How Exercise Improves Microbiome Health (and Vice Versa)

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By Mary Grace Descourouez, MS, NBC-HWC 

The human gastrointestinal tract is home to trillions of microorganisms that create the gut microbiome. The gut is where the body digests and absorbs nutrients from our food and, therefore, where we get our energy to perform daily human functions. Microbiota are microorganisms in the gut microbiome that help the body harvest energy, fight pathogens, and regulate immunity. Having a high diversity of microbiota helps us to process food effectively, providing the substrates and nutrients needed to keep us going throughout the day. Therefore, it is crucial to make lifestyle choices that promote a healthy and diverse microbiome.

Many people know that a nutrient-rich diet contributes to a healthy microbiome, however, research shows that movement and exercise may also have a positive effect, and, inversely, a healthy microbiome may improve athletic performance.

“It is a relatively new field, but available studies suggest a bidirectional relationship between performance and the health of the microbiome,” says Anne Friedlander, PhD, Exercise Physiologist and Assistant Director of Stanford Lifestyle Medicine. “People who are more active have a healthier and more diverse microbiome, and that, in turn, provides the person with the nutrients required to enhance physical and cognitive performance. It is a mutually beneficial relationship.” 

How Exercise Improves the Microbiome 

Movement and exercise have many benefits on our overall health, including positive effects on the microbiome. Studies show that athletes have a more diverse microbiome composition than non-athletes. Microbiome diversity is important because it helps make our food’s nutrients more bioavailable for optimal functioning of the body.

Another study found that active women were associated with high microbiome diversity compared to sedentary women. Specifically, researchers found that consistent physical activity increased the amount of 11 genera of “good” bacteria, including Bifidobacterium spp, Roseburia hominis, Akkermansia muciniphila, and Faecalibacterium prausnitzii. 

How the Microbiome Improves Athletic Performance

Just as exercise positively impacts the microbiome, emerging research shows that microbiome health may also play a part in enhancing exercise performance.

For example, a 2019 study showed that a specific gut microbiota in marathon runners may have enhanced their athletic performance on race day.  In this study, researchers collected fecal samples from the runners before and after the marathon and compared them to microbiota of non-runners. The “good” bacteria Veillonella emerged as the most common in the runners, especially post marathon. Veillonella is a bacterial strain that converts exercise-induced lactate into propionate, which is a natural enzymatic process known to enhance athletic performance.

Researchers then put the Veillonella bacteria from the marathon runners into lab mice who underwent a treadmill exertion test to investigate the hypothesis that this bacterial strain enhances athletic performance. The results showed the mice improved performance by 13 percent after inoculation. This study is one of the first to infer that a healthy microbiome could enhance athletic performance.

“We have a long way to go to fully understand the complex system that involves the microbiome and athletic performance, but the early data look promising regarding gut health and exercise,” says Dr. Friedlander.  “Exercise, along with eating fermented foods and fiber, is a great place to start if you want to improve your gut health and overall health.”

3 Ways to Get (and Stay) Motivated to Exercise

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By Carly Smith, BS, MPH(c) 

One of the hardest parts about exercising is finding the motivation to do it. Especially if you’re new to working out, motivation can be fleeting and dependent upon your daily mood or energy level. Even though we know that exercise greatly benefits our health, it may require weeks of effort and dedication before seeing significant results. 

So how do we stay motivated? Stanford Lifestyle Medicine Assistant Director and Exercise Physiology expert, Anne Friedlander, PhD, recommends three ways to incorporate exercise into our daily routine and establish a habit of exercise that remains consistent in the long run. 

Bundle Your Activities

Bundling your activities is a version of multitasking where you combine a pleasurable activity that provides instant gratification with an activity that involves delayed benefits, such as watching your favorite television show or listening to an audiobook on the treadmill. This type of multitasking, also known as “temptation bundling,” is a promising method to create and maintain an exercise habit. When your exercise is combined with a specific tv show, audiobook, or playlist each time, there is the incentive to exercise especially if you only allow yourself to partake in the engaging media while exercising. It creates an association between entertainment and physical activity, which allows you to benefit from exercise in the moment, rather than weeks or months later. 

While this approach may bypass the mind-body connections that exercise can offer, temptation bundling is a great way to create a new exercise habit or get back into a routine. After you’re confident in your ability to maintain your exercise routine, you can let go of the television show and focus on optimizing your mind-body connection while exercising which can enhance the cognitive and mood benefits of exercise. 

Research has been conducted on whether temptation bundling can improve motivation to exercise. In this study, researchers provided free audiobooks during workouts and measured the frequency in which people exercised. The results showed that not only were participants more likely to exercise compared to those not offered the audiobooks, they were more likely to keep up the habit after the study was over. The study also showed that the media needed to be enjoyable to the participants to increase incentive to exercise, meaning when the audiobook covered a topic that was particularly engaging for the participant, their motivation increased. 

