Body Hacking Using Exercise Physiology to Slow Aging with Anne Friedlander

So welcome everyone, thank you for coming out bright and
early in the morning to see this talk. I appreciate it and
I hope we have some fun today. So as you know, the title of the talk is,
Body Hacking, right? But I’m gonna qualify that a little bit. I hope I won’t disappoint too many of you,
but I’m gonna call it, Body Hacking (For the Sane), right? Cuz if you look online about body hacking,
people are implanting things, and they’re injecting things, and
they’re doing all sorts of craziness. So what I wanna do today is give you
some helpful hacks that you can use when you go out of this class later today,
so more practical information. So you heard a little bit about
me in the introduction, but I’m gonna expand on that a little bit. So I’ve been in the program in human
biology for 20 years now, so I came down to do a postdoctoral fellowship, and
dug my claws in, and never left. So as you know,
this is a very nice place to be, so I decided this is where I wanted to spend
my time, and I’ve been here ever since. I’m an exercise physiologist. So what that means is, I study how the
body adapts to acute and chronic exercise. And then I use exercise as a means to
an end, so to make people healthier, to change the trajectory of aging,
to improve human performance. And for me, you got a little sense of this
in the intro, it’s both a profession and a passion. So I like to be outside doing it,
exercising, going into different environments and
really understanding how my body’s changing in those different environments,
the intricacies behind human physiology. And then I really love sharing that
information with people like you, because I think that the more
people learn about their bodies, the more interesting it becomes, and the
healthier the choices are that they make. So I also enjoy telling stories, and that’s a big thing now here at Stanford,
so telling stories. Science communication, so there’s a new
notation in science communication that students can get, to learn how
to communicate about science outside of the scientific world to
the general population. And that is very important these days, given that science is kind
of getting a bad rap. There’s a lot of pushback against it. So if you can engage people in science,
if you can reach out and talk to them about things that
they understand and appreciate, then that can be a powerful message. So one of the stories that I’ve told
in my career, you just heard about. So I taught that online class, your body in the world adapting
to your next big adventure. Just out of curiosity,
are there people in here who’ve taken it? How many people have taken the class? Okay, so a couple people, so
I’m gonna show you a teaser for that class, for a couple reasons,
which I’ll explain later. So, let’s see this, and I traveled
all over the country with my TA, experiencing different environments. We filmed it, and then we gave follow-up lectures on the
physiology underlying those experiences.>>As humans, we exist within a varied and
changeable environment. We are the most adaptable
animals on Earth. [MUSIC] Below your conscious awareness,
trillions of cells are communicating to precisely adjust to the stresses
experienced daily or during a once in a lifetime
extreme adventure. [MUSIC] In this class, you will experience different
environments through story videos, and learn what changes occur in your
body at the systemic and cellular level. You will gain a new appreciation for the amazing capacity of your
body to adapt and to survive. [SOUND]
You will learn practical tips that will enhance your
own personal experience and physical performance in
extreme environments. [SOUND] Your body is awesome. [MUSIC] Welcome to Environmental Physiology. [SOUND]
>>As you can see, it’s exciting, right? It’s a little bit of marketing there, but
I showed that to you for two reasons. One is that we’re redoing the class
to make it a self-pace class. So if you’re interested in that kind
of thing, look in the next month or so on the Stanford sites, and you might be able to join up and
learn about your body in the world. And the other thing is,
I wanted to give you the feeling for what I see in the human body,
that I really do believe it’s awesome. It’s an amazing piece of machinery, and
it’s worthwhile learning about it and understanding how to drive your own car,
so to speak. So that’s a little bit about my story,
and you have your own stories, right? So I don’t know about them personally, but
I do know that part of your story was that you were probably here at
Stanford as a student. You may be a spouse or a guest, but you’re
here at Stanford, and now you’re back here in this classroom at Stanford again,
so that’s a nice story arc. And in between there,
you may have gotten one or many jobs, you may have gotten married,
you may have kids, you may have grandkids. And you also may have noticed some changes
in your body throughout that time, some of them good,
maybe some you’re not so fond of. And maybe that’s what drew you to this
class, to see what’s happening with aging, and things that we can do
to slow that aging process. So hopefully, part of your story
includes physical activity. But if it doesn’t, I’m here to tell you,
it’s never too late. So you can start incorporating
that into your personal story now. Okay, so why did I call it Body Hacking? To be perfectly honest,
