PLFR
Fitness Newsletter
ISSUE 10 Spring 2012
Free
Heart Health
Pg.1-4
High Intensity Interval Training
Pg.4-5
Chicken, Shrimp and Fruit Salad
Pg.5
Mountain Climbers
Pg.6
Upcoming Fitness Events
Pg.7
Heart Health: The Ultimate Fitness Goal?
By Lance C. Dalleck, Ph.D.
Cardiovascular diseases (CVD), such as coronary artery disease, account for more than 17 million deaths worldwide each
year, representing nearly one-third of the annual death toll. The risk of mortality from heart disease can be significantly
reduced by positively modifying various CVD risk factors that contribute to the progression of the disease. Historically, prevention and rehabilitation exercise programs have been designed with the intent to lower blood pressure and reduce excess levels of cholesterol and fat mass. While hypertension, high cholesterol and obesity undoubtedly contribute to heartdisease risk, more recent research suggests that there may be an even more powerful predictor of heart disease: cardiorespiratory fitness. It has recently been shown that low levels of cardiorespiratory fitness better predicts an individual’s risk
of developing heart disease and heart-disease mortality compared to traditional CVD risk factors. This article examines the
growing body of research highlighting low cardiorespiratory fitness as a critical CVD risk factor, and presents key training
requirements for optimizing this ultimate health outcome.
Cardiorespiratory Fitness: A Risk Factor for CVD?
Cardiorespiratory fitness, typically determined by measuring maximal oxygen uptake, or VO2max, refers to the highest
rate at which oxygen can be taken up and consumed by the body during intense exercise. Historically, the magnitude of an
individual’s VO2max has been viewed as one of the most important predictors of endurance exercise performance. A classic
study conducted in the 1970s at Ball State University confirmed the importance of VO 2max to endurance exercise performance, with findings indicating a strong correlation between VO2max and 10-mile run times (Costill, 1970). Although it
seems logical to assume that an individual with high levels of cardiorespiratory fitness will also have good cardiovascular
health, it is interesting that low cardiorespiratory fitness is not usually recognized as a CVD risk factor. For instance, the
American College of Sports Medicine (ACSM, 2010) uses eight factors to stratify individuals into low-, moderate- or highrisk categories: age, smoking, obesity, impaired fasting blood glucose, dyslipidemia, family history, sedentary lifestyle and
hypertension. Cardiorespiratory fitness is notably absent from this risk-stratification schema, as it is from many other CVD
risk-factor lists. However, a wealth of research findings accumulated over the past quarter century may soon change
things. In fact, cardiorespiratory fitness recently was coined the ultimate marker for risk stratification and health outcomes
(Franklin, 2007).
The Evidence
One of the very first studies to explore the connection between cardiorespiratory fitness and heart health was published in
1989. This hallmark paper reported that an inverse relationship existed between VO 2max values and risk for CVD (Blair et
al., 1989); similar findings were reported by Blair et al. in 1996. In both studies, these relationships held true for individuals with no other risk factors for CVD, one risk factor for CVD, and two or more CVD risk factors. More recently, the question of whether cardiorespiratory fitness should be considered a separate risk factor, in addition to lack of physical activity,
was addressed in a meta-analysis (a statistical method that combines the results of numerous studies). The author noted
1
that both increased cardiorespiratory fitness and increased physical activity were associated with decreased risk for CVD
risk compared to those imparted from increased physical-activity levels. Therefore, it was concluded that being unfit warrants consideration as a separate CVD risk factor—independent of physical inactivity and other traditional CVD risk factors—and merits screening and intervention.
In 2005, researchers reported findings from a study that examined the effect of cardiorespiratory fitness on risk of mortality from CVD in a cohort of diabetic men within normal weight, overweight and obese categories (Church et al., 2005).
Both diabetes and obesity are associated with increased risk of mortality from CVD. For all weight categories (normal,
overweight and obese) it was shown that the risk of CVD mortality was two- to four-times higher among diabetic men
with low levels of cardiorespiratory fitness compared to those with moderate-to-high levels of cardiorespiratory fitness.
