Tag Archives: recovery time

Female sprinter | The Paleo Diet

So with the New Year upon us, diet and exercise resolutions typically feature prominently in many people’s lives.  However, in most cases, these resolutions fail fairly quickly and; in many cases, they have already been broken.  Despite the well-recognized beneficial impact of regular exercise on numerous health parameters, exercise participation and adherence in the general population remains poor1 – ‘lack of time’ being one of the most commonly cited reasons why individuals fail at committing to a regular exercise program2.  Consequently, it would be prudent to examine effective exercise programs that do not require a significant time commitment.

Last year, I wrote an article here that covered some of the science behind supra-maximal interval training (SIT), a mode of exercise that creates physiological benefits with a minimal time investment. And; so, if you think the title of this piece sounds too good to be true, I advise you to go and read or re-read that article so that the protocol I’m about to describe to you is more believable; as well as, understand that it does indeed have scientific backing and makes physiological sense. So the purpose of this article is to simply provide the reader with an easy to implement effective exercise protocol that requires an incredibly small investment of time.

When I lecture about SIT, I describe an activity that helps my audience understand why intensity, not duration, is the key ingredient to improving one’s fitness.  I ask the audience to close their eyes and imagine they are standing at the base of the stairs inside a football stadium. I, then, ask them to imagine ascending the stairs as fast as they can while I describe to them the many varied speeds that would be witnessed despite everyone putting forth the same relative effort.  I also describe what everyone would be typically feeling at 15, 30, 45 and finally 60 seconds when I shout stop. I, then, ask them to compare the heaving breathing and the feeling of lactic acid in their lungs and muscles that they would be experiencing to what they would experience following an hour-long walk or slow jog.  Then a simple question:  which of these two training modalities do they think is going to stress them more to cause a physiological change to their cardiorespiratory and metabolic fitness?  Common sense leads everyone to consistently choose the all-out sprint as the method that they think would lead to a greater physiological change.  After then quantifying the number of steps attained, I state that everyone is done training for the day and; since they will inevitably feel some effects from that all-out effort, they will have a day’s rest before returning to the stadium for their second all-out stair-climb on day three.  I tell them we are going to continue doing this for 30 sprints, which will equate to two months of training requiring just 3½ minutes per week! To clarify this time commitment, it would take two weeks to complete seven “every other day” 60-second sprints, hence 3½ minutes per week.  And, finally, the ultimate question, “does anyone doubt, that on the 30th sprint, you will be able to attain significantly more steps than you did back on day one?”  Intuitively, people understand that they would be able to do more steps on their last sprint compared to their first.  And if this happens, by definition one is now fitter since a greater amount of work has been accomplished in a given amount of time.  So you can indeed improve your fitness in just 3½ minutes per week when the training effort is maximal or close to maximal.

You can test this out for yourself, and so here’s your challenge for the New Year:  While continuing with your current level of activity, add just 3½ minutes per week of all-out sprinting and see for yourself what this can accomplish.  I will offer different options for you on how to accomplish adding in these “sprints”; but, first let me describe what I recently did to prove my point.  Since improvement is always harder when one is already very fit, I reduced my own training to the lowest possible quantity, given that conditioning people is part of what I do for a living and am; therefore, constantly on my feet; as well as, demonstrating exercises throughout the day.  However, eliminating my own training for a few months led to a significant decrease in my maximal 60-second sprint speed, on a treadmill set to a 15% incline, from about 9.0 mph to around 7.0 mph.  I, then, embarked on an exercise protocol that involved sprinting on a treadmill, set at a 15% incline, for just 60-seconds, every other day, beginning at 7.0 mph, a speed previously established as a maximal or at least close to maximal effort.  If the 60-second sprint was successfully completed, the subsequent sprint was done at a speed 0.1 mph greater than the preceding sprint, equivalent to running an additional 2.68 meters in 60-seconds.  If the 60-second sprint was not successfully completed, the speed was not increased for the next sprint until it was successfully completed.  The protocol was conducted for five weeks such that a total of 18 sprints were completed.  Table 1. shows the speed (mph), time completed (s), meters attained, increase in meters from the first sprint, and percent improvement from the first sprint for each of the 18 sprints, and Figure 1. graphically displays the additional meters attained from the first sprint.

