A little while back I posted the following video on my Facebook because it got me pretty fired up and I wanted to stimulate some discussion.

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Literally within the first minute fitness guru Paul Chek states that “cardiovascular exercise is one of the most dangerous things you can do”.  He then goes on to suggest that the cortisol response from cardio is going to be detrimental to your health while lifting heavy weights repeatedly is somehow not going to have a similar response (hint: cortisol also rises after resistance training).  He later concludes that your body will adjust to cardiovascular exercise and that the number of calories you can burn will ultimately go down over time and prevent you from being able to lose fat.

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Of course, I find this interesting because I know a few endurance cyclists (and have seen data from cyclists in various labs) and it appears to me that these people are able to generate HUGE wattages on their bikes and burn through far more calories in an hour of cycling than and a novice rider.  Interestingly, I am betting these people are possibly healthier than the novice riders too, but I’m just speculating here.

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Then…to make matters worse, Dr. Mecola goes on to post this article that appeared on Facebook with the title “New Study Shows Cardio Workout May Damage Your Heart”.  The title on the actual page is “One of the Worst Forms of Exercise There is”.  Of course, they’re actually talking about this study which ultimately shows that there are some minor right ventricular changes in athletes who have completed endurance races between 3 and 11 hours.

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Are these really dangerous?  Maybe.  But the reality is that Mercola and his gang are using these changes (and all the stuff from other studies they citied) as surrogate markers for risk of death or cardiac issues which isn’t really a well established relationship.  In fact, part of the conclusion states (with reference to the right ventricular changes) “that the long-term clinical significance of which warrants further study.”

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Further to that, these are people who ran for 3-11 hours straight!  I couldn’t run for 11 hours if I was being chased by Freddy Krueger.  And if I did, you could probably bet that my heart wouldn’t like it.  As with most things in physiology, there is usually some kind of inverted U pattern for improvement.  No stimulus or a very low stimulus provides very little rests.  A mid-range (optimal) stimulus provides better results.  And going too far and really pushing the envelope can result in some sort of decrease in results.  In this case, the type of training for the races might be optimal for performance, but not health.  Truth be told, I’m not sure the results really even tell us that.

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What I do know is that I’ve never seen cardiovascular exercise listed as one of the major risk factors for cardiovascular death.  In fact, a new paper detailing the leading LIFETIME risk factors for cardiovascular disease listed hypertension (high blood pressure), diabetes, hypercholesterolemia (high cholesterol), and smoking as the 4 most major risk factors.  Nowhere on that list did I see “doing cardio will kill you” or “cardio will esplode your adrenalzzz”.

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Going a little further down the rabbit hole, there has been plenty of research showing that exercise (including steady state cardio via activities as easy as walking) can improve health.  Heck, you could even do it on a treadmill…in running shoes!  (Yes…I know…blasphemy).  If you have the time I’d suggest you watch Dr. Robert Ross talk about it HERE.  He’s a great speaker with a ton of knowledge and I’d highly suggest you bookmark it if you don’t have time to watch it right now.

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Does this mean I think steady state exercise is incredible for weight/fat loss?  Not necessarily, but there is some evidence to suggest that cardio alone can contribute to weight loss with around 200 minutes per week making a pretty meaningful difference in some studies.  But if you’re familiar with my blog you’ll know (via the link in the previous sentence) that when combined with diet I don’t think what type of exercise you choose (steady state, metabolic workouts, intervals) really makes a difference in terms of fat loss anyway.

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I am not personally a fan of long term steady state activity, as I prefer higher paced superset type workouts in the interest of time and preserving muscle mass during fat loss (with the calorie deficit coming mostly from diet).  However, if you know someone who wants to hop on a treadmill for their 30 minutes of steady state cardio they probably aren’t going to die.  In fact, it might just improve their health.

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Don’t let any internet fearmonger tell you otherwise!

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PS: If you’ve found this useful or are just plain old fed up with people making up stories about the dangers of cardio, please share this post.

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PPS: Using studies that only support your pet theories without examining the entire body of scientific evidence (as was done with the article on the dangers of cardio) is called “cherry picking”.  If you’d like to learn more about how to properly read fitness research you can check out my product HERE.

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In Part I of this series I described the categorization and classification of obesity, in Part II I shared some resources and very important concepts about obesity management, in Part III I discussed how I could go about training those with a BMI greater than 35.  Today I want to talk a little bit about training people with obesity whose BMI is less than 35, but still over 30 which is pretty much the standard criterion for obesity in most places in the world (except for a few places that I mentioned in Part I).

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Within this category I find that there are often two different types of people.  The first are those who are inactive, have less than average muscle mass, and are generally out of touch with all that is fitness.  The second type I generally see within this category are those who are regularly active, lift weights, and are fairly muscular.  They are often everyday gym rats, off season bodybuilders, and even trainers and coaches.

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While those in the first group tend to accept that they are obese, those in the second group often having difficulty truly accepting this and often  point out that BMI does not take into account their muscle mass.  For this reason, it is important to remember that while you CAN have a BMI greater than 30 and not be over fat, males with a body fat percentage over 20% and females with a body fat percentage over 30% are considered obese regardless of their BMI.

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I won’t get into it too much here, but you can see how working with those who are already active could warrant more intense training programs and different exercise variations.  However, I find that these people are most difficult to reach in terms of establishing long term realistic behavior changes as they tend to see themselves in the different category than those who are starting from ground zero.  In my experience, this group tend to think that they are able to handle more “hardcore” dieting and training practices to bring about rapid fat loss and they struggle to come to terms with the fact that while they certainly train hard, they need to address the root causes of their excess weight in much the same way as those who are less experienced with training.  In short, carb and calorie cycing, refeeds, and all of the other advanced nutritional practices are secondary to slow, progressive behavioral change.

