Exercise and Dietary Intervention for Metabolic Syndrome

According to a growing number of physicians and other experts in metabolism and endocrinology, there is a growing epidemic of an underlying inflammatory condition usually referred to as metabolic syndrome, a condition highly correlated with abdominal obesity, low relative LBM /muscle mass--aka sarcopenia (muscle wasting), sedentary lifestyle, often high fat/high fructose diet, and insulin resistance. This complex of symptoms and bio markers (blood chemicals such as hormones that show up in blood samples), is intermediary to the onset of various cardiovascular diseases and type 2 diabetes.

Measures such as targeted exercise intervention and sound diet (including intermittent fasting), as well as abdominal fat loss and muscle mass gains, have strong independent effects in mediating metabolic syndrome.

I will talk about lipid panels and, very briefly some of the bio chemical markers that are positively or negatively correlated with metabolic syndrome and try to encapsulate what it all seems to mean based on the latest research, in another article.

At some point I will probably write an article on intermittent fasting.

Meanwhile, I would direct you to www.leangains.com and of course, anything by Dr. Jason Fung, MD, on youtube.

The focus of this article is exercise intervention.

I am highly influenced by a philosophy and methodology of physical conditioning that makes exercise programming simple and straight forward.

This field of conditioning is called High Intensity (Strength) Training (HIT), it's "aerobic" equivalent, having finally become fashionable in the form of HIIT (High Intensity Interval Training), and Sprint Interval Training, modern equivalents of "Fartlek" training, and other earlier forms of "aerobic" conditioning in which intensity is highly varied, as compared to "steady state aerobics."

Anyone who finds himself reading this, is probably well aware of the body of literature that has emerged in recent years regarding HIIT/SIT.

What is not well known in popular fitness conception is the origins of this approach, which, in modern times date back to the work, beginning in the 1960's, of Arthur Jones, the inventor of the modality later named High Intensity Training, by exercise physiologist, Ellington Darden, Ph.D., author of The New HIT and about fifty other books on the subject.

Jones also invented the Nautilus and Medx lines of exercise equipment. His son invented Hammer Strength.

There are physicians such as Doug McGuff, MD, and Ken Leistner, DC, who are also experts in the field of exercise conditioning, whose work I would advocate becoming familiar with, if you want to understand why I favor this conditioning approach.

This exercise approach is indeed very simple and relatively easy to program and vary in a logical fashion over time, especially compared to the various complex strategies that have arisen in the many conditioning cultures.

Other proponents of HIT are Drew Baye (www.baye.com), Dr. Mercola, D.C. and Wayne Westcott, Ph.D.

I have developed a high degree of confidence in this approach, for use by most people, most of the time, to achieve and maintain a high level of complete physical fitness, exercising anywhere from two times per week to once every ten or eleven days, depending on how soon one achieves full recovery and "supercompensation." This depends on how hard one trains, what other physical challenges one has, such as work requirements, and sport/recreation activities, and how much negative stress one has in general, how much time one actually has for sleep, etc.

In the summer, I tend to swim often, briefly and hard, just because I like it, and in the winter I shovel a lot of snow. I inter weave these activities with occasional strength training sessions.

Most people, most of the time, do not necessarily require 150 minutes per week of "aerobic" conditioning. Especially on top of strength training sessions.

One of the biggest problems people run into is over training. Another is compliance.

For many people, 30 minutes of vigorous aerobic activity five times per week is optimal for various reasons. Some people like to run, and if you don't ignore warning signs of things like shin splints then you can achieve a high level of cardio-respiratory fitness (CRF) this way.

I would caution one not to neglect some occasional strength training.

Problems like osteoporosis and sarcopenia (muscle wasting), happen to all of us to some degree as we age. Sarcopenia and osteoporosis are dangerous disease processes that affect many people to a significant extent. To do nothing about it is dangerous.

Slow jogging can shrink muscles and lead to osteoporosis. If all you can do is slow jogging, try to do it on grass in the park or on the beach, and gradually work up to from 3 to 7 or 8 bouts of fast running for 30-60 seconds, interspersed with one to three minutes of relatively low exertion, while your heart rate returns closer to the resting state.

(When I say start gradually, this is especially important in cases of metabolic compromise and increased risk for heart disease. Consult with your doctor or exercise physiologist along the way).

Moving much faster will help prevent the body from favoring relatively weaker, slow twitch motor units (muscle fibers combined with the nerves that activate them).

There is considerable evidence that frequent, moderate aerobic exercise combined with strength training (not a lot) results in combined effects against the onset of metabolic syndrome, by way of two different pathways.

However, compliance with programs of greater frequency, duration and excessive ambulation, is a problem with sedentary, de-conditioned populations.