So, if you’re having trouble starting or maintaining an exercise program, listen to an interesting audiobook while out on a jog or watch your favorite television show while cycling indoors to get you moving towards your health goals.  

“It is amazing how powerful temptation bundling can be if you find a good story or podcast and you only let yourself listen while doing your physical activity.  You may actually look forward to your next workout!” says Dr. Friedlander. “Eventually physical activity may become its own reward, but in the meantime, lace up your shoes and queue up that mystery thriller.”

Find a Workout Buddy

Working out with a partner, friend, or family member creates a two-way street of accountability and makes you more likely to show up for your goals. While the presence of your workout partner nudges you to stay on your goal, your presence also motivates them to do the same. Skipping a solo workout may require very little thought or work, but skipping a partner workout requires more work and requires you to explain to the other person your reason for skipping. This process helps avoid the fleeting temptations that would deter you from exercising based on mood or energy levels. 

Having someone to match your level of commitment also introduces a link between social connections and physical activity in the creation of a more healthy lifestyle. The pillars of our lives are interconnected, and strong habits often involve behaviors that embrace multiple aspects of our health. 

A workout buddy can be more than someone that helps you stick to your program. They can also be someone to offer and receive encouragement and support, talk about goals,discuss overcoming obstacles, and form memories and relationships. By making the habit a more involved aspect of your social life, you open yourself to broader potential benefits. 

“I am not a morning person, but I have a puppy who loves his playdates,” says Dr. Friedlander. “Every morning at 7 am I meet friends for a walk and puppy playtime. The group definitely helps me get out the door because I don’t want to disappoint either my human or puppy companions”.  

Choose an Exercise You Enjoy Doing

Just because exercise is something that you should do, doesn’t mean that you cannot enjoy it. There is a certain level of discipline that is required to maintain an exercise routine over time, but you will be more motivated to stick to your routine if you like the type of exercise you are doing. If you enjoy team sports, you may enjoy achieving your exercise goals by joining a pickleball league, swim club, or soccer team. Alternatively, you may enjoy attending dance or yoga classes with friends or carving out a specific time in your schedule to lift weights at the gym. Even moderate-to-low intensity exercises, like going out for a walk every night after dinner, is beneficial for your health. 

The best exercise for you is one that you know you will actually show up for time and time again. An added bonus is that you do not have to spend hours exercising to impact your health. The United States Department of Health and Human Services says that no matter the amount of exercise you are able to achieve, most efforts to overcome sedentary lifestyles have a positive impact on all-cause mortality. This means that even incorporating small bouts of moderate-to-vigorous exercises can increase your relative life expectancy. Thus, shifting your focus to do activities that you enjoy and will do daily or weekly may give yourself the best odds for success in the long-run. 

“If you’re having trouble finding motivation, start small,” says Dr. Friedlander. “Following exercise guidelines is optimal, but doing any level of physical activity is better than nothing and can improve your health and mood, especially if kept consistent.”

 

The Impact of Exercise on Brain Health and Preservation

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By Carly Smith, BS, MPH(c) 

The foundation of longevity science exists in a balance of healthy physical, mental, and emotional aging. In the past, researchers have studied these aspects of health as independent subjects, but now scientists emphasize that every aspect of our health is intertwined. One of the major motivations behind the Stanford Lifestyle Medicine movement is to increase awareness of how total health is dependent upon the interactions between the pillars of our lives. 

Recently, members of the Stanford Lifestyle Medicine team collaborated to conduct a systematic review of existing research on “The Role of Physical Exercise in Cognitive Preservation.” The article, which was published in the American Journal of Lifestyle Medicine, responds to a call for more scientific investigations to focus on the prevention of cognitive disabilities associated with old age, such as dementia. 

“After conducting this review, a major takeaway is that we should be motivated beyond physical improvements to continue moving our bodies to promote long-term cognitive benefits,” says Matthew Kaufman, MD, lead author of the review article.

Exercise and the Brain

Both aerobic exercise and strength training are widely researched lifestyle interventions for quality health improvement.The US Department of Health and Human Services (USDHHS) recommends weekly exercise of at least ​​150 minutes of moderate-intensity aerobic exercise and two days of strength training for improving physical and mental health. 

There are multiple proposed mechanisms that define how regular physical activity combats cognitive decay. As you exercise, your heart increases the amount of blood that it pumps out to the rest of the body to compensate for the increased workload. This increase in cardiac output also increases cerebral blood flow, which is linked to heightened neural activity and reduced oxidative stress (or an improved ability to detoxify agents in the body). Another proposed mechanism is the increase in trophic factors (proteins that aid cell survival and growth), such as BDNF, VEGF, and IGF-1. These trophic factors support neuroplasticity (the structural reorganization of the brain to support learning) and angiogenesis (the growth of new blood vessels). Therefore, it is reasonable to promote exercise as a lifelong tool for optimizing brain health.

