exercise – Harrison Hansford

Isometric exercise MAY reduce blood pressure and appears safe!

High blood pressure is the leading risk factor for death across the globe, affecting 1.13 billion people, resulting in over 10 million deaths in 2019. Clearly high blood pressure is a huge problem, and the issue of treating this condition is much researched. There are many drugs which are effective at reducing blood pressure, but this has still not reduced the overall burden of the condition, potentially due to unwanted side effects. Exercise (aerobic and strength-based) has been shown to reduce blood pressure, but often is quite tiresome and time-consuming. Isometric exercise is a type of resistance training which involves exercises such as wall sits, or hand grips. Isometric exercise however is quick (usually taking just twelve minutes!) to undertake and relatively easy to do!

My team and I recently conducted a systematic review and meta-analysis looking at the effects of isometric exercise on blood pressure (https://www.nature.com/articles/s41440-021-00720-3). Systematic reviews are the highest level of evidence and usually are used to inform clinical practice and health policy.

We found that isometric exercise appears to be safe, in all populations including those with hypertension and older adults. This is an important findings as this was previously unknown and many clinical guidelines have not recommended isometric exercise due to safety concerns.

Importantly, we also found that isometric exercise may significantly reduce blood pressure. We found that it may reduce systolic blood pressure (the top number on a blood pressure reading) by 8mmHg, and diastolic blood pressure (the bottom number) by 4mmHg, both of which are clinically important amounts, similar to many other drugs!

It is important to note that I say isometric exercise “may” reduce blood pressure, because the quality of the studies included in our review was very poor, which limits how much we can trust them and their results. However, it appears unlikely the isometric exercise is dangerous as was once believed and could be another great tool for people living with high blood pressure who don’t like exercising, struggle to make time for exercising or have physical limitations which makes exercising difficult.

Have a read of our study and feel free to contact me if you cannot access the paper!

Reference:

Hansford, H.J., Parmenter, B.J., McLeod, K.A. et al. The effectiveness and safety of isometric resistance training for adults with high blood pressure: a systematic review and meta-analysis. Hypertens Res (2021). https://doi.org/10.1038/s41440-021-00720-3

Where do your priorities really lie?

I’m away for the weekend with some friends at the beach and in holidays like this you realise see what your priorities are. I went to bed earlier than everyone else on Friday night and was up early to do a 12km run, meeting everyone out for coffee and breakfast afterwards. Whilst that isn’t very out of the ordinary it did make me realise how my rehab and training comes before many other things in life.

Many people write down their priorities or think that certain things are a high priority for them. You only find this out when in a situation which challenges you to make a choice. If the default is going for a run, over spending more time drinking, you know where your priorities lie, and vice versa, if you choose to stay and drink more, then sleep in and miss your run, it’s clear where the higher priority lies.

Neither of these are the ‘right’ priority, socialising is almost as important (more important for some) as exercising. This was just an interesting observation I’ve had and it’s nice to be able to see really where my priorities lie.

Runners High

I went for a great high intensity run the other morning, absolutely brutal at the time but boy do you feel amazing afterwards. I realised that since my surgery a year ago I had forgotten what the post exercise high felt like. For those who haven’t felt it, it’s very hard to get annoyed, you’re so positive and your body feels great. I find there’s a definite dose-response curve for it, so the harder the session, the better you feel.

This is also the perfect way to avoid conflicts with the people around you. The amount of times my girlfriend and I have been in bad moods then have gone for an exercise session and have felt fine afterwards.

Putting aside the overwhelming evidence for the positive effects of exercise on mental health, it’s so easy to see how exercise makes you feel better when you’ve finished a session. This might even be a reason why high intensity interval sessions are so popular, there’s no better way to start your day!

Keep on turning up

I’m really beginning to understand how people can say “I don’t have time to exercise”. This afternoon I got home from a day at placement, my legs were heavy and I was just drained. The last thing I wanted to do was go out for a run. I did it anyway. Just after starting Garmin told me I was in -3 performance condition and I felt every bit of that. I didn’t have any expectations about times or enjoyment, I just wanted to get through it.