Perhaps the strongest case to support cardiorespiratory fitness as the ultimate health outcome was made in a paper published in 2009. The author presented data to show that low cardiorespiratory fitness accounted for more overall deaths,
including those from CVD, when compared to deaths that could be attributed to traditional risk factors, such as obesity,
smoking, hypertension, high cholesterol and diabetes (Blair, 2009). Clearly, sufficient levels of cardiorespiratory fitness
should be considered paramount to overall health. But at what point should you become alarmed with the cardiorespiratory fitness level of your clients?
Low Cardiorespiratory Fitness: How Low Is Too Low?
In addition to training status, the magnitude of an
individual’s cardiorespiratory fitness level is deTable 1. Normative Values for Maximal Oxygen Uptake
pendent on numerous variables, including age,
kg/min)
sex, race and genetics. Table 1 includes normative
values for VO2max with specific reference to age
Age
and sex. In the previous section it was shown that
low cardiorespiratory fitness is a powerful risk facPercen20–29
30–39
40–49
50–59
tor for CVD. But how low is too low? Williams
tile*
(2001) noted that the highest relative risk of CVD
existed for those individuals with cardiorespiratory
Men
fitness levels below the 20th percentile. Perhaps
90
54.0
52.5
51.1
46.8
equally important is the fact that the most substantial drop in CVD risk involves just moving your
80
51.1
48.9
46.8
43.3
client from the 20th to the 30th percentile. Put
70
48.2
46.8
44.2
41.0
more simply, it is not necessary to turn your clients into Lance Armstrong to make them heart
60
45.7
44.4
42.4
38.3
healthy! The case study featured in the sidebar
50
43.9
42.4
40.4
36.7
below puts these findings into more functional
terms, while the subsequent section examines
40
42.2
41.0
38.4
35.2
why increased cardiorespiratory fitness levels low30
40.3
38.5
36.7
33.2
ers one’s risk for CVD.
20
39.5
36.7
34.6
31.1
Note: VO2max below the 20th percentile is associ10
35.2
33.8
31.8
28.4
ated with an increased risk of death from all
Women
causes (Blair et al., 1995). Study population for
the data set was predominately white and college90
47.5
44.7
42.4
38.1
educated. A modified Balke treadmill test was
80
44.0
41.0
38.9
35.2
used with VO2max estimated from the last grade/
speed achieved. The following may be used as
70
41.1
38.8
36.7
32.9
descriptors for the percentile rankings: well above
60
39.5
36.7
35.1
31.4
average (90), above average (70), average (50),
below average (30), and well below average (10).
50
37.4
35.2
33.3
30.2
Reprinted with permission from The Cooper Insti40
35.5
33.8
31.6
28.7
tute, Dallas, Texas from Physical Fitness Assessments and Norms for Adults and Law Enforce30
33.8
32.3
29.7
27.3
ment. Available online at www.cooperinstitute.org.
20
31.6
29.9
28.0
25.5
(mL/
60–69
43.2
39.5
36.7
35.0
33.1
31.4
29.4
27.4
24.1
34.6
32.3
30.2
29.1
27.5
26.6
24.9
23.7
Case Study
10
29.4
27.4
25.6
23.7
21.7
Aspen, a 49-year-old woman, begins an exercise
program with a VO2max value of 26.7 mL/kg/min, placing her in the 15th percentile according to her age and sex. This
cardiorespiratory level places her in the highest category of risk because she is below the 20th percentile (Williams,
2001). After three months of training, her VO2max increases by 15 percent to 30.9 mL/kg/min, which now places her in
the 35th percentile based on her age and sex. Most importantly, this realistic improvement in her cardiorespiratory fitness level has reduced her risk for CVD mortality by 30 percent.
2
Whyyou
that
Do will
Higher
give Levels
her a signal
of Cardiorespiratory
when she matchesFitness
her firstEquate
time, but
to that
Reduced
she can
Risk
go of
longer
CVD?
if possible.
A
good VO2max
Give does
her the
notsignal
simply
atmean
a timewe
that
have
is actually
the potential
102 percent
to complete
of hera first
localtime.
road Chances
race—it also
are is indicative of heart
her second
health.
But time
why?will
There
exceed
are several
her first.”
reasons why the training adaptations that culminate with improved cardiorespiratory
fitness concurrently augments skeletal muscle structure and function, which in turn contributes to reduced risk of CVD.