I made a little mistake. [LAUGH] So I gave them the title before
I started working on the talk, and what this really should be called is,
>>All right, small change, but a big difference,
cuz Body Hacking’s a little too extreme. Biohacking is defined as follows, to
manipulate a biological system to obtain a desired result, and,
do it yourself biology. So we’re gonna be doing both
of that today in this talk. And obviously,
I’m an exercise physiologist, we’re gonna be talking about movement and
physical activity. Movement should not be a hack in our
lives, but it sorta has became one, and our great ancestors were
the ultimate endurance athletes. And it’s theorized that we used
to hunt by the persistence hunt, where we would actually run down prey. So we would run for hours,
and hours, and hours, to the point that animals would
keel over from exhaustion. And then we could walk up to them and
bump them on the head and have them for food, right? But our sweat glands, the way we move, our two legs, allow us to run for
long periods of time. These days, unfortunately, we can barely
run after three-year-olds, many of us.>>[LAUGH]
>>So we have come a long way the other direction, and part of that is that we’ve
engineered activity out of our lives. So we have escalators, and appliances, and we drive everywhere, and
we have massive amounts of screen time. So everything’s become very convenient,
which is very handy, but it means that we don’t have
exercise in our lives anymore, and it’s only getting worse, unfortunately. So just two weeks ago,
there was this headline in my online feed. Online shopping makes people weak
because they no longer carry groceries, say physiotherapists.>>[LAUGH]
>>I’m like, yeah. And then a week later, Walmart comes out, Walmart puts it eggs in time
saving basket: grocery pick-up. That’s gonna be very popular. I think it’s a good move for Walmart,
for their business model, right? So they pick up all the groceries for people, they have their employees
walking up the aisles, you drive by, they throw it in the back of your car,
and you’re done, right? One more thing, one more way that exercise
has been engineered out of our lives. And incidentally, if anyone knows any
high up Walmart executives I have a great idea that I think they’ll love, so if you
could hook me up I’d really appreciate it.>>[LAUGH]
>>So it’s just a little plug there. So we’ve compartmentalize our
exercise into gyms and I do this too. I go to the gym but I have to laugh
sometimes when I’m sitting there looking at all the people lined up on treadmills
and bikes and lifting weights and thinking why are we outside living our
lives, doing this is part of our lives. And I had a friend who had this
characteristic, who would circle and circle the gym in her car to
find a parking place close.>>[LAUGH]
>>So she could go to the treadmill and walk on the treadmill. The weird thing is, is I kind of get it,
the exercise is there in the gym and you don’t want to park far away right,
but how weird is that. I mean it doesn’t make any
sense that we’re in that state. So the purpose of my talk today,
I hope is to inform, illustrate, and inspire and hopefully deliver
new information in the form of hacks that can reduce the burden
that some feel towards exercise. So just to start off. 85 years old can look really different,
so you can look like this gentleman who’s in a nursing home and dependent on others
for all his activities of daily living or you can look like Alma Kent here at 85,
running the London marathon. Now, if I were to ask anyone in this room,
who’d they rather be at age 85? They’d pick Alma Kent, I suspect. So there are some things that
are beyond your control, right, there are some accidents,
there’s some diseases. But the thing is, there are a lot of things that you can
do throughout your lifespan to direct the trajectory of your aging more towards
Alma and more away from this person. And one of those things is physical
activity, so we call this healthy or successful aging. And if you look in the literature
at how aging is depicted, it looks something like this. It’s pretty grim right? You have aging,
decreased endurance and strength and function and that leads to a decrease in
physical activity and the you have all these increase disease risks and
cognitive function impairment, etc. So I look at this with great optimism because right in the center of all of
those things is physical activity. So if you flip that arrow all the other
arrows change too and you have that power. You have that physical
activity power to impact the trajectory of your aging in that way. So if you were to put that in a graphical
form it might look something like this. Where you can have
anything on this access. It could be cardio vascular function,
it could be strength, cognitive function, you have this increase in the early years,
you have sort of a plateauing with a slight fall in middle age, and
then a more rapid acceleration, and hopefully avoiding this
threshold of disability. But, with physical activity, a lifetime of physical activity,
the curve will look more like this. You’ll have higher peaks, you’ll still
decline a little bit in middle age but when you decline later on,
this slope is a little bit different and you will end up above this
threshold of disability. So you have a compression of comorbidity, you’re able to function more