“It is important to understand the physiology of this relationship in order to maximize exercise regimens for prolonged cognitive benefits and goal setting,” says Dr. Kaufman, current Stanford Physical Medicine and Rehabilitation Resident.  

Key Takeaways from the Systematic Review

After reviewing over 1,600 total studies, 17 met the team’s final criteria for further analytical evaluation. To be included in the final review, studies must have been a randomized controlled trial published after 2000, excluded cognitive impairments more severe than moderate diagnoses, and included at least one physical activity intervention that lasted for 12 weeks or more and followed the USDHHS recommended guidelines. For this review, both aerobic exercise and strength training were included as exercise interventions. The final 17 studies selected for “qualitative synthesis” looked at the relationships of exercise and global cognition, exercise and memory, and exercise and executive function. 

The review team found the largest consensus in the research for improvements in memory for individuals with moderate, mild, or no cognitive impairments following the 12-week exercise interventions. For individuals with mild cognitive impairments, exercise was shown to improve cognition. Although weaker, there was also evidence found for relationships between regular exercise and improved global cognition and executive functioning. Some studies also found significant associations between improvements in physical and cognitive fitness and increases in regional brain volume or blood flow. 

However, included studies that analyzed the lasting effects of exercise following the study indicated a need for continued exercise. Improvements in memory and cognitive health were not always maintained once regular exercise stopped. This suggests the importance of exercise as a long-term principle of lifestyle medicine for adequate prevention of late-stage diseases. 

“Given that our review demonstrates that people did not see lasting benefits after stopping their exercise, the importance of routine exercise to continue reaping benefits is suggested,” says Dr. Kaufman. “It also strengthens our association that exercise interventions can, in fact, improve cognition.”

The Unexpected Health Benefits of Forest Bathing

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By Vedika Patani and Carly Smith, BS, MPH(c)

This blog is part of the Stress Management newsletter. If you like this content, sign up here to receive our monthly newsletter!

Many people know that hiking in nature can help reduce stress and anxiety. But not everyone knows that forest bathing is a way to take the therapeutic effects of a scenic walk to the next level. While hiking is a great way to get outdoors and exercise, forest bathing is a practice of being calm and quiet among trees and being present with our natural surroundings.

“Both hiking and forest bathing harness the power of nature to offer a wide range of benefits for our physical and mental wellbeing,” says Rusly Harsono, MD, head of Stanford Lifestyle Medicine Social Engagement and Clinical Assistant Professor at the Stanford School of Medicine. “Hiking provides an outdoor activity that activates our nervous system for greater physical health, whereas forest bathing calms our nervous system and improves our emotional wellbeing, which is equally important to physical health.”

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What is Forest Bathing?

Forest bathing, or Shinrin Yoku, originated in Japan in the 1980s and involves taking deep breaths and experiencing the forest with full presence. Contrary to hiking, where the mind can still ruminate about work or challenging relationships, forest bathing is a mindfulness practice in that it brings the mind into the present moment by taking in the forest with all five senses. For example, a forest bather would visually observe the colors of the leaves and stop to notice the sun’s rays through the trees. They might close their eyes and take in a deep breath through the nose to capture the scent of pine. As they take a step, they may hear the crackling of a fallen leaf from under their shoe, and then pause to notice the sensation of the wind on their cheeks.

During the pandemic, forest bathing grew in popularity in the US as people searched for ways to calm their nervous system and connect outdoors while social distancing. But forest bathing is proving to be more than a lifestyle trend. Research is attributing this practice to numerous health benefits. 

Forest Bathing and Mental Health

While hiking focuses on the improvement of physical fitness, forest bathing fosters improved mental and emotional health. Some people who experience anxiety find that forest bathing calms their nervous system because their attention shifts from their worries to noticing the natural elements all around them—and these results are scientifically measurable.

Studies show that forest bathing can decrease the stress hormone cortisol. In one meta-analysis, researchers reviewed 971 articles and found that forest bathing effectively reduced serum and salivary cortisol levels, indicating its potential to reduce stress. 

Another meta-analysis reviewed studies where forest bathing was introduced to people living in urban environments, who generally have a higher risk of hypertension and psychological stress. Not only did the practice reduce their stress, but it also significantly lowered their blood pressure. 

“Forest bathing can be beneficial for everyone, but it is particularly advantageous for individuals living in urban environments,” says Dr. Harsono. “Urban dwellers typically experience higher stress levels, noise pollution, and reduced access to natural settings. Forest bathing provides them a valuable opportunity to escape these stressors and experience improved wellbeing through connection with nature.”

A Natural Immune Supporter

Forest bathing is not just important for improving wellbeing, but it may also improve one’s physical health. Studies have found that forest bathing could increase immune cell activity and aid in the expression of anti-cancer proteins. In one study, a group of 12 men aged 37-55 spent three days practicing forest bathing in three different forests. Afterward, the men showed a 50 percent increase in natural killer cells (which can kill tumor cells) and an increase in the anti-cancer proteins perforin, granzymes, and granulysin. 