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I would also add to this discussion the importance of remembering a point I made in Part I.  It isn’t as important to know the classification of obesity (how heavy you are) as it is to know about how obesity is impacting your health.  In short, you could have class 3, stage 0 obesity (BMI over 40, but no obesity related health problems) or you could have class 1, stage 2 obesity (BMI over 3o with significant obesity related health problems).  So weight (over even body fat percentage) doesn’t give us the whole picture anyway.  If you exercise you MAY be in better health because of the simple fact that exercise is medicine, or you may be suffering from metabolic changes associated with obesity despite the amount of exercise you’re getting.  So whether you exercise or not, I think the two groups here both need to consider changes to their behaviors in the interest of long term health.

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Goals

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Before we go forward I want you to consider something before you outright reject it.  What if we suggested to people that instead of losing weight that they just focus on maintaining weight?  I’m not body composition change or anything fancy.  There is no trick here.  But what if instead of working towards fat loss, we just stopped the gain?  Is that success?

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The basic premise is that each of us tends to slowly gain weight as the years go by and that if we could just stop the gain we’d be miles ahead.  I’m not suggesting that you’ll have an easy time convincing clients that this is the way to go, but sometimes perspective is the key here.  How many times have you (or someone you know) pulled out a picture from 10 years ago and thought “Damn…I used to look like that?  And I thought I was fat?  I would KILL to look like that again!!!”.  Hindsight is 20/20.  Add to that the physiological and psychological effects of losing and regaining weight repeatedly and you can see why maintaining weight might be a good option.  In this case, I think many would do well to maintain their current weight and work towards preventing future gain.

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I’m not saying that you’re going to get clients to buy into this off the bat.  But if you’ve worked with a client for a long time and they’ve failed change their behaviours to the point where they’re able to lose weight (if you’ve been in the industry for a while you know you’ve seen this even if you’re unwilling to publicly admit it) it might be a good time to reiterate this point so that they can see the smaller version of success that they ARE achieving.  Further, I find it helps in cases like these to reiterate successes like adding exercise and the benefits it provides to keep the client motivated to maintain the changes that they have made.  At one point in my career I used to “fire” clients for being non-compliant and failing to get results with weight loss.  Had I had this perspective then I certainly wouldn’t have made this embarrassing mistake and they’d probably be healthier for it.

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Back to reality though.  If a client comes in and you tried to sell them on this they’d be out the door before you could blink.  I think that mentioning the concept is a good idea, but suggesting a weight loss of no greater than 1-2 pounds per week is probably a good idea.  Truthfully, we all know that when starting a program it’ll come a little faster at first anyway (business tip: under promise, over deliver), but if the weight loss keeps moving much faster than this it could be a good sign that you’re overly depriving your client and that the changes won’t stick.  You don’t have to take my word for it, but I’m right. 

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But here is the real key.  Measure multiple things and create goals for each.  Track weight, measurements, body fat percentage, health markers (get their physician on board and make sure to educate them on obesity), cardiovascular fitness, and so on.  That way, if there is little progress on one, there will be others to highlight at any given time.  And MOST importantly, define weekly BEHAVIORS that you want to change (no more than 1-2 at a time) and focus most heavily on these goals.  Behaviors become habits which lead to outcomes.  Even if the client is able to deviate from plan and lose weight, the reinforcement should be focused on the behaviours as opposed to the outcome.  Because, in the end, if the behaviors don’t change, the results will eventually come undone.  So…the instead of behaviors leading to the goals…the behaviors ARE the goals.  Or to phrase it another way, the results are YOUR goals, the behaviors should be the goals of your client.

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Training

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I was thinking I’d write a detailed explanation of the training I use for people in this category, but frankly, it isn’t really much different than the training I outlined in Part III with only a few exceptions.

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I will do a full movement assessment on people in this category provided that they are not overly limited in any specific way.  Most are not so I proceed with a full breakdown of posture, mobility, stability, flexibility, and strength on this crowd.  If the client can, we do foam rolling.  And I certainly don’t have any issues with doing mobility work specific to the needed determined in the assessment for this group either.

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In terms of resistance training, I’ll generally follow the same template as I would do with heavier folks with the exception of the fact that this group will probably be able to handle (both physically and psychologically) more volume so I might do 2-3 set of each exercise instead of starting with 1.  That said, in the beginning pretty much anything you do will bring about results so I don’t push the envelope too much.  Make the person enjoy exercise and they’ll come back.  Of course, if I get one of those I mentioned earlier who already trains like a beast I’ll make them hurt.    Let’s be honest, they’ll enjoy that.  But they’re still going to have to make behavior changes too as this is the component upon which long term results are dependent.

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For cardio with this group it all comes down to what they prefer to do.  Now that doesn’t mean that if they prefer to sit on the couch and watch television that they aren’t going to do cardio.  But if they would rather do moderate intensity cardio for a longer time I’m good with that.  I don’t think cardio is that important for fat loss when combined with a solid diet anyway.  I use it for health and other benefits so I don’t care how they get it.  If they prefer more intense stuff, they can do that.  Of course, the idea is always to be increasing in intensity over time regardless, but I don’t freak out if people don’t want to do intervals.

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Summary

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In short, I think the biggest difference between these folks and those with a BMI greater than 35 is how you frame their goals.  The training is simply a matter of matching the level of exercise progression/regression to meet their needs and not making them hurt so bad that they don’t want to come back.  While this group is often easier to work with in terms of what they are physically capable of doing, their nutritional shortcomings are often just as difficult to overcome as those at higher body weights.  In the next article of this series, I’ll be talking about nutrition and how it applies to these groups.