effectively in your later years. And even if you haven’t exercised your
whole life, if you put the curve on, it’ll look something like this. So not as much as if you’d exercised
your whole life, but definite benefit, definitely ending up above that threshold. So I did sort of a stream
of consciousness, I just threw in a bunch of things
I know that exercise effects. Lot of different things,
everything from functional capacity, to disease prevention,
to cognitive function, to aging per se. So we have this magic pill. We have it, it can be free. There are very few side effects. So what’s the problem? Well As you know,
most people don’t do it, right? So 20% of the people in the US of adults,
meet the recommended guidelines for physical activity. And there’s lots of reasons for this. The guidelines look something like this,
and I’ve summarized, or sort of paraphrased, but
the American Heart Association, American College of Sports Medicine,
they’re all similar. And they say basically 150 minutes of
moderate intensity exercise per week, the more intense the exercise,
the less you need. You have to do resistance and
flexibility 2 to 3 times, neuromotor exercise 2 to 3 times. That’s a lot of time, that’s a lot of
time you need to put into this and most people don’t have that or
aren’t willing to spend it. These added a few new things to try and
make it easier for people. So they’ve added the fact that you
can cut it up into little chunks, so little ten minute chunks, even maybe down
as short as five throughout the day. So walking to your car,
walking to lunch, walking upstairs. And also avoid sedentary behavior, which
we’ll talk about at the end of the talk and as an independent health risk. All right, those are the guidelines and
what’s even worse is if you look at the data on who
does any recreational activity. The numbers are pretty invisible. So back in 88, about 15% of men and
women, if you average that, did no leisure-time activity and now in 2010 we’re up to about 50% of
people do no leisure-time activity. And the no will become very
significant later in the talk. So, we have great potential
with physical activity, we also have a problem,
people aren’t doing it. So, is there a way to address the major
barrier for most people, time, by providing hacks that either optimize time,
or integrate movement into daily life’s. Okay. So when I first created this talk, I had
little arrows for all sorts of things, I had bones and joints and
hearts and brains and everything. And there are things for all this but
we don’t nearly have enough time, so I tried to pare it down. So we’re gonna go through
as much as we can of this. We’re gonna start with
the fitness variables and then we’re gonna move onto
the health variables. All right, so
let’s start with cardio vascular fitness. So we’re gonna look at the problem,
the opportunity and the hack. So looking at the problem
I’m gonna be very brief here because the basic message is, that cardio
vascular fitness goes down with age. So something called VO2max
which is the gold standard for cardiovascular fitness because it
has elements of ventilation and transport and uptake and use of oxygen,
is linearly related with workload. So higher VO2max, the more work you
can do, over time it goes down, in both trained women in this case and
untrained women. And you can see there’s
a huge variability. So this seven-year-old has a VO2max
that’s higher than this 20-year-old, right, so there’s a lot of variability. They’re all going down. This line of the endurance
training ends up higher and above this threshold of disability. Who will notice the fall first,
probably the athletes, cuz they just can’t quite do what
they used to do, so they’re noticing. These people may not be noticing,
but they’re heading for a point where they’re not gonna be
able to take care of themselves, they’re gonna have functional limitations. And it’s not just function,
it’s all cause mortality. So I know this graph is probably
a little hard to see, although, the screen is very large so
maybe you can see it. But this is study by John Myers,
who’s over the Palo Alto VA, looking all of the vets who came in
during a period of time for stress test. So how hard they can work? And look at over 6,000 man, he divided
them up on Quintiles of physical fitness. So, this is the most fit group, the
highest group, this is the least fit and this is the relatively risk of death
over an average seven year follow-up. So compared to the fittest group, the least fit group has a 4.5 times higher
risk of death in the follow-up period. You can see that there’s
sort of a swooping line, where the biggest drop
occurs between these two. And this is both in normal subjects, and
in subjects with cardiovascular disease. You can also have a similar curve based
on the amount of physical activity. So this is a more recent study,
it just came out a week or so ago. So here is increasing physical activity,
and here is that curve. So the more activity that you do, the less
risk you have of all cause mortality, and a big drop in that earlier part,
right? 15,000 men and women in that one,
in 39 countries. So the opportunity is, it’s changeable. So these are survival curves,
and we’ll look at the women. And the top line here is those people who
are, I’m sorry, let me step back a moment. So in this study, they did two test on
people within a nine year period and they looked at how they
