One of my recent Wellness Garage consultations was with a triathlete and marathon runner. During our review, we looked at his six core behaviours (nutrition, exercise, sleep, mindfulness, relationships and purpose). When it came to exercise he thought that he was covered from a health perspective. Very good evidence shows that runners live longer than non-runners and that aerobic fitness is one of the most important biomarkers for vital longevity. His aerobic exercise at over 300 minutes per week, and his accomplishments including several Ironmans indicated that he was a highly developed aerobic athlete. The problem for me was that he was not doing any resistance work. We discussed the evidence and I told him that he was missing something vital from his program. The best illustration of this comes not from any population studies, but from a serendipitous twin study done by some Cal State kinesiologists and published in 2016.
Two identical twins with over 35 years of very different exercise behaviours were examined for key health outcomes and biomarkers.
One twin was a track coach and competitive masters runner training in endurance sport for 35 years, logging close to 40,000 miles. His identical twin brother was a truck driver whose only recreational physical activity has been 20-30 min walks, 3 to 4 times per week.
These brothers were tested for strength (hand grip and quadriceps), aerobic capacity (VO2 Max) as well as body composition (lean muscle mass, body fat % and bone density).
At first glance, looking at the profiles of the two brothers it seems obvious that the Ironman should test better than the sedentary brother on every parameter, but that was not the case.
As expected the trained twin had a higher aerobic capacity (VO2 Max) and lower body fat.
Surprisingly, the untrained twin was stronger in both grip and leg strength.
Both had identical findings for lean muscle mass and bone density.
The study concluded that endurance sport improves aerobic capacity and body composition by decreasing body fat BUT is associated with lower strength in both hand grip and very surprisingly leg strength.
From a health and longevity stand-point both aerobic capacity and leg strength are independent predictors of mortality. Training can improve both, but training adaptations are specific to the imposed demands.
Therefore the optimal strategy to maximize health and longevity must incorporate both strength and endurance training.
This study really drives home the point, runners and triathletes who are not doing strength training may actually be weaker than if they were sedentary! If you are serious about your health (not to mention performance), adding strength work makes sense.
With my triathlete client, we have recommended a strength training program to develop leg, back and core strength. This program, with emphasis on heavier weights lifted using the large muscles of the body, is an excellent way to increase mitochondrial density and improve metabolic health, which is probably one of the reasons why strength is associated with better health and longevity.
PHYSIOLOGICAL PROFILE OF MONOZYGOUS TWINS WITH 35 YEARS OF DIFFERING EXERCISE HABITS
PDF Download available from: https://www.researchgate.net/publication/316337441_PHYSIOLOGICAL_PROFILE_OF_MONOZYGOUS_TWINS_WITH_35_YEARS_OF_DIFFERING_EXERCISE_HABITS
Accessed Nov 25 2017
When I was 5 years old, I distinctly remember the day the police knocked at our door. They were there to ask if my mother could accompany them to the home of our neighbours. The Harpers were an elderly couple, both in their eighties living independently in an older home immediately beside our home. That day Mr. Harper had died suddenly while driving his car. Fortunately no one else was injured. The police felt that it would help Mrs. Harper if my mother was there when they told her the news. My mother did her best to help, but I remember her later telling me that that Mrs. Harper looked lost when she heard the news. Less than two months later, she died in her sleep.
Later, during my family practice years, I came to realize that this was not uncommon. Long-married spouses often die shortly after each other, even when the widow has no known health conditions. With these couples, their sense of purpose is lost with the death of their spouse, and with this loss, their health often diminishes rapidly.
Purpose, as a biomarker of better health outcomes has been shown in multiple studies. A meta- analysis of 10 studies, totalling over 136,000 seniors showed that those with a high sense of purpose in life lived longer and had fewer heart attacks and strokes. Adjusting for all other factors, having a high sense of purpose in seniors reduced mortality by 20%. While mechanisms are unclear, they seem are likely similar to the way that strong social relationships lead to better health through a combination of behavioural, psychosocial and physiological differences.
Other studies, across broader age ranges, show similar longevity effects along with decreased rates of Alzeimher’s disease, mild cognitive impairment or disabilities in general. Simply put, having purpose improves health and longevity.
Most recently, a study in seniors showed that those with a higher sense of purpose maintained stronger hand grips and better walking speeds - both key biomarkers for ageing. Current research is exploring the mechanisms that support these findings.
So while we wait to fully understand why having a high sense of purpose improves health and longevity, it makes sense for each of us to foster our purpose.
The question is how?
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In a famous 1965 study of 6,928 people followed for over 9 year, Berkman and Symes showed that people who lacked social and community ties were more than twice as likely to die than those with extensive social ties. This effect was independent of health practices (smoking, drinking, obesity) and independent of usage of preventive health services. Even among people with disease - those without strong relationships were more than twice as likely to die as those with robust social connections.