Another research study showed that forest bathing improved immune function. When we inhale the oils released from trees (phytoncides), our cortisol levels decrease, and natural killer cell activity increases. These findings suggest forest bathing may have a preventive effect on cancer due to its ability to stimulate immune responses; however, more research needs to be conducted to better understand this phenomenon.

Forest Bathing Everywhere

One would think that forest bathing is only possible if you live in the country, however, this study showed that urban forest bathing (i.e. being mindful at a nearby park) still brought feelings of peacefulness to adolescents that live in metropolitan areas. This study observed the changes in the mental wellbeing of 44 adolescents before and after urban forest bathing. The results reported reduced anxiety, rumination, and skepticism, as well as increased feelings of social connectedness.

Lastly, landscape designers have taken note of the research supporting the healing effects of nature. At Stanford’s Lucile Packard Children’s Hospital in the heart of the San Francisco Bay Area, patients and their families have access to gardens and outdoor spaces to stroll and mindfully take in the natural beauty.

“Lucile Salter Packard’s vision for the hospital was to nurture the body and soul of every child by creating a restorative environment by integrating nature and art,” says Dr. Harsono, Pediatrician at Stanford Medicine Children’s Health. “We frequently bring children to the hospital garden during their recovery to help them manage their treatment and discomfort. Research supports this idea of incorporating forest bathing experiences into the care of sick children to improve their health outcomes and overall quality of life.”

 

The Benefits of HIIT and Other Forms of Interval Training

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By Maya Shetty, BS

In an era where time is a precious commodity, individuals are constantly seeking efficient ways to achieve their fitness goals. Amidst this quest, high-intensity interval training (HIIT), which is a type of interval training (IT), has gained popularity among fitness enthusiasts due to its ability to yield significant health benefits in a short amount of time.

“I recommend interval training for people who are busy but still want to get fit, because it gets great results in a fraction of the amount of time compared to more traditional cardio workouts. Interval training can be a powerful tool in a well-rounded fitness plan,” says Anne Friedlander, PhD, exercise physiologist and assistant director of Stanford Lifestyle Medicine.

What is Interval Training?

Interval training (IT) was originally defined in 1973 as “intermittent periods of intense exercise separated by periods of recovery.” HIIT stands for high-intensity interval training, which has become the most popular form of IT in recent years. This back-and-forth between physical effort and rest is effective because it challenges the body without causing total exhaustion. IT can encompass various exercise modalities, including cardio, explosive movements with weights, and bodyweight exercises, as long as the period of intense exercise strenuously stimulates the body.

Despite IT’s recent surge in popularity in the US, European runners in the 1950s commonly used this training method, including long-distance runner Emil Zatopekl from the Czech Republic. Zatopekl’s success in the 1952 Olympics is believed to have ignited the widespread adoption of IT across various sports disciplines.

In 2006, a study conducted by Canadian researcher Martin Gibala sparked enthusiasm for IT to improve fitness, not only among athletes, but for the general population as well. The Gibala paper found that even though study participants trained eight hours less over a two-week period, their IT protocol (four to six, 30-second cycling intervals at supramaximal effort with a four-minute recovery) yielded similar fitness and muscle improvements compared to their moderate intensity continuous training (MICT) protocol (90 to 120 minutes of continuous cycling). Adaptations included better time-trial performance (time to complete a set amount of work on a bike), increased oxidative capacity (ability of muscles to use oxygen), buffering capacity (ability to handle acidity during exercise), and glycogen content (more energy stores in the muscles).

Since this pivotal 2006 study, researchers have studied IT protocols extensively and found, when compared to MICT, participants can elicit the same or greater benefits in mitochondrial density, aerobic capacity, metabolic health, insulin sensitivity, body composition, heart disease progression, and markers of genetic age.

In the last two decades, IT has evolved into various types, such as HIIT and sprint interval training (SIT), which have differences in physiological and psychological responses depending on the duration and intensity of the exercise protocol. Many use the classifications outlined in a 2014 review paper, which defines HIIT as a training protocol that requires “near maximal” effort, eliciting 80 to 100 percent of maximal heart rate (HRmax) or aerobic capacity (VO2max). (A very rough estimate of your max heart rate can be obtained using the formula: 220 – your age.) SIT, on the other hand, is classified as a training protocol that requires “supramaximal” or all-out effort, using at least 100 percent of one’s maximal aerobic capacity.

“No matter what your starting fitness level, adding intensity to your workouts can help you achieve your health and fitness goals,” says Dr. Friedlander, adjunct professor in the Stanford Program in Human Biology. “There are many different protocols out there, but the key element is pushing yourself hard for short bursts of time separated by recovery periods. Those bursts of hard work will jump start beneficial adaptations in your physiology and metabolism.”

