Book Review: Which Comes First, Cardio or Weights?

I just read Which Comes First, Cardio or Weights?: Fitness Myths, Training Truths, and Other Surprising Discoveries from the Science of Exercise by Alex Hutchinson, published in 2011.  Per Amazon.com’s rating system, I give it five stars (I love it).

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Since starting Mark Verstegen’s Core Performance workout program four months ago, I’ve developed a serious interest in exercise.  I stumbled across one of Alex Hutchinson’s helpful (and recommended) blogs: Sweat Science.  That’s where I heard about this book.

Mr. Hutchinson uses a Q & A format to address 113 debatable issues facing people who exercise regularly.   The questions are independent although grouped according to subject matter, such as “Nutrition and Hydration.”  This is great for those who have time only for snippets of reading (bathroom reading, for example).

High-intensity interval training (HIIT) is a particular interest of mine lately.  I see it as way to replace five hours a week of traditional cardio (aerobic) training with just one hour.  The author gives a nice description of HIIT and succinctly and accurately summarizes the science in support of it, along with the risks.

Mr. Hutchinson typically answers controversial questions with the best available evidence from current scientific research.  Rarely, he has to depend simply on expert concensus, which is less reliable.  I envision a new edition every five years or so.

The book is easy to read.  The style is congenial and witty.  Contrary to a recent publishing trend, the font size is reasonably large. 

The audience for this is folks who have made a commitment to make regular physical activity part of their lifestyle.    Trust me, I’m a doctor: the guys at the gym and Internet sources are quite often wrong on these issues. 

If you refuse to do more than just stroll in the neighborhood for 30 minutes a day, you don’t need the book.  But I urge you to consider challenging yourself to do more.   

Steve Parker, M.D.

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France Pulling Diabetic Drug Pioglitazone From Pharmacy Shelves

Bloomberg reported yesterday that the French drug agency is pulling pioglitazone from the market in view of its recent association with bladder cancer.  I mentioned this here May 14.  Pioglitazone is sold in the U.S. as Actos.  I don’t expect the U.S. Food and Drug Administration to follow suit soon.

Steve Parker, M.D.

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Exercise, Part 10: What If I’m Markedly Obese?

The more overweight you are, the harder it will be to exercise.  At some point even light exercise becomes impossible.  Average-height women tipping the scales at about 280 pounds (127 kg) and men at 360 pounds (164 kg) aren’t going to be able to jog around the block, much less run a marathon.  These weights are 100 percent over ideal or healthy levels.  An actual “exercise program” probably won’t be possible until some weight is lost simply through very-low-carb eating, calorie restriction, or bariatric surgery.  The initial exercise goal for you may just be to get moving through activities of daily living and perhaps brief walks and calisthenics while sitting in a chair.

"I'll get started after I finish this cigarette."

Markedly obese people who aren’t up to the aforementioned extreme weights can usually tolerate a low-intensity physical activity program.  At 50 percent over ideal weight, an average-height woman of 210 pounds (95 kg) is carrying 70 excess pounds (32 kg) of fat.  Her male counter-part lugs around 90 pounds (41 kg) of unnecessary fat.  This weight burden causes dramatic breathlessness and fatigue upon exertion, and makes the joints and muscles more susceptible to aching and injury.  If you’re skinny, just imagine trying to walk or run a mile carrying a standard five-gallon (19 liter) water cooler bottle, which weighs only 43 pounds (19.5 kg) when full.  The burden of excess fat makes it quite difficult to exercise.    

If you’re markedly obese, several tricks will enhance your exercise success.  I want you to avoid injury, frustration, and burn out.  Start with light activity for only 10 or 15 minutes, gradually increase session length (e.g., by two to four minutes every two to four weeks) and increase exercise intensity only after several months.  Your joints and muscles may appreciate easy, low-impact exercises such as stationary cycling, walking, swimming, and pool calisthenics/water aerobics.  You may also benefit from the advice of a personal fitness trainer arranged through a health club, gym, or YMCA/YWCA.  Check out several health clubs before you join.  Some of them are primarily meat markets for beautiful slender yuppies.  You may feel more comfortable in a gym that welcomes and caters to overweight people. Hospitals are increasingly developing fitness centers with obese orthopedic, heart, and diabetic patients in mind.