Subsequent to this study, the linkage between relationships and better health outcomes has been documented across many diseases: cardiovascular disease, recurrent myocardial infarction, atherosclerosis, autonomic dysregulation, high blood pressure, cancer and delayed cancer recovery, and even slower wound healing. Digging deeper, research has shown a clear relationship between increased inflammation and depressed immune function in people with poor relationships.
While all relationships drive health and well-being, none is more significant or more studied than marriage. Across all varying marital histories, the link is incredibly clear - people in stable, long-term marriages have better health, those who have been married are healthier than those who have not. Better health outcomes, include decrease rates of chronic disease, mobility limitations, self-rated health, and depression.
The clarity of the association between the quantity and quality of relationships and health has been firmly established - the bigger question is why.
Evidence points to three broad mechanisms: behavioural, psychosocial and physiological.
Since health behaviours drive about 40% of health outcomes, it is not surprising that there are behavioural differences between people in relationships and those who are socially isolated. These differences; increased positive behaviours (exercise, consuming nutritionally balanced diets, and adherence to medical regimens) and fewer negative behaviours (smoking, excessive weight gain, drug abuse, and heavy alcohol consumption) seem to be driven by influence and control over habits. One notable exception to this is marriage and parenthood that has been associated physical inactivity and weight gain.
While the linkage between these behavioural differences and health outcomes is clear; the psychosocial mechanisms - social support, personal control, symbolic meanings and mental health are complex and harder to grasp; most likely operating in an interconnected manner. Nonetheless, people in solid relationships show clear differences in measures across these mechanisms and this clearly plays an important role.
Physiological mechanisms are also complex, but because they are more measurable seem more clear. People with supportive relationships have better markers for immune, endocrine, and cardiovascular function. They recover from stress more easily and over time this improved recovery ability results in less wear and tear and ultimately better health. This effect is even more pronounced in children - emotionally supported children show clear developmental, immunological, metabolic, hormonal and neurological advantages that have clear consequences for improved health as adults.
Okay - that is a lot of science - all to say: healthy relationships are a key driver for health and their importance cannot or should not be overlooked in your own life.
For those not in a spousal relationship, fostering other relationships (friends, family, church and community groups) shows almost equal benefit.
Of course it is not just the quantity but the quality of the relationships that matters - and here is where the Wellness Garage principles are concentrated.
As with all of the Wellness Garage core behaviours, strong relationships improve your health, and positively impact all other dimensions of life. As anyone who has had relationship stress will appreciate, when your relationships suffer, everything else (diet, exercise, sleep...) does too. As part of our Precision Health Tune-Up’s we will help you assess your relationship strengths, and as with other behaviours, coach you to improve.
It is easy for most people to accept and understand the linkages between what you eat, your activity and your sleep on your overall health.
Our next core behavior can be harder for people to understand. I have labeled it Mindfulness, others would choose to call it flow, many health practitioners would describe it as stress management
These labels can attract or repel, as they may have other associations that we do or don't identify with. From my perspective, the label is less important than the realization that the interaction between the mind and the body is foundational for health.
We are only beginning to understand the scope of this interaction and the realization that it is very clearly bi-directional - the mind affects the function, performance and health of the body AND the body affects the function, performance and health of the mind.
Having a personal wellness practice that does not incorporate specific mind behaviors really makes as much sense as doing all the training for a marathon, but getting no sleep; or focusing exclusively on what you eat but never exercising.
Not having a mindfulness practice of some sort is similarly neglectful, yet for many of us we ignore this part of our health. For many of us, it is cultural to ignore mindfulness - we live in a culture that since Descartes and the Enlightenment has placed a premium on the rational mind - "I think therefore I am". As Kotler and Wheal make the point of in their excellent book "Stealing Fire", quoting Abraham Maslow: "When all you've got is a hammer, every problem looks like a nail". We are facing the same situation with our rational minds at the expense of our health. Developing practices that allow us to tap into the full capacity of our mind may be the way out of the mental health crisis that we see today.
At Wellness Garage, we have laid out some simple rules for each core behavior that will improve one's health without risk. For mindfulness we start very simply.
Applying these simple rules to your life, while taking some effort, will improve your health and well-being, and I guarantee that they are without negative side-effects. The first two, being grateful and kind, are so simple they require no training, perhaps only some accountability tracking.
Meditation can be more intimidating and challenging. Increasingly there are apps such as Headspace, and technologies like Muse that can help novices quickly master the basics of meditation, as well there are numerous classes and courses available locally.
At Wellness Garage, we have a dedicated meditation space that is available for drop-in meditation and soon we will be offering courses for beginners.
Dr. Brendan Byrne