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If you have any specific thoughts or questions about these articles, please drop them below.  And don’t forget to follow me on Twitter and Facebook if you’re not already.

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Check out Part V of this series HERE.

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I hope this has been of help to you.  If so, please “like” or share this article so we can spread the word.

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Okay…in Part I of this series I talked about the categorization and staging of obesity and in Part II I dropped a few fundamental thoughts (and some great resources) for preparing to train clients with obesity.  If you haven’t read these I’d suggest you go back and read them first.

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Goals

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Today I want to move forward and actually get into details about how I train people with obesity.  More specifically, I want to focus today on how I train clients with Class 2 and Class 3 obesity (BMIs over 35 and 40 respectively), but first I just want to touch on the subject of goals.  I read somewhere recently that when those with the higher classes of obesity are asked to define their weight loss goals it is common for many to desire and expect weight losses of as much as 50% of their current body weight.  In other words, if you’ve got a 500 pound man, his goal might be to reach 250 pounds.  If you’ve got a 300 pound woman, her goal might be to reach 150 pounds.

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Frankly, I don’t have any studies to back up this assertion, but based on my experience I can only say that there is certainly some truth to this.  As a human, I can certainly understand how someone with class 3 obesity might just want to be “normal”.  However, as a fitness professional I feel it is my responsibility to temper this belief with a delicately put explanation of reality.  The very real truth is that weight loss will likely be much less.  Even with bariatric surgery (eg: gastric bypass) the average weight loss is around 20-30% so the likelihood of weight losses this great with non-surgical methods are not great.  That certainly isn’t to say that they can’t happen (I’ve seen it with a couple of my own clients), but I think it is more prudent to emphasize the medical benefits of weight losses as small as 5-10%.  In fact, even without a body weight change, the addition of exercise alone can improve health markers, mobility, and wellbeing.

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I think the key here is to not prevent clients from making these goals for themselves (good luck if you try to do that), but to stress the benefits of lesser weight losses and applaud them as they achieve them.  Further to this point, with these clients in particular I would generally focus less on the outcomes and have them focus heavily on weekly behavioral goals instead.  As it will take a long time to lose this much weight, clients will get more consistent feelings of accomplishment from achieving small goals instead of looking at the overall goal (which can be discouraging).

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It is important to remember that two of the biggest predictors of long term adherence to an exercise program are the reality of their expectations and self efficacy (belief that they can do it).  Expecting too much and falling short obviously makes us want to give up which is why I try to emphasize realistic goals.  And giving them small weekly steps increases the belief that they can achieve the activity required which only sets them up for success.  Of course, you can probably see how this could work for non-obese clients as well…which it does.

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Side Note

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I chose to distinguish the training of Class 2 and 3 obesity from Class 1 or even just people in the overweight category because I think that goal setting should be different and the programs could actually be different between these groups to some degree (depending on the level of impact their obesity has on their movement).  I’ll talk more about this in my next post, but for now, I’d suggest employing the goal setting practices above for higher BMI clients.   But now that we’ve got that taken care of, let’s get into the training.

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*Note that the training I’m discussing here is if I am personally working with a client.  This is NOT the same as I’d recommend to an unsupervised person with obesity trying to get started on their own.*

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Assessments

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As many of you know, I’m big on assessments with clients.  However, in dealing with obese clients whether or not I use a formal movement assessment depends on their ability to actually move in the first place.  If they’re relatively young and otherwise healthy (Stage o or Stage 1 obesity) I’ll do a movement assessment as usual.  If their movement is greatly impaired or their obesity is really impacting their ability to move (due to pain, being deconditioned, etc) I skip it.  Of course, I could modify my assessment, but generally I don’t.  Someone in this position has bigger issues than whether they can dorsiflex their foot to X number of degrees or any other measure when it comes to movement.  Some may disagree and choose to assess anyway…and that is up to them.  Personally, I don’t always do it as I figure I can do it later when they’ve established themselves in some good nutritional and exercise patterns that will address their bigger issues.

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However, with clients that are in this category of obesity I think it is important to make sure to have their physician involved with doing some baseline and follow up assessments as well.  Measuring fasting glucose, lipid profiles, and various other health markers is wise to ensure that what you’re doing is actually making them healthier AND it serves as yet another marker of progress for the client.  And from a business perspective, their physician might notice what you’re doing and refer you more people…just sayin’.

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More to the point though, the doctor can also assess for sleep apnea (which can be related to depression and lack of weight loss) and other obesity related issues.  Free bonus tip:  If your client has sleep apnea make sure they get the mask refitted as they lose weight as it can become ineffective.

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Foam Rolling

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As a general rule, if a client can do this, we’ll do it.  If they can’t get down to the floor and up again without a big struggle, we skip it.  I do believe it is important, but not important enough to humiliate a client.  As they’re able, we’ll add it in.  The Stick may be an option for those who can’t get down to the floor if it is absolutely necessary.

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For those who can get down to the roller, remember that they’ll be putting a lot more weight onto a focused spot on their body and it can hurt.  If this is their first encounter with fitness that might be discouraging.  For this reason, we have 3 different foam rollers of increasing density with one being quite soft, and a little harder, and being the normal foam roller most would use.  I’ve found this helps.  My buddy Nick Tumminello also once mentioned putting a couple rollers under the area being rolled to increase the surface area and decrease pressure to get the same effect.  Nick is smart!

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Mobility Work

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For those clients I’ve done a formal movement assessment on, I will normally design the mobility program based on that.  For those I haven’t assessed, I make an assumption based on educated guesses as to what is typically tight/weak/etc.  This may be a crappy approach, but in the end, I’m getting people moving.  For many, breaks will be needed between drills and for some the drills alone can actually be the exercise session.

