Action plans: How to be fitter and stronger – and even reverse cellular ageing

by Veronika Meduna / 03 June, 2017

Suli Tuitaupe teaches a dozen gym classes a week. Photo/Martin Hunter

The benefits of exercise are critical and you don’t need expensive gym memberships or equipment to get into it.

Suli Tuitaupe was once a big man. As a 21-year-old, he weighed 125kg, and although he didn’t feel unhappy or unhealthy, he knew he had to change something. He still remembers the crunch point, when he realised his pants size had reached triple digits.

He bought a gym membership, but struggled for a long time to find the motivation to use it. “Then I realised that the money I’d paid would probably have been enough to buy a treadmill, so I decided to get my money’s worth and I made myself go.”

Two decades later, Tuitaupe teaches 12 gym classes a week, works as a fitness trainer and running coach and is completing a master’s degree in health sciences at the University of Canterbury, with a focus on physical activity as a way of preventing illness. He feels for everybody who turns up at the gym or a running group for the first time, determined but struggling to make a change towards a more active life. “It’s not a fast fix,” he says. “But over time, you can make a huge change. And if I can do it, you can do it.”

Tuitaupe, who is a Samoan Kiwi, tells his own story to motivate people who are new to exercise, and if that’s not enough, he talks about his mum, Fa‘asalalau, who is now in her seventies and started exercising only a few years ago. He has stories of Pasifika leaders who took part in a six-week exercise intervention programme he set up last year with a Health Research Council grant. The participants were all overweight and relatively unfit, and they began their routine with 15 minutes of moderate exercise three times a week. Gradually, they increased the pace and duration of their activity and tracked any changes through subjective assessments, interviews and a suite of measurements, including weight, blood pressure, resting heart rate, energy levels, aerobic capacity and strength.

“Health statistics are not in our favour,” says Tuitaupe, but even after six weeks, participants reported that they were eating and sleeping better, were more involved, had more energy and were able to unwind more easily. Some committed to joining a sports team.

The desire to lose weight can be a strong motivator, but the benefits of regular exercise go far beyond trimming your waistline. It is no exaggeration to say that physical activity is the best thing you can do for your health, no matter your age or ability, and there are many good reasons for doing it. The most significant include reducing the chances of heart disease, stroke and type 2 diabetes, but exercise will also boost your immune system. It eases mild depression, reduces the risk of osteoporosis and even some cancers, helps maintain muscle mass into older age and so prevent falls, lifts mental sharpness in older people and, last but not least, adds healthy years to your life.

Thousands of research papers have been published pointing out the health benefits of exercise, and we know a regular workout is a potent medicine that keeps your heart healthy and your muscles strong. So, with all this evidence, why is it so hard for so many of us to get moving?

At 21 and 125kg.

Half-hearted

A 2013/14 New Zealand Health Ministry survey showed that 51% of adults meet the recommendations for a healthy dose of physical activity – which means that half of us don’t. The ministry follows World Health Organisation (WHO) guidelines and recommends a weekly 150 minutes of moderate exercise (at a level that will increase your breathing and heart rate slightly but still allow you to carry on a conversation) or 75 minutes of vigorous exercise (when you can no longer chat) spread throughout the week. Ideally, every day should include some form of physical activity.

Many of us blame lack of time for our inactivity, but recent research shows that high-intensity interval training (HIIT) can help to overcome this hurdle. Initially developed to help high-performance athletes to push themselves even further, HIIT delivers benefits similar to moderate exercise in far less time by alternating short bursts of very intense exercise (say 30 seconds of sprinting) with periods of lower intensity (a minute of walking) in repeat cycles.

In March, researchers at the prestigious Mayo Clinic in the US made headlines when they announced that HIIT not only improves fitness and strength, but could also reverse cellular signs of ageing. The team put groups of young (18-30) and older (65-80) people through 12-week exercise routines that involved interval training, weight training or a combination of both. They monitored muscle mass, oxygen capacity and insulin sensitivity as well as changes within individual cells.

With his proud mother, Fa‘asalalau.

