Why Exercise? 1) Hi - in this section we are taking a brief look at why exercise is important and how to get it. We are looking at what the latest research says - drawing on evidence of how we humans have evolved over millions of years. I would expect you to be thinking, hang on a minute, I already know exercise is good for me, and after all I am using an FES Cycling system - can’t we just fast forward over this bit? Well maybe you are committed to regular exercise - but if you are like me you have to be thinking from time to time about exactly where exercise should fit in as part of your overall priorities. Our friend and therapist Andy Galbraith likes to say “Take time to exercise or make time for illness” - and we can all agree with that, but the bit that is missing is just how should we train effectively. How intensively and how frequently do we need to train for example? Most of us don’t want to spend hours every day exercising so how do we know if we are doing enough to get the health benefits we want? There is another complication too. Much of the research that exists around exercise has not been carried out with persons that have a disability and that certainly is something to keep in mind. 2) I think it is fair to say that, if Amazon sales are anything to go by, both Diet and Exercise are topics on the minds of many people. Exercise products in particular are often offered for sale and purchased. 3) Logic would surely dictate that our obsession with fitness and fitness products means we all are - basically - highly tuned athletes - but I’m not so sure that in general, people are getting fitter. 4) A classic way of thinking about an exercise strategy for sport is the so-called FITT approach. This approach considers four basic elements of exercise. The Frequency, Intensity, Time and Type of exercise - and it is the combination and variation of these three things that leads to greater fitness. Page 1 of 7
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5) In our personal situations we are using a RehaMove FES system and perhaps engaging in other exercise - and ideally we have a fitness goal in mind. It then makes sense to consider how Frequently and Intensely do we need to train? How long do we need to train for?
6) As a starting point we would generally advise clients to be using FES Cycling 3 times per week or 20 to 40 minutes per session. The intensity of exercise is a bit more difficult to be precise about. It depends on a number of factors. I’ve described this here as an intensity which gives “sustainable active cycling against maximum resistance” - I’ll explain this in a moment. We have generally always suggested an approach which considers using FES Cycling as a journey which is more like a marathon than a sprint. Each person will respond differently to FES Cycling - it will depend in part on their starting level of fitness. However, we would always advocate striving to get muscle contractions strong enough to pedal actively for a whole session against resistance. 7) What we would recommend is starting with a level of resistance (typically Gear 0 or 1) that allows active cycling and then only increasing the resistance when you can actively cycle for the whole session. This is what we describe as sustainable active cycling. Following this pattern you might find that muscles fatigue at first and active cycling doesn’t happen for more than a few minutes. However over a few weeks, the muscles respond to the FES and gradually you move to a position when you are actively cycling for the whole session. It’s at this point that you can increase resistance by using a higher numbered gear.
8) If you have explored your RehaMove you will probably know there is a “Period” setting feature that can be really helpful when you are just starting out or find that you are plateauing in a particular gear. We will look at setting this up in more detail when we get to the hands on stuff, but basically, setting a period creates a stimulation “break” during a session. This lets the muscles recover for a minute or so. When the break ends you are likely to find that active cycling resumes with a bit more power. Page 2 of 7
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As this slide shows, when we compare the situations with and without period breaks it is likely that if muscle fatigue is an issue, using period breaks will mean that the total workload during a session will increase.
9) Before we get too deep into the details of FES Cycling let’s step back a bit and consider why exercise matters. What research shows is that Exercise is Essential for humans - we have evolved to depend upon physical activity for our survival . For us humans, sitting at a desk or in front of the television for protracted periods is associated with increased risk of disease and a shorter life span, even among people who exercise. Worldwide, physical inactivity is arguably on a par with smoking as a health risk, killing more than five million people annually. Among Scottish adults, a research study showed those watching more than two hours of television a day had a 125 percent increase in cardiac events such as heart attack or stroke. A study of Australian adults reported that every hour accumulated watching television shortened life expectancy by 22 minutes. UK able bodied adults typically clock up about 5,000 steps per day, which contributes to the alarming rates of type two diabetes, affecting one in 10 of us, and heart disease, which accounts for a quarter of all deaths. In fact our taking fewer than ten thousand daily steps is associated with increased risk of cardiovascular and metabolic disease.