What are the Benefits of Interval Training?

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Muscle Health

The 2006 Gibala paper was the first to reveal how SIT has nearly the same effects on skeletal muscle adaptations as MICT despite significantly less training time and workload. Additional research has shown that a single session of HIIT or SIT increases mitochondrial biogenesis (the process through which muscle cells increase the number and functional capacity of mitochondria), and repeated sessions lead to overall increases in mitochondrial density. Mitochondrial biogenesis plays a crucial role in energy production, metabolic regulation, and overall cellular health. It is important to have healthy and functioning mitochondria to maintain muscle health and decrease the risk of sarcopenia (age-related muscle loss).

Research suggests, in the short-term, that the intensity and interval nature of HIIT and SIT increases mitochondrial biogenesis more than MICT, even when performed for less time and at an equal or less total amount of work. Therefore, incorporating interval training into your lifelong exercise routine (such as adding short bouts of running to your daily walks) will help improve your short-term, and possibly long-term, muscle function.

Body Composition

A meta-analysis that included individuals of all ages and health statuses found SIT protocols were more time efficient than MICT and HIIT in decreasing body fat.

Another meta-analysis, looking at studies including only overweight individuals, found HIIT protocols were more time efficient than MICT in reducing whole-body fat mass and waist circumference. Here, the researchers found that running protocols were more effective than cycling protocols for decreasing body fat, potentially because running uses more muscles throughout the body, which leads to greater energy expenditure.

Cardiovascular Health

A wealth of research since 2006 has consistently demonstrated that IT provides superior improvements in markers of cardiovascular health, cardiometabolic health, and mitigates the risk of heart disease progression more efficiently compared to MICT.

Cardiorespiratory health: VO2max (the body’s maximum rate of oxygen consumption) is a common indicator of cardiorespiratory health. Individuals with a higher VO2max tend to have better overall physical fitness, improved lung function, stronger heart muscles, and enhanced oxygen delivery to the body’s tissues.

A meta-analysis determined that both HIIT and SIT protocols are more efficient than MICT regarding the improvement of VO2max (cardiorespiratory fitness). One study found that SIT increased VO2max to the same extent as MICT, but in one-fifth of the time.

The duration of intervals may also have an impact on VO2max. A comprehensive meta-analysis revealed that IT protocols with longer intervals of intensity (three-to-five minutes) yielded greater improvements in VO2max compared to shorter interval protocols performed for the same total amount of time.

Cardiometabolic health: Interval training is also a powerful tool for improving markers of cardiometabolic health, such as insulin sensitivity and insulin resistance.

A meta-analysis found a variety of IT protocols were superior to MICT in improving insulin resistance, lowering blood glucose levels, and decreasing body weight. The analysis examined various IT protocols, including HIIT and SIT, with a range of two-to-sixty intervals, durations from four seconds to five minutes, and both maximal and supramaximal intensities. Some studies were conducted in lab settings with stationary bikes or treadmills, while others were outdoors on tracks or trails.

“Although research has confirmed that IT is a more time-efficient method than MICT for improved muscle, cardiorespiratory, and cardiometabolic health in the short-term, more research is needed to confirm that those superior benefits continue in the long-term,” says Dr. Friedlander. “As with many aspects of life, balance is key.  Therefore, integrating IT into a well-rounded fitness plan is probably healthier and more advantageous in the long-term than doing IT as your only training method.”

Brain Health

Research suggests that regular physical activity can mitigate age-related volume loss in brain regions associated with memory by improving blood flow to the brain and increasing the maintenance and production of neurons.

One study suggests that intense exercise, like HIIT and SIT, can enhance memory in older adults more effectively than MICT protocols. Participants in this study underwent a HIIT protocol, which included four-minute intervals of running on a five percent incline, interspersed with three-minute recovery periods of walking. They performed this protocol three times per week for a total of 12 weeks, resulting in improved memory performance significantly more than MICT or stretching protocols.

Another study found that young adults had more memory improvements following HIIT sessions (two-minute intense intervals interspersed with two-minute recovery periods) than MICT training sessions. The underlying mechanisms behind these improvements in memory are unknown, but the study did find a correlation between memory improvements and the release of blood lactate following exercise.

During exercise, the chemical lactate travels via the bloodstream to the brain and it is hypothesized that lactate promotes the creation of new cells and blood vessels, thus improving brain function. Higher exercise intensity leads to higher lactate production, resulting in increased levels of lactate in the bloodstream.

It has also been hypothesized that exercise induces the release of brain derived neurotrophic factor (BDNF), a protein that plays an essential role in the health and function of our brain cells. BDNF can be thought of as a “brain fertilizer” that helps neurons grow, survive, and communicate with each other.

