Monday, December 23, 2013


"The root of all health is in the brain. The trunk of it is in emotion. The branches and leaves are the body. The flower of health blooms when all parts work together." 
- Kurdish Saying

Note:  The following article was composed by M Doug McGuff, M.D.  Although it may be somewhat technical for the reader, it offers an important view of "what works and why" 
in exercise. PB
Please review my summation and interpretation at the end of this article!
                                    by M. Doug McGuff, M.D.

For the past three decades the medical community has largely recommended aerobic exercise to patients as a means of improving their health. This emphasis on steady-state activity was largely based on the work of Kenneth Cooper, M.D. and a multitude of studies showing positive cardiovascular outcomes when performing aerobic exercise. Running, Jogging, and aerobic dance became national fads. Thirty years later, many of us are finding that the exercise rage that we helped create may have done more to destroy America's knees than it did to save America's hearts.

We must understand that aerobics is a word made up to describe a particular exercise philosophy. The word aerobic describes the subsegment of metabolism that involves the Krebs cycle and respiratory chain, which requires oxygen to function. During low level physical exertion, energy demands are met primarily by this metabolic pathway. At higher levels of exertion, other metabolic pathways predominate. The research that has been performed in the past has operated on the assumption that exercising to produce aerobic metabolic adaptations is most desirable. Measuring how aerobic a particular exercise is largely determined through V02max testing (maximal oxygen uptake). When exercise showed improvement in cardiovascular outcomes the link between aerobic metabolic conditioning and cardiovascular health was established. It then became a forgone conclusion that exercise that did not rely predominantly on the aerobic metabolic system would have no effect on cardiovascular health. Thirty years later, the literature is suggesting that we were wrong.

The Best Kind of Exercise

A review of the more recent literature seems to suggest that resistance training may be the best way to train the cardiovascular system. If you think about it, this makes sense. The only way we can get at the cardiac or vascular system is by performing mechanical work with the muscles. It only makes sense that the higher the intensity and quality of the muscular work, the greater will be the effect on those systems that must support the muscular work. If you think of exercise in biological terms, you will note that exercise is simply an irritative stimulus which acts upon the body (an organism); if the stimulus intensity is high enough, and the organism has the resources available (nutrition, rest) it will produce an adaptive response. By raising the stimulus intensity we can produce a more pronounced and well-preserved adaptive response.

How do we know that resistance training produces a strong cardiovascular effect? Most of us have been told that high muscular tension increases peripheral vascular resistance and traps venous blood, which inhibits venous return. These supposed effects act to decrease cardiac output (or so we were told). If you think about it, these arguments make little sense. Venous return is largely dependent on muscle contraction to move blood centrally. Forceful muscle contractions should enhance, not inhibit cardiac return. Furthermore, the release of catecholamines* during intense exercise causes gut vasoconstriction, but stimulates vasodilatation in the muscles, the net effect of which should be to decrease peripheral resistance. Decreased peripheral resistance combined with enhanced venous return should enhance cardiac output. Increased end-diastolic pressure should enhance coronary artery perfusion, making permissible meaningful exercise to even those with coronary artery narrowing. The argument seems logical, but until recently it has not been measured directly. An article from the June 1999 issue of the American Journal of Cardiology actually used right heart catheterization to measure hemodynamic changes during high intensity leg press exercise in patients with stable congestive heart failure. The measurements taken noted significant increases in heart rate, mean arterial blood pressure, diastolic pulmonary artery pressure and cardiac index. Furthermore, there was a significant decrease in peripheral vascular resistance, an increased cardiac work index and left ventricular stroke work index, suggesting enhanced left ventricular function.(1).