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Early in my career I used to try to make sure the client achieved their “planned workout”, but these days I think it is more important to just “roll with the punches” and work within the limits the client has.  Push a little.  Gain a little progress.  Show them small successes.  Then STOP!  Don’t force it.  Just encourage them and keep them coming back for more.  This will do infinitely more for anyone than breaking them down with hard workouts that make them overly sore and sick.

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Resistance Training

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Here’s the thing – with obese clients in these categories muscle will be lost with weight loss.  You can work to prevent it, but ultimately, it is going to go down.

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Here’s the other thing – many of these clients will have never worked out in their lives.  For most, it has at least been a long time.  Which ultimately means, it doesn’t really matter what you do (unless you do something completely idiotic) because they are going to get results (i.e., some muscle retention, strength, etc).

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I generally start these clients with 1-3 sets of 10-15 repetitions on 5-6 exercises in a whole body workout 2-3 times per week.  So on their first day (and for each workout for a few weeks) I might do 1 set of 10-15 on each of 6 exercises.  Over time I’ll bump it up to two sets.  And finally up to 3 sets.  Then I’ll probably move towards pairing antagonist exercises (like a row and a bench press), but keeping the same set/rep scheme.  Over time I may substitute in new exercises, but keep everything else the same.  In short, I keep it wicked simple.  My goal is to create CONSISTENCY as I think this is the most important factor for these folks.

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With increasing length of training time, strength, mobility, and weight loss their programs will start to look increasingly like my “normal” training programs, but at the start (and by start I mean first 3, 6, or even 9 months) their programs are pretty basic.

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Cardio

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While interval training may be faster and debatably “better” than steady state cardio (although I’m hard pressed to believe the second statement), I think it is probably the worst choice for a novice obese client.  I’ll often have them do as little as 10 minutes of moderate intensity cardio after a session and aim for a couple of extra walks (5-30 minutes depending on mobility, etc) during the week.  Ultimately, I tend to see walking as the gateway drug of fitness and while it isn’t necessarily the best exercise for weight loss, there are some remarkable health outcomes that can be brought about by walking alone.

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Over time I’ll increase the time (for the person who can only walk short distances) and intensity of cardiovascular activity for these clients.  Eventually I might include some more interval type protocols in the interest of time, but this would be far down the line and subject to client tolerance and interest in this type of training.  But the big thing you’ll notice in these programs is that resistance training is only typically 2 days per week (3 days max) and that my goal is to build up to 150-200 minutes of weekly physical activity by adding increasing amounts of cardiovascular activity (which can be as simple as walking).  Keep in mind that going from zero minutes of physical activity to 200 can take a LONG time…so patience is key and it is important to focus on the aforementioned small weekly steps forward.  Encouragement is paramount!

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Summary

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And that’s about it.  Pretty simple really.  I’m sure I’ve overgeneralized here as there are definitely cases where obese clients have done much less than this (only walking) and others have done much more.  Looking back, I’m not really happy with the article as I feel there are many more qualifiers and exceptions I should have included, but this would easily end up being a novel.

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In my next post I’ll discuss the differences between training those in these categories of obesity and class 1 obesity, and the following post will cover a discussion of nutrition for both groups.

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In the meantime, if you have a specific question related to this post, please ask in the comments section below and I’ll be happy to address it.

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Check out Part IV of this series HERE.

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If this article has helped you or you think it might help others please share it via Facebook, Twitter, or whatever social media you like or simply hit the “like” button below.

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Notice I selected a picture of an obese person that didn't involve inaccurate stereotypes of them eating crappy food or being lazy.

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Over the past year or so a few fitness professionals (many of whom I respect) have written blog posts on how to train people with obesity.  As someone who is very familiar with this area, I figured I’d chime in with my own thoughts to add to the discussion and information about training this specific population for those who are interested in my take on the subject.

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As some of my readers know, I do some work for one of the very few government funded bariatric medical programs in my province providing evidence based (i.e., research backed) treatment for patients with obesity.  In our clinic we see hundreds of patients per year with weights ranging from 250 to 700 pounds.  My main role is to oversee the design and implementation of the exercise component of the program to get everyone exercising regardless of their physical, emotional, psychological, and economic limitations.  Combining that with my ongoing experience in the private sector in training people for fat loss (both online and in person), I feel that I’m in a good place to share my views on the topic.

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Definitions, Categorization, Etc.

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Before we can really talk about obesity though, we’ll need to clear up some definitions and lay down a foundation of understanding about how it is categorized.

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In short, obesity is defined and categorized primarily based on something called the Body Mass Index (BMI) which is essentially a height-weight scale.  In a publication in the early 1970′s it  scale was created as a proxy to determine body fatness in relation to height and weight, but more recent evidence suggests that this isn’t exactly true.  I’ll get into that in a bit, but for now you should know that BMI is the most widely used tool for the categorization of obesity in a medical setting.

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If you want to determine your BMI you can go HERE and use the calculator to let you know where you’re at.

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Categorization Based on BMI

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Under 18.5  -  Underweight

18.5 – 25  – Normal Weight

25 – 30  -  Overweight

30 – 35  -  Class I Obesity

35 – 40  -  Class II Obesity

Over 40  -  Class III Obesity

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Although this is the accepted World Health Organization categorization for obesity, it is pretty arbitrary and the divisions between most of the categories have no scientific explanation.  And since their are regional differences in “normal” body weights,  some places have different categorizations for obesity.  For example, the Japanese categorize anyone with a BMI of 23 as overweight and anyone with a BMI of 25 as obese.