 

Sprint Table with Caption (2)

 

Sprint Graph with Caption (2)

 

As both Table 1. and Figure 1. demonstrate, over the course of just five weeks, sprinting all-out for 60 seconds every other day, resulted in an improvement of 32.18 meters (105.58 feet) from the first sprint, a 17.14 percent improvement.  Note that not every sprint was successfully completed on the first attempt at the increased speed.  When you are working at a maximal effort, there are many factors that influence performance, mental fortitude probably playing the largest role.  But even when the sprint isn’t successfully completed, your system is still being significantly challenged and a training effect is still occurring.  Consequently, over time, you will see an increase in performance albeit with a few peaks and valleys along the way.

Now, while this protocol will help you improve your fitness, I’m not suggesting that adding a few more sprints to your work-out is not going to help you more.  In fact, you might be thinking, if I’m going to make the effort to get to the gym, I might as well do a couple more sprints while I’m there!  So, of course, you can do more; but, be careful how much SIT you do, as it is easy to over-train.  Research has already shown that SIT for 8 minutes per week for just 2 weeks can both double endurance capacity3; as well as, substantially improve insulin action4 , so doing significantly more than that likely isn’t necessary for most people.  Additional exercise time could be better spent in other modes of exercise to improve strength and mobility for example.  Since I began my interest in SIT back in the mid 1990s, the research has always suggested a similar quantity to that used in the above referenced research.  As a consequence, I have used with my clients and recommended in lectures, a 12-minute per week protocol that has proven very successful.  This 12-minute per week protocol involves completing four, 60-second sprints, separated by a 4-minute recovery, three days per week.  The three days also need to be separated by at least one days rest in order for the body to adapt and recover.  Consequently, a Monday, Wednesday, Friday timetable works well for many people.  It is important not to shorten the 4-minute recovery because if you do, you will not be able to maintain the power output attained in the first “all-out” effort interval.  In fact, 4 minutes is a minimal recovery timeframe and you can certainly take more recovery with no detriment to the training.  In fact, I have often stated that having a very long recovery (e.g., an hour or more) is better because you will ultimately be able to increase your power output by having more recovery. It is not about “keeping your heart-rate up” during the work-out, the 60-second sprint itself is challenging enough.  Now obviously having an hour recovery is not the most time-efficient if you’re doing this work-out at the gym; however, if you have access to a modality at home or work, this approach can work very well.  For example, many people have a tall enough staircase at their workplace which works well for SIT as the impact is low while the intensity can easily become maximal.

I have conveyed this message to thousands of fellow health-care professionals in my capacity as a lecturer for the Titleist Performance Institute, who, in-turn, have passed this on to their clients, and I have yet to hear that the protocol hasn’t significantly improved anyone’s health and performance.  A year after one such lecture, a physical therapist approached me at another seminar to thank me for the recommendation.  He worked at a hospital and used the staircase in his building to run four, 60-second sprints throughout the day on a Monday, Wednesday, and Friday. A great benefit to spacing the sprints throughout the day is that you do not really perspire in just 60-seconds and; so, with a long recovery, you do not need to be changing into work-out clothes – avoid high-heals; but, other than that, your pretty much good to go in your usual work attire.  The physical therapist went on to tell me that he corralled a group of his co-workers to commit to the program along with him and; in doing, so was able to lose over 50 lbs. over the course of the year!  Pretty good for just 12 minutes per week!

There are many different modalities that can be used for SIT; but, for those where balance, mobility or joint issues come into play, the upright stationary bike is probably the best alternative.  It also works well for everyone else, too.  However, unlike for most treadmills, where the speed is pre-determined, upright stationary bikes set a resistance and the speed is dictated by the user.  As a consequence, the speed is quicker at the beginning and slows quickly as fatigue develops with time; hence, 60 seconds feels like an eternity. So if you choose to use an upright stationary bike, set the resistance to as high as you can handle and complete the time prescription in 30-second increments rather than 60.