The profound effect of resistance training on the cardiovascular system might make one worry that the demands are too great and resistance training may actually be dangerous to those with know or lurking cardiovascular disease. A review of the literature shows that we need not worry too much. A recent article in the March-April Journal of Cardiopulmonary Rehabilitation examined circuit weight training at varying levels of intensity in patients with CAD. They actually noted a lower rate-pressure product when compared to treadmill walking and no subject displayed any ST-segment depression or angina during circuit weight training.(2). This parallels my experience training patients with known CAD. Despite training these subjects at very high intensity, taking every set to muscular failure, we have never had a subject experience angina. This is even true for subjects who have angina climbing steps or walking uphill. I believe that the augmented venous return improves coronary perfusion and permits a more meaningful level of exertion in these patients. Resistance training has even been shown to be safe early after myocardial infarction (again, I believe for similar reasons). An article from the March-April Journal of Cardiopulmonary Rehabilitation looked at resistance training as early as 6 weeks post MI and compared it to more traditional aerobic-based rehab protocols. Amazingly, they noted "...30 of 42 subjects had one or more cardiovascular complication (arrhythmia, angina, ischemia, hypertension, hypotension) during the aerobic exercises as compared to only 1 subject with complications during resistive exercises". (3). Furthermore, it appears that we need not worry too much about the blood pressure response from resistance training. A meta-analysis from the March issue of Hypertension concluded that "progressive resistive exercise is efficacious for reducing resting systolic and diastolic blood pressure in adults." (4). Another article confirms that resistance training does not exacerbate exercise blood pressure. (5).

Peripheral Effects

Despite its profound effects on the cardiovascular system resistance training still has its major impacts through peripheral adaptations, mainly in terms of increased muscle strength. We have all told our patients that just performing activities of daily life (walking, taking the stairs, yard work) can preserve our cardiovascular health. Unfortunately, the age-related loss of muscle (sarcopenia) can undermine our ability to carry out those activities. Resistance training can prevent and even reverse sarcopenia.(6). Furthermore, as a muscle becomes stronger, fewer motor units will have to be recruited to perform a given task, thus reducing the demand on the cardiovascular system. Clearly, the best kind of exercise is the kind that will tax the musculature the most, this will create a powerful cardiovascular stimulus, while producing hemodynamic changes that minimize the risk of cardiac ischemia and also produce the most profound peripheral changes in the form of muscle strengthening.

The Best Resistance Training

The best resistance training would be high intensity but of low force so that the beneficial effects can be obtained without the risk of injury. Heightened intensity would also be helpful because the duration of the workout could be shortened and the recovery interval between sessions prolonged. A brief and infrequent exercise protocol would go a long way toward improving long-term compliance with an exercise program.

At my facility we use the SuperSlow™ protocol which involves lifting the resistance over a 10 second time span and lowering the resistance over a 10 second time span. The very slow lifting speed provides two beneficial effects. First, by moving so slowly the weight cannot get moving under its own momentum and this enhances muscular loading and intensifies the exercise. Secondly, the slow movement eliminates acceleration. Since force=mass x acceleration, we can greatly reduce the amount of force that the exercising subject will encounter. The SuperSlow™ protocol was originally devised for use with osteoporosis patients.(7). The protocol is so effective at raising intensity that we find workouts of about 12 minutes to be optimal and a recovery interval of 7 days to be optimal for most subjects. We have been able to double subjects strength in about 12-20 weeks. Recent research performed by Dr. Wayne Wescott compared the SuperSlow™ protocol to standard repetition speed resistance training and noted a 50% better strength gain in the SuperSlow™ group.(8). The researchers were so astounded that they later repeated the study and were able to reproduce the results.(9).

So, it appears that exercise will make a paradigm shift in the new millennium. Aerobic exercise will fall into the background while resistance training takes center stage. If you want more information on these changes, consult your medline ( or feel free to contact me.