survived after those two tests. So in this case, they were fit on both
their test, so the highest survival. In this yellow, they were the low
fitness category on both of their tests. But look especially at this red line. So this was low on the first test and
then fitter on the second test and the survival curve bumps up. This one started fitter with blue and
then got less fit on that test. So you have to keep doing it, right, but
you can change that survival curve and change the trajectory of aging. All right, so
this is what you came here for, right? The hack. You already know this stuff though,
the hack. Alright, so if the time is
of the essence then one hack could be High Intensity Interval Training. How many people have heard of that in
the context of the general public? Okay, well I’m gonna tell
you why it’s effective. So High Intensity Interval Training,
and this is sprint interval training. This is a subset of this greater category. It’s not just for athletes anymore,
so it’s been around for a long time. Little time, big effects. So Gabala started this craze with a paper
that came out of his lab in 2006. Someone kinda new was out there,
knew you could increase V O2 max and stuff, but what was pretty amazing. So they had two groups that
they compared directly. Both groups were biking, one did 30
seconds as hard as possible, 4-6 reps, 3 times per week, for
a total of 6 sessions. So 15 minutes of total training time,
plus the added rest time. The second group did 90 to 120 minutes of
cycling at 65% of their maximum capacity, 6 sessions 4-5 hours of training. So this is like a standard
endurance training protocol. And the results were that the HIIT group,
the short training group, had the same or better outcomes
with tenth the exercise amount. So if you don’t include the rest there. And this was not just,
little bit off there, but this says time trial performance,
mitochondria, glycogen, and buffering. So not just in the high-end exercise,
but in markers of endurance, of being able to do exercise for
a long time. And that was very new because you thought
you had to do this volume training in order to get endurance adaptations. So, there have been a lot of other
studies that have come out since then and they’ve been trying to shrink, and
shrink, and shrink the amount of time that people have to do to see if they
can get the event, the right response. So now, this same group
recently came out with a paper. Sorry the references are cut off. Just came out this last year. And they looked at 12 weeks
of endurance training. Sedentary young men on a stationary bike, they did moderate intensity
continuous training. So that’s the MICT group,
which is 45 minutes at 70% VO2peak and the SIT group, the sprint interval
training, was 3 times 20 seconds, all-out sprints with 2 minutes recovery. So that’s a total of 1 minute of exercise. And there was 5 minutes of warm up and
cool down, so the total time if you include
the rest sessions in the SIT for the recovery sessions, it was 50
minutes versus 10 minutes per session. So here’s that cardiovascular
fitness marker, so this is the continuous exercise, this
is the sprint training, this is control group, you see it was the same response,
right, for a minute of exercise. And the really interesting thing
of course, are the other markers. So there’s markers of mitochondria. So the energy has it’s inner cell
that provides your energy for every day life interest activity. They increase essentially
the same statistically, but if anything the sprint
crews a little bit better. And then insulin sensitivity. A key marker in health as we age and
in diabetes improved also with that SIT. So, a powerful response for
a minute of exercise per session.>>How many sessions per week?>>Two sessions per week. Okay, so what does HIT do? Well, there’ve been a lot of studies,
as I said. And here are some of the adaptations
in the training realm. So not surprisingly,
a lot of the max adaptations. So increase in VO2max, buffering capacity,
decreased glycogen use, and lactate. Which is a good thing. Means there’s less
disruption of steady state. Fitness endurance. So increased endurance, muscle aerobic
enzymes, and mitochondrial biogenesis. And the health also with
increased insulin sensitivity, systolic blood pressure, bad cholesterol,
mitochondrial repair, and fat oxidation. So lot of stuff going on in
those little burst of activity. So I like to think of this as a hack, because I feel like it’s
tricking the metabolic pathways. So we know a lot about
the metabolic pathways, and it’s not important, obviously,
to know [LAUGH] all these today. But that transition of going
from low energy to high energy, where there’s this period where
your body has to catch up. And then you’re really
at a high intensity, so your body’s never quite comfortable. Those little transitions are tricking
this pathway, which is normally activated with long term endurance training,
into thinking it needs to ramp up its energy production, needs to produce
more mitochondria for the next round. And so that cut start to cascade of
adaptations that are really important. And as we learn more and more about the biochemistry,
why not go to next step, right? Why not just take exercise
out of the equation.>>[LAUGH]
>>Exercise in a bottle, right? So we have exercise
mimetics now out there. In 2008, so a while ago now, there was a
front page article on the New York Times, ‘Couch mouse to Mr.
