Doctor’s Tip: Exercise — what to do and how much |

Doctor’s Tip: Exercise — what to do and how much

Greg Feinsinger

Exercise is the 12th and final item on Dr. Michael Greger’s daily dozen list, the others being 10 things we should eat every day and the 11th being what we should drink every day.

The Blue Zones are five places in the world where people live particularly long and healthy lives — proven to be due to lifestyle rather than genetics. They include the highlands of Sardinia; Okinawa; the Nicoya Peninsula in Costa Rica; an island off the coast of Greece called Ikaria; and the Seventh Day Adventists in Los Angeles — who for religious reasons are at least vegetarians if not vegans. These five populations eat primarily plant-based, unprocessed food; eat a lot of legumes; and engage in frequent, low level physical activity.

Exercise lowers your weight, your blood pressure, your blood sugar, your cholesterol and your stress hormones. In moderation, exercise decreases inflammation and oxidative stress. It improves health of the endothelium that lines your arteries and decreases the risk of heart attacks and strokes. It decreases risk of several types of cancer, maintains joint health and range of motion, helps prevent and treat depression, helps with sleep, helps prevent dementia including Alzheimer’s, improves low back pain, increases bone density, helps you live longer and enhances quality of life as you age.

Recommendations vary for how much aerobic exercise people should get and often are influenced by how much exercise experts think people will actually do (an example of the paternalism in medicine, where experts tell people what they want to hear instead of telling what the science shows and let them make up their own minds). In his book “How Not to Die” and on his website, Dr. Greger presents evidence that what’s optimal is 90 minutes of moderate-intensity or 40 minutes of vigorous exercise a day. You should exercise for at least 30 minutes a day, and if time doesn’t allow that, you can break it up into three 10-minute segments.

Examples of moderate exercise are brisk walking at a pace of 4 mph, downhill skiing, hiking, shooting baskets, yard work and yoga. A good rule of thumb is that when you engage in moderate exercise you should able to talk but not sing. Vigorous exercise would be bicycling uphill, cross-country skiing, running, singles tennis, swimming laps and water jogging. Avoid exercising right after a meal. Also, avoid exercising in the evening, which can make you feel “wired” and cause rather than prevent sleep problems.

A lot of aging is loss of strength, and it is advisable for people 40 and over to engage in upper and lower body and core resistance work for at least 20 minutes twice a week, on nonconsecutive days, using light weights, kettlebells or rubber bands. If you do this without resting in between exercises, this counts towards your daily aerobic exercise.

Humans evolved over millions of years to be moving about, and sitting is bad for health. In particular, sitting adversely affects the delicate endothelium organ system that lines arteries. If you have a desk job, consider a treadmill desk or at least a standup desk. Another strategy is to take frequent, short breaks and walk around. If you watch TV at night, buy a small piece of equipment that enables you to slowly, constantly pedal.  One company that sells them is called Stamina,

Only 23% of Americans meet the national exercise guidelines, and fewer meet Dr. Greger’s more evidence-based guidelines discussed above. On the flip side, there is such a thing as too much exercise, which applies to a very small percentage of people. This causes rather than prevents inflammation and oxidative stress. Endurance athletes who engage in repeated marathons, ultramarathons and ironman triathlons show evidence of heart damage after competitions and are more apt to have arrhythmias such as atrial fibrillation.

If you have led a sedentary life or have other risk factors for heart disease, it’s fine to ease into a light exercise program such as walking on the level, but check with your doctor before embarking on a vigorous exercise program, since a stress test might be warranted to check for a major coronary artery blockage. And it’s not safe to be a weekend warrior — being sedentary all week and engaging in vigorous exercise on weekends.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email

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