Heart Disease: Insufficient Sleep ✔ Diet ✔✔ Inactivity ✔✔✔ - Inactivity is the #1 Risk Factor for Heart Disease Across Adult Lifespan. Plus: Top 10 Reasons For Global Disease

You don't have to do kettlebell handstands. Just be active, girls!

We are often talking about the importance of sleep, and in fact, people who don't sleep enough have an increased risk of developing heart disease (+45%) and the fact that sleeping "too much" 9h+ is associated with a similar increase in (+38%) risk of heart disease in women (Ayas. 2003; similar data is available for men), alone, would not justify discarding the important contribution of short sleep durations to the ever-increasing number of patients with heart disease.

Similarly, a hypercaloric high fat + high sugar Western / Standard American style convenience + fast food based diet and its unwanted consequences, i.e. obesity, diabetes, etc. are unquestionably among the cornerstones of the heart disease epidemic.

One way to maximize your activity is HIIT - learn more at the SuppVersity

Never Train To Burn Calories!

Tabata = 14.2kcal /min ≠ Fat Loss

30s Intervals + 2:1 Work/Rec.

Making HIIT a Hit Part I/II

Making HIIT a Hit Part II/II

Triple Your Energy Exp.

And still, according to a recent study from the Centre for Research on Exercise, Physical Activity and Health at the School of Human Movement Studies of the University of Queensland  in St Lucia, Queensland, Australia, says: "From about age 30, the population risk of heart disease attributable to inactivity outweighs that of other risk factors, including high BMI" (Brown. 2014)

Now, we cannot tell, whether the same is true for men, as well, but even if it wasn't, the data from Table 1 would obviously be both, remarkable and memorable.

Table 1: Age-specific relative risks for ischaemic heart disease (IHD) for four risk factors in women (Brown. 2014)

If you look at the "population attributable risk (%)"-graph from the original paper (Figure 1), it becomes even more obvious: physical activity is the key to heart health - actually even more so for young vs. old women (187% increased risk in 20-24-year-olds vs. 95% risk increase in 53-58-year-olds; see Table 1).

 Figure 1: Population attributable risk (%) for four risk factors for IHD in women across the adult lifespan (Brown. 2014)

Even smoking is not match for inactivity, when it comes to the downstream effects on heart health. It is thus not surprising that scientists from the Albert Einstein College of Medicine report in a recent paper that for otherwise healthy middle-aged women who are overweight or obese, physical activity may be their best option for avoiding heart disease.

According to a study that followed nearly 900 women for seven years. These findings were reported in a paper led by authors at Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, the University Hospital for Einstein, and published today in the Journal of Clinical Endocrinology & Metabolism.

Inactivity is a major factor, but there are other heart disease triggers: As previously stated, inactivity is one factor out of many, the study by Wang et al. identified the following additional triggers of heart diseases, namely, elevated bloog glucose = 3x higher risk, hypertension = 3 higher risk, weight gain = 16% higher risk.

Throughout the seven-year study, the women were tested annually for heart disease risk factors. They also completed an annual survey describing their physical activity for the prior 12 months, which ranged from active living, caregiving and doing household chores to exercise and sports.

METs, i.e. metabolic equivalents are a way to measure the intensity of physical activity (occupational data based on Church. 2011)

During the seven years, 373 of the participants—43 percent of the total—had progressed from having at most a single risk factor for heart disease (i.e., metabolically benign overweight/obese) to at-risk overweight/obese, meaning they had developed two or more of the following five heart-disease risk factors: hypertension; low blood level of HDL ("good") cholesterol; elevated blood levels of triglycerides, elevated fasting glucose level (indicating pre-diabetes or diabetes); and elevated levels of C-reactive protein ( indicating inflammation).

And contrary to what you may have expected in view of the constant upheaval about "eating healthy", low-to-moderate physical activity—at the start of the study and during it—was the only lifestyle factor found to protect overweight/obese women from becoming at-risk for heart disease - to be specific, their heart disease risk was reduced by 16%.