Mighty by Pills Alone’. So what they found was that there is
a mimetic, there is something that activates this protein that starts
this cascade that goes to here. And you can take it in pill form. So the mice that they had which were
not exercising increase their endurance significantly relative to the other
mice who were not exercising and been never had to move. So I think this is a disaster. [LAUGH]
>>[LAUGH]>>Because there are so many other things associated with
exercise that are beneficial. That if people have a pill, it’s gonna
be another excuse not to do it, right? And So far, it’s not available in working
in humans, but we’re making progress. We’re learning more and more about this of
what little buttons to push in ourselves to get the response that we want. So, that is definitely hack, right? But hopefully one that most
people will not use, okay. So there are many follow-up studies and the reason I put this up is because
it matters less exactly what you do. It’s just that transition from
low energy to high energy and getting really kind f as hard as you
are comfortable doing is important and it’s hit the mainstream,
that’s why many of you seen it. There’s lot of websites talking about
this, perfect for older adults, and there’s this cycle of 20 seconds
separated by 90, and for cycling, treadmill, dumbbells, swimming, boxing. That’s an unusual one, but
I could see it, I guess. And even AARP website suggests that
each IT is good for its members. So, is it doable and is it safe? So the doable question is definitely yes. So, the shorter you make the increment,
not surprisingly, the more people like it., right?>>[LAUGH]
>>So squeeze it down, people like it. And that’s turning out that you can use
other types of exercise to do this. So recent study just came out
this year from that same lab, they’re big on the HIIT studies
that use stair climbing. So two groups, 3 x 20 seconds all
out continuous stair climbing, the 2 minutes recovery or 3 x 60 seconds up and
down 1 flight for 2 minutes of recovery. So if you only have one flight,
you can go up and down. So, and that was 3 times a week for
6 weeks and they saw the same improvements that
they saw with the cycling protocols. Although, some of the health parameters
weren’t evident in that particular study but I suspect we are gonna see
a lot more looking at that issue. Is it safe? Yes, it’s considered safe. It’s been tested in young, old,
cardiovascular disease, cardiac rehab, diabetics. Here’s one study in cardiac rehab that
did have a couple of incidents but not a disproportionate amount from
the modern intensity training. And it’s usually deemed that the benefits
you get from on your heart is worth the risk associated with it. The intervals allow your
heart some recovery time. So by working hard and then resting, your
heart gets to recover during that period. So if you are new to it, if you’re older,
you should check with your physician and you should ramp it out. So maybe not going for the protocol
that’s as hard as you can possible go and picking something that’s easier on
the joints like cycling or stair climbing, something like that would be good. Okay. So what we don’t know is
the long-term benefits. So all these studies so
far have been pretty short, 12 weeks, made the longest 16 weeks. So we don’t know over time
whether it’s gonna match the endurance training that people get. So hopefully it will, hopefully it
will be a way for people to at least maintain their fitness throughout their
life as time gets shorter and shorter for them, available time. And we will see, I know that there’s
a long term study going on right now but of course the data’s not available because
they’re long term studies, so we’ll see. So, the problem as we know,
we lose strength as we age, that’s like combination of a loss
of muscle fiber size and number. So hypoplasia, and also a decrease speed
in shortening which affects power. So power we use for those activities like,
getting out of a chair, for walking up stairs, getting out of
the way of a bus, things like that.>>[LAUGH]
>>Opportunity. It’s pretty clear, right? If we do strength training, we
are better off in terms of our strength. So, here is the strength
training line up here. It’s the untrained, so we start higher and
we end up higher in our later years and the fall off is less
with strength training. So it also impacts longevity. So just like cardiovascular
fitness impacts longevity, so does strength, especially at the low end. So if you are on the weaker third, then you’re more likely to have
an all-cause mortality event. And on the upper sides,
you get the benefit of longer life and a reduction of risk of
all cause mortality. At lower years you’re trying
to maximize your peak, adult life you maintain your peak, and
at older life you minimize your losses. So, lot of benefits from weight training,
not just increased strength and power, but better functional capacity, higher bone
density, insulin sensitivity, systemic inflammation, increased longevity,
and better body weight maintenance. So we should be going to the gym. I personally dislike lifting weights,
I don’t find it very interesting. But as I’ve gotten older, I’ve tried to
force myself to do it, because it’s harder and harder to maintain your strength as
you age from just normal activities and normal endurance activities and
playing tennis and things like that. You really need to get in there and
do some resistance exercise whether it’s home, the gym, carrying your groceries
back like this which I do periodically. So again, the hack is you may not
need to lift as much as you think. So the gym where failure is good, right? So in Silicon Valley, we’re all about failure and
rebonding while in the gym too. So this graph shows mixed FSR,