Karageorghis suggests borrowing a technique from British high jump coach Ron Murray. “In the
training session
Increased
Capillary
beforeDensity
a major championship, [Murray] would pretend to accurately measure the
height of the
Increased
cardiorespiratory
bar to make his
fitness
athletes
is associated
believe that
with
it was
increased
a centimeter
capillary
ordensity,
two higher
which
than
results
it actually
in an enhanced ability to
was. The
deliver
oxygenated
athlete would
blood
clear
to exercising
the bar with
skeletal
relative
muscle
ease (Gill
and go
andinto
Malkova,
the competition
2006). It also
feeling
means
really
there is an increased capacconfident.”
ity
to deliver blood glucose to skeletal muscle where it can subsequently be taken up and used for energy or stored as glycogen. The capacity to dispose of blood glucose more effectively reduces the risk of impaired fasting blood glucose values
Kauss
and
type
recommends
2 diabetes—both
that you
risk
remind
factors
your
for clients
CVD (ACSM,
of times
2010).
when they did exceed their expectations or
accomplish things they didn’t think were possible. “Use life experience to get the limiting thoughts
out of theirBreakdown
Complete
minds."
of Fats
Insulin resistance is a metabolic abnormality in which the binding of insulin to receptors on the skeletal muscle membrane
are blocked. This disrupts the transport of blood glucose into the muscle. As described earlier, this can lead to impaired
blood glucose, and eventually type 2 diabetes. A main contributing factor to insulin resistance is the incomplete breakdown
of fats that have entered into skeletal muscle cells (Horowitz, 2007). When this occurs, the body responds by turning on an
inflammatory pathway that inhibits insulin binding. Some of the featured training adaptations that result in improvements
to cardiorespiratory fitness include increased mitochondrial mass and number, as well as an increase in the various enzymes involved in mitochondrial respiration. These physiological changes in the skeletal muscle not only improve cardiorespiratory fitness, but also favor an increased capacity for fat metabolism. Accordingly, there is a decreased likelihood of
an incomplete breakdown of fats entering into skeletal muscle, which subsequently reduces the activity of the inflammatory pathway contributing to insulin resistance (Horowitz, 2007).
Exercise Programming Considerations for Improving Cardiorespiratory Fitness
When formulating an exercise program specifically focused on improving cardiorespiratory fitness, consider the following
three issues:
1. A minimal training intensity is required for a training adaptation to occur in terms of cardiorespiratory fitness.
2. There is a dose-response relationship between exercise volume and improvements in cardiorespiratory fitness.
3. High-intensity interval training (HIIT) can yield rapid improvements in cardiorespiratory fitness.
A Minimal Training Intensity
Regular physical activity confers numerous health benefits; however, for favorable training adaptations to occur, a minimal
threshold intensity must be exceeded. The American College of Sports Medicine (ACSM, 2010) recommends an exercise
intensity of 40−85% heart-rate reserve (HRR, which represents the difference between maximal heart rate and resting
heart rate) or oxygen uptake reserve (VO2R, which represents the difference between maximal oxygen uptake and resting
oxygen uptake). Importantly, unless the exercise intensity exceeds the lower end of this recommended range, meaningful
improvements in cardiorespiratory fitness levels are unlikely to occur. It also is important to note that for less-fit individuals (those starting an exercise program with a cardiorespiratory fitness level below 40 mL/kg/min), research has shown
these individuals will only need to exceed 30% of HRR or VO2R to experience a beneficial training effect (Swain and Franklin, 2002).
A Dose-response Relationship
Provided that the exercise intensity is sufficient, a favorable dose-response relationship exists between overall training volume and improvements in cardiorespiratory fitness (Garber et al., 2011). Simply put, the more time an individual allocates
to aerobic-exercise training per week, the greater results one can expect. Two important questions to ask in terms of training volume are:
1. What is the minimal amount?
2. What is the optimal amount required for positive training adaptations?
Research has shown that moderate-intensity (40−50% HRR or VO2R) exercise sessions of 15 minutes per day, performed
five days per week, result in significant improvements in cardiorespiratory fitness (Church et al., 2007). This weekly training volume of 75 minutes per week is likely approaching the minimal amount of aerobic exercise necessary to induce a
training benefit. Determining an optimal amount of training volume is a more difficult proposition and one research has yet
to fully elucidate. Nevertheless, it has been shown that in a dose-response manner, as weekly training volume increases
from 30 minutes per day to 45 minutes per day, on five days per week at moderate intensity, cardiorespiratory fitness
continues to improve.