At the end of the trial, all three exercise groups had gained lean muscle and improved their aerobic capacity, but HIIT exercise yielded the biggest benefits at the cellular level, with a big boost in the capacity of mitochondria, our cells’ energy factories. The authors say that in some cases, the high-intensity biking regime seemed to reverse the age-related decline in mitochondrial function and proteins needed for muscle building. Better still, the effect was most pronounced for the older study participants.

But this doesn’t mean HIIT is a magic bullet to make you younger, says Mike Hamlin, a sport and exercise scientist at Lincoln University. The study’s HIIT routine included cycling three times a week in four-minute high-intensity bursts, broken up by three-minute recovery periods, and two sessions a week of steady, brisk walking on a treadmill.

“We just need to be a bit careful about what we call HIIT,” says Hamlin. “Originally, it was about maximal exercise: short, sharp, very hard and at maximal capacity. This research used four-minute exercise intervals on three days and two days of aerobic exercise, so really it’s a mixed exercise, and the changes could be due to any part of it.”

In 2014, Hamlin’s team published results from a study that tested HIIT in what he calls a “real-world setting”: they recruited overweight or obese inactive adults into an exercise programme held in a park, rather than at a gym. Participants were split into two groups: one used a routine of several four-minute bouts of exercise at about 90% of maximal heart rate, followed by a recovery period of a few minutes at lower heart rates, while the other group “went all out” in shorter 30-second bursts, then also reduced intensity for a few minutes. The team compared these two groups with an active control group on a walking routine. Overall fitness was monitored by measuring oxygen capacity (a measure of the maximum amount of oxygen that will bind to haemoglobin in a given unit of blood) before and after the 12-week programme.

Tuitaupe’s brother Mark and sister Afutele with mum after going to the gym.

Faster results

Hamlin says the study extended earlier findings on high-intensity training programmes in participants at risk of cardio-metabolic disease (diabetes, heart disease or stroke) and typically takes place in a gym in supervised exercise sessions. It confirmed that participants improved their fitness as effectively as those undertaking conventional walking routines, but were faster at achieving their goal. However, the overall cardio-respiratory benefits were modest, at best an increase in comparative fitness of 10%.

Last year, a team of medical scientists at Central Queensland University in Rockhampton analysed the results of 65 intervention programmes that used HIIT to encourage people to incorporate exercise into day-to-day life and found significant benefits, particularly for overweight or obese people. For these participants, short-term programmes of less than 12 weeks significantly improved maximal oxygen uptake, diastolic blood pressure and blood sugar levels. Long-term HIIT programmes burnt fat, reducing waist circumference and the percentage of body fat, as well as improving the resting heart rate and blood pressure. For people who were not overweight, HIIT also improved oxygen uptake and general fitness, but had no other significant effects.

Hamlin says HIIT routines were developed because many people couldn’t find the time to exercise, but other forms of exercise are also beneficial and equally important at maintaining health into older age.

University of Otago sports scientist Jim Cotter agrees that all forms of exercise are important, particularly as we age.

Mike Hamlin.

“The muscle mass that you take into old age is important, and so is the aerobic fitness, just to maintain functional capacity and stop you from getting into a vicious circle. The more muscle you have, the more glucose-disposal and glucose-control capability you have. You can change that quickly as the [Mayo clinic HIIT study] shows, but you have to have muscle there to work with.”

From a physiological perspective, he says, the benefits of HIIT are clear, but if you got to middle age without a regular exercise regime, it might not be the best place to start. “The biggest risk factor for something going wrong is lack of rest in exercise.

On that basis alone, it’s just common sense that you move into things gradually. You just have to make exercise part of your day-to-day life in whatever way you can: using active transport to get to work, mowing the lawns with a push mower, doing more manual tasks to gradually increase your functional capacity.”

Cotter says resistance training, also known as weight training, which did not show the cellular improvements that HIIT produced, is nevertheless an important part of any exercise regime, because it helps to maintain muscle mass into old age. “But we know you should not combine resistance training with your aerobic training because mechanistically one interferes with the other.”