I think a common thing I forget is that people dont enjoy exercising all the time, nor should they. Sometimes it’s just about turning up and getting through it. I was completely unmotivated and said to my mum before I left, “the hardest part is putting the shoes on,” and it totally is, nobody has ever backed out of doing a run after putting their runners on.

I’m sure this is where the idea of getting your workout clothes out the night before comes from, because preparing to go is the hardest part. If there are no barriers to preparing to go, you’re going to do it. Even if you just say, I’ll put my runners on, that is going to be enough to get out the door, even for a bit.

Sometimes it’s not about being motivated, it’s just about doing the best you can. When you’re exhausted, that’s not much, but it’s infinitely better than nothing.

Paper Review: Comparisons of Interventions for Preventing Falls in Older Adults

Background

Falls for older people can be life-changing, or even life ending. In 2012, Falls cost medicare $31 billion and result in reduced quality of life in those who have them. The consequences of a fall can be dire, falls are can be a complication of many factors; aging, frailty, poor vision, poor balance, strength or other factors. Some of these are inevitable, like aging, or even poor vision, but the rest all all preventable, or can at least, the progression can be slowed.

I have personally been working in an older persons mental health ward and whilst none of the people are in there directly because of a fall, they are all at a high falls risk and that will limit their ability to go home, potentially sending them to an aged care home. I’ve seen great preliminary results by taking them through balance training and lower limb strength training, and they have been enjoying it too, but now it’s time to see what the evidence says works best.

This is my review of the paper: Comparisons of Interventions for Preventing Falls in Older Adults: A Systematic Review and Meta-analysis by Tricco et al. (2017)

Methods

The authors conducted a systematic review and network meta-analysis, which is the highest level of evidence, systematically combing over the previous literature, ideally, capturing every study which is relevant and comparing the effects they found. A network meta-analysis also allows you to compare different interventions to each other, allowing you to determine which is ‘best.’

This study was prospectively registered and had a protocol which typically improves the quality as the authors determined what they would do before seeing the data, improving the validity of the findings. They included RCT’s with their primary outcomes being number of injurious falls and fall related hospitalizations. They searches published and unpublished literature and assessed the quality of studies using the Cochrane risk of bias tool.

When analyzing the data, they conducted random effects network meta-analysis, which essentially mean that they accounted for differences within the studies in their analysis.

Results:

In total, their search produced >10,000 results, leading to the inclusion of 300 studies, which is very large. The participants were on average between 74 and 84yrs old with a relatively even gender split.

They found that exercise halved the odds of having a fall (0.51 OR), with combined exercise and vision assessment and treatment being the more effective (OR 0.17) and the former + environmental assessment and modification resulting in an OR of 0.3 and finally the most effect treatment was combined clinic level quality improvement strategies, multifactorial assessment and treatment, calcium and vitamin D supplementation (OR 0.12).

Another finding was that exercise did not improve quality of life compared to usual care which is interesting.

Implications

So what does this all mean? It looks as though exercise very clearly reduces the risk of falling and having an injurious fall, but also that there are other factors which can be added to exercise to reduce the risk of falls even further, including a vision assessment and supplementation to improve bone mineral density.

So what am I going to do with this? Well I’m going to check what medications my patients are on, ensuring that, if they need to be, they are taking calcium and vit. D supplements, asking how their vision is, checking that they believe it is okay and if not, refer them to an optometrist.

What are the limitations of this study for me? well one major issue I have is that it doesn’t explain what types of exercises were undertaken in any of the trials, which limits how much I can change my exercise prescription based on this study, although it reinforces that simply exercising improves outcomes.

So where does this paper leave us? It leaves us knowing that this thing called “exercise” is effective, but it doesn’t explain what exercise helps, this will require a little more reading and another paper review, so stay tuned.

Candid thoughts

This is my first go writing up a review of a paper, I know this probably is a little all over the shop but it’s for me to practice more than anything, assisting in my endeavor to be a good, evidence based clinician.

