Melanie Cole (Host): We all know that exercise is good for you, but can you do too much? Is that even possible? My guest today is Dr. Ted Farrar. He’s a board certified primary care sports medicine physician and fellowship director at BayCare. Dr. Farrar, let’s first talk about the benefits of exercise in terms of disease prevention and mood and stress and just generally feeling good.

Dr. Ted Farrar (Guest): So Melanie, thanks for having me on the show. I’m very happy to give you a few minutes to talk about exercise. So the question is, you’re asking what are the benefits of exercise? I think there’s a one sentence summary that Dr. Butler, who was the former director at the National Institute of Aging, he said the following, “If exercise could be packed in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.” That in a nutshell tells you almost everything that you need to know about the benefits of exercise. Not only will it help you live longer, it helps you improve your blood pressure control. It can help you improve your glucose control. It can help feelings of depression. It’s been shown to help people stay more mentally sharp. All these things have been proved again and again in the literature and the reality is that if a doctor could give you a prescription for exercise, and you were to take it, you likely would need less visits to the doctor.

Melanie: Very well put, Dr. Farrar, and exercise is medicine, and as you say, it can help with so many of these diseases that we hear about today. How much exercise is recommended daily and what do you think is the best way to achieve that?

Dr. Farrar: So the recommendations for weekly exercise come from the American College of Sports Medicine, and the current recommendations are essentially 150 minutes per week, usually between two to four days in 30 minute increments. The reality is that’s about two and a half hours a week split over multiple days, not necessarily every day and it doesn’t have to be all at once. The evidence shows that you can do a little bit of that exercise in the morning and you can do some more in the afternoon and it should be a mix of both aerobic, strength, flexibility, and functional exercises, especially in older patients.

Melanie: So that was going to be one of my next questions, do you have to do this recommended amount all at once, and you answered that, thank you so much. So people hear, oh okay I’m going to do this, I’m going to do it in 10 minute increments, but then some people say, oh well you’re exercising too much. Is there a phrase as too much? Can you do too much exercise?

Dr. Farrar: So that’s a loaded question. It really depends on who’s asking it. So for example, most people in this country don’t get enough exercise. In fact, inactivity is far more common than any concerns that we might have as a nation about exercising too much. So if you ask somebody who doesn’t exercise regularly, hey is that person exercising too much? Maybe they’re training for a marathon for example, the person who doesn’t do any exercise might think, wow that’s way too much. If we asked several people who run marathons or do triathlon on a regular basis, they may say that their type of training is completely normal and it is not too much. So I guess it’s in context, and that’s the part that gets interesting for me because the research is evolving over time, and some of the newer research actually does start to put a little bit more of an objective note of what too much exercise may or may not be. So one of the ways to think about this is that we know from the research now that compared to people who don’t exercise at all, if you start to perform exercise most days of the week, say five or six hours a week, which is actually more than what the ACSM recommends, we see a very definite decrease in a person’s overall mortality. So what that means is less problems for people who start to exercise somewhere in the range of five to six hours a week. The evidence is very clear about that. So then if you have people who exercise more than that, let’s say we’re pushing maybe 10 or 12 hours a week, which seems like an awful lot. They still have a lower risk of all cause mortality is the word compared to people who don’t exercise at all, but compared to people who are kind of in the middle of the road that I mentioned, you start to lose some of those benefits. So what I’m trying to say is there’s a sweet spot for exercise, and then if you go beyond that, you’re still doing much, much better than anybody who doesn’t exercise at all, but maybe not as good as people who are in the sweet spot. And if I might go on just a little bit further than that, there has been some recent published data just this year that really shows that the too much part starts to show up around 19 to 20 hours a week. That’s a lot of exercise. If you’ve ever talked to people who perform full distance iron man races, you’ll see that those are the numbers that those people try to aspire to. That is a lot of exercise, and it only takes getting to that point before it starts to show that you’re kind of coming back to the baseline. So this goes back – this I would say Melanie comes back to the first part of my answer, which was who’s asking the question? If it’s somebody who doesn’t do any exercise at all, believe me they’ve got plenty of exercise they can do before they have to worry about losing the benefits. Those who already exercise quite a bit, well they probably need to have a lot more education about where’s the sweet spot and when do I have to worry about too much? It’s a long answer, I appreciate that, but it’s definitely a complicated question because who you’re talking to has a lot to do with how you want to describe that.

