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Exercise: New Year Resolutions in the Midst of the COVID Pandemic

Catherina Chang Martinez, PhD

New Year. New Resolutions. With the start of the New Year, many of us make commitments to improve our health. Some of us take on a new routine or hobby, give up or change old habits.  As the holidays go, many of us take on the resolution to engage in more exercise and lose the extra pounds gained through the indulgence during the holidays.  As we embark on the new journey to better health at the start of a new year, it is important to know that we are not alone. There are many around us that are also trying to engage in a healthy resolution to be fit. And there are many resources available to increase our physical activity and remain fit throughout the year.

It has been well established that physical activity contributes to many health benefits. Those who engage in regular exercise benefit from better sleep, growth, development, mood, and overall health.1 On the contrary, the lack of exercise and an increase in sedentary behaviors may contribute to overweight and obesity. Overweight and obesity have deleterious effects in adults, including increased risk of cardiovascular disease, cancer, metabolic syndrome, depression, poor quality of life, and decreased life span.

As the global COVID‐19 pandemic unfolded in year 2020, over 90% of U.S. adult residents found themselves confined to their homes, with restaurants, shops, schools, and workplaces shut down to prevent the disease from spread.2 For some, it meant additional changes, including working remotely, homeschooling children, and personal changes in lifestyle behaviors. Some of these, unfortunately, have led to increased sedentary activity and decreased physical activity, known risk factors associated with overweight and obesity.

For some groups, the transition to lockdown and social distancing has resulted in increased physical activity, especially for bodyweight training, and higher adherence to a healthier diet. Some individuals have engaged in higher consumption of farmers’ produce or purchasing of organic fruits and vegetables, resulting in lower body mass index.3   However, this has not been the norm. More studies report adults experiencing five-to-ten pound increases in weight as a result of increased eating in the home environment. The increased levels of stress, combined with the lack of dietary restraint, snacking after meals, reduced physical activity, and inadequate sleep has further aggravated the risk of overweight and obesity in our population.4   Some groups report less frequent consumption of vegetables, fruit, and legumes during the quarantine, and higher adherence to meat, dairy, and fast-foods.5   Anxiety, depression, self-reported boredom, and solitude have worsened the consumption of snacks, unhealthy foods, cereals, and sweets. These have correlated with higher weight gain for many.6

Being overweight not only increases the risk of infection and complications for those categorized as obese. Recent studies also suggest that the large prevalence of obese individuals within the population might increase the chance of appearance of the more virulent viral strain, and prolong the virus shedding throughout the total population. This may further increase the overall mortality rate as a result of COVID-19. A study on previous influenza pandemics suggests losing weight with a mild caloric restriction, including AMPK activators and PPAR gamma activators in the drug treatment for obesity-associated diabetes. Practicing mild-to-moderate physical exercise may further improve our immune response. Regular physical exercise enhances levels of cytokine production mediated via TLR (toll-like receptor) signaling pathways during microbial infection, improving host resistance to pathogen invasion.7 Regular physical activity may then serve as a cornerstone measure to improve our defenses against influenza viral infection, cardiometabolic diseases, and COVID-19.

Physical activity remains one of the seven modifiable health behaviors and an important metric of The American Heart Association (AHA) Life’s Simple 7 (LS7), associated with improved cardiovascular disease survival and reduced healthcare costs.8   As we battle the restrictions imposed by the pandemic, we have to also think that these circumstances present opportunities to engage our communities in healthy lifestyle practices. Practice aimed to increase our physical activity, may contribute to improving overall health status in the midst of the COVID pandemic.

Here are some ideas on how to meet the New Year resolution to exercise and increase our levels of physical activity:

  • Move More
    • Set up a timer or alarm to move at least once every hour.
    • A good starting goal is to engage in physical activity at least 150 minutes a week. This represents three 50-minute sessions or five 30-minute sessions a week.
    • Start slowly. Gradually build up to at least 30 minutes of activity on most or all days of the week.
    • Check with your healthcare provider before beginning a physical activity program and follow their recommendations.
  • Establish a routine
    • Start with small changes.
    • Make the time.
    • Try to engage in exercising consistently at the same time every day and every week.
    • Stick to the new routine for at least a month.
    • Find a convenient time and place to do activities.
    • Be flexible. If you miss an exercise opportunity, get back on track.
    • Work physical activity or exercise session into your day in another way.
    • Keep reasonable expectations of yourself and your physical activity or exercise routines.
    • Reward or praise yourself for sticking to the changes.
    • Use non-food items to reward yourself.
  • Get support
    • Find buddies or friends who are also making the same commitment to be fit and engage in physical activity.
    • Invite others to join you on your journey.
    • It becomes more fun when you exercise or move in a company.