So, in closing, don’t give up on a new year’s exercise resolution because you can’t commit to a plan that requires an amount of significant time.  Hopefully, you’ve seen that a little exercise can go a long way when implemented with an all-out effort.  And if you do fail with your New Year’s resolution, don’t give up for the long term; realize that you can get right back on track any time with a minimal amount of time required.

REFERENCES

[1]Hallal PC, Andersen LB, Bull FC, et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012; 380(9838): 247-57.

[2]Korkiakangas EE, Alahuhta MA, Laitinen JH. Barriers to regular exercise among adults at high risk or diagnosed with type 2 diabetes: a systematic review. Health Promot Int 2009; 24(4): 416-27.

[3]Burgomaster KA, Hughes SC, Heigenhauser GJF, Bradwell SN, Gibala MJ. Six sessions of sprint interval training increases muscle oxidative potential and cycle endurance capacity in humans. Journal of Applied Physiology 98: 1985-1990, 2005.

[4]Babraj JA, Vollaard NB, Keast C, Guppy FM, Cottrell, Timmons JA. Extremely short duration high intensity interval training substantially improves insulin action in young healthy males. BMC Endocr. Disord. 2009 Jan 28; 9:3.

 

A Paleo Physician’s Journey through Major Surgery

Originally Published in Practical Evolutionary Health

At age 46 I had a total hip arthroplasty (THA). Metal and plastic components replaced my hip joint (the stem, ball and socket of the hip). I am convinced that if I had adopted a Paleo lifestyle at age twenty instead of age 58 I would have not needed that surgery. But more about that another time.

On Monday I underwent a revision of that surgery to replace some components, scrape out bad bone, remove inflamed joint lining, flush out plastic debris, and place some bone grafts into areas where bone cysts had formed. The surgery was necessary because the plastic debris from my first artificial joint had stimulated my immune system in a way that caused my macrophages (white blood cells) and osteoclasts (a special kind of bone cell) to start destroying the bone around my hip socket. This process is called osteolysis.

Our immune cells evolved to destroy and consume bacteria and viruses, not plastic powder. So as the plastic liner of my hip prosthesis wore down, the plastic debris provided a constant source of inflammation, stimulating my immune system to get rid of a foreign invader. The bone around my prosthesis got caught in friendly fire. This problem does not seem to occur since a newer form of plastic, having only 10% the wear rate of the old plastic has been introduced. Time will tell if that proves to be true.

To prepare for surgery I reviewed my Paleo behavior with respect to diet, sleep, exercise, stress reduction and outdoor time. My exercise routine was already very reasonable. I had been strictly avoiding grains (except for occasional white rice) and legumes but did include some fermented dairy (kefir and cheese) and wine. So I eliminated all dairy and all alcohol. Sleep has always been an issue because as a physician I take call and sometimes work through the night with emergency cases.

My last call night was 3 weeks before surgery and I was up all night. The next day I flew to NJ for two important events (a reunion and a wedding) both of which were definitely not Paleo environments. A flight cancellation required more sleep deprivation in order to reach my first event on time. That sleep deprivation in combination with the changes in time zone disrupted my circadian rhythm so upon returning home two weeks before surgery I knew I had to play catch-up to be ready for surgery. I avoided alcohol except for a few drinks at my brother’s wedding and violated the wheat prohibition once with a piece of wedding cake.

When I returned to California I was 6 pounds heavier and jet lagged. I promptly got an upper respiratory infection (probably acquired on my flight home) which started in my throat and nose and went to my lungs.

So now I am jet-lagged and infected just two weeks from surgery. Not a good situation.

Thereafter I was strictly Paleo in diet, sleep, and stress reduction (yoga and meditation) but had to limit exercise to yoga and walking in order to fight the infection and prepare for surgery. I spent as much time walking outdoors as was feasible and focused on eight hours sleep each night. After one week I was beating the URI so I decided to do two 30 minute sessions of resistance training during the last week before surgery.