Although it is probable that increased training volume for 60 minutes per day on most days of the week will yield even
greater increases in cardiorespiratory fitness, this has yet to be studied in a carefully controlled manner.
High-intensity Interval Training
One of the classic methods for eliciting improvements in cardiorespiratory fitness is through high-intensity interval training
(HIIT).
3
This tactic has long been a staple of training programs for endurance athletes; however, only recently has this practice
found its way into the workout regimen of everyday fitness enthusiasts. Recent research has demonstrated that quick and
impressive improvements in cardiorespiratory fitness can be amassed with HIIT. For example, one study reported a 20
percent improvement in cardiorespiratory fitness in only six weeks of HIIT (Gormley et al., 2008). Nonetheless, you should
practice a degree of caution when considering adding HIIT to your clients’ exercise programs. Although no adverse effects
of HIIT have been reported in the literature, the long-term effects and safety of HIIT remain to be determined. Furthermore, the specific features of an ideal HIIT program (i.e., exercise intensity, duration of each interval bout, rest intervals
between bouts, number of interval bouts per session and number of HIIT sessions per week) have yet to be fully evaluated
(Garber et al., 2011). Given these considerations, a conservative approach to HIIT is recommended [e.g., three, 5 x 5minute interval bouts at 85−95% HRR or VO2R, with five minutes of active recovery at an intensity below 40% HRR or
VO2R, on one or two days per week (Gormley et al., 2008)].
From Theory to Practice
In summary, key training considerations for the enhancement of cardiorespiratory fitness include exceeding the minimal
training threshold intensity, weekly volume of exercise and judicious use of HIIT. Clearly, given that low cardiorespiratory
fitness accounts for more deaths in both men and women than any other CVD risk factor, clients should be strongly encouraged to list improved cardiorespiratory fitness as one of their primary program goals.
Lance C. Dalleck, Ph.D., is academic coordinator of the cardiac rehabilitation postgraduate program at the University of
Auckland in New Zealand. His research interests include improving exercise performance and health outcomes through evidence-based practice, quantifying the energy expenditure of outdoor and non-traditional types of physical activity, and
studying historical perspectives in health, fitness and exercise physiology.
Source: ACEFitness.org
High-Intensity Interval Training
Looking for a way to add variety to your exercise plan while taking your fitness to the next level? High-intensity interval
training (HIIT) is a cardiorespiratory training technique that alternates brief speed and recovery intervals to increase the
overall intensity of your workout. HIIT is used by athletes and everyday exercise enthusiasts to reach performance goals
and enhance fitness and well-being.
How does it work?
Most endurance workouts, such as walking, running, or stair-climbing—are performed at a moderate intensity, or an exertion level of 5-6 on a scale of 0-10. High-intensity intervals are done at an exertion level of 7 or higher, and are typically
sustained for 30 seconds to 3 minutes, although they can be as short as 8-10 seconds or as long as 5 minutes; the higher
the intensity, the shorter the speed interval. Recovery intervals are equal to or longer than the speed intervals.
High-intensity interval training is done at a submaximal level; around 80-95% of maximal aerobic capacity. Sprint interval
training (SIT) is a type of high-intensity interval training that pushes beyond this level to 100% or more of maximal aerobic capacity, or an exertion level of 10.
What are the benefits of HIIT?
The payoffs of pushing yourself with HIIT are plentiful, and include:
Significantly increased aerobic and anaerobic fitness
Decreased fasting insulin and increased insulin sensitivity
Reduced abdominal and subcutaneous (just under the skin) fat
The surprising thing about HIIT is that it involves such a small total amount of exercise. By including HIIT in your exercise
plan, you can realize remarkable results in a short amount of time, which is good news for busy people.
Is HIIT safe?
High-intensity exercise of any type brings with it a higher risk of musculoskeletal injury and cardiac events. But along with
healthy subjects, HIIT has been studied as a training method for people with heart disease and congestive heart failure.
Under clinical supervision, subjects were able to tolerate high-intensity intervals without negative effects. Most importantly, they experienced bigger improvements in cardiovascular function compared to those undergoing continuous moderate-intensity training.
The bottom line? HIIT may or may not be safe for you. Check with your health care provider before adding it to your exercise plan.