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Of course, any astute fitness minded person will also note that BMI is limited in that it is not able to determine actual muscle and fat weight so someone who works out regularly and has a higher muscle mass might be categorized as obese while actually being quite lean.  In fact, the reverse can actually true as well which means that people with a “normal” body weight might actually carry an excess amount of body fat.  These are the people that we might call ”skinny-fat”, but are clinically defined as having normal weight obesity.

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Although I’m not sure this is universally agreed upon, having a body fat above 20% for males and 30% for females would make you obese regardless of your BMI.  And all of this leaves out the fact that where that fat is distributed may have an effect on cardiac health (i.e., fat around the waist = bad, fat around the hips = good) so you may be in danger regardless of whether or not you actually have a lot of fat.

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The Staging System

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So thus far we’ve talked about categorization of obesity based on weight and to some degree we’ve talked about body fat percentage without mentioning the methods used to measure body fat which is a different post entirely (Short version: Your home bathroom scale that measures body fat probably sucks).  However, to train people with obesity it is important not to just know how much they weigh, but the degree to which obesity is actually impacting their health, movement, etc.  To determine this it is helpful to determine the “stage” of obesity using something called the Edmonton Obesity Staging System (EOSS).  While I could type it all out for you, I’ll just swipe it from the site of Dr. Arya Sharma who is one of the creators of the system.

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STAGE 0: Patient has no apparent obesity-related risk factors (e.g., blood pressure, serum lipids, fasting glucose, etc. within normal range), no physical symptoms, no psychopathology, no functional limitations and/or impairment of well being.

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STAGE 1: Patient has obesity-related subclinical risk factor(s) (e.g., borderline hypertension, impaired fasting glucose, elevated liver enzymes, etc.), mild physical symptoms (e.g., dyspnea on moderate exertion, occasional aches and pains, fatigue, etc.), mild psychopathology, mild functional limitations and/or mild impairment of well being.

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STAGE 2: Patient has established obesity-related chronic disease(s) (e.g., hypertension, type 2 diabetes, sleep apnea, osteoarthritis, reflux disease, polycystic ovary syndrome, anxiety disorder, etc.), moderate limitations in activities of daily living and/or well being.

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STAGE 3: Patient has established end-organ damage such as myocardial infarction, heart failure, diabetic complications, incapacitating osteoarthritis, significant psychopathology, significant functional limitation(s) and/or impairment of well being.

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STAGE 4: Patient has severe (potentially end-stage) disability/ies from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitation(s) and/or severe impairment of well being.

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Looking at the list above, you might discover that as a client you have a person who is actually has Class III obesity, but is a stage zero and has no related health or mobility problems.  This could be a guy who was a lineman on his college football team, maybe he’s actually still fairly active, and he’s not sick.  This guy might thrive with hard training and a slowly integrated nutritional program.

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Training this guy might be different than working with someone with class I obesity that is a stage 3 and has disabling arthritis making it difficult to move let alone hit up some heavy squats.  This person would obviously require a drastically different program which is why I get worried when I see generalized recommendations for training obese folks.

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And if YOU are an “offseason” bodybuilder or you just train regularly and don’t have a solid nutrition program you might have gotten off easy before with the old mantra that “BMI doesn’t take into account my muscle mass so I’m not really obese”, but now you know that if your body fat is breaking 20% (or 30% for women) you ARE obese.  And you might actually be a class 1 or 2 on the staging system too.  You know that heartburn you’ve been getting and the slightly elevated blood pressure that you’re not paying attention to?  Those are potentially obesity related issues.

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So if you wonder why I spend so much time talking about obesity on my blog it isn’t because I’m talking about someone who is vastly overweight.  In my experience, most people who see themselves as having “only a few extra pounds” are actually clinically obese…and this includes those who exercise regularly and even fitness professionals themselves (we are not immune).

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Now that we’ve covered the basics and some definitions, in my next couple posts I’ll come back and drop some information about how I would go about training someone with different classes and stages of obesity.

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Check out Part II of the series HERE.

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PS:  If this post helped you or you think it would benefit others please share it.

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PPS:  Please feel free to join me on Facebook and Twitter.

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A couple weeks back I wrote a post in the benefits of writing action plans to implement small behavior changes to bring about long term results.  Frankly, I think that this is the best way to overcome stumbling blocks in getting started with an exercise or nutrition program for the beginner and for reaching new levels of achievement for advanced trainees.

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As a result of that post, I’ve had a few questions and I figured that today would be as good a day as any to one of them.

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Question: If I successfully implemented a behavior last week, do I have to change it or increase it this week?

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Answer: Definitely not.  If last week you decided you were going to exercise 3 times for 30 minutes and you achieved that goal, there is no reason to expect that this week you should attempt to do 4 days per week or increase the time to 45 minutes.  However, the aim of an action plan is to make regular small steps forward in ANY behavior the leads you towards your goal.  So this week you could very well maintain your previous exercise goal and address another behavior instead.

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For example, if your long term goal is weight loss and last week you began exercising as was discussed above, perhaps this week you can begin to address another simple habit like sleep as this can also effect weight management.  If you regularly go to bed late and get up early for work you might set an action plan to go to bed by 9:30 at least one night this week and build on that in later action plans.

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Ultimately, the when thinking about action planning it helps to take a look at what the ideal situation would look like for you to achieve your goal.  For fat loss you’d likely be exercising a few times per week, lifting weights, eating less junk food, maintaining a moderate calorie deficit, eating plenty of veggies and fruit, consuming adequate protein, drinking mostly water and few calorie containing beverages, sleeping 7-8 hours per night, and so on.  Doing all that at once is easily a recipe for failure (which is why most people that try this do not actually succeed in the long term), but breaking it down into very small managable actions will make it possible to implement this over a very long time line and make it more likely that you’ll be able to maintain it.