Melanie: It’s a perfect answer, Dr. Farrar, it explains it so well and how subjective it can be from the eyes of the person asking the question; it makes perfect sense. So now when we’re thinking about exercise, and you mentioned different types of exercise, what are the exercises that are the best for your heart, diabetes, blood pressure? Speak about aerobic exercise, and if someone is a new exerciser, what would you like them to think about or how to begin an aerobic exercise program?

Dr. Farrar: So let’s start with that last part first. If somebody’s a novice or new to exercising in general, somebody’s who’s basically getting ready to get up off the couch. If they’re someone who is considered middle aged, and I’ll leave that in italics for people to interpret a little bit, but mostly I want to say if you’re in your 40s and you’re going to start an exercise program, you really should consult with your physician first because those, especially starting with men a little bit younger than women, especially when you start getting into your mid-40s, there can be silent cardiovascular disease that you may want to consult a physician about before going and deciding that you’re going to start running. Now for those that don’t fall under that need, aerobic exercise can be guided by trained exercise physiologists. The ACSM is very good at programs to help train people for just that type of guidance that patients may need, and the reality is the aerobic exercise will usually start for somebody who’s untrained really at a walk, literally walk before you jog type of philosophy and as they perform better at these lower levels, they’ll increase both their time and their intensity, and a lot of that calculation has to do with the specialization of how old the patient is, and you can calculate how hard their heart has to work. These are things that can be worked out by the exercise physiologist while they’re going to work with the patient. So aerobically you’re going to build up to this concept of roughly 150 minutes per week. Generally speaking that range from running, that can be swimming, that can be a bicycle, that can be on a spin bike which is essentially the same as bicycling. You might be inclined to do Zumba classes with an instructor, which is both a strength training and an aerobic class, but it definitely gets the aerobic conditioning if you’re pushing yourself through that class. So those things will help cardiovascular fitness for sure. They also will help build some strength because you have to use those muscles to get that aerobic endurance built; however, you really shouldn’t be negligent about resistance exercise. Now resistance exercise for a lot of people means, oh my gosh they want me to go into the gym, and lift weights and become Arnold Schwarzenegger, and that’s really not what we’re talking about at all. For most people in younger and middle aged, we’re talking about just trying to build some strength, not necessarily large muscles, but just strengthening the muscles at the size that they are and we know that when you do that, for example if you’re a diabetic, your blood sugar control will typically improve. It doesn’t mean you won’t stay a diabetic but the amount of medication that you need is likely to be unchanged if you do adequate amounts of strength training, and that’s because muscle is very important to the way insulin and blood sugar is handled in the body. Now if you do those things, and you’re saying doctor, I want more, what else is there? Well if you’re a little bit older, let’s say you’re in a retired age, there’s evidence to show that the type of exercise to work on balance, flexibility, functional movement becomes more important because we’re trying to maintain the muscle mass and not let it waste away. We’re trying to maintain your coordination so that you won’t fall and that you’ll still feel good when you exercise because falls and injuries from falls become a bigger issue with older patients. So the types and duration of exercise will change a little bit throughout a person’s life.

Melanie: Wow doctor, you certainly covered the gamut of the importance of exercise and the different types whether it’s functional exercise or aerobic or strength training, you covered it and cleared it up so beautifully for us. Wrap it up. Let people know your best advice. If they’re a new exerciser and they’re just beginning or if they’re a seasoned exerciser and they just need a little bit more motivation, wrap it up with your best advice about the importance of exercise.

Dr. Farrar: My best advice for people is don’t be afraid. Challenge yourself to do something new and different if exercise is something you haven’t done before. Find friends that do it or find a group of friends that want to do it, and you’ll have more success together and more fun together than you would have by yourself, and don’t be afraid to ask for a little guidance from a physician. If you’re in that middle aged group and you’re a little bit nervous, they can give you a lot of support when you begin those first stages, and you will be impressed with yourself if you can do those things.

Melanie: That’s great advice doctor. Thank you so much for joining us today and sharing your expertise. What wonderful information. You’re listening to BayCare Health Chat. For more information, please visit baycare.org, that’s baycare.org. This is Melanie Cole, thanks so much for listening.