Research studies have determined the majority of BDNF is produced in the brain, but other parts of the body, such as skeletal muscle and blood vessels, can also produce BDNF when stimulated by exercise. The previous studies in older and younger adults found that both HIIT and MICT protocols increased BDNF in the bloodstream immediately following exercise.

“Whether your goals relate to health, performance, or body composition changes, research has shown time and time again that IT protocols provide a time efficient way to target those goals,” says Dr. Friedlander. “However, you shouldn’t do IT every day as the intense nature of the activity requires sufficient recovery time, so as not to wear yourself down.”

Types of Interval Training Workouts

Since it is not recommended to do IT every day, one can integrate one of the following IT workouts a couple of times into their weekly exercise regimen.

Here are a few IT training methods that can be modified to any fitness level:

Martin Gibala General Recommendations: Gibala, one of the most notable IT researchers, recommends three sessions of HIIT or SIT exercise per week. Intervals should be between one and four minutes and the entire workout, including rest, should be between 20 to 30 minutes.

Fartlek: Fartlek is a running training method that involves alternating between faster-paced running and slower recovery periods, which can be at an easy or moderate pace. Fartlek training is flexible and can be adjusted based on the terrain, fitness level, and desired outcomes.

Tabata: Tabata involves 20 seconds of all-out intense exercise followed by 10 seconds of rest, repeated for a total of eight rounds (four minutes total). Tabata workouts can be customized for various training modalities that include stationary bikes, sprints, or body weight exercises.

4×4 Interval Training: In 4×4 IT, one performs four sets of intense intervals, with each set consisting of a four-minute, high-intensity exercise followed by a three-minute recovery period. This protocol should last a total of 28 minutes with each set lasting seven minutes (four minutes of activity and three minutes of recovery).

10-20-30: 10-20-30 training involves intervals of an aerobic exercise that alternates interval times. The workout consists of repeating cycles of 30 seconds of low-intensity exercise, followed by 20 seconds of moderate-intensity exercise, and finally, 10 seconds of high-intensity exercise. This pattern is repeated for several intervals, typically for a total of four to five minutes. 

“Whatever your fitness level, incorporating safe and balanced interval training into your exercise routine can improve several aspects of your health and fitness.  This is even true as we get older,” says Dr. Friedlander. “As we age, we tend to stay in our comfort zones, but sometimes it is good to push ourselves to keep our maximum capacity higher. This allows all of our other activities of daily life to feel easier. It can help us live life to the fullest into our later years.”

 

“If you’re new to interval training, start by adding a few bursts of running or hill climbing into your daily walk or find the stairs in your building at work and do three rounds of vigorously climbing while slowing descending them,” says Dr. Friedlander. “Regardless of your age or fitness level, we encourage you to embrace the challenge of IT and experience its whole-body health benefits!”

 

By Maya Shetty, BS

Enhancing Health and Speed in Female Distance Runners Through Improved Diet

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A groundbreaking nutrition study for female collegiate runners was recently published by Professor  Michael Fredericson, MD, Stanford Lifestyle Medicine (SLM) Director, and Megan Roche, MD, member of the SLM Movement & Exercise pillar. The study’s goals were to improve the health of these runners through a diet intervention, decrease the incidence of bone stress injuries (aka stress fractures), and ultimately improve their performance.

“A runner’s diet is extremely important for maintaining overall health,” says Dr. Fredericson, who has served as the Stanford University track team head physician for decades. “Runners who are excessively lean are prone to injuries, infectious diseases, mental health problems, and loss in bone density.”

The study followed 78 female long-distance runners at both Stanford and UCLA. Over a four year period, the athletes were educated on caloric and balanced nutrient intake, with regular presentations by dieticians and individualized consultations. Athletes with nutrition deficiencies, irregular menstruation, or injuries had more frequent meetings with dieticians. Throughout the study, incidence of bone stress injuries were tracked in the participating athletes.

The nutrition counseling resulted in a remarkable 50 percent reduction in bone stress injuries and doubled the occurrence of regular menstruation among athletes, indicating improved overall health. Even though bone stress injuries affect runners of both genders, there is a higher prevalence among females, which is why the study focused specifically on female distance runners. While the reasons for these findings remain unclear, factors such as male bone density and potential protective effects of testosterone might contribute to the observed gender discrepancy.

In addition to these improvements in health, the nutrition counseling intervention also enhanced athletic performance. Athletes who regained their menstrual cycles and achieved higher bone density also demonstrated enhanced athletic capabilities.

“Your strongest self is your fastest self,” says the second researcher of the study, Dr. Roche, who is an ultrarunner and running coach. “The idea that a leaner body makes for a faster stride is common among distance runners. But it’s inaccurate and sets a dangerous ideal.”

Crucial to the success of the study was shifting the team’s mindset on nutrition and weight. At Stanford University, the coaches and dieticians for the  women’s track and cross-country teams, who were actively involved in the study, played a significant role in fostering a positive perspective on nutrition among the athletes.