Steve Parker, M.D.

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Quote of the Day

The first flavor we experience in infancy is the sweet taste of milk.  We learn to associate it with comfort, security and love.  During childhood, we are offered sweet treats to cheer us up when we are sad, to reward us for being brave at a difficult time, or for being good when our parents need us to be.  Thus, sugary food becomes a reward, an incentive or a token of love and is inextricably woven into our emotional fabric.

     —Conner Middelmann-Whitney in Zest For Life: The Mediterranean Anti-Cancer Diet

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Dr. Robert Su Interviews Me

Ever wonder what I sound like? 

Dr. Robert K. Su interviewed me for his podcast recently.  That faint accent of mine is from Texas and Oklahoma.

Anyone with diabetes or prediabetes or worried about sugar toxicity is well-served by a close look at Dr. Su’s website, Carbohydrates Can Kill.  Dr. Su has a degree in Pharmacy as well as a medical degree.  He’s an anesthesiologist and pain managment specialist.

Steve Parker, M.D.

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Egyptian Mummies with Atherosclerosis in the News Again

Remember about a year ago the report that hardening-of-the-arteries was found in Egyptian mummies?  The heart arteries were  also involved.  Princess Ahmose-Meryet-Amon is officially the first person in history diagnosed with coronary heart disease. 

This finding is noteworthy in view of the common view that atherosclerosis is a disease of modern civilization (usually referring to the last one or two hundred years).

You’ll find more details at this May 17 post at CardioBrief

We’ll know more if these researchers ever publish their findings in a peer-reviewed scientific journal.

Steve Parker, M.D.

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Diabetic Drug Pioglitazone Linked to Bladder Cancer

A recent report in Diabetes Care (doi 10.2337/dc10-2412) suggests a link between pioglitzone and the development of bladder cancer.  This is preliminary, not definitive proof.  Further study may erase all concern about bladder cancer.  The only other diabetic drug in this class (thiazolidinediones) is rosiglitazone: its use was just recently drastically reduced by the Food and Drug Administration.

Will pioglitazone eventually be pulled from the market because of this?  How many will suffer from bladder cancer in the meantime?  Nobody knows at this point.

We have 11 classes of drugs to treat diabetes.  Would you believe we don’t know all the potential long-term adverse effects of most of these drugs?  It’s true.

To me, that’s more reason to control diabetes with diet modification, such as the Low-Carb Mediterranean Diet or Dr. Bernstein’s Diabetes Solution.

Steve Parker, M.D.

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Penelope Cruz Touts Mediterranean Diet

Penelope Cruz credits the Mediterranean diet with helping her keep her weight under control, according to “The Times of India.”

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R.I.P., Rosiglitazone

Rosiglitazone is pretty much dead.  Here’s the eulogy at the FDA website.  Rare is the doctor who will jump through all the paperwork hoops when we have 10 other classes of drugs to treat diabetes, plus another, safer drug in the thiazolidinedione class.

Rosiglitazone is linked to higher rates of heart disease and death.

Steve Parker, M.D.

 

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Recreational Activities Are Not Necessarily Exercise

Exercise is not supposed to be fun.  If it is fun, then you should suspect that something is wrong.

The quote above is from an essay entitled “Exercise vs Recreation” by Ken Hutchins, posted at the Efficient Exercise website.  Skyler Tanner works at Efficient Exercise and his blog is one that I follow.  We have a strange connection.  Skyler grew up in Fountain Hills, AZ; I live about 20 miles from there.  He lives in Austin, TX, now; I lived there for eight years.

Here’s another quote from that essay:

One pound of human fat can support the energy demands of running 35-45 miles, probably more.  This would require the average man to run for 6-8 hours.  He would burn the calories he could easily ingest in as many minutes.

Hutchins’ essay is thought-provoking.  It may change the way you think about exercise.

Steve Parker, M.D.

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