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So you select the easiest possible remaining behavior that needs to be changed and start working on it in the simplest possible way for you whether it be only one meal per week or one day per week.  Over time, new habits will form and the results will come.  They key is patience and consistency.  If you can accept that it will take time, the wait will pay off and you’ll eventually leave all those trying more severe programs in the dust as they struggle to maintain their new habits and eventually regain the weight they lost.

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And for those who are more advanced, the same thing appliles.  You may have already implemented behaviors that have set you on the path to your goals.  The key now is to identify which ones still lie between you and your intended outcome, pick the easiest one to change…and get after it.

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In the end, it is nice to read this stuff, but unless you’re actually doing it, you might as well have not wasted your time.   What is your action plan this week?  If I get enough people sharing theirs I’ll share my own next week.

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PS: If this post has helped you or you think it might be helpful to someone you know, please don’t hesitate to share it.

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Those who follow me on Facebook will know that I frequently signify the completion of each of my workouts with a status that simply says “Dose”.   I do this largely to share the message with others that exercise, all by itself, is simply one of the most powerful tools we have for the prevention and treatment of many disorders, dysfunctions, and diseases.  I want them to know that Exercise is Medicine!

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More importantly, my hope is that by sharing when I’ve had my “dose”  this will incite others (even if it is just ONE person) to move that day and begin to make a difference in their own lives and the lives around them.

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Now, if I’m being honest, the phrase above isn’t my own. “Exercise is Medicine” is actually the name of an initiative coordinated by the American College of Sports Medicine and I have borrowed it because it is such a powerful statement and I think it speaks to a lot of people.  Because of this, I want to use today’s post to touch briefly on the medicinal (and almost magical) benefits of exercise.  More specifically, I want to focus on the improvements that can be had with exercise EVEN IF WE DON’T RESTRICT CALORIES.

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1. Improved Cholesterol

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Exercise alone has been shown to increase HDL (good) cholesterol, which is a valuable improvement for heart health.  And while some might argue that cholesterol is largely related to genetic factors and another faction might even argue that improving cholesterol isn’t linked to many “hard” outcomes (like improving mortality rates), I feel it is still worthy of attention and it is formally considered a risk factor for cardiac issues is most medical establishments.

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2. Decreased Triglycerides

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Triglycerides, in the simplest sense, are the fats that float around in our bloodstream and when they become elevated can put us at increased risk for heart disease. Exercise can burn off these fats and it has been shown (in many cases) to be even better than calorie restriction for this very purpose.

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3. Decreased Blood Pressure

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High blood pressure (otherwise known as hypertension) is a leading cause of strokes and it is often called “the silent killer” because you don’t necessarily notice the change happening as it slowly increases over time. Exercise can reduce both systolic (the top number) and diastolic (the bottom number) blood pressure thereby reducing our risk of stroke.

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4. Improved Insulin Sensitivity

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When we eat a carbohydrate (vegetables, fruits, starches, and candy) the sugars from those foods goes into our blood stream. Our pancreas then releases the hormone insulin to tell many of the cells in our body to take up and use those sugars. *Note to fitness peeps – Don’t crucify me here, I’m simplifying for the masses*

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When our cells become insulin resistant they fail to listen to the signals given by insulin (kinda like I do to my wife when she asks me to take the garbage out) and the sugars in the blood continue to rise. Left unchecked, this problem can become worse and eventually may lead to diseases like Type 2 Diabetes which can bring with it a whole host of other problems like vision loss, neuropathy, and kidney problems.

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The most incredible thing though, is that as soon as you begin to move your body shuttles the sugars from your blood into your cells for use, blood sugar normalizes, and your sensitivity to insulin jumps up drastically. In fact, this jump is so drastic that if you want to show the effects of exercise on chronic changes in insulin sensitivity (not just those from the most recent exercise bout) you have to wait FOUR DAYS to test for this. So the result is INSTANT and lasting.  The second you move…you improve!!!

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Add to that the fact that over time insulin sensitivity will become improved even while you’re not exercising if you continue to maintain that active lifestyle!!!  Whether you’re currently healthy, insulin resistant, or Diabetic exercise can help.

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5. Reduced Waist Circumference and Visceral Fat

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You’ve probably heard that certain body shapes are more at risk for cardiovascular issues and that is probably an understatement. While there is some research suggesting this is not the case, most professionals would agree that fat stored around the waist (more specifically around the organs – called visceral fat) is a ticking time bomb.

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Fortunately, exercise can decrease abdominal fat and waist circumference EVEN WITHOUT WEIGHT LOSS. I’ve seen cases where people are losing 8-10 inches off their waists in 6 months with no change in weight so not only does it look better, but they have drastically reduced their risk of death from cardiovascular causes.  So you can get new jeans and be healthier!  Score one for activity!

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6. Improved (or maintained) Bone Density

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As women get older – or for those who have had their ovaries removed – the risk for bone loss increases leading to hip fractures, immobility, and other complications increases. Simple higher impact activities or moderate resistance training can prevent bone loss and even increase it if you work hard enough.

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7.  Increased Strength

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I could go on all day about the virtues of being strong, but in terms of every day activites, it just makes life easier.  From picking up groceries and children, to lifting stuff at the gym getting strong is like a magic pill that helps make things that were once difficult feel simple.  Exercise can make you stronger and THAT is medicine.

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8. Stress Reduction

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Whether this is brought about by neurochemical changes in the brain or some psychological factor I don’t know.  Frankly, I don’t even really care.  To me, lifting heavy things helps to vent my frustrations through the iron.  But at the same time, going for an afternoon in the park with my wife and daugher, running on the climbers, and swinging on the swings does exactly the same thing for relaxing my mind and bringing me in touch with what is REALLY important in life.