*  Catecholamines cause general physiological changes that prepare the body for physical activity (fight-or-flight response). Some typical effects are increases in heart rateblood pressureblood glucose levels, and a general reaction of the sympathetic nervous system


1. Meyer, K. et al. Hemodynamic responses during leg press exercise in patients with chronic congestive heart failure. Am J Cardiol 1999 Jun1;83(11):1537-43.
2. Degroot DW, et al. Circuit weight training in cardiac patients: determining optimal workloads for safety and energy expenditure. J Cardiopulm Rehabil. Mar-Apr;18(2):145-52.
3. Daub WD, et al. Strength training early after myocardial infarction. J Cardiopulm Rehabil. 1996 Mar-Apr;16(2):100-8.
4. Kelley GA, Kelley KS. Progressive resistance exercise and resting blood pressure: A meta-analysis of randomized controlled trials. Hypertension. 2000 Mar;35(3):838-43.
5. Harris KA, Holly RG. Physiological response to circuit weight training in borderline hypertensive subjects. Med Sci Sports Exerc 1987 Jun;19(3):246-52.
6. Rogers MA, Evans WJ. Changes in skeletal muscle with aging: effects of exercise training. Exerc Sport Sci Rev 1993;21:65-102.
7. Hutchins, K. 1992. SuperSlow: The Ultimate Exercise Protocol. Media Support/SuperSlow Systems. Casselberry, Florida.
8. Wescott, W. Exercise Speed and Strength Development. American Fitness Quarterly 13(3):20-21.
9. Wescott, W. et al. Effects of regular and slow speed training on muscle strength. Master Trainer 9(4): 14-17.


M. Doug McGuff, MD is a graduate of the University of Texas Medical School at San Antonio. Dr. McGuff completed his emergency medicine residency at the University of Arkansas for Medical Sciences where he served as Cheif Resident. Dr. McGuff is currently a partner in Blue Ridge Emergency Physicians, P.A. in Seneca, South Carolina. Dr. McGuff also owns Ultimate Exercise, a licensed SuperSlow(tm) facility that provides one-on-one exercise instruction in a clinically controlled environment.
  • Doing aerobic exercising (using treadmills, bicycles, stepping machines, etc.) are not necessary.  Any exercise that is intense enough will have a positive effect on the health of the heart, circulatory system and muscles.
  • Resistance training using weights may be the best way to train the cardiovascular system.  The higher the intensity the greater the benefits will be if the trainee has adequate rest and nutrition.
  • Resistance training has been shown to be safe early after myocardial infarction (heart attack).
  • The best kind of exercise is the kind that will tax the muscles the most, including positive effects on the heart.

Monday, December 16, 2013


"Sometimes we just need to take a deep breath, exhale and relax.  Simply appreciate where you are and what you have"


Sarcopenia is characterized by a decrease by the size of the muscles which causes weakness and frailty.  This loss may be caused by different cellular mechanisms than those that cause muscle atrophy.  During sarcopenia, there is a replacement of muscle fibers with fat and an increase in fibrosis.  An excellent article from WebMD follows this introduction.