The HIT approach only requires 12-20 minutes of relatively high exertion, once or twice weekly for most healthy people. As far as I am concerned, this is the most efficient way for most people to train, most of the time.

The capacity to develop high cardio respiratory fitness, CRF, from this mode has been largely ignored.

There is no more effective way to load muscles and elevate the cardio-respiratory rate to where it is needed to be, than to use external resistance such as weights. Exercises like the squat and dead lift will tire your muscles out fast and elevate the cardio rate as high as anything else.

Doing strength exercises slowly is also the safest way to elevate the CR rate.

Running fast can be dangerous, especially when dodging auto mobile traffic.

What I have to say about it is not the Alpha and Omega of the subject of athletic conditioning, especially when it comes to high performance distance events, but HIT is a highly reliable, safe, effective approach to conditioning, including especially for athletes

(see arthurjonesexercise.com).

The International Association of Resistance Trainers certifies exercise trainers and their philosophy is HIT. They can provide lots of statistics and historical data suggesting the effectiveness of the HIT paradigm for conditioning athletes.

However, I am an exercise generalist. My most immediate concerns have to do with conditioning the general population in order to effect better health and well being, hence my concern with the metabolic syndrome (MS).

Sports are recklessly dangerous...

If you are going to run or play in a sport, do not do so to get into shape. Lift weights first, for a couple of months at least, then engage in your sport or recreational activity.

Perhaps the better clinical term for exercise in compromised populations such as those with MS, would be MIT, moderate or mitigated intensity training, because you have to be careful until your health improves. Then you have to be more careful...of cars...linebackers...

HIT sessions are characterized by the following:

Relatively infrequent and brief.

Moderately to severely intense (highly individual specific). The better the shape, the more intense.

Moderately to severely exhaustive (in the short term...during and immediately after the session. You should be able to repeat the session later in the day or engage in your athletics/recreation session).

Slow, controlled, safe movements, using mostly multi-joint, large muscle mass incorporating exercises, done to momentary exhaustion of the targeted muscles.

Exercises are done in sequence, with just enough rest in between exercises to enable safe, effective execution of the next exercise, but also maintain an elevated cardio-respiratory rate.

Breathing is slow, controlled and continuous, meaning very little if any acute rises in blood pressure, making this safe and effective for cardiac rehab purposes.

Google Dr Doug McGuff for more on this.

Among most athletes, and in the exercising population in general, this interval conditioning approach remains highly under rated, in my experience.

HIT strength conditioning holds great promise for most people in achieving their desired and genetically possible levels of overall physical conditioning...including offering an effective means of maintaining elevated LBM (lean body mass) over time, a key independent factor in mediating metabolic syndrome, and preventing the onset of diseases such as type 2 diabetes and CVD.

HIT is a generalized fitness, not sport specific paradigm. All we are trying to do is make the body stronger all around, including the elevation of cardio respiratory or metabolic efficiency.

We don't use, nor need balance devices, bosu boards, agility drills and plyometrics.

This is a conditioning paradigm, not a sport.

Sports are dangerous, due to fast movement speeds.

Key advantages of this paradigm for many people are time efficiency and enhanced recovery related to this approach, hence less inclination toward over training, and the accumulation of stress induced free radicals that can quickly compromise health and drive inflammatory conditions.

Women still seem to have a somewhat more widespread aversion to strength training, than men, which is a shame. Too many men as well refuse to train hard with weights if at all.

I see people in some gyms "lifting weights," but just fooling around, standing around conversing in between relatively meaningless bouts of "exercise" known as sets.

Women need strength training more than men, in my estimation.

Do NOT be scared away by the term "high intensity."

In proper practice, this is really controlled or optimized intensity training.

By no means do I advocated that anyone approach muscular exhaustion ("failure") so closely, or exceed it as the case may be, to the point of exertion on the last couple of repetitions, that it leads to debilitating muscle soreness.

It is not necessary to be sore in order to confirm that the activity has been effective.

Of course, a massage after an exercise session can effectively reduce or eliminate DOMS (delayed onset muscle soreness).

If you are sedentary and or have a lot of abdominal fat, and/or an atrocious diet, if you do nothing more than add about fifteen minutes (6-8 exercises in sequence) at moderate to high intensity of exertion, to your activities list, a couple of times a week, I am confident that you will experience a notable difference in well being over the next several weeks, as should be validated at least a little bit by blood makers such as lipid profiles and resting glucose metabolism, and other indicators of the Syndrome.

Of course as you get into better shape, you can train harder, and the progressive changes in mood and well being can lead to increases in other activities such as the elliptical, rowing or bicycling devices common at any gym, perhaps as a warm up and /or cool down to the resistance training (RT) component.

I strongly discourage folks from running on the roads with so much high speed traffick.

