sedentary lifestyle has become their baseline. And we’re not here to judge them for that. In this day and age, it can be difficult. But how we help people to be creative, and find enjoyable ways to work in some beneficial movement?
o Even though a sedentary lifestyle may be the baseline, and commonplace, for some, in terms of health, we’re already in the negative. An idle, immobile way of life is not a neutral place. The lack of movement goes hand-in-hand with decreases and deficits in health and functional capacity.
o This is true for the mind, body, and soul. So let’s take a peek at what we may be looking at in this situation.
 For the mind, we can expect lower plasticity (the ability of the brain to adapt, change, and learn), less efficient blood flow and blood vessel growth, thereby limiting oxygen and nutrient delivery, lower cognitive function, memory, and processing speed, less neuron development or neurogenesis, a heightened response to pain, a higher risk of neurotransmitter imbalance (meaning that everything from mood and focus to depressive symptoms could be negatively affected), and so on.
 For the body, we can experience insulin resistance, hindered lymphatic system function, a less capable immune system, decreased bone density, lower lean body mass & muscle tissue, and a general decline in function, mobility, and the ability to perform activities of daily living.
 For the soul, some of which we’ve already touched on, we can see the worsening of symptoms of things like anxiety and depression, hindered energy and mood, lower threshold for stress and pain, lower self-esteem and self-confidence, distorted body image, and possible negative influences on our social connections with the people around us.
 A lack of activity and exercise translates to FAR more issues than just that way we look, or the amount of fat mass that we carry.
 Shifting our focus back to cardiac health; The heart is a muscle. Any muscle that is not encouraged to adapt via more intense effort, will not function near as efficiently as it could. Think of it as not reaching the heart’s full potential. This is also a good time to discuss collaterals. What are collaterals? The creation of collaterals is an aspect of angiogenesis, or the creation of new blood vessels. is Think of them as the body’s own natural bypasses. When a blood vessel fails to provide sufficient blood flow to an area, collaterals can be created as viable, alternative sources of blood flow. Exercise helps to encourage this process through the release of various growth factors for blood vessel growth, as well as demand from the tissues, themselves. Active tissues require an adequate blood supply. The human body, in all its complex glory, will do everything it can to provide that supply, but the sedentary body will not be near as effective at getting this done.
• Some activity/exercise
o General recommendations/ average activity levels and benefits
o Now let’s move on to the next step (pun intended). Let’s assume I piqued your interest with the doom and gloom of the previous section. Let me keep your attention with a positive statement, a little can do a lot! Any additional movement that gets you a little more mobile through, and has you sitting less, will provide benefits. Most healthcare and cardiac professionals will agree that doing anything is better than nothing. You might be thinking, “yeah, but walking that extra 10 minutes this week isn’t going to do much.” You’d be surprised. There’s a common concept in the resistance training community, known as “beginner gains” or “newbie gains.” It’s basically a phase of rapid improvement at the beginning of someone’s exercise journey, or even their return to exercise if they have been less active for some time. But this concept isn’t isolated to any one modality of movement. This is also true for the general initiation of movement across the board, and the benefits we can get from it.
o The transition from a sedentary lifestyle to a mild or moderately active lifestyle yields a relatively large cardiac risk reduction, whereas further increases in exercise volume produces much smaller and minute risk reductions. There are studies that have simply looked at the effects of standing more than 2 hours per day, and even doing something as simple as standing more produced significant benefits and risk reduction. If someone starts working in some dedicated exercise, whether it be walking, jogging, weight training, etc., even below the recommended guidelines of 150 minutes per week for moderate intensity/ 75 minutes for high intensity, we still see significant benefits and reductions in risk and all-cause mortality.
o So what’s the take home message here? Don’t feel like you have to train for a 5k, go to the gym 5 days per week, join a group fitness gym, buy some insanely expensive piece of exercise equipment, etc. These can all be options, but they are not a necessity. Some people just need to hear that doing anything helps. So for those that have packed schedules, crazy lives, past injuries and limitations, etc., this is for you. Just do anything that you feel like you can work in that is enjoyable, and realistic for you. Don’t feel like you have to overhaul your lifestyle to do some exercise program that isn’t realistic. And later on, if you feel like you can progress things a bit, go for it!