Tuitaupe’s master’s degree focuses on exercise as a way of preventing illness. Photo/Martin Hunter

Tuitaupe’s master’s degree focuses on exercise as a way of preventing illness. Photo/Martin Hunter

A Harvard Medical School report on how exercise can boost energy supports Cotter’s recommendations. It also acknowledges one of the reasons many of us find it difficult to get going: it’s easy to lose fitness but much harder to rebuild it. The less fit you are, the more you feel the effort, even when you’re doing less than a fit person. “Compared with an active person, a sedentary person experiences more fatigue when carrying out a physically demanding task and has both a higher heart rate and lower oxygen consumption.”

The link between exercise and energy can be counter-intuitive. When your energy levels are low, you need to expend some to get some. But you don’t have to work out to the point of exhaustion to start reaping benefits.

The energy boost comes in four main ways, the Harvard report says:

  • As you work out, your muscles burn more energy, and as they do, mitochondrial function increases.
  • Your body’s oxygen-carrying capacity increases with regular exercise because it creates more capillaries, and by breathing more deeply and increasing your heart rate, you pump more oxygen into your blood.
  • Exercise affects the levels of several hormones and other chemical messengers, some of which control your mood.
  • Working out helps you to get more refreshing rest by increasing the time you spend in deep sleep. “Even if you get the same amount of sleep, the sleep of active people is more restorative and refreshing, and they don’t wake up as often,” the report’s authors say.

Stretching and balance exercises don’t seem to have significant effects on how energetic you feel, but Cotter says they are crucial for maintaining flexibility as you age.

Jim Cotter.

Run free

After time, money can be a major hurdle, preventing people from taking up regular exercise. Here, running can help. It needn’t cost more than a good pair of running shoes, and it comes with the added bonus of time spent in the outdoors. In 2014, a study by an Iowa State University team found that running even five or 10 minutes a day could reduce the odds of dying from cardiovascular disease by up to 45%.

Led by assistant professor in kinesiology Duck-Chul Lee, a former bodybuilder and weightlifter who once had high hopes of becoming Mr Korea, the team followed 55,000 men and women for 15 years to gauge the health benefits of running. The results showed that runners reduced their risk of heart attacks and stroke regardless of how fast or far they ran, and they lived on average three years longer. Lee argued at the time that, from a public health perspective, the promotion of running should be as important as reducing smoking rates, obesity or hypertension.

Tuitaupe agrees that physical activity should be promoted as part of preventive healthcare. He hopes to keep working with Pasifika communities in group-exercise sessions, which help to overcome the psychological barriers that many people encounter.

“During the first few weeks, you have to have the right support around you,” he says. “If you’re by yourself, it’s easier to cheat, but in a group, you’re accountable to each other and you have common goals. You don’t want to let each other down.”

His plan is to develop exercise programmes that build on cultural preferences – such as dance for the Pasifika community – and use familiar venues, such as church and community halls, instead of gyms.

Doing something is always better than doing nothing, says Cotter. His prescription to keep ageing in check is to get out and find a workout that you enjoy and are most likely to stick with.

The Hadza people in northern Tanzania do an average of 130 minutes of exercise a day. Photo/Getty Images

Evolutionary mismatch

Keeping our bodies in optimal shape requires a certain amount of aerobic exercise, and researchers have long suggested that our increasingly sedentary lifestyle is out of sync with our evolutionary past. Anthropologists at the universities of Arizona and New York have explored this mismatch by studying the level of physical activity and cardiovascular health in the Hadza people, modern hunter-gatherers living in northern Tanzania.

They found that the Hadza typically spend about 130 minutes in moderate or vigorous activity every day, more than four times the levels recommended by the World Health Organisation to promote heart health. They also showed no evidence of risk factors for cardiovascular disease, with very low incidence of high blood pressure throughout their lives. The researchers stressed the role diet plays in keeping the risk of heart disease low among hunter-gatherers, but the study nevertheless affirms the link between physical activity and health.

This article was first published in the May 20, 2017 issue of the New Zealand Listener.


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