Dr. Fredericson and Dr. Roche hope that athletes from every sport, age, and gender can learn from this study. Here is their advice for all athletes:

  1. Eat enough to maintain a healthy weight, which varies from athlete to athlete.
  2. Replenish within 30 minutes after a workout, ideally with carbohydrates and protein.
  3. Consume four to five frequent smaller meals throughout day, rather than three larger meals.
  4. Don’t shy away from healthy, plant-derived fats, like nuts and avocados.
  5. Remember to get enough calcium and Vitamin D for bone strength.

 

By Maya Shetty, BS

Practice of the Month: HIIT Workouts for All Levels

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High-Intensity Interval Training (HIIT) is an intense workout that effectively boosts aerobic capacity and overall health in a shorter amount of time than traditional workouts. 

Former pro-athlete, celebrity trainer, and founder of Platinum Fitness, Peter Park, recommends HIIT workouts for his clients at every fitness level. He suggests one-to-two HIIT workouts per week, in addition to three-to-four days of low-intensity cardio exercise, such as walking or biking for 20 minutes to an hour. 

“Cardio workouts build endurance while HIIT builds muscle strength and higher-end aerobic capacity,” says Park, author of Foundation Training: Redefine Your Core, Conquer Back Pain, Move With Confidence and Rebound: Regain Strength, Move Effortlessly, Live Without Limits.

HIIT Routine

Park has 23 years of experience training elite athletes and has designed the following HIIT routine:

Warm up: Perform five reps of the exercises in the graphic at a slow and controlled pace, modifying as needed, and repeat.

Main set: Perform eight reps of the exercises at a faster pace with minimal rest between each exercise, then take a 45-second rest. Repeat with nine reps, then 10 reps for a total of three cycles.

Exercise Details:

  1. Body weight squats: Perform squats to parallel while extending your arms fully as you descend. Ensure you engage your core and maintain proper posture throughout the movement. Aim for a complete range of motion, focusing on squeezing your quads, core, and glutes at the top of each repetition. Maintain a steady tempo while staying in control.
    • Modification: Sit in a chair and stand back up.
  2. Push-ups: Keep your core engaged and maintain proper posture while performing push-ups. Maintain a controlled tempo and form.
    • Modification: Perform the push-ups on your knees, or against a wall or table.
  3. Jumping jacks: Stay smooth and controlled throughout the movement.
    • Modification: Stand with your feet hip-width apart and perform the jumping jack movement with your arms only.
  4. Stand-ups (aka Burpees): Begin by lying on your stomach on the floor with your hands at chest level. Jump your feet forward, contracting your abdominals, and stand up quickly. Return to the lying position and repeat the process.
    • Modification: Press hands into floor and step back into a high plank position, then step forward and return to a standing position.

Tips for HIIT at Every Fitness Level

Beginner: For individuals just starting out, focus on incorporating intense periods of exercise lasting at least one minute into one’s regular training routine. For example, one could speed up sections of a morning walk or finish a workout with a burst of all-out effort. Don’t worry if you become breathless and have trouble speaking – this is how you’re building your aerobic capacity!

Intermediate: Individuals who already participate in regular exercise but are relatively new to HIIT should focus on incorporating two-to-three HIIT workouts per week into their regular exercise regime. Any exercise modality can be turned into an IT protocol as long as one can push themselves into near maximal or maximal exertion. To optimize benefits, research suggests higher intensities and longer intervals are best. 

Advanced: In well-trained individuals, intense exercise is necessary to generate additional improvements in exercise performance and overall health. To achieve these benefits, extremely high-intensity sprint interval training (SIT) or long-interval HIIT at least three times per week may be necessary. 

Important Considerations

Prepare your body before engaging in HIIT: The intense nature of HIIT can be problematic for individuals with weaker musculoskeletal systems or chronic health issues. Additionally, healthy individuals unfamiliar with this workout type also risk injury. So, remember to build up your capacity for this workout by gradually incorporating periods of higher intensity into your regular exercise routine.

“Pushing your body to its physiological limits without proper training can lead to injuries, compromising your overall health and performance,” says Park. 

Don’t perform interval training every day: While it may be enticing to engage in HIIT daily due to its wide-ranging benefits, this workout can strain the body and hinder physical adaptations when performed too frequently. Instead, opt for one-to-two HIIT sessions per week and mix them with low-intensity activities such as walking or yoga for active recovery. 

Have fun: While incorporating HIIT into your exercise regimen, remember to prioritize your safety and comfort, but also do your best to make it enjoyable so that you stick with it. “HIIT workouts are much more fun with a training partner,“ says Park. “So, grab your spouse, friend, or co-worker and help each other get out of your comfort zone!”