• Current recommendations/ maximal return on investment
o So what do you do if you’re already active, and curious about how to pursue maximal benefit from your exercise? As mentioned previously, the current recommendations for exercise volume are 150 minutes (or 2.5 hours) per week of moderate intensity exercise, and 75 minutes (or 1.25 hours) for high intensity exercise. Figuring out the volume of exercise for maximal cardiac benefit can be difficult to calculate, but research suggests that the range could go from baseline recommendations all the way up to 3-4 times that amount, which would be roughly 9 hours per week of moderate intensity, and about 5 hours per week of high intensity exercise. But before your surprise eyebrows launch off your face, and you finish verbalizing those choice words for me, remember… The biggest risk reduction comes from just getting out of that sedentary lifestyle. In any way, and any amount. Getting up to these volumes will provide additional benefit, but at a slower rate. So they can help, but they aren’t necessary to still see some great health improvements.
o In the discussion of optimal approaches to exercise planning, a couple other things should be noted.
 First, a mixture of moderate intensity and high intensity exercise will likely provide further improvements in cardiac health, as well as general healthy adaptations. High intensity exercise should pursued slowly, and with caution. And although some will avoid vigorous exercise due to slight, temporary increases in risk, the overall risk is actually fairly low. This is something to discuss with your provider, and if you still aren’t comfortable with it, sticking to moderate intensity movements is perfectly fine.
 Also, in terms of cardiac health and exercise, cardiovascular-specific exercises are typically the focus, but other modalities such as resistance training and mobility can further optimize your return on investment. Adding some sort of strength training, even just a couple days per week, can help produce further improvements in cardiopulmonary fitness, increase quality of life, and provide general benefits to functional ability and independence. We want to be able to squat, bend, push, pull, lunge, and twist because these are things that we are built to do. Exercising in various ways helps us to preserve these primal movements, and maintain our functional ability. Even if you feel like you are limited in these movements, any improvement is a win. Focus on being better, not perfect.
• Extreme exercise
o Now let’s get into the high end of this topic. When have we gone too far? Is that even possible?
o This gets into what is sometimes referred to as the Extreme Exercise Hypothesis, and it stems from information and research gathered from marathon runners, triathletes, cross-country skiers, cyclists, and other exercises capable of high endurance volumes.
o Some examples of issues that are commonly reported in this subset of exercising population are things such as myocardial fibrosis (a type of scar tissue that can develop within the heart) , coronary artery calcification, and a higher risk of Afib. My wife actually works in a cath lab, and she says it’s always surprising when they have an otherwise healthy, endurance athlete on the table that they have to perform a procedure on. But luckily, when looking at the research on this topic, the risk of these things occurring, or causing life-threatening situations, is actually quite low, and this level of exercise still puts a person at a far lower risk of mortality than if they were sedentary. And some of these changes can be protective. The plaques found in the blood vessels of endurance-related masters athletes tend to be more stable, and less likely to break off and cause a blockage. Now, this isn’t to say that we don’t want to be mindful of overdoing it (with exercise, or anything for that matter), but we also shouldn’t avoid any exercise because of some minor risk at the higher levels of exercise volume.
o But the slight increase in risk highlights a few things. It reinforces that rest is important. The yin to the yang. Everything must exist in balance to be optimal. If we are overworking our bodies, and not allowing for adequate rest and recovery, we are going to be at a higher risk of some these issues. Also, lifestyle matters, as always. A person that eats well, sleeps well, manages their stress, doesn’t smoke, etc., is going to have a much lower risk of adverse events. So if someone loves their high volumes of exercise, and they are able to do it safely and intelligently, then they may just want to make sure that the rest of those lifestyle and health-related variables are accounted for in a positive way. Our health is a collection of habits, not the result of a singular focus.
o The takeaway here, is that it is very difficult to define an upper limit for exercise volume. And although there seems to be a bit of a Goldilocks zone that will provide the highest return on investment, and lowest risk, every volume and intensity of exercise results in a dramatic reduction of cardiovascular mortality, as well as all-cause mortality, in comparison to inactivity. In other words, even at the highest levels of exercise volume, the benefits still far outweigh the risks.
• Summary/ Main takeaways
o We need to remember, is that ANY activity that reduces the amount of time you are sedentary, will provide significant benefits. Benefits that can include positive effects on lipid levels, blood pressure, inflammation, glucose metabolism, vasodilation, nitric oxide availability, etc. There are literally hundreds of things I could list. And if you are given an opportunity to pursue any type of cardiac or cardiopulmonary rehab, it’s highly recommended that you pursue these. They can help you to get back into the swing of things in a structured and guided environment. And never hesitate to ask questions if you’re not sure of how to start, how to progress, or how to maintain safety.
o The body is meant to move, so let’s find some ways to make that happen.
• Thank you for once again tuning in to the Fresh Focus podcast. Be sure to subscribe, leave a review, and share these episodes with anyone you know that may be concerned about, or struggling with, their cardiac health.