so fractional synthetic rate before exercise, and then four hours
post exercise in three groups. So the first group is lifting weights
that are 90% of your maximum capacity. So very heavy weights, to failure. You get a big jump in synthetic
rate here afterwards. The middle group is lifting 30%
of your maximum weight matched. So the same amount of
total weight as this. But you can say didn’t go to failure,
and so now it’s down here, it didn’t have the same synthetic rate. But that 30% of your maximum
weight lifted to failure, gives you very similar values for
synthetic rate. So it’s not so much how much weight you’re lifting but
whether you’re lifting it to failure. So failure triggers a series, a cascade in your muscle that
leads to muscle hypertrophy. And so the first tip is that lifting to
failure is more important than the amount of weight in terms of muscle
protein synthesis and muscle size. Now I need to have qualify
that a little bit because if you want to get stronger, you need
occasionally to life heavier weights because you need to adapt
the connective tissue as well. So you don’t want your
muscles getting bigger and not ever putting that kind of
strain on the connective tissue. And also the neurological adaptation so your brain’s ability to signal your
legs and your arms to actually, to contract all simultaneously, you need
to have slightly heavier weights as well. But a chunk of it can be done
at that lower weight to failure. And here is the other sort of hack part, if lifting to failure,
one set may be enough. So traditional lifting is that you
need to do three sets to failure. But it turns out that if you’re actually
going to failure, the signaling’s very similar between that when you do
one set and three sets., right? So you’ve already activated the pathway,
you don’t need to do more. So you can cut down the total time. So if you do compound
movements in the gym or wherever, you can cut down to 15
minutes and the result’s priceless. And they’ve even found that just doing
the test that they use in these studies to see if you get stronger can
make you stronger., right?>>[LAUGH]
>>So there, you see and control groups oftentimes
are getting stronger like that. Well, yeah,
maybe they’re lefting on the side. No, they’re actually doing the test. That makes them stronger. So, there’s a whole study that just
came out that looks at that very issue. So, 38 young, untrained men and women. 8 weeks of chest press and
leg extension training 2 times per week. The HYPER group did 4 sets to failure,
8 to 12 reps, 90 second rest. The test group did the test. So they did the 1 repetition
max testing only. Which involves going in whenever the HYPER
people went in to lift weights, and doing the test. So you lift as much as you can. If you can, you add a little more,
you lift it again. If you can, you add a little more
until you can’t lift it anymore. So the maximum movements that they did,
ever, was five. But it was until they
couldn’t lift it anymore. So this might be a little hard
to see cuz there are light dots. But this here is individual
changes in upper body strength. And here’s the test only group and the
HYPER group, essentially the same value. If you look at upper body endurance,
slightly better, but not significantly better in
the HYPER group than the test group. And here’s the kicker. Here’s the hack. This is the difference in the amount
of weight that they lifted throughout the whole time. So here is for knee extension. Dominant knee extension. Non-dominant, and then chest press. This is the HYPER group,
lifted all that weight. And this is the group
that just did the test. And yet,
the results were pretty much the same. So, the bottom line for muscle. If you’re willing to push
yourself to failure, it may not require as much time as you think to
improve your strength and fitness. Fingers crossed that we can move to the
health part without the Prezi quitting, all right. So we’re gonna move into more of sort
of the activities of daily living. Which some of you may be more interested
in, some of you may be less interested in, but it’s a nice little balance here. Okay, so for health, how much, or how little, is enough of exercise? Cuz most people want to know how little,
right? It’s a tough question,
because everyone’s different. But I’m gonna give you some information,
and then we’ll sort of work it out. So here are the guidelines
that I put up before. And if you’re doing these, great. Keep doing them. Cuz there’s a lot of data behind
these that show that this will help your health and your longevity. And, make your functional capacity higher. So that’s wonderful. But there’s this whole group of people who
are doing no physical activity, right? So what can we do for them to help? Well, it turns out that if you
get those people just a little bit more active, you get a big bump up
in health, and a decrease in mortality. So here’s number of deaths per
10,000 over a follow-up period. Here are men’s fitness levels. So quintiles, again, and women’s. You can see that going from the least
active to the next category, you get the biggest jump. And this is a pretty old study, I think
it might be 1990 or something like that. But there’s been a lot of studies since
then that have corroborated this, that have similar values for
this biggest jump. In fact, I showed you two earlier. And here is that study
we looked at earlier. Looking at not fitness level,
but activity level. And on this scale it
doubles it every time. So 0 to 5 MET hours per week. So a MET hour is the intensity times
the amount of time divided by the weeks. So MET hours doubling each time,
and here it is on a linear scale. You can see that the drop
off is even more dramatic. So, what is a MET hour like? What does that even mean? Well, here are some examples of MET hours. So walking for