Start the New Year with a commitment to better health by increasing activity and engaging in regular exercise. Engage others in exercise while keeping social distancing guidelines. Celebrate the small changes. Make a commitment to a Better You!

References:

  1. Centers for Disease Control (CDC). Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Physical Activity Basics. Reviewed 2020 Nov 18. Accessed 2021 Jan 13. https://www.cdc.gov/physicalactivity/basics/index.htm
  2. Bhutani S, Cooper JA. COVID-19-Related Home Confinement in Adults: Weight Gain Risks and Opportunities. Obesity (Silver Spring). 2020;28(9):1576-1577. doi:10.1002/oby.22904
  3. Di Renzo L, Gualtieri P, Pivari F, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med. 2020;18(1):229. Published 2020 Jun 8. doi:10.1186/s12967-020-02399-5
  4. Zachary Z, Brianna F, Brianna L, et al. Self-quarantine and weight gain related risk factors during the COVID-19 pandemic. Obes Res Clin Pract. 2020;14(3):210-216. doi:10.1016/j.orcp.2020.05.004
  5. Sidor A, Rzymski P. Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland. Nutrients. 2020;12(6):1657. Published 2020 Jun 3. doi:10.3390/nu12061657
  6. Pellegrini M, Ponzo V, Rosato R, et al. Changes in Weight and Nutritional Habits in Adults with Obesity during the “Lockdown” Period Caused by the COVID-19 Virus Emergency. Nutrients. 2020;12(7):2016. Published 2020 Jul 7. doi:10.3390/nu12072016
  7. Luzi L, Radaelli MG. Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic. Acta Diabetol. 2020;57(6):759-764. doi:10.1007/s00592-020-01522-8
  8. Garg PK, O’Neal WT, Mok Y, Heiss G, Coresh J, Matsushita K. Life’s Simple 7 and Peripheral Artery Disease Risk: The Atherosclerosis Risk in Communities Study. Am J Prev Med. 2018;55(5):642-649. doi:10.1016/j.amepre.2018.06.021

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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#HeartMonth and Healthy choices

William Aitken, MD

See what’s on Netflix or go for a run? We’re more than half-way through #HeartMonth and I’m still picking the next episode of Netflix nine times out of ten. That said, with the Heart Month hashtags flooding my twitter feed I have been inspired to start “prescribing” exercise to patients who are having trouble making healthy exercise choices. Thanks to #cardiotwitter I also have a couple of interesting studies to show patients on the benefits of running.

One observational study at the London Marathon found an approximately 4-year reduction in vascular age associated with training for and completing the race among first-time runners. Most of these people ran 6 to 13 miles per week for the 4-5 months leading up to the race. [1] A separate, outcomes-focused meta-analysis published in 2019 analyzed data from 14 studies and found a 27% risk reduction of all-cause mortality associated with running. The authors concluded that mortality risk reduction was seen with running even just once per week. [2]

Heart disease is the nation’s leading cause of death, but it doesn’t have to be. February is American #HeartMonth to reminds us that we can fight back by making healthy choices: being active, eating healthier, and going for that occasional run.

My son and I after his first Turkey Trot last year

References:

  1. Bhuva A, D’Silva A, Torlasco C, et al. Training for a First-Time Marathon Reverses Age-Related Aortic Stiffening. J Am Coll Cardiol. 2020 Jan 7;75(1):60-71. doi: 10.1016/j.jacc.2019.10.045.(https://www.ncbi.nlm.nih.gov/pubmed/31918835)
  2. Pedisic Z, Shrestha N, Kovalchik S, et al. Is running associated with a lower risk of all-cause, cardiovascular and cancer mortality, and is the more the better? A systematic review and meta-analysis. Br J Sports Med 2019; 0:1-9. doi:10.1136/bjsports-2018-100493 (https://www.ncbi.nlm.nih.gov/pubmed/31685526)

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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“Run, Forrest, Run!” – Effects of Cardiovascular Exercising on Mental Health

Trupti Shetty
running

Source:pixabay

If life gave me a box of chocolates, I am pretty sure I would eat them all. As a basic science researcher, I am all too familiar with burn-outs and stress, and more recently to the effects of stress-induced anxiety. So, I started running. I ran when my worries got too overwhelming, I ran when I had a bad day in the lab. Next thing I knew, I was running for pleasure. And this is something I did not see coming, especially because I hated running before!

Long before medications were available or even prescribed for mental or emotional disorders, exercising remained the only prescription for tacking problems of mental health by doctors.1 The AHA recommends 150 minutes of moderate-high intensity aerobic exercising a week for adults. Researchers have found this to improve balance of neurotransmitters and show effects as early as the first thirty minutes.