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9. Increased Muscle Mass

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As muscle mass is corrlated with strength, metabolism, and absolute sexiness (okay…I made up the last one…but I figure it helps with that too) you can’t go wrong by getting active.  You’ll be stronger, leaner, and sexier for your efforts.  In fact, those who lose weight without activity tend to lose muscle mass, reduce their metabolic rate, and have a harder time overcoming plateaus.  So whether you’re dieting or not…movement is good.

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10. Weight Loss

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I’ve said in the past that I don’t think adding exercise to an already solid diet does a lot in terms of absolute amount of weight lost.  In that case, I think it comes down to more of what kind of weight is lost.  With activity involved, a greater proportion of the weight lost will be fat and more muscle will be retained so exercise obviously has a role here.

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But even without calorie restriction, moderate intensity exercise can bring about a weight loss if the appropriate amount of activity is done.  Below 150 minutes per week you’d be looking at 9lbs in a year, over 150 minutes per week and you’ll achieve closer to 18lbs in a year, and once you exceed 200 minutes per week (about 30 minutes per day) you can score yourself about 33lbs of weight loss in one year with NO DIETARY CHANGE!!!  Of course, changing your diet is good too, but in terms of health you could lose weight and become more active and you’d be reducing TWO risk factors for heart disease!

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Frankly, I could probably go on forever and talk about the effects of cardiovascular fitness on reducing mortality and so forth, but I think you already get the idea.  My two most major points are that exercise is NOT just about weight loss (although it helps) and that regardless of how much you’re willing to do, the benefits are incredible as long as you start.

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Even if it sounds like a HUGE leap for you…take small steps as I suggested HERE.  Plan week by week and set achievable action plans.  The medicine and the magic of exercise will pay off.  And when it does…you’ll feel awesome!  So walk, run, swim, dance, or lift.  It doesn’t matter.

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Exercise is medicine!  Just move and get your dose!

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*Note – I realize that I’m probably preaching to the choir here (or at least a lot of you) so please share this with those who need to hear it via Facebook, Twitter, email, or whatever method you can.*

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Every so often we tend to let our weight get a little beyond where we might like due to work stress, having kids, etc and we rationalize that we’ll just have to “take it off later”.  However, recent research on leptin shows that perhaps this doesn’t work exactly as we might expect.

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You see, leptin is a very interesting hormone that was evolutionarily responsible for protecting our body from starvation.  At our normal weight (i.e., when we are not calorie restricted) leptin levels remain stable and our metabolism plugs along just fine.  However, as we lose weight our leptin levels fall which can slow down our metabolism and make us want to eat more to restore us to our original weight and bring leptin back up to its original levels.  This is normal and anyone who had tried to lose weight in the past will know exactly what I’m talking about.

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But here’s the kicker, when we gain extra weight and carry it around for a while our leptin threshold (the point leptin levels have to reach to keep us weight stable) becomes higher.  In other words, we’ll have to eat more to restore leptin to that higher level and this predisposes us to go right back to that weight.  So basically, once we gain weight and carry it around for a while, it will actually get harder to maintain any future weight loss.  Shit!

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And to make the problem worse, the new leptin threshold (you know…the one we created by allowing ourselves to carry around the extra weight that we were going to take off later) does not appear to go down even if we take off the weight and maintain that new body weight for a long time.  Instead, the higher leptin threshold appears to be permanent and once it is changed there doesn’t appear to be much we can do about it.  Double shit!

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So what can you do about it?

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 If you’ve gained some weight and you’re not where you’d like to be then you need to immediately implement a plan consisting of several well thought out action steps that will carry you to your goal before your body adapts to your current weight.

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Alternatively, if you’ve been at your current weight for a while and you think your body may already have adapted, what you can do is start by taking action today to prevent future weight gain.

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Of course, if you need that extra litte bit of incentive to finally take action I should remind you that today is the last day to Tom Venuto’s Burn the Fat, Feed the Muscle product before the end of day and you’ll have the opportunity to get lean, and defeat leptin, and win an all inclusive trip to Maui all at the same time.

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Whether or not you decide to use Tom’s product is up to you, but frankly, the incentive to go to Maui is pretty convincing to me.  But the very least you need to do is start taking some action today (no matter how small) to start moving in the right direction.

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Recently there has been a lot of buzz in the fitness industry about a new study showing that 45 minutes on vigorous activity boosts post exercise calorie burning by 190 calories.  Frankly, I think the study was done VERY well, but I think people are taking it to mean more than it does.  I figured I’d do a quick review to share a few of my thoughts.

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In short, the researchers took 10 subjects had each one spend 24 hours in a metabolic chamber on two separate occaisions.

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For the uninitiated, a metabolic chamber is an 8 x 10 foot room with a 7 foot ceiling that is completely sealed for the period in which the subject is studied.  (In other words, if you don’t like enclosed spaces you’d probably freak right the hell out)

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On one occaision the subjects did no physical activity within the chamber other than what was necessary for daily living (washing, brushing teeth, etc).  The rest of the time was spent sitting and no additional activity was permitted.

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On another occaision, the same methods were followed except that subjects performed 45 minutes of exercise at a “vigorous” intensity (75% VO2 max – actually VO2 peak, but that’s just being picky). 

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On both occaisions subjects received meals that were designed to keep them in calorie balance so on the exercise day subjects were fed more food to account for the calories expended from activity.

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The results of this very strictly controlled study showed that when the subjects exercised they burned 514 calories from the exercise bout itself and an additional 190 calories in the post exercise period.

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So what does this study actually tell us?

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This study shows that you’ll burn 190 extra calories after doing vigorous exercise than you would if you did absolutely nothing!

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Mind-friggin’-blowing isn’t it?!?

