What is the best way to measure and monitor intensity during exercise?

Maximum heart rate is the maximum attainable heart rate for a person usually reached during all-out maximal exercise. Percent of maximum heart rate is often used as a marker of intensity and has even been used to prescribe exercise intensity. However, making a prescription based on heart rate alone, while precise, is not always very accurate.

The most accurate way of prescribing exercise intensity is ventilatory threshold. However, measuring ventilator threshold is difficult, time consuming, and requires a fully equipped exercise physiology laboratory. Ventilatory threshold is measured using collected exhaled air as you exercise at higher and higher intensities. By analyzing breathing rate and exhaled air, the two ventilatory thresholds, VT1 and VT2, can be measured. The ventilatory thresholds correspond to how your body is creating energy and how the heart and lungs are working. Training below VT1 (Zone 1) can be sustained for long periods of time, but usually doesn’t lead to much improvement in cardiovascular fitness. Training between VT1 and VT2 (Zone 2) cannot be sustained for very long, but leads to greater improvements in cardiovascular fitness. Training above VT2 (Zone 3) can only be sustained for very short periods of time and is most effective in maximizing work capacity. Heart rate matched to the laboratory measured ventilatory threshold is a very accurate way of prescribing cardiovascular intensity.

However, since we don’t all have access to an exercise physiology lab, heart rate prediction formulas have been used to prescribe exercise intensities by estimating maximum heart rate. The traditional maximum heart-rate estimation is 220 minus age. For example, somebody who is 25 years old would have an estimated maximum heart rate of 195 beats per minute. Recently, a more accurate formula for women has been suggested, 206 minus 88 percent of age. A 25 year old woman would then have an estimated maximum heart rate of 198 beats per minute. While these calculations are usually easy to compute and provide an easy marker from which you can determine exercise intensity, they should be questioned due to inaccuracies. The estimation may be 10 or 20 beats per minute more or less than your actual maximum heart rate. Basing exercise intensity on an inaccurate estimation of maximum heart rate can mean straying from your training prescription and training in a different heart rate zone than intended.

A better and more accurate way to monitor intensity during exercise is by using the Talk Test. Research has shown that one’s ability to talk correlates with VT1 and VT2. The point at which talking first becomes slightly difficult was at the same intensity as VT1. The point at which talking becomes impossible or very difficult was at the same intensity as VT2, according to the ACE-sponsored research study. Using the talk test, while not as specific as a number on a heart rate monitor, is a much more accurate way of prescribing exercise intensity. This talk test is best used when cardiovascular training is highly specific and competitive, for example an endurance athlete training for a triathlon.

Another way to monitor exercise intensity is by the Rating of Perceived Exertion (RPE), or Borg scale. Using the Borg scale, with values from 0 to 20, can help you monitor your cardiovascular intensity. A rating of 7 corresponds to very, very light training intensity. A rating of 12 corresponds to moderate intensity. A rating of 17 corresponds to very hard intensity. A rating of 20 corresponds to maximum all-out intensity. Notice how, as your fitness increases, your exertion level at a previously difficult intensity starts to decrease. For example, running a 10 minute/mile pace used to be a level 16 exertion level for you. Two months after exercising regularly, you notice that the same 10 minute/mile pace is only an exertion level 12. RPE is a useful way of monitoring progress and keeping intensity appropriate. It is best used when cardiovascular training is more generalized and less specific. A person most likely to benefit from using the Borg RPE scale is following a general weight loss program.

By focusing on exercise intensity as a personal measure that is different for different individuals, rather than a number to attain, you can set better exercise intensity prescriptions. As you become better trained, the intensities at which VT1 and VT2 are reached will increase. This means that performing the same intensity that used to be difficult is becoming easier and easier, meaning an increase in cardiovascular fitness!