Intermittent Fasting: Understanding the evidence

I began thinking about intermittent fast (IF) a few weeks ago after becoming fascinated by Peter Attia’s (MD) ‘The Drive’ Podcast, where he discusses all things related to longevity and increasing one’s ‘health span’ which is staying disease free for longer, rather than living longer with a disease. I’ll discuss this difference on another blog, the focus of this blog is understanding the evidence for IF and why I’ve started doing it.

What is Intermittent Fasting?

IF is a very broad term and can mean not eating for as little as 16hrs, or as much as 3-5 days!! It’s quite simple, it’s just having more clearly defined periods of feeding, and fasting, rather than eating all the time. This confused me quite a lot because I was always told you want to have ~5 smaller meals throughout the day and initially I struggled to reconcile this with the theory behind IF. I haven’t yet been able to research this as much as I would like so the comparison of the evidence comes in another blog.

What are the benefits of IF?

As someone who eats, a lot.. this all sounded ridiculous to me, until I started reading up about the benefits and I was blown away. I just read through a review paper (which provides a broad overview of the evidence) on IF published (NOTE: The article is behind a paywall, but I cant send the PDF to anyone who wants it) in the the New England Journal of Medicine, one of the most prestigious medical journals. I was was amazed at the far-reaching benefits of IF, including:

Reduced risk of cancer
Improved metabolic profile lowering the risk of diabetes (or even reversing it),
Lower blood pressure, heart rate, improved HDL (the good cholesterol), reduced LDL (the bad cholesterol)
Decreased inflammation and molecular stress
Increased BDNF, a key signalling molecule which is reduced in mental health conditions
If IF couldn’t get any better, it also improves your gut microbiota, which is key for having a healthy gut.

These aren’t even all the benefits, but as you can see, IF seems to improve almost every aspect of health. So how and why does it work?

Figure from: de Cabo, R., & Mattson, M. P. (2019). Effects of intermittent fasting on health, aging, and disease. *New England Journal of Medicine*, *381*(26), 2541-2551.

How does intermittent fasting work?

The in depth explanation is outlined in the figure above from the paper. The main benefits stem from this thing called autophagy, which is a fancy word for getting rid of cells you don’t need. Essentially what happens is that when fasting, your cells start to get rid of the parts of the cells which are damaged and recycling the parts which aren’t, whilst reducing overall protein building. Autophagy is a period where every cell in your body begins to get refined, like an essay which is being edited, the extra bits which aren’t helpful, or even damaging get removed. Autophagy is believed to be the reason for the many anti-cancer properties of IF, because the cells which are maladaptive (potential cancer cells) get removed in this process.

But wait! Does this mean I’m going to lose all of my muscle mass, or not be able to put on muscle?

Well, I was worried about that as well, but interestingly there is another strength of IF here and it comes about because you have this intensified block of feeding, which promotes a greater recovery (outlined in the figure above). It is during the periods of feeding where you turn back on all the things you switch off during the fasting, you get increased protein building, increased mitochondrial biogenesis increased glucose which all promote an enhanced level of cell growth and tissue remodeling. Essentially, you go through this period of building up during the feeding period, then you strip away all the parts which you aren’t essential and helpful during the fast.

So how do I start?

Well, I’ve justed started on the past few days so the jury is still out on how it goes in practice, but I’ve been using a free app called Zero (funnily enough with Peter Attia as the medical director) which starts you off on a 16:8 regimen, which means 16hrs fasting, and 8hrs feeding. What this looks like for me is finish eating by 8pm, and then start eating again at 12pm the next day. One thing I will say is tea has been an absolute godsend for increasing satiety and it hasn’t been much of struggle at all getting through to lunchtime on an empty stomach.

I’d recommend starting out with Zero on the 16:8 regimen and see how it goes! Fot me the benefits seem to far outweigh the risks, so i’m going to try it for at least a month and see how it impacts me, and I’ll be sure to write about my experiences as well.

If you do have any medical conditions I would also recommend seeing a dietician or GP before starting this as it can be quite a change and this is all just information not clinical advice.