By the day of surgery the URI was completely cleared and I was down 6 pounds to my baseline.

I self-administered my own pre-operative medication protocol (designed to mitigate post-operative pain) and received a spinal anesthetic from my friend and colleague using a combination of local anesthetic and a small dose of spinal morphine. The latter can provide pain reduction for up to 24 hours after surgery.

So here is the amazing result.

5 hours after surgery I walked without pain using a walker bearing full weight on the surgical leg. I walked again that evening without pain. I knew this was the honeymoon period because the spinal morphine was still protecting me.

The next morning the honeymoon was over but I was still able to walk with full weight bearing without any pain medications and subsequently walked several times up and down the hospital halls during the first three post-operative days. Although I had pain with movement I had no pain at rest.

On the day after surgery my CRP (C reactive protein) was 0.2 mg/dl. CRP is a measure of inflammation in the body. Normal range is zero to 0.5. I was elated. One day after a major traumatic event which typically initiates an inflammatory cascade, I did not have excess inflammation throughout my body as measured by CRP. My WBC (white blood cell count) was also normal.

A paleo lifestyle will not prevent pain after surgery but being in a low inflammatory state before surgery certainly helped with recovery.

My walking ability immediately after surgery and during the next three days astounded the physical therapists and nurses. They all stated I had set records.

My colleagues in the Anesthesia Department could not believe that I received no opiate or NSAID pain medications during my recovery. It is now five days since surgery. I have taken no opiate pain killers or NSAIDs except for low dose aspirin (starting yesterday) to help prevent blood clots

I avoided NSAIDs because NSAIDs increase intestinal permeability (which leads to an inflammatory response) and also because NSAIDs increase risk of cardiovascular events (heart attack, stroke, blood clots in the legs which can travel to the lungs and cause death in severe cases)

I can attribute my success to many factors including an excellent anesthetic, a great surgeon, an optimal pre-operative medication protocol, the superb nursing and therapy staffs and the Paleo lifestyle. In preparing for surgery I was able to make an effective come back from a stressful travel week, two successive nights of sleep deprivation and an upper respiratory infection only because of the Paleo approach.

As I walked my laps around the orthopedic unit I noticed that most patients spent the entire day in bed except for a few laps each day with PT. Many factors contribute to that problem. Our PT department is very aggressive but post-operative pain, obesity, inflammatory diets and sedentary lifestyles all contribute to slow recovery. The hospital menu is highly inflammatory thick with processed-carbohydrates, pro-inflammatory grains, legumes, and refined vegetable oils, and yes, even some trans fats. A strictly Paleo menu would be very helpful. But most of those patients have been living the Standard American Lifestyle (inflammatory diet, chronic sleep deprivation, inadequate exercise, poor stress management, etc.) for a lifetime prior to surgery and it can take months to years of a Paleo lifestyle to mitigate a lifetime of self-abuse. Even then some damage is permanent (like my hip).

I ate the hospital’s fresh fruit, vegetables and wild seafood, the rest was delivered from home by my loving spouse. Kathie is my anchor in the storm and my guiding light when I become lost. The importance of love and human physical contact is well recognized by the Paleo community so it is appropriate that I end with an expression of gratitude to Kathie and the host of friends who visited me during recovery. Hugs and kisses are as important as an anti-inflammatory diet.

Live clean and prosper.

Bob Hansen M.D.

Bob Hansen, M.D. is a practicing physician, board certified in Anesthesiology and Internal Medicine with a Certificate of Special Qualifications in Critical Care. I practice pain management and   anesthesiology in Redding, CA.  My blogging interests include the effects of lifestyle (nutrition, exercise, sleep, stress reduction) on health and health care policy. My education includes an undergraduate degree in Mathematical Economics from Brown University, MBA in Health Care Management from Boston University, and a Doctor of Medicine from Boston University. My personal journey in seeking optimal health has lead me to discover that some advice offered by trusted private organizations and government agencies is based more on politics and economics than sound science. I hope to offer here a point of view based on science and personal experience.

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