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Health Protocols

Exercise Enhancement

Types of Exercise

A comprehensive exercise program includes aerobic, muscle strengthening, flexibility, and balance exercises.17,18

Aerobic Exercise

Aerobic exercise is rhythmic and prolonged physical activity that elevates the heart and breathing rates. Examples of aerobic activity include fast walking, running, bicycling, and swimming. Aerobic training increases cardiorespiratory fitness, improves cerebral blood flow, and reduces the risk of death due to heart disease and all causes.17,19-21

"Aerobic exercise" refers to aerobic metabolism, in which oxygen is used to regenerate the energy-storing molecule ATP (adenosine triphosphate) in the mitochondria. Glucose in the blood, glycogen (stored carbohydrate) in muscle cells, and free fatty acids in blood and muscle cells provide fuel for ATP production.22

Muscle-Strengthening Exercise

Muscle-strengthening or resistance exercise involves forceful muscle contraction against external resistance.17 This type of exercise increases muscle strength, size, and endurance, and prevents sarcopenia, or age-related loss of muscle mass and strength. Strength training, when undertaken at an adequate pace, also improves cardiovascular endurance. Examples of muscle-strengthening exercise include weight training using free or machine weights, resistance bands, or body weight.17,18,23

Flexibility Exercise

Flexibility or stretching exercises entail slow and steady stretching of muscle groups. Stretches should be held for 10 to 60 seconds without jerking or bouncing, and repeated two or three times, progressively increasing the stretch. While mild discomfort is expected, flexibility exercises should not be painful, as pain may indicate minor muscle tearing. Flexibility exercise combined with muscle-strengthening exercises improve range of motion and relax muscles. Stretching before exercise may increase mental preparedness, but there is conflicting evidence as to whether it prevents injury. Stretching after exercise, when muscles are warm, may be more effective.17,24-26

Balance Exercise

Balance exercises, such as holding positions on one leg or using balance boards, may help individuals with awareness of motion and relative position problems and may also help prevent falls.17,27 The American Heart Association and American College of Sports Medicine recommend balance exercises for individuals who fall often or have mobility problems. The guidelines include recommendations for the following types of activities18:

  • Increasing the difficulty of postures and decreasing the base of support, such as progressing from two-legged postures to one-legged postures
  • Movements that disturb the center of gravity, such as heel-to-toe walking and turning in place
  • Postures that stress certain muscle groups, such as standing on toes or heels
  • Reducing sensory input, such as standing with eyes closed

Muscle strengthening exercise also improves balance by strengthening the muscles and tendons that support joints.17

Recent research has examined how different methods of exercise training affect various aspects of cellular biology, including telomerase activity and telomere length. Telomeres are structural components at the end of chromosomes that play a role in cellular aging and regeneration. During each cell division cycle, telomeres shorten. When they reach a critical length, the cell enters senescence. Shorter telomeres are associated with cardiovascular disease, obesity, and diabetes, as well as a reduced life expectancy. A healthy diet, non-sedentary lifestyle, and regular exercise may be associated with longer telomeres.28

Telomerases are enzymes that add nucleotides to telomeres, thus regulating telomere length. Research indicates telomeres may shorten in a progressive, age-related manner, but telomerase activity decreases steadily from age 4 to 39. After age 40, approximately 65% of people have low but stable telomerase activity levels, while approximately 35% have no detectable activity levels. Studies indicate active adults have an upregulation of telomeric binding factors, which protect telomeres from shortening, as compared to those that do not regularly exercise.29 

Other observational studies suggest higher levels of physical activity are associated with longer telomeres, particularly in older individuals. This may be because exercise combats oxidative stress and inflammation, alters telomerase activity, and increases the number of skeletal muscle satellite cells (skeletal muscle precursor cells that help regenerate muscles after an injury).29

In one study, 124 healthy, previously inactive men were randomized into an aerobic endurance exercise group, a high-intensity interval group, a resistance training group, or a control group that did not exercise. Each intervention involved three 45-minute training sessions per week for six months.

VO2max was increased by all three training methods. Telomerase activity was up-regulated two- to three-fold in the endurance and interval training groups, but not the resistance group. White blood cell levels increased in the endurance and interval groups as well. A single bout of endurance training, but not resistance training, increased telomerase activity in certain leucocytes. Thus, aerobic activity may promote cellular health and healthy aging.30

More interventional studies are required to confirm the specific effects of exercise intensity and frequency on telomere length and telomerase activity.

High-Intensity Interval Training

High-intensity interval training, or HIIT, is becoming increasingly popular. This type of exercise training consists of short, repeated bursts of intense exercise followed by periods of recovery.31,32

High-intensity interval workouts can be performed using several different protocols. The high-intensity exertion phase can last from five seconds to eight minutes, and is followed by recovery periods of no or low-intensity exercise that can last as long as the active phase. During exertion, the heart rate reaches 80‒90% of maximum. Perhaps the most common protocol involves 30 seconds of maximal effort cycling followed by four minutes of recovery, with the cycle repeated four to six times per session, three times per week. Other less-demanding formats have also been devised.32-34

In a 12-week study in previously sedentary men, a total exercise time of 30 minutes per week, of which only three minutes was intense exertion, was compared with 150 minutes per week of moderate-intensity continuous training. Despite a five-fold-less time commitment, interval training was found to be equally effective as traditional endurance training at improving insulin sensitivity, cardiorespiratory fitness, and skeletal muscle mitochondrial content.35

Several other studies have indicated HIIT is superior to continuous moderate-intensity training at improving cardiorespiratory fitness, vascular endothelial function, insulin sensitivity, and arterial stiffness. HIIT also improves blood pressure and cholesterol profiles, promotes fat loss while maintaining muscle, and may be of particular benefit to those with or at risk of type 2 diabetes.32,36-38

In a review of studies in patients with lifestyle-induced chronic diseases, HIIT was nearly twice as effective as lower-intensity continuous exercise at improving cardiorespiratory fitness—a strong predictor of mortality.38

Despite perceptions that compliance with recommendations for more vigorous exercise is poor, a study in prediabetics found short-term adherence to HIIT was greater than traditional continuous workouts.39 In another study, high-intensity interval running was perceived to be more enjoyable than continuous running. In addition, since a lack of time is a common excuse for avoiding exercise, the shorter duration of HIIT can be a major workout incentive.32,39,40

HIIT should be adjusted to a person’s own fitness level. People with health conditions are advised to obtain medical clearance prior to starting a HIIT program.32