Top 10 risk factors ranked by attributa- ble burden of disease globally and in Australasia (Australia, New Zealand, New Guinea (Brown. 2014)

Make no mistake about it: While being inactive is the major risk factor, it's usually so intricately linked to being obese, which is usually promoted by an unhealthy diet and a lack of regular sleep that we cannot fully discard any of the other factors. If you look at the data in the table to the right, you will also see that "globally", i.e. across all ailings and age groups, other factors are the major determinants of health & disease and ultimately, life or death!

Accordingly, health is always about the whole package, a package that includes an exercise (related Facebook News), a diet and an anti-stress + sleep component. And you don't want to miss one of them, your health depends on them!

Reference: 

• Ayas, Najib T., et al. "A prospective study of sleep duration and coronary heart disease in women." Archives of Internal Medicine 163.2 (2003): 205-209.
• Brown, Wendy J., Toby Pavey, and Adrian E. Bauman. "Comparing population attributable risks for heart disease across the adult lifespan in women." British journal of sports medicine (2014): bjsports-2013.
• Church, Timothy S., et al. "Trends over 5 decades in US occupation-related physical activity and their associations with obesity." PloS one 6.5 (2011): e19657.
• Wang, D, et al. "Progression from Metabolically Benign to At-risk Obesity in Perimenopausal Women: A Longitudinal Analysis of Study of Women Across the Nation (SWAN)." JCEM (2014).

High Intensity Exercise & Decreased Post-Exercise Energy Expenditure? Why the Latest Study Results are No Reason To Stop Working Out or Return to the "Fat Burning Zone"

Is HIT obesity incompatible? One thing appears to be sure - the purported post-workout increase in energy expenditure is reversed in the obese.

You may remember the positive results of the 100 squats a day challenge from the SuppVersity news on Friday, right? If you do, you will probably also remember the red box in which I mentioned the ongoing debate that's revolving around the issue, whether or not regular bouts of vigorous physical activity can protect you from the detrimental effects of sitting around 8h+ per day (see "100 Squats A Day Challenge"). While it may not really help us to answer the question whether "sporadic" activity is enough, a recently published study in the journal of the International Association for the Study of Pediatric Obesity certainly provides an interesting and novel angle on the debate.

What happens after you've burned those extra calories?

In a series of three experiments, a group of French researchers tried to elucidate why most of the studies that investigate the effect of physical activity on the change / loss of body fat report sub-optimal results. Within the last two decades, researchers such as Goran et al. (1992), Morio et al. (1998) or Donelly, et al. (2003), have repeatedly suggested that the primary reason for insufficiency of physical activity alone to modulate body weight was not restricted to the compensatory intake of food, but would - at least partly - be mitigated by a compensatory decrease in total daily energy expenditure (DEE).

As usual the existing evidence in ambigous, but a 1999 study by Kriemler et al. provided evidence that the high intensity exercise early in the morning will result in a decreased energy expenditure during the res of the day and the following day (Kriemler. 1990). Since Kriemler and his colleagues relied exclusively on the heart rate of their subjects to assess the energetic expenditure, Thivel et al. re-investigate the purported metabolic slow down in response to high intensity exercise in a series of three experiments.

• 

  The fitter you are the greater the benefits of working out at high intensities (learn more)

  Study 1 involved only obese adolescents and used a combination of heart rate and accelerometer data to evaluate the energy expenditure

• Study 2 was conducted with lean (17% body fat) and obese (44% body fat) adolescents and evaluated the energy expenditure by the means of a SenseWear Armband

• Study 2 involved only obese adolescents and used the most sophisticated measuring technique, a open-circuit whole-body calorimeter in a metabolic chamber

In study 1 and 2 the subjects had to perform a cycling exercise consisting of 3 x 10 min at 70%VO2max (EX), while study 3 compared a 3 x 11 min at 75% VO2max high intensity (very long) interval protocol to a 3 x 20 min at 40% VO2max low intensity extremely long interval protocol (click here to learn how to design a real high intensity interval workout).

Does HIIT slow down the obese metabolism or does it simply increase laziness?

While the general trend, the scientists observed was pretty meaningless (more on that in the "bottom line"), the differences we see between the studies and between lean and obese subjects are quite telling and do in fact relate back to the initially mentioned question of "working out like crazy" and "