Try to make it easier for yourself by revising your diet, even with moderate changes like replacing soft drinks with seltzer, and cutting down on high calorie, low mass items like butter and sugar. Anything that drives up CRF, increases muscle mass, improves insulin action/glucose utilization, and reduces abdominal fat, gets you closer to optimal health.

See a physician before you get started and find a capable trainer, someone who knows spotting well and will exact just enough effort, no more, no longer, especially at first.

Talk with your physician about what your blood sample profiles really mean. Establish a baseline of the different indicators (pro and con), and get a blood test done once every ninety days. (See my coming article on serum analysis for diagnosing MS).

As for aerobics...you can do well without them, but there is a lot of evidence that 3-5 bouts of moderate to high intensity aerobics every week fights MS effectively, independent of other variables and especially in combination with strength training (a circuit of 8-10 strength exercises 2x per week).

A lot of this has to do with personal preferences and exercise motivation, which leads to compliance over time. If you like recreational and sporting activities, go ahead.

I say, if you are lazy, and healthy, be lazy, but at least pump iron once or twice a week and do it slow and hard, and try to take the stairs rather than the elevator.

If you are fat, lazy and suffering, lift weights a little less hard a couple of times a week.

After a while, when you get feeling better, you will probably want to be more active in general as a matter of course.

My preferred summer time activity is swimming. Given that one knows how to swim, and is not going to risk a heart attack or drowning while swimming alone, swimming is usually a very safe, challenging endeavor in which the anti gravity effects of the water cushion the joints. Speed of movement is limited by the water somewhat and it is a nice way to achieve a high level of conditioning.

One fairly convenient approach for beginning a new program would be to train three times a week, adding a twenty to thirty minute moderately intense (at first) aerobics session, to two strength sessions.

Whatever you prefer, don't get carried away with it. Try not to be sore.

This can be hard to avoid for athletes and serious recreation enthusiasts.

Let the pain be your guide and adjust accordingly.

Train moderately to severely hard or not at all, only when well rested and, generally when you really feel like it, to the degree that you really feel like it.

Some of you Type A exercise junkies out there seem programmed to regard more as always better. If lots of physical activity is your hobby, go ahead, but be well rested first.

I think it is a bad idea to expect the obese and sedentary, to get up and ambulate with great vigor five times a week for a half hour or more.

The General Adaptation Syndrome discovered by Dr. Hans Selye teaches us that too much exercise is a bad idea. Recovery time and quality recovery support factors, like sleep, and an occasional massage, seem under rated and often neglected. Bad idea.

Exercise is medicine and it is dose related. Too much can be bad.

However, for a lot of people in today's Western society, more would definitely be better.

A lot of the tendency to over train has to do with New Year's resolutions, approaching beach or wedding seasons, and people trying to rush results, usually after being very sedentary for some time and eating poorly.

Slow and sure is the path of the Jedi.

It is always a bad idea to try to rush results in physical conditioning.

Whatever your preferred activities, if you are healthy, train very hard once in a while so as to maintain an acceptable level of cardio respiratory fitness, which has been shown to result in stronger protection against MS, independent of other factors, but try to enjoy the process.

It's the only way you can make it a way of life that is conducive to health and well being.

Recovery is often neglected. When it is time to rest, rest.

If you are smart about your approach, and stay within your recovery parameters, just beginning a targeted exercise program that is vigorous enough to challenge and manageable enough to sustain, is a powerful weapon against MS almost guaranteed to produce dramatic improvements in health and well being, including modification of underlying inflammatory conditions, beginning immediately, in almost everyone who is sedentary, independent of whether you reduce abdominal fat, although improvements in LBM and CRF help as well.

Some people are not genetically predisposed toward chiseled abdominals, but you can have some excess abdominal fat and still achieve a high level of overall fitness. Exercise alone is an an effective and immediate tool for combating MS for those who have been sedentary.

It is my observation that this is true, and I am not aware of anyone with problems associated with MS or any number of other conditions, but otherwise basically healthy/not injured, who did not respond well to new vigorous leisure time physical activity, given they avoided over training.

Incidentally, if you have a condition like shin splints, especially shin splints, please stop running. This is a dangerous compartmental syndrome that can have catastrophic effects.

It can require surgery, resulting in awful scars.

This is a clear example of what not to do: train or work through acute pain.

It is a good idea to stop training entirely for a couple of weeks once in a while, and a better idea to get a massage from time to time.

Barring injury, exercise really is the answer to a great number of ailments.

Exercise is medicine and we all need just enough.

Future articles on exercise will address things like the anatomy of a basic strength conditioning circuit, establishing a home gym inexpensively, women's fitness, kids and weight training (a good idea)...

William D Miller, BS, Exercise Physiologist, LMT