Muscle Medicine: The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints (12 page)

Cardio 101

(Red flag: Get clearance from your doctor before beginning a cardio program)

If you’re new to cardio work or have been away so long you might as well be new, pick a sport or an activity that you think might appeal to you. If you have no physical limitations, the field is wide-open. If, however, knee trouble runs in your family and you’ve got the beginnings of osteoarthritis, regular jogging isn’t a good bet, nor, for that matter, is any jarring activity that sends impact shock to the knee. Walking, the elliptical trainer, swimming, aqua aerobics/“water jogging,” and cycling are all sensible choices.

Next, you need to develop a base of endurance fitness, slowly and surely so as not to overtax the muscles, connective tissues, or the heart. Here, we recommend a “walk/run” approach, a concept we learned from the well-known running educator Jeff Galloway and modified for beginners and recreational runners coming off injuries. The concept is simple and can be applied to any form of endurance exercise: basically, alternate periods of low- and medium-intensity effort. Your doctor should advise you on the intensity levels for your beginner’s program, but here’s a typical program. Start with approximately ten minutes of low-intensity warm-up at 50–60 percent of maximum heart rate (if you’ve got a heart-rate monitor) or 5–6 on a 10-point “perceived effort” scale (if you don’t). That’s followed by one minute of moderate-intensity work (60–70 percent of maximum heart rate or 6–7 perceived effort), then one minute of low-intensity work. These rounds of low- and medium-intensity exercise alternate for as many as ten cycles, depending on the length you choose for your workout. End with a ten-minute, cooldown low-intensity walk (or cycle or swim).

If you can comfortably handle this routine after a week or two, then bump it up: the opening ten-minute walk followed by alternating rounds of two-minute
moderate-intensity runs and one-minute walks, then the ten-minute cooldown. As your cardiovascular system gets stronger and more efficient (and injuries, if you have them, heal), you can work through the program all the way to alternating rounds of fifteen-minute runs and one-minute walks. After developing a good aerobic base, recreational athletes whose sports require short bursts of intense effort should also devote one or two workouts a week that include ten to forty minutes in the higher-effort zone (an example might be 70–90 percent of maximum heart rate or 7–9 perceived effort) to train their cardiovascular system to handle those stiffer demands. Sprints, short ten-second-to-one-minute bursts on the cardio machine, sprinting against high resistance in a cycling class, or hill-climbing on a real bike— they all work.

Of all the aerobic sports we’ve discussed, running—the impact of all those foot

RUNNING

Running can be a wonderful way to exercise while enjoying the outdoors or the company of friends, but it can also create or aggravate injuries and weaknesses. Over time the accumulated impact shock of intensive long-distance running will likely take a toll on your entire lower body, not just your knees. (If you don’t believe us, ask some of the distance running stars of the seventies and eighties who built their careers on hundred-mile-a-week-plus training.) You can earn almost all of running’s cardiovascular health gains with only moderate distance work, twenty to thirty miles a week. So be smart. Don’t overdo the hill workouts that place extra stress on the knees, especially the running-downhill part. Try to run on softer surfaces and avoid running on crowned roads where your “downhill” leg is stressed by the slope. Consider a run/walk program or strategy. If you’re over thirty or thirty-five and you’re not training for competition, there’s no need to run more than every other day—your muscles and connective tissues need time to recover. Cross-training with sports such as cycling and swimming that are easier on the joints and muscles is an excellent way to maintain aerobic fitness on the off days and to avoid burnout. Make sure your running shoes fit properly and replace them every five hundred miles or so, or every six months, whichever milestone you hit first. (From constant pounding, or just from the passage of time, the air-cell foam in the inner soles hardens.)

strikes—places tremendous demands on the legs and the core muscles (see the box on page 63). Even if you are in great cardiovascular shape, it’s still a smart injury-prevention strategy to slow down at regular intervals and walk for thirty seconds or a minute. Listen to your body, and walk after every lap, mile, or five minutes of running time—whatever feels right for you. By giving the muscles a chance to

SURVIVING THE GYM

You’ll notice that none of the exercises we offer require you go to a health-club gym. A well-equipped gym is a good place to work out, but don’t pin all your hopes on it if you don’t have the schedule or the self-discipline to make it there three to five times a week. We actually prefer the body-weight-resistance exercises you can do at home to the weight machines at the gym. Exercises such as the basic push-up or the pull-up don’t isolate one set of muscles like many gym machines. They work a bunch of different muscle groups (the push-up develops the pectorals, biceps, triceps, shoulder muscles, abdominals, back-stabilizing muscles, etc.), all of which lead to better, more functional, all-round fitness. As you recall from
chapter 2
, muscles work in tandem, agonist and antagonist. If you’re pumping up your quadriceps on the leg-extension machine and ignoring the hamstrings, you’re creating muscle imbalances that can increase the odds of injury.