Here are some evidence-based effects of exercising on mental health –

  1. Stress and anxiety – Chronic stress can shrivel parts of the brain. Exercises have found to reverse this effect and even induce growth of neurons and improve synaptic plasticity in the brain.1,2
  2. Depression – Regular aerobic exercising can improve blood circulation to the brain and it is known to positively influence hypothalamus-pituitary-adrenal axis of the brain. All of this bounce back the balance of neurotransmitters, elevate mood, attenuate stress and fight back fear.3
  3. Addiction – While dealing with addiction, exercising has been shown to give a sense of control. Individuals with a tendency to be obsessive, need to fill a void quickly and exercising has shown to be effective in this regard.
  4. Hormonal fluctuations in women – Hormones estrogen and progesterone play an important role for neurotransmitter in the brain, by providing receptors for them to bind. In some women, this complex pathway can behave in a way that increases aggressive behavior which is found to be dramatically reduced by exercise. Exercising is certainly known to increase levels of tryptophan, the precursor to the happy chemical serotonin. This helps in dealing with the constant fluctuations of hormones during a cycle.1
  5. Attention deficits – Aerobic exercising has been successful with disorders of distractions, improving focus, concentration and memory of a task.

As with any given task, starting it – is always a challenge. If you are someone like me who is a novice at running, or the thought of running itself induces fear and anxiety – then start with small steps. Take a walk, slowly increase that to brisk walking and when you feel comfortable start jogging. It doesn’t necessarily even need to be running – jumping rope, biking, throwing ball – any activity that spikes your heart rate are good.

So, will you run away from your problems?

 

References:

  1. John Ratey, Spark: The Revolutionary New Science of Exercise and the Brain, ISBN:0316028355
  2. Carek PJ, Laibstain SE, Carek SM, Exercise for the treatment of depression and anxiety. Int J Psychiatry Med. 2011;41(1):15-28.
  3. Toups M, Carmody T, Greer T, Rethorst C, Grannemann B, and Trivedi MH. Exercise is an effective treatment for positive valence symptoms in major depression. J Affect Disord 2017; 209: pp. 188-194

 

 

 
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A New Year, A New Story: Tips for a Healthy Lifestyle in 2019

Allison Webel, PhD

A new year presents a new opportunity for improvement. Each year, thousands of advertisements beckon us to join or buy the most recent fitness and wellness craze – wearable technologies, personal coaching, pea protein and oat milk. However, if trends are not your thing, you may find it reassuring that “traditional” fitness and wellness strategies (e.g., training for a 5K walk/run, taking the stairs instead of the elevator, and reducing your sugar intake) can also be re-imagined and integrated into your daily routine leading to a healthier, and likely happier you.

Perhaps contrary to the many images trying to sell wellness products, adopting fitness and wellness strategies are equally if not more important for those who are living with a chronic disease. In November 2018 at the American Heart Association Scientific Sessions, the Physical Activity Guidelines were updated and, for the first time, specified that physical activity can help to manage chronic conditions including decreasing pain, reducing the rate of progression for high blood pressure and diabetes, reducing anxiety and depression, and improving cognition in those with chronic comorbidities. These critical health outcomes symptoms are particularly important for adults living with HIV, who tend to experience worse symptoms than many living with other chronic illnesses – and consequently, they may stand to benefit the most from increased and improved physical activity.

Figure 1 Photo by Christine Schmitt via flickr (http://bit.ly/2LZufoz)

However, in addition to physical activity, nutritional intake is a critical part of improving health and wellness among adults living with HIV. A recent practice paper of the Academy of Nutrition and Dietetics found that nutritional status affects the overall health and longevity of this population. They suggest that improved diet can lead to reduced blood pressure, obesity, and diabetes, which will result in improved cardiovascular health. Lead author of the report, Amanda Willig, RD, PhD, from the University of Alabama at Birmingham, suggests that when anyone (especially someone with a chronic disease such as HIV) is starting to adopt a new diet to “Remember, the enemy of good is perfect. A perfect diet is not needed to see big changes in your health.”

So what are the good diet changes needed to improve health? Regardless of one’s HIV status, Dr. Willig’s recommendations on healthier eating are the same: “Watch your portion sizes, try to eat vegetables every day / fill ½ of your plate with vegetables at meals, limit the amount of sugar in your diet, and choose water over sugar sweetened beverages like soda, sports drinks or sweet tea.”

However, for those with HIV, there are some special considerations. While the evidence is still emerging, Dr. Willig indicated that those with HIV may need more Vitamin D than they did prior to their HIV infection for their overall health.  And if one’s CD4+ T-cell count is less than 250, they may want to avoid eating raw or undercooked meat and seafood, as they be at higher risk for food poisoning. Additionally, for the growing number of people living with HIV who are over 50, they may need to increase their protein intake from 0.8 grams per kg per day to 1.2 grams per kg per day. This will help with maintaining muscle mass and preventing bone loss.