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I think the researchers did a very good job at answering the question they asked, but I’m not sure the the research is of much relevance to non-researchers (i.e., people who want to lose fat).  I don’t think there is really anything new here.

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Previous research has demonstrated that intensity and duration can both contribute to the post exercise calorie expenditure so this research just reinforces this fact. 

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.And more importantly, does it really matter?

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To illustrate the effects of such a protocol in the real world a training study would have to be conducted to show that fat loss would result as a chronic effect of this protocol.

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But again…you’d be looking at doing nothing versus doing something so I’m pretty sure you wouldn’t be surprised to see that the exercise group might come out on top.

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In summary, exercise versus not exercising DOES result in increased calorie expenditure.  You might even hypothesize (probably correctly) that this would result in greater weight loss over time. 

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Would there be a difference between two exercise intensities if done for the same time with both groups already in a calorie deficit and free living conditions (i.e., not being told to sit down all day in a box)?

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I don’t know the answer to that.  But I’m not holding my breath since exercise really doesn’t tend to result in more weight loss in trials where diet changes are already in place.

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In the end, this study does show we burn more calories when we exercise which is good (not surprising).  But it doesn’t really tell us much more than that.

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Knab AM, Shanely RA, Corbin K, Jin F, Sha W, Nieman DC. A 45-Minute Vigorous Exercise Bout Increases Metabolic Rate for 14 Hours. Med Sci Sports Exerc. 2011 Feb 8. [Epub ahead of print]

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Side Note - I found it interesting that this study actually had two references from Eric Poehlman whose career has come crashing down after admitting to falsifying data in grant applications and several studies.

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If you’d like to review studies like this for yourself, check out my product How to Read Fitness Research.

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I have a confession to make.

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I use interval training with my clients for fat loss.

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For those who are new to this blog this will probably come as no surprise as interval training is pretty trendy and everyone and their mother “knows” that interval training is better than steady state exercise for fat loss.

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However, my regular readers will know that I’m not buying this at all.  As far as the research is concerned, I don’t think that there is any evidence to date showing that interval training is vastly superior in terms of total fat loss compared to steady state exercise.  In fact, there are only a handful of studies (less than 5) actually looking at this and the differences in fat loss between groups are actually quite small.

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To further complicate matters, in studies where intervals and steady state have been compared, there was no calorie restriction.  As I mentioned previously, adding exercise to diet rarely yields additional weight loss so I’m wondering just how much of an extra effect intervals would have if this was added to the mix.  I’m guessing the divide between intervals and steady state would get even smaller!

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Until a study is conducted where steady state is compared to intervals with dietary restriction and a similar amount of mechanical work,  I think the jury will be out on the true effectiveness of this method for fat loss.  I could be wrong, but in the end, I think they may just pan out to be even.

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Of course, some might find this shocking given the amount of media hype about how intervals will make you lose 26 pounds of fat in 18 seconds.  But the truth is, that if you prefer steady state exercise or you don’t love puking on your shoes after repeated sets of sprints, you don’t necessarily need to jump on the interval bandwagon if you want to get lean.  After all, people used steady state exercise to get lean for years before intervals were “in”.

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So why would I use intervals in my fat loss programs???

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One word.  TIME.  I certainly don’t believe that intervals are better, but I know they are faster and that is where I believe the big distinction is.  Maybe it is semantics, but I don’t think it is fair to tell people that intervals are superior when the research doesn’t support it.

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If you only have time for short bouts of activity then I’m in full agreement that intervals are a good choice (which is why I think so many facilities that use them feel intervals are superior).  But for those who prefer steady state exercise and have more time available for this I don’t feel that we need to force them into interval training.

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Both work.  Find what you like, get it done, and be consistent.  Diet is probably more important anyway.

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What do you think?

A while back I did a guest post for my buddy Bret Contreras where I basically stated that the acute rise in hormones like testosterone and growth hormone from certain types of training protocols has no additional  effect on muscle hypertrophy (growth). 

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Then, just a couple weeks ago, one of my friends emailed me a recent study showing exactly the opposite with the primary difference being the timing of the “hormone inducing” workout.

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In both studies the authors had the subjects train one arm in a low horomone condition and the other arm in a high hormone condition on alternate days.  In the first study though, the authors had the subjects perform additional leg exercise AFTER the arm training to increase anabolic hormones in the high hormone condition.  In the more recent study, the subjects  performed the leg exercise to increase growth hormone and testosterone BEFORE the arm exercise in the high hormone condition.

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In the first study they found no difference in strength and muscle growth between the two conditions and in the more recent study they found that the higher hormone condition increased the strength and muscle growth to a greater degree.

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At first glance, it appears that boosting hormones via training BEFORE training your smaller muscle groups (like biceps) can increase your results.

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However, one other major difference was that in the first study they gave each subject a drink containing protein both before and after the workout.  In the more recent study, they “encouraged” subjects to consume something afterward, but nothing was formally provided.

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Previous studies have demonstrated that there may be a maximum level of protein synthesis that can be achieved and that giving a bolus of protein in conjunction with exercise would make this easily achievable.  Because they didn’t give a peri-workout beverage at all in the second group, it is hard to know whether the differences would have been seen if protein synthesis had already been maxed out.

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So it MAY be that doing hormone inducing exercise before your smaller muscle groups can accelerate muscle growth.  Or it may be that doing hormone inducing exercise before training your smaller muscle groups can accelerate growth when protein synthesis isn’t already maxed out from pre or post workout nutrition.

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The moral of the story though, is that since the second study didn’t control peri-workout nutrition, we just don’t know.  For now, I’m still leaning towards the conclusions of the first study since the second study lacked the appropriate control to really answer this question.

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If you’d like to review studies like this for yourself, check out my product How to Read Fitness Research.

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