an hour at 3 miles per hour is 3.3. Heavy gardening work, 4,
bicycling, swimming, running, etc. So we’re talking in this category here. So let’s say even if it’s
the middle of this category, we’re talking one hour of walking a week. Maybe if we’re at five, it’s one and
a half hours, or something like that. So you divide that up over the week,
ten minutes a day of brisk walking. And that has that dramatic
improvement in health. And reduction in all-cause mortality. Hey, you get to swim for
half an hour, a week. If you’re a runner, turns out you don’t actually need that
much time running for health again. So these are not gonna necessarily
make you Olympic athletes or anything. But they’re gonna make you healthier. So if you’re a runner,
this is a similar type of thing. There are quintiles of
amount of time here. So these correspond with the points above,
so these are they don’t run at all. And here we have less than 51 minutes. So about eight minutes a day of
running and you get that drop. And then it looks pretty steady after
that in terms of all cause mortality. Either for cardiovascular mortality or
all cause mortality, and then it goes up from there. So, you get a big bang for
your buck at the low end. It’s sort of the law of
diminishing returns. Whether you’re talking about fitness or
disease risk. So on the fitness curve, you know athletes
that train, and train, and train, and train hours every day. And they improve 2% over the year, right? But you get someone off the couch, and they can improve 20,
30% in their first three weeks out. Same thing with disease risk,
you get the biggest improvement here. You get a little bit active, and
then it kind of stretches out from there. So we should be thinking in terms of
public health, not like this, but like this. Going out for a brisk walk on the beach. So could [INAUDIBLE] activities help? They probably can. So go back to that original slide I
showed you about all the things that make our lives easier. So start thinking in your own life about
removing those things from your life. Instead of emailing your person in the
office down the hall, go and talk to them. Go downstairs to get the pages
down there in the printer. Walk with your dog, walk with your kids. Some of you I notice,
are noticing this last category here. So-
>>[LAUGH]>>I’m not sure if that’s a true lifestyle activity. It actually may be a higher intensity
activity, but I couldn’t resist. I’m sure you can burn a lot of
calories in that situation.>>[LAUGH]
>>So again, five to ren minute increments,
working them into your day. So the mechanism here is probably
using your muscles, right? There’s no mystery here. Caloric expenditure or
reduction in sitting time. So we have one more category, sitting. So let’s go over there. Every time this moves now,
I get a little antsy, okay.>>[LAUGH]
>>Sitting, ack, right? So, could interrupting
sitting simply be a hack? So you’ve seen some of
these headlines probably. The perils of sitting, sitting kills,
sitting is the new smoking, beware of the chair, right?>>[LAUGH]
>>So, they´re out there. In fact, I feel a little guilty having
you all sitting here watching this.>>[LAUGH]
>>I teach an hour and a half class at Stanford. And always, in the middle of the class,
I make everyone get up and do some type of movement exercise. Cuz I just don´t wanna be part of the
problem, I wanna be part of the solution,>>[LAUGH]>>But we’re only at an hour, so I think we can make it. You can walk around afterwards. So, sitting is this new public health
risk, and people are focusing on it. Here’s another little icon from the
medical, billing, and coding organization. So they’re on board. It does talk about how, on average,
people spend 9.3 hours sitting, 6.5 walking around, and
then 0.7 in more vigorous activities. So this is of waking hours. So if you can get that 9.3 hours below 6,
There’s a big jump in improvement. And there’s some statistics on here
that I haven’t personally validated, but they seem in line with
the research out there. Here’s an actual study done by Claude
Bouchard looking at the relationship between, again, relative risk for
all cause mortality and the cardiorespiratory fitness, moderate to vigorous physical activity,
and sitting. So, the sitting here’s
on the reverse scale. So, this is less sitting,
and this is more sitting. You can see it holds its own with
those other powerful variables. So looking at that,
the less sitting that you do, the lower your risk for
all cause mortality. And this is controlled for
other variables as well. So what do we know about sitting? Well, it’s an independent risk factor for
disease. So the more you sit, the more likely you are to have things
like abnormally high BMI, abnormal lipids, so it affects fats and glucose,
diabetes and cardiovascular disease. It’s thought that it’s not actually
the other side of activity. It’s its own thing. So when I’m standing here, I’m using
my posture muscles to keep me up. My posture muscles are those red muscle
groups that burn a lot of lipids, you can use throughout the day. They’re not your explosive exercising
muscles, and that process clears lipids from my system, and it changes a variety
of parameters associated with disease. All right, so using them is important,
even sitting on the Swiss Ball, for example, would be good, cuz you have
to constantly balance yourself, even if you’re in the sitting position. The interesting thing is outside activity
is only partially protective, and interrupting sitting may help. So I have this watch
that I frequently wear. It didn’t really go with my outfit,
so I didn’t wear it today. But I basically wear it
around all the time. And sometimes it pisses me off,
because I will go out and I will go cross-country skiing for