In your average gym, people often “cheat” by using momentum to lift weights that are too heavy for them. This herky-jerky approach risks injury and defeats the point of the exercise, which should be to develop muscle strength evenly across the joint’s range of motion. The best way to achieve this is by focusing on a slow, controlled motion as you lift the weight up (concentric motion) and lower it down (eccentric motion), whether you’re pushing a barbell or your own body weight.

If you are going the gym route and you’re not well versed in the proper techniques for the latest gym equipment, get a trainer, at least to get started. And not just any trainer, but one who is sympathetic to your goals. If you’re a fifty-year-old woman who wants help losing ten pounds and building up some lean-muscle mass, and the first trainer you come across only wants to do Olympic weight lifting, keep looking. Assuming that any health-club trainer should be able to customize a program to meet your needs may be setting yourself up for disappointment.

relax, you can cut down on the incidence of strains to the Achilles tendon, calf, hamstring, and abdominal muscles that are the bane of the sport. At twenty, this kind of “defensive” running probably isn’t necessary for most people. At forty, it could be what keeps you in the jogging game.

Advanced Cardio

Getting in shape is one thing, keeping fit is another. For the serious recreational endurance athlete who’s been running or cycling or swimming for years, we offer some hard-won advice about keeping it going in a fun and healthy way that we’ve drawn from our own experience and from friends and patients such as Mike Llerandi, who for the past twenty years has been one of the country’s top amateur triathletes.

Mike’s philosophy of training and aging is “adapt, don’t concede.” As your family and work responsibilities likely increase in your thirties, forties, and beyond, make good use of your weekends. If, for example, you can fit in a two or three-hour bike ride on a Saturday or Sunday, you can use the workweek for shorter, brisker rides and still be able to cycle at a fairly high level. As much as possible, integrate your family and social life with your athletic one. The Llerandi gold standard? Try to do at least one weekly workout with your spouse. You may have to back off on the intensity or duration (possibly not a bad thing), but you may get a less stressful life and a better marriage. Kids can be brought into the act as well. (For several years, Mike’s daughter accompanied him on his training runs on her bike, handing him the water bottle when he needed it.) Having one or more friends with whom you regularly run or cycle or swim is a huge plus. Not only does a group ensure that the workouts actually take place, but they’ll also be more fun, with a jolt of competitive energy.

You need to assess your own (aging) body with the same practical realism that you bring to balancing life and training. Workouts that might have seemed routine in your twenties are likely to break you down in your forties. Overtraining can show up in subtle ways (trouble sleeping, bad mood, greater-than-expected muscle soreness) and not so subtle ways (injury), so it pays to be vigilant. Again, adapt, don’t concede. Take a hard look at those three variables of your training schedule—
intensity, duration, and frequency—and see what you need to modify to stay fresh. Because the body of the older athlete requires more time to recover after a hard effort, the three variables of training may need to be downscaled.

Dr. Kelly

I’ve had three patients, women runners under thirty, who had stress fractures in the hip that led to hip replacements. I’ve had to tell patients, “Why don’t you accept that you just happen to have hips that weren’t designed for training for marathons. You should find an activity that doesn’t result in stress fractures.” Older runners will sometimes ask me, “Why did my hip cartilage tear now?” I tell them that the body isn’t designed to last forever. The same way you have wrinkles on your face, you have wrinkles or the effects of aging throughout your body. You have to constantly reassess and adapt your exercise program so you don’t make the damage worse than it needs to be. I know I can’t do certain things. That doesn’t mean I’m a bad person or that I can’t stay in shape. But I do have to work around those physical limitations. But people get fixated on the idea that they have to run.

Few runners or cyclists or swimmers in their forties and older can pack in more than one weekly workout at all-out levels of exertion without eventually running out of gas or getting injured. Whether you’re a masters-level competitor or just someone who values his or her fitness, most of your training should be spent in a comfortable aerobic zone: 65–75 percent of maximum heart rate or approximately 6.5–7.5 perceived effort.

Cross-training is the safe way to keep your workout frequency high, up to five or six sessions a week. With different sports, you’re working different and often complementary muscle groups so you’re less prone to muscle overload or imbalance injuries. Running and cycling, running and swimming, and cycling and swimming are all great pairs. Of course, in theory you could still overdo the cardio intensity with a mix of sports, but in practice runners tend to go at a saner pace on the bike as do cyclists when they run.

Maybe the hardest thing the recreational athlete must do is to junk the philosophy of “no pain, no gain.” A good workout isn’t the one that leaves you feeling wiped out. Finishing a workout feeling relaxed and refreshed is the winning strategy in the long run. Consider yourself in training for the big event, otherwise known as life.