"From the time you are born to around the time you turn 30, your muscles grow larger and stronger. But at some point in your 30s, you begin to lose muscle mass and function, a condition known as age-related sarcopenia or sarcopenia with aging. People who are physically inactive can lose as much as 3% to 5% of their muscle mass per decade after age 30. Even if you are active, you will still experience some muscle loss.
Although there is no generally accepted test or specific level of muscle mass for sarcopenia diagnosis, any loss of muscle mass is of consequence, because loss of muscle means loss of strength and mobility. Sarcopenia typically accelerates around age 75 -- although it may happen in people age 65 or 80 -- and is a factor in the occurrence of frailty and the likelihood of falls and fractures in older adults.
Although sarcopenia is mostly seen in people who stay physically inactive throughout life suggests there are other factors involved in the development of sarcopenia.
The primary treatment for sarcopenia is exercise. Specifically, resistance training or strength training -- exercise that increases muscle strength and endurance with weights or resistance bands -- has been shown to be useful for both the prevention and treatment of sarcopenia.
Resistance training has been reported to positively influence the neuromuscular system, hormone concentrations, and protein synthesis rate. Research has shown that a program of progressive resistance training exercises can increase protein synthesis rates in older adults in as little as two weeks.
For optimal benefits with minimal risk of injury, the proper number, intensity, and frequency of resistance exercise is important. For that reason, you should work with an experienced physical therapist or trainer to develop an exercise plan.
Although drug therapy is not the preferred treatment for sarcopenia, a few medications are under investigation. They include: 
Urocortin II. This peptide has been shown to stimulate the release of a hormone called adrenocoticotropic hormone (ACTH) from the pituitary gland. Intravenous urocortin II has been shown to prevent muscle atrophy from being in a cast or taking certain medications; it has also been shown to cause muscle growth in healthy rats. But its use for building muscle mass in humans has not been studied and is not recommended. 
Hormone Replacement Therapy (HRT). When a woman's production of hormones is diminished at menopause, hormone replacement therapy has been shown to increase lean body mass, reduce abdominal fat short-term, and prevent bone loss. However, in recent years there has been controversy surrounding the use of HRT due to increased risk of certain cancers and other serious health problems among HRT users.
Other treatments under investigation for sarcopenia include testosterone supplementation, growth hormone supplementation, and medication for treatment of metabolic syndrome (insulin-resistance, obesity, hypertension, etc.).  If found useful, all of these would complement the effects of resistance exercise, not replace them."

Monday, December 9, 2013

"You live longer once you realize that any time spent being unhappy is wasted"
- Ruth E. Renkl

What Happens When You Exercise?

There are times when you can take a very complicated subject like muscle physiology and metaphorically simplify it for "Dummies".  No, this isn't meant to be a degrading of any one's intelligence, but rather to create a means to memorize any subject easier, longer, and more comprehensively.  Let's get started.

An army is composed of soldiers and a muscle is made up of muscle fibers.  These are the basic units to start with in our discussion.  Some of the soldiers drive tanks, other's are in the infantry and some man anti-aircraft canons (or guns).  The soldiers are given specialized tasks.  Muscle fibers are grouped together to form different muscle bundles that also do specialized work.  The quadriceps extend the leg, and the hamstrings flex the knee joint while extending the hip joint.

Exercise is basically "medicine" for the muscles, but cause the muscles to respond differently than you may imagine.  Exercising does not build muscles, it causes a break-down process called catabolism.  There is microscopic bleeding, tearing, and irritation of the muscle fibers.  This process is magnified and enhanced during high intensity training (HIT).  When you leave the gym the muscles are repaired by nutrition and rest, especially sleep.  The results are in muscles that are enlarged (hypertrophied) and increased in number (more muscle fibers are formed; hyperplasia).  This process is a building stage called anabolism (as opposed to catabolism).

So if you want a strong army you need many soldier's that are trained, physically, to fight, endure, and "win the battle".  With exercise, you want to recruit as many muscle fibers as possible, train them, with the result of having a stronger, healthier and firmer body.  The human body is really a muscle machine designed to move.

There are specialized organelles, mostly in muscle, called mitochondria.  They are responsible for developing energy to move the body, run, stretch, play tennis, etc.  When people go on weight reducing diets, besides loosing fat, they also lose muscle tissue.  It's essential to exercise when going on a diet, as it is all the time during your life in your body.  If there is a sizable reduction in muscle substance, energy production is reduced, and can lead to a life of the "couch potato".

There are many other benefits of exercising and books have been written of this subject. Kinesiology is the study of muscular movement and physiology. It is a subject major in many colleges and universities.