four hours. I’ll come back, I’m exhausted. And I come back, I sit down with my lunch
for a peaceful moment, and [SOUND]. It starts buzzing at me, cuz I’ve
been sitting for more than an hour. I’m like, come on, you’re killing me here. I’ve just been outside. But the thing is,
that watch is pretty smart, right? So it knows that even though
I’ve exercised already that I really should be getting up every hour. So its not fully protective. So the watch is smarter
than I am sometimes. And it buzzes every hour, so I’m at my desk at work,
reminds me to get up to walk around. And there are studies to
show that even if you keep the sitting amount
the same between groups, but in one group, you have them get up for
two, three minutes every hour. They’re gonna be better off than the other
group in terms of disease risk profile. So if you do it every 30 minutes,
that’s even better. So the many potential targets for
this, work, screen time, school, the environment. So changing buildings so that you have to
go upstairs, putting printers downstairs, having standing desks in school,
all those types of things. There are a lot of public
health implications for this that could be very useful. So how much sitting is too much? Everybody asks this question. It’s very hard to answer. The best analogy I’ve heard is
it’s like the sun and skin cancer. So we know it’s bad for you. We know you wanna minimize it. But you can’t really say, well,
if you’re exposed this much time, you’re gonna get skin cancer. Some people may be exposed their
whole life and not get it, some people may be out for
short periods of time and get it. So, it’s a contributing factor,
but there’s genetics. There’s a lot of other
things that go into it. But I will show you sort of my
interpretation of what it means. So, if this is our general
mortality curve, right, with the optimal amount of exercise here
in the middle, not including our hack of high intensity interval training,
but we have this going on. I would put the sitting
line kind of like this. So that it shifts that line up. You’re still getting benefit
from the modern exercise, but you’re not getting as much benefit as if
you’d reduce the sitting time as well. And down at this low end where
people are doing no activity, it’s really important
to limit the sitting. Because this space between
the two is even bigger, so you add exponentially more to your risk
if you don’t exercise and you sit a lot. Here, the exercise is partly protective,
but you still need to be aware that you
need to be getting up periodically. So examples of things that you can do,
take all your calls standing up. You can see that I’m a bit of a pacer,
right, I like to walk. I’m surprised I haven’t made it
all the way across the stage. But I take all my calls standing up. And it’s actually gotten much easier
since we’ve gotten cell phones, cuz I used to be around my office chained
to the desk, walking around like this. And now I can just walk
freely with my phone. Take a walk after every meal,
no matter how short. While working, set a timer on your phone
and take a stroll around the floor or up some stairs every 45 minutes. Get up in between when you’re watching
TV in between the commercials and do something. And if possible, set up and use a standing
desk in your office, or even better, a treadmill desk. So I know a lot of people who’ve convinced
their departments that they have to have a standing desk, and then they
always have it in the seated position.>>[LAUGH]
>>It doesn’t work that way, right? You have to actually use it in the upright
position for it to be effective. All right, so let’s dive in for some concluding comments right into
the belly because we can cuz it’s Prezi. So, what I’m hoping I’ve impressed upon
you is how powerful physical activity is. I know you’ve known that all along,
you’re probably very active yourselves. But there’s an expanse of benefits
that come with physical activity, and I didn’t even get to all the ones about
cellular aging and things like that. So I may actually put together
an expanded class on this also online, where you can go into all
the different categories. So if you’re interested in this topic,
keep an eye out for that as well. So it’s very powerful,
there are shortcuts that you can take and that we’re finding that really, if it’s
on the high intensity level, less and less may be effective for
those goals that we’re trying to achieve. So, just a little side note, that it
doesn’t just affect fitness and health. There are all these things that come
with increased physical activity. So if you can get children active very
early, it affects their grades, and how much they smoke, and then leading
to reduced risk for various diseases. And as people get older that are active, they have kids that tend to be more
active, so there’s this beneficial cycle associated with keeping people
active throughout their lifespan. And the last thing I wanna leave you with, before we get on to questions,
is just a little snippet of the brain. So, here is a brain in
a child after exercise, after walking for
20 minutes, versus sitting. So you can see that there’s
a lot more activity. So, this is a brain scan going on here. And if you give them a test after that, their academic achievement is higher
after that 20 minutes of walking. So, you’re not children,
but this works on you too. So, because you’re back here in class,
I wanted to show this to you. So there’s a powerful effect of exercise
on the brain as well, both acutely and in terms of cognitive function. So before you go to your next class,
go out and walk around a little bit. And you’ll come back prepared to absorb
more information when you come back to your next classes without quizzes.

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