How can I get started with HIIT?
Choose an aerobic exercise—like stationary bicycling. Warm up for 5 minutes, and perform just a few alternating speed
and recovery intervals; 3-4 of each should be plenty and will give you a feel for it; finish with an easy cool down. Here’s an
example:
4
HIIT protocols vary widely. There’s no one best single way to structure them. Experiment
with shorter and longer speed and recovery intervals to find what works best for you.
Gradually work up to 8-10 or more speed intervals, depending on your fitness goals. Keep
in mind that the most common mistake made with interval training is making the recovery
intervals too short.
Perform HIIT workouts 1-2 times a week at most to reduce your risk of injury. This highintensity training method is best used periodically for up to 6 weeks or so to enhance regular training rather than as a year-round fitness strategy.
For best results, work with a certified fitness professional to create a personalized HIIT
training plan. HIIT requires a big, sweaty effort, but if you stick with it, chances are you’ll
be rewarded with impressive results.
Source: AceFitness.org
Additional Resources
For All-Day Metabolism Boost, Try Interval Training — American College of Sports Medicine
Interval Training Advantages — IDEA Health and Fitness Association
A Healthy Mix of Rest and Motion — The New York Times
Time
Interval
Exertion
Level (0
-10)
5 min.
Warm-up
3–4
1 min.
Speed
7–9
2 min.
Recovery
5–6
1 min.
Speed
7–9
2 min
Recovery
5–6
1 min.
Speed
7–9
2 min
Recovery
5–6
1 min.
Speed
7–9
5 min
Cooldown
3–4
22 min. Total Time
(4 min. total speed)
Chicken, Shrimp and Fruit Salad
Recipe courtesy of Madhur Jaffrey
Serves 6 as a first course or 4 as a main course
¼ teaspoon salt
1 cup peeled and diced Granny Smith apple
1 cup seedless red grapes, cut in half
1 cup seedless green grapes, cut in half
1 orange, segmented, with each segment cut in half
1 tablespoon garlic, fried
½ cup shallots, fried
1 boneless, skinless chicken breast
16 medium shrimp
4 tablespoons roasted, unsalted peanuts, chopped
1 teaspoon salt
1 teaspoon sugar
2 tablespoons lime juice or lemon juice
2 to 3 serrano chilies
2 tablespoons cilantro leaves
Cut the chicken into long thin strips and put these into a clean medium-sized frying pan. Add water to cover and ¼ teaspoon salt, and bring to a simmer. Simmer gently for about 5 minutes or until the chicken is just done. Remove the
chicken from the water and tear it into shreds 1-inch long or cut it into a ¼-inch dice. Save the water in which it was
cooked.
Peel and devein the shrimp. Bring the chicken poaching water to a simmer and add the shrimp. Turn the heat to mediumlow. Stir and poach the shrimp for 2 to 3 minutes or until they are just cooked through. Drain. Cut the shrimp into a ¼inch dice. Combine the chicken, shrimp, and peanuts, cover and set aside.
Combine 1 teaspoon salt, the sugar, and the lime juice in a small bowl and mix. Set aside. Cut the chilies into very fine
rounds. Wash and dry the coriander. Cover and set aside.
Combine the apples, grapes, oranges, chicken, and shrimp in a large bowl. Add the lime juice and sugar mixture. Season
with salt and pepper. Add in half of the fried shallots and garlic. Toss. Place in a serving bowl and garnish with the reserved shallots, garlic, cilantro leaves, and chilies.
Nutrient information is for 1 main-course serving:
Calories: 250 ⁄ Protein: 25 g ⁄ Carbohydrate: 25 g ⁄ Fiber: 3 g ⁄ Sodium: 670 mg
Saturated fat: 1 g ⁄ Polyunsaturated fat: 2 g ⁄ Monounsaturated fat: 3 g
Trans fat: 0 g ⁄ Cholesterol: 80 mg Source: Madhur Jaffrey's Far Eastern Cookery, by Madhur Jaffrey (Harper and Row, 1989)
Reproduced from the April 2007 Healthy Kitchens, Healthy Lives conference, The Culinary Institute of America.
