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What is healthy exercise?

Forget health hacks and quick fix exercise tricks, the best approach to getting active is to keep things simple, MYKE BARTLETT writes.

Professor Daniel Green has made a career out of studying the sort of exercise that might help prevent chronic conditions such as heart disease. As such, Daniel – a cardiovascular exercise physiologist based at the University of Western Australia’s School of Human Sciences – is the perfect person to explain what we mean when we talk about healthy exercise.

“There’s two ways to tackle that,” Daniel says. “There’s the amount of exercise you need to maintain health and, if you’ve already got an existing disease, there’s the amount of exercise you need to stop that disease progressing and getting worse. The type of exercise you use in each of those cases is a little different.”

For people already living with a chronic condition such as diabetes, exercise can have a “double whammy” effect, he says.

“Exercise has direct effects on the heart and arteries and it has indirect beneficial effects. Regular exercise, taken at the right level, can do things like modify your risk factors for cardiovascular disease. It has beneficial effects on things like blood lipid profiles, it has beneficial effects on your blood pressure, it has beneficial effects even on things like inflammation, platelet function, and whether your bloods are more likely to coagulate and not cause a heart attack or stroke. Those are the indirect effects.”

Exercise can be described as a “poly pill” because it has such wide-ranging and positive impacts on so many areas of physical health (although exercise shouldn’t replace prescribed medication). But these indirect effects are only part of the picture.

“Exercise also has direct effects on the artery itself. Every time you’re exercising, the blood flow increases through your arteries, and it increases through your heart and your heart rate goes up.

Recent evidence shows that when you increase the blood flow and you increase the pumping rate, that makes the heart and arteries healthier over time. It’s sort of tuning up the pump, and the hoses and all the things that you want to protect.”

This “tune up” can help reduce the risk of heart disease, heart attacks, strokes, and in people with diabetes, even disease of the microvessels – those small blood vessels that affect things like your eyes, kidneys and skin – which in turn reduces the risk of ulceration.

It’s best to start by keeping it simple. Do something that is safe for you to do, preferably with other people, and ideally a bit of aerobic exercise that gets your heart pumping.

What sort of exercise works best? The answer isn’t straightforward, Daniel says.

“Anything is better than nothing. Do something that you enjoy because you’re more likely to keep doing it.”

Instead of getting distracted by the endless churn of articles offering fitness hacks or quick fix exercise regimes, it’s best to start by keeping it simple. Do something that is safe for you to do, preferably with other people, and ideally a bit of aerobic exercise that gets your heart pumping.

“Start easy and build up as you go. Don’t try to beat the clock or do things that you were able to do 30 or 40 years ago. Keep it enjoyable. As you get better at it, you might think about ramping it up in terms of frequency or intensity.”

For people with type two diabetes, exercise that targets skeletal muscle mass is a good idea and can help with insulin resistance. Some years ago, Daniel was part of a research group that designed an exercise program specifically for people living with type 2 diabetes. The idea was to make the program as easy as possible but with the greatest possible impact on health. The end result was a circuit weight training approach, where people weren’t exhausting themselves by exercising large muscle groups all at once.

“Instead of things like running on treadmill or even cycling on a bike, the program targetted small muscle groups like just one arm or one leg and then exercised them intensely. That way you get the maximum amount of exercise intensity for that isolated group of muscles, but you don’t burden the entire body.”

Professor Danny Green

The study was highly successful, improving blood glucose management as well as heart and artery health. The program has since become a mainstay in clinical practices working on cardiac rehab.
More recently, Daniel has been involved in a study looking at the difference between water based and land based exercise. The results suggest that walking upright in warm water which comes up to your waist or abdomen could help muscle growth and heart health.

“The water acts a sort of a resistance and we found an increase in leg muscle mass in those experiments. It’s quite good exercise for older patients because if you fall over, you’re in the water.”

The study was actually developed to see if water walking might help treat dementia because the pressure of water appears to improve blood flow to the brain, as well as the heart. While people living with diabetes do need to be conscious of foot health and ulcers, water walking can be a gentle and social way to get started on a new exercise regime.

Daniel does suggest that anyone living with diabetes should consult an accredited exercise physiologist before starting, to make sure they’re choosing a form of exercise that is safe, as well as healthy.

“While we don’t want to put any barriers in the way of starting exercise, you’ve got to balance that against safety. Speak to your GP about seeing an accredited exercise physiologist as part of your health care plan.”

That aside, Daniel says his advice for getting started is pretty simple.

“Make sure your footwear is good. Don’t go too hard too early. Walking is a great exercise, walking in the water might even be better. There’s no bad form of exercise if you’ve screened yourself well in the first place. Start easy and find something you enjoy.”


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