10) Think about the influence of TV watching - I will save you the math: bingeing all of Game of Thrones in its entirety - apparently more than 63 hours of content -will cost you one day on this planet. The take away is that Exercise is not optional - it is essential for health in all of us. It’s basically, the way humans have evolved. Discoveries from fossil excavations, zoos and laboratories around the world are revealing just how radically our bodies have changed over the past two million years. Unlike our Page 3 of 7
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close cousins the apes, we have evolved a dependency on physical activity. We must move to survive. Somehow humans evolved to require much higher levels of physical activity for our bodies to function normally. Sitting for hours on end, (or watching the television) have gone from standard practice to a health risk. 11) An interesting fact from research is that for health benefits it’s not so much the Intensity of exercise that matters but the VOLUME. Get it right and every organ system benefits down to cellular level. We are likely to sleep better, remain cognitively sharp and with a stronger immune system. 12) If we think about what that means for exercise requirements I would point out that this is good news for the average person. We don’t need to exercise intensively to get health benefits - volume counts and this makes our bodies more efficient. It is not necessary to only think that high intensity is all that counts. 13) Since the 1980s, exercise has been sold as a way for the general public to lose weight or its been considered as a health-conscious addition to our lifestyle. But exercise is not optional; it is essential, and weight loss is probably the one health benefit it largely fails to deliver effectively. Our bodies have evolved to require daily physical activity, and consequently exercise does not make our bodies work more so much as it makes them work better. Research has shown that physical activity has little effect on daily energy expenditure (modern tribal hunter-gatherers burn the same number of calories every day as sedentary Westerners), which is one reason exercise is a poor tool for weight loss. Instead exercise regulates the way the body spends energy and coordinates vital tasks. Recent advances in the study of human metabolism have shown that exercising muscles release hundreds of signalling molecules into the body, and we are only beginning to learn the full extent of their physiological reach.
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Endurance exercise reduces chronic inflammation, a serious risk factor for cardiovascular disease. It lowers resting levels of the steroid hormones testosterone, estrogen and progesterone, which helps account for the reduced rate of reproductive cancers among adults who exercise regularly. Exercise may blunt the morning rise in cortisol, the stress hormone. It is known to reduce insulin insensitivity, the immediate mechanism behind type 2 diabetes, and helps to shuttle glucose into muscle glycogen stores instead of fat. Regular exercise improves the effectiveness of our immune system to stave off infection, especially as we age. Even light activity, such as standing instead of sitting, causes muscles to produce enzymes that help to clear fat from circulating blood. Populations such as the tribal hunter gathers of today do not develop heart disease, diabetes or the other maladies that afflict industrial countries. 14) But we do not need to behave as hunter-gatherers or run marathons to reap the benefits of a more evolutionarily informed life. The lesson of research is that volume matters more than intensity. Success means they are on their feet and moving from sunrise until dusk, racking up more than two hours of physical activity a day, most of it as walking. A recent study of Glaswegian postal workers shows us what this can look like. These men and women were not committed athletes but were active throughout the day, handling the mail. Those who got 15,000 steps or spent seven hours a day on their feet had the best cardio- vascular health and no metabolic disease. Perhaps best of all, we know that even light activity causes muscles to produce enzymes that clear fat from our blood. We can emulate these same habits by walking or biking instead of driving, taking the stairs, and finding ways to work and play that keep us off our butts. 15) When thinking about exercise and health benefits we have to distinguish between training for a sport and training for health. When health is our goal we have resilience as a worthwhile outcome.
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To think of Resilience we could do worse than imagine a tree. It is routed to the Earth, is strong yet is flexible and bends with the wind. It endures come what may but it doesn’t move. We tend to think of strength in a way that is shaped by our culture. It’s interesting to look at other cultures to see how they cultivate health and strength by exercise. 16) I have a long interest in the martial arts and discovered that in ancient times anyone who wanted to learn combat martial arts had to learn something called chi Kung first. This was about developing internal energy before building strong muscles. The technique developed so long ago was sometimes called “standing on stake” or standing like a tree. This exercise involves taking up and holding certain postures like the one shown here with knees flexed, arms raised as if holding a ball and shoulders relaxed. In most conventional exercise as practiced in the West, the emphasis is on intensity. Of course this works. Over time you will get stronger and fitter but you will find that with this method, before the body is tired, you are often limited by your heart rate and breathing. Many people find this hard and give up before they can enjoy the benefits of exercise. Chinese combat science always commenced basic training with “standing like a tree”. This exercises the muscular and vascular system whilst keeping the pulse rate within normal range and allowing comfortable breathing. It’s easy to dismiss this until you actually try it. 17) This cartoon nicely expresses how you might feel when practicing standing like a tree for just 5 minutes. It might sound easy but the experience can be brutal. Why I raise this is that sometimes people that use FES Cycling are disappointed that they don’t find themselves gasping for breath and exhausted after every session. Even if you can’t stand like a tree, the point is that gentle methods of exercise can actually be very effective when health is our goal. Remember that volume of exercise matters more than intensity. Do what you can as often as you can but worrying about how much exercise you are doing is almost certainly bad for you too. Page 6 of 7
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We must remember that we are aiming to preserve our health for the long term and gentler methods are effective in promoting well-being. 18) At the link shown here you will find some recently published guidelines for exercise aimed at adults with a spinal cord injury. This is based on a review of the science and suggests some safe minimum for fitness and cardio-metabolic health. You might find them so general that you struggle to see how they apply to you. It is useful to review these as guidelines whilst understanding that these may not fit perfectly with your individual circumstances. 19) If you want to learn more about how humans have evolved to need exercise than I recommend this article from Scientific American Magazine. 20) Finally, if you are curious about standing like a tree these are a couple of very readable books.
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