Monday, December 2, 2013


"In running, it doesn't matter whether you come in first, in the middle of the pack, or last.  You can say, "I have finished".  There is a lot of satisfaction in that"

- Fred Lebow



By monitoring heart rate, the simple observation that the harder we exercise, the faster our heart beats is put to good use.  A heart rate monitor essentially measures your pulse rate, immediately and accurately, even during your exercise period.  You do not have to stop exercising to check your pulse in your wrist or by palpating your neck.  Professional athletes and amateurs alike have, for decades, been relying on the information provided by their heart rate monitor for the following reasons:

A heart rate monitor is like a rev counter, giving a precise measurement of exercise intensity. Training at your own ideal pace is made possible with a heart rate monitor. Direct measurement of heart rate during exercise is the most accurate way to gauge performance.Progress can be monitored and measured, increasing motivation. It maximizes the benefits of exercise in a limited amount of time.It introduces objective observation. Are you on the right track? Are you improving? It is a tool for regulating frequency and intensity of workouts. Because of the immediate feedback it provides, heart rate monitoring is an ideal training partner.

The heart moves blood from the lungs (where the blood picks up oxygen) to the muscles (which burns the oxygen as fuel) and back to the lungs again. The harder the training, the more fuel the muscles need and the harder the heart has to work to pump oxygen-rich blood to the muscles. When there is a load placed on the heart, as in exercising, the rate of the heart beat speeds to a higher level and the monitor can monitor the progress of the heart rate.

There are some excellent monitors on the market and it’s important to know what to look for when you purchase one.  My suggestion is to look in sporting goods stores, compare one model with another and also be sure that you buy the kind with a chest belt rather than just a wrist monitor.  The belted types are more accurate.  Also, it’s important that you purchase a monitor that ‘blocks out’ stray electronic signals.  This requirement is called Coded Transmission by Polar.  Other manufactures have their own terms for protected transmission of your heart rate. You will be exercising in a gym with treadmills, bikes, etc., that have monitors built in, some television monitors nearby, and they can all affect the cheaper heart rate monitors.  Note:  I have noticed that many times while working out in a commercial fitness center, the reliability of the built-in heart rate monitors are not always accurate, and accuracy is very important when checking your heart rate.  Many times the built-in monitors do not work at all – get your own and learn how to use and benefit from it.
When you start your workout, your heart rate increases rapidly in proportion to the intensity of your training.  In Heart Rate Monitors, the transmitter belt, worn around your chest, detects the electrocardiogram (ECG - the electric signal originating from your heart) and sends an electromagnetic signal to the wrist receiver where heart rate information appears.
As you get fitter, your heart is able to pump more blood with every beat. As a result, your heart doesn’t have to beat as often to get the needed oxygen to your muscles, decreasing resting heart rate and exercise heart rate on all exertion levels.  In other words, it becomes more efficient and stronger.

Go to Google, type in ‘Heart Rate Monitor’s by Search, and see what’s available online.  I buy many things online, you can save money, and sometimes you can buy without paying for shipping or taxes.
You should get a monitor that has the following, as minimal requirements:
1.      Be able to set the parameters; high and low bpm (beats/minute) limits, and some units        have sound warnings when exceeded.
2.      Get one with ‘Coded Transmission’.
3.      It should give you the calorie expenditure for the time of your exercise period.
4.      The battery should be able to be replaced.
5.      It should have the total amount of time you exercised.
6.      Be sure you can read the face of the monitor while exercising.  Don’t buy one with tiny      markings!
7.      Check out the return policy and guarantee period.  When in the gym, check to see if the    heart rate is close to the monitors on the treadmill, bike, or elliptical trainer.

My personal choice and the one I use is a Polar Monitor FT7 but it’s relatively expensive and probably more than what you need.  Polar has been making monitors for many years and I think they make the best ones available.  Note:  I get no rebate for recommending this company and I do not benefit in any way in making the recommendation!  Also note that whatever type of activity you may be involved in, a quality monitor is worth what you pay for it.  Besides looking into a mirror to check your progress in exercising, a monitor can give you a pretty good idea of what your cardio-respiratory progress is.  You can check your VO-2 reading, a leading guide on evaluating your fitness.