Yet whether you are decreasing your portion size or increasing your daily protein intake, changing behavior can be hard and as we age, it can seem complicated and sometimes discouraging. In addition to seeking help from registered dietitian or a Physician Nutrition Specialist who can help you decide which lifestyle nutrition plan is best suited to you, Dr. Willig also suggested several tips for adopting a healthy diet in 2019 (see insert).

 

Dr. Willig’s Tips for Adopting a Healthy Diet in 2019

  • Keep a food diary for 3-4 days to learn not just what you are eating but why.
  • Start with the small steps that can produce big changes, such as cutting out sugary drinks or not eating during the night.
  • Regardless of the nutrition plan, portion sizes still matter. One can eat too many of the “right” foods, so learn what a portion of the foods you eat actually looks like.
  • Make sure your nutrition plan fits your lifestyle. If you want to cook, you can to experiment with baking and sautéing instead of frying foods. If you travel often, learn to read nutrition labels and restaurant nutrition information to avoid eating too many calories.

 

Additional strategies can be found on the American Heart Association’s Healthy Living Website.

As you start to navigate how to start the year committed to becoming healthier you, there will undoubtedly be challenges – busy schedules, competing demands, mood, weather and so on. But you can overcome them and take small steps to become a healthier you in 2019. As you start this journey, consider the words of writer Alex Morritt, “New year — a new chapter, new verse, or just the same old story? Ultimately we write it. The choice is ours.” The new year has just begun, and regardless of your age, sex, health status, or neighborhood in 2019 you get to write your own story – one in which you relentlessly pursue a healthier you.

 
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Should Doctors Be Role Models For Their Patients “Showing, Rather Than Just Telling”

M Chadi Alraies, MD

Last year, the grand round speaker was a renowned physician in his field. He gave us an excellent presentation related to heart disease prevention and lipid management. However, the audience were surprised with the fact that the speaker was obese, at least 50 lb. overweight. I invoke this anecdote to buttress my argument that physicians need to be role models to inspire confidence in their patients. It is a fact that healthy physicians make better role models for patients. Whether doctors avoid smoking, eat right, exercise, or maintain a proper weight can influence how they talk with patients about making lifestyle choices.

As an interventional cardiology fellow, I advise the importance of maintaining a healthy lifestyle to my patients on daily basis. However, the majority of us fall guilty of neglecting what the American Heart Association recommends of 30 minutes aerobic activity five times a week. One of the biggest reasons for not maintaining a healthy life style is time! Long working hours, interrupted sleep, travel, deadlines, and lack of proper work/life balance, are all obstacles that prevent from leading a healthy lifestyle.

How can we maintain healthy lifestyle with limited hours in a day? We often set unrealistic goals (i.e. losing a certain number of pounds at the end of the year, increase muscle mass to 40%, decrease waist size by 4 inches in 6 months, etc.). Therefore, setting up short-term goals is measurable and more effective. Also, changing a few habits throughout the day can have a remarkable impact on your health and fitness. In general, doing little things on a regular basis is better than nothing.

At work, try to park at the farthest spot in the lot or parking garage to gain few extra steps, use the stairs instead of the escalator, avoid high-carbohydrate diet and snacks, and protein shakes for snack and between meals. The “power of 5-minutes;” if you are in the cath lab or clinic, try to take 5 minutes for lunges, burpees, squats, sit ups, or pushups in an empty patient room or locker room. Don’t leave work at rush hour! Instead, find a place in the hospital to do 30 minutes of exercises until traffic is better then leave to go home.

At home, try not to eat 3 hours before bedtime. Avoid high-carbohydrate snacks between dinner and bedtime. Try to avoid checking your phone or answering emails after 8 pm. Go to bed early, get up 30 minutes earlier than usual and do quick morning exercises. If you have a gym membership and you never had the time to go, early morning before work is the best time.

The majority, if not all, of the cardiologists go to meetings and conferences. I find a lot of downtime during conferences that can be used to exercise. Before starting your day, spend one hour in the gym. This can be done almost at the end of the day if you are not a morning person. Have protein bars, nuts in your bag so you can snack on during the day. Avoid muffins, cakes, and candies that are often served at the exhibit halls. We have seen multiple photos on social media tagged with the hashtag “#EscalatorShame” with escalators packed with cardiologist! Use the stairs not the escalators at the convention center.

Don’t expect immediate results! Do little things when you can, as much as you could, and I guarantee outstanding results. So next time we tell our patients to exercise or lose weight, we can reflect on our personal experience and give them the best advice.

 Chadi Alraies Headshot

M Chadi Alraies, MD is an interventional fellow and vice chair of Council on Clinical Cardiology Fellow-In-Training & Early Career Committee of American Heart Association.