Finding Your Why

Last weekend, I attended The Fitness Summit, in Kansas City, Missouri. Presentation topics included Nutrition, Training the Hybrid Athlete, Wellness, Uncommon Mobility Methods, and Gym Design. At first, it seemed like every presentation had a different angle: offer many choices, don't offer choices; recommend pre-packaged foods, encourage food journaling. Overwhelmingly, however, every presenter stressed the importance of "Finding Your Why."

Finding your why is important in all aspects of life. Many people focus on what they have to do. The endless tasks continue to mount up, and we may wonder why we're never getting ahead. Life gets a lot simpler when we stop to ask ourselves why we do things.

For the purpose of this email, think about why your health and fitness goals are important to you. Whether your goals are specific or general, what is it that motivates you to exercise and keep a healthy diet? By focusing on the underlying reason behind our motivations, preforming the tasks, be they exercise or healthy eating, can all start to feel much easier.

My why(s):

• regular exercise decreases the pain I feel from rheumatoid arthritis
• I come from a very active family and it's important to me to maintain the family value of running and exercise
• exercise keeps me emotionally stable

What are your Why(s)?

Adults will Walk For Money, Charity

A recent study showed that financial or charitable-giving incentives motivated adults to move more. In a 16 week study, 94 adults aged 65 and older were given pedometers and challenged to increase their daily steps by 50%. Participants were assigned to one of four groups.

Control: received weekly feedback on progress
Financial: received a $20 reward
Social-Goals: received $20 donation to charity
Combined: received $20 that they could choose to cheep, donate to charity, or split between themselves and the charity

All three incentive groups met the step goal on more days than the control group. The financial group took more than double the steps taken by the control group, and the social-goals group eked out a few hundred steps more per day than the financial group. The combined group walked less than the other two incentive groups but still more than the control group.

That said, a 4-week postintervention follow-up found no difference in steps among the four groups, with all three incentive groups dropping back to the same level as the controls.

How do you feel about these results? It seems that incentive schemes can increase adults levels of walking, but only temporarily. What would be a more long term plan for success in increasing activity.

The study appeared in the American Journal of Preventive Medicine (2017; http://dx.doi.org/10.1016/j.amepre.2016.11.011).

Office Stretching Program

Recently, the scientific community has identified a new disease called the “Sitting Disease.” The average American spends 55% of waking time (7.7hrs) sitting. Sitting for long periods of time has been linked with increasing the risk of heart disease, diabetes, and even death. Other research found that women who sat more than six hours per day were 94% more likely to die than those who sat less than three hours per day. In men, the longer sitters were 48% more likely to die.

In addition to this, the “desk posture” we adopt leads to certain musculoskeletal adaptations. By sitting and using our arms in front of us (at a keyboard), we tend to develop tightness in the chest. This leads to weaker muscles in the upper back. Over time, this can cause a forward shoulders hunched posture. In the hips, sitting leads to tight hips flexors and weak glutes. The weakened glutes force the hamstrings and low back to become overactive to compensate for the inactivity of the glutes. Over time, these musculoskeletal changes can lead to low back pain, upper back pain, etc.

Can exercise counteract prolonged sitting?
Research has come to two different conclusions when it comes to whether or not exercise can counteract prolonged sitting. One conclusion is that no amount of exercise can counteract prolonged sitting. The other conclusion is that exercise can improve health outcomes, even with prolonged sitting. I tend to agree with the 2nd conclusion. Expecting exercise to “counteract” another habit is unrealistic. Everything we do is cumulative, and thus, while we cannot counteract prolonged sitting, we can improve health outcomes by exercising before or after prolonged sitting at work.

In addition to exercising before or after work, taking some time for more activity in the office can also be a very effective way to combat the effects of prolonged sitting. Activity trackers nowadays have reminders that will remind you to get up and move at certain time intervals. I would also recommend adopting an office stretching habit 1-2 times per day. Stretching will increase performance in physical activities, decrease your risk of injuries, help joints move through their full range of motion, and enable muscles to work most effectively. Print out and try to implement this office stretching handout. I’m here to help if you have difficulty understanding any of the stretches.