5
Mountain Climbers
Step 1
Starting Position: Come to a hands and knees position on the floor with your toes pointed toward the floor. Your hands
should be slightly ahead of your shoulders and your fingers pointing forward. Bring your left foot forward and place it on
the floor under your chest. Your knee and hip are bent and your thigh is in toward your chest. Lift your right knee off the
ground, making your right leg straight and strong. Your right toes are tucked under, heel up. Brace your abdominal muscles to stabilize your spine. Pull your shoulder blades down and back.
Step 2
Keeping your hands firmly on the ground, your abdominals engaged and shoulders strong, jump to switch leg positions.
Both feet leave the ground as your drive your right knee forward and reach your left leg back. Now your left leg is fully
extended behind you and your right knee and hip are bent with your right foot on the floor.
Step 3
Exercise Variation: If you have limited range of motion in the hips, place hands on a step or platform.
Keep your weight evenly distributed on both legs. Do not shift all your weight forward into your front foot.
Step 1
Starting Position: Kneel on an exercise mat or floor, positioning your knees and feet hip-width apart, with your feet dorsiflexed (toes pointing towards your body). Slowly lean forward to place your hands on the floor slightly in front of your
shoulders, fingers pointing forwards. Flex your left hip, bringing your left thigh to your chest, placing your left foot on the
floor, heel slighlty lifted and toes pointing forward. Lift your right knee off the ground, fully extending your right leg behind you, with your foot in dorsi flexion, (toes pointing towards your shins, heel up). Stiffen your abdominal muscles
(“brace”) to stabilize your spine, then depress and retract your scapulae (pull your shoulders down and back)
Step 2
Keeping your hands firmly on the ground, abs engaged and shoulder strong, simultaneously switch leg positions. Both feet
leave the ground as your drive your right knee forward and extend your left leg back. Now your left leg is fully extending
behind you and your right hip is flexed with your right foot on the floor.
Step 3
Exercise Variation: If you have limited range of motion in the hips, place hands on a step or platform.
Keep your weight evenly distributed on both legs. Do not shift all your weight foward into your front foot.
For professional guidance in your exercise program,
find an ACE-certified Personal Trainer in your area. Before beginning any fitness program, always see a qualified healthcare provider for advice and
to address any questions or concerns. The exercises presented on this website are for suggestion only and should not be substituted for medical
diagnosis or treatment. Participate at your own risk and stop if you feel faint or experience shortness of breath.
6
Upcoming Fitness Events
Rhody Run Port Townsend
May 20, 2012
Register@ www.rhodyrun.com
Rhody Run is a twelve (12) kilometer run/walk located in Port Townsend, Washington on the third Sunday of May in conjunction with
the local Rhododendron Festival. The run has been in existence since 1979 and celebrated its 30th year in 2008. Approximately 2,000+
attend the event each year.
Course
The course distance is 12 K (7.46 miles). The Rhody Run is sanctioned by PAC Northwest and USATF. The course is not USATF distance
certified.
The Rhody Run starts and finishes at the same point and covers a loop through a rural area with views of mountains, woods, and the Strait
of Juan de Fuca. The course consists of mixed flat, hills and roads and can be a demanding course. There are aid stations at miles 4 and
6. Splits are given at every mile. Projected finish times are given at miles 4, 5, and 6.
Olympic Medical Center 5K 10K
Course
Out and back on the Olympic Discovery Waterfront Trail. 5k/10k events start from City Pier in Port
Angeles - where the marathon and half marathon races finish - and run east on the waterfront trail,
turning south at Ennis street, follow to Front street. Turn east on Front and follow 1/2 block to the
Rayonier truck access road. Turn north and follow the creek to the Rayonier parking lot. 5K runners
turn west toward the finish line at City Pier. 10K runners turn east and follow the Olympic Discovery
Trail to the turn around.
Enjoy food and music at the finish and get ready to cheer the half marathoners and marathoners to their finish.
Registration @ http://www.nodm.com/events/5k10k
PLFR Fire Fit
Prepared by Rodney Gregory
B-Shift Firefighter &
ACE Certified Peer Fitness
Trainer
ACE Certified Peer Fitness Trainers:
7650 Oak Bay Rd
Port Ludlow WA 98365
Rodney Gregory FF B-Shift
Alex Kosiuga Lt. FF B-Shift
360-437-2236 ph
360-437-9184 fax
Lonnie Reynolds Lt. FF C-Shift
Kurt VanNess FF A-Shift
7
www.plfr.org