 

By Peter Park, CSCS, BS & Maya Shetty, BS

5 Tips for a Successful Pickleball Experience

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In the summer of 2023, pickleball was a popular sport for people of all ages. Pickleball is a paddle sport that combines elements of tennis, badminton, and ping-pong. Personally, I am a big pickleball enthusiast because it offers a perfect blend of competitiveness, social interaction, and physical activity. If you’re new to pickleball and want to join in the fun, here are a few valuable lessons that I wish I had known before first stepping onto the court:

Warm-Up: As a former collegiate athlete, you’d think I knew better, but I made the mistake of skipping the warm-up before my first pickleball session, and the consequences were immediate. Just an hour into the game, I pulled my quad and had to sit out the rest of the game. Warming up prepares your body for the physical demands of pickleball and significantly reduces the risk of injuries. Given that pickleball requires flexibility and a wide range of motion for success, a proper warm-up can give you that competitive edge you need on the court. Don’t repeat my mistake – prioritize warming up before your next pickleball game!

Hydration: Staying properly hydrated before playing pickleball is crucial. I’ve experienced firsthand how one hour on the pickleball court can quickly turn into four. So make sure to bring plenty of water and take water breaks between each match.

Footwork Matters: I initially underestimated the importance of footwork in pickleball. However, I soon discovered that the same quick positioning and agile footwork I honed on the tennis court were equally crucial in pickleball. Remember to wear shoes with good traction, support, and fit so you can move quickly without turning an ankle.

Communication is Key: Pickleball is often played in doubles, which requires excellent communication with your partner. If you have played pickleball, you know the irritation when the ball is hit right down the center and no one goes for it. Coordinate your moves, call out shots, and support each other on the court. Good teamwork can give you a significant advantage over your opponents.

Stay Patient: In the thrilling game of pickleball, it’s all too easy to get swept up in the excitement and rush your shots. But, I’ve learned that patience is a virtue during those long and intense rallies because (add the reason why). With experience, I’ve come to realize  that I can outplay most opponents through patience and consistency rather than power.

 

By Maya Shetty, BS

Is Running Bad for Your Knees? Research Says, “No”

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Many people believe running is bad for your knees, but this commonly-held belief is not backed by solid evidence. Let’s take a closer look at the research and unravel the truth behind this myth.

A recent study explored the public’s perception of running and knee joint health–the findings were surprising. Around 29 percent of the general public believed that frequent running is harmful to the knees, and a significant 54 percent thought the same about running long distances. 

Interestingly, a different picture emerged when comparing these perceptions with those of healthcare providers. A greater proportion of healthcare providers actually viewed regular running as beneficial for knee health. 

 

“Despite the prevailing beliefs, current evidence finds that recreational running is not a risk factor for knee osteoarthritis. In fact, it has been found to be quite the opposite–running can be good for your knees.”  – Corey Rovzar, PhD, DPT, and postdoctoral fellow at the Stanford Prevention Research Center.

 

Studies have shown that recreational runners have a knee and hip osteoarthritis (OA) prevalence that is three times lower than that of sedentary non-runners. Competitive runners showed an even more impressive four-fold reduction in knee and hip OA prevalence. These results are due to the fact that regular running strengthens the muscles around the knee joint and supports overall joint health. Running also plays a vital role in maintaining healthy cartilage and bone density, which are crucial for knee function.

Considerations for Individuals With Pre-Existing Knee Conditions

If you have a pre-existing knee condition, such as knee OA, running may exacerbate symptoms because the cartilage in the knee has broken down, leaving less cushioning around the joint. Cartilage does not have the ability to regenerate and while running can maintain cartilage health, it can not bring it back once it’s gone. If you struggle with knee OA, opting for lower-impact exercises, such as walking, cycling, or swimming, is advisable. Consulting with a healthcare provider or a physical therapist can help you develop a safe and effective exercise routine that works specifically for you. 

Guidance For Inexperienced Individuals

Michael Fredericson, MD, the Director of the Lifestyle Medicine Program and PM&R Sports Medicine at Stanford, cautions against taking up running after the age of fifty without prior experience. According to Dr. Fredericson, “You need to get fit to run, rather than run to get fit, and this becomes even more important after the age of 50. If you’re just starting out, begin with general conditioning that targets hip and core muscles and slowly build up your running.”

It’s time to put this myth to rest. Running is not bad for your knees; in fact, it can be healthy for them! If you do not suffer from a pre-existing knee condition and are generally fit, let’s embrace the evidence and remember that running, when done responsibly, can contribute to healthier and happier knees. So, lace up those running shoes and hit the pavement with confidence, knowing that you’re taking strides toward a stronger and more resilient you!

 

By: Corey Rovzar, PhD, DPT, Maya Shetty, BS, & Michael Fredericson, MD

Sources:

  1. Esculier J-F, Besomi M, Silva D de O, et al. Do the General Public and Health Care Professionals Think That Running Is Bad for the Knees? A Cross-sectional International Multilanguage Online Survey. Orthopaedic Journal of Sports Medicine. 2022.
  2. Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J. The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017 Jun