Standing a little more each day tones muscles, improves posture, increases blood flow, ramps up metabolism, and burns extra calories.

Take more steps to ward off sickness

Good news for regular exercisers: The more active you are, the less likely you are to get sick. At least that's according to data compiled by Jawbone, a manufacturer of wearable tracking devices.

The company wanted to determine a person's likelihood of becoming sick, so it compiled a variety of self-reported data from the Jawbone UP app. Based on that information, data analysts developed a sickness likelihood score. Here's what they learned:

• People are more likely to fall ill during winter months
• Individuals with higher BMIs tend to become sick more often
• Men aged 25-45 who take an average of 14000 steps daily are four times less likely to become sick than those taking fewer than 4000 steps daily
• When sick, most people see a decrease in steps of 5%-12% and an increase in sleep time of 5%-7%

Have you noticed a similar effect from exercise yourself? Regular exercise boosts immunity, so that may be the contributing factor to why fewer active people are getting sick.

Please let me know if you'd like help making regular exercise a part of your life!

Some kind words

One of my clients just sent me a very kind write up of her personal training experience:

I am a 62 year old female. I just completed 4 months of personal training with Viktoria and Fit Athletic Club/Carmel Mountain Ranch.
I have tried so many, many times to get fit-- joined clubs, had personal trainers, done it all, but this is the first time I have ever stayed committed to the process. I have seen in four short months, my body fat mass drop, my balance improve considerably, and I am definitely stronger and overall I feel good.

Viktoria is very knowledgeable, made it "fun", listened to my concerns (I have chronic back pain) and at the same time pushes me forward. I definitely believe by starting out with her as a trainer and getting understanding of the equipment and type of exercises I should be doing has made all the difference in my being able to stay committed.

Viktoria is a very good rep for your gym/company and a very valuable member of your team.

Combating Prediabetes in Healthy Weight Adults

Recent research from the University of Florida reports that one-third of normal-weight adults over age 45 have prediabetes, a high-risk state for developing type 2 diabetes. The researchers compared data from 1988-1994 with data gathered in 2012. The results showed that the prevalence of prediabetes among healthy-weight adults aged 20 and older increased from 10.2% to 18.5%. Among people aged 45 and older, the prevalence of prediabetes increased from 22% to 33.1%. The report raises concerns about current practices used to detect the disease.
Current recommendations for prediabetes screening focus nearly exclusively on adults who are overweight or obese. These guidelines make it less likely that individuals with healthy BMI will be screened, despite the increasing prevalence of prediabetes among this group.

Fortunately, there may be a solution. Another study, this one from Duke Health, examined the effect of different exercise intensities on glucose homeostasis. Good news: it doesn't have to be "go big or go home" for people to benefit.
The 6 month intervention study separated 150 adults with prediabetes aged 45 to 75 into the groups below. I've indicated their improvements in glucose tolerance with the---->

1. low amount/moderate intensity (walking 7.5mi/week)---->5% improvement
2. low amount/moderate intensity (walking 7.5mi/week) plus caloric restriction and reduction in fat intake---->9% improvement
3. high amount/moderate intensity (walking 11.5mi/week)---->7% improvement
4. high amount/vigorous intensity (jogging 11.5mi/week)---->2% improvement

Results showed that the diet-plus-exercise group led the pack with the greatest glucose tolerance improvement. This emphasizes the importance of combining a healthy diet and exercise. The exercise intensity did not have to be very vigorous, as seen in groups 1, 2, and 3. This indicates that the time duration of the exercise may also be an important factor to consider; the same volume of exercise performed at a higher intensity will take less time.

Bottom line: Exercise and healthy diet is important to everyone regardless of weight in order to decrease risk of prediabetes.

Healthy Weight Adults at Risk for Prediabetes

Regular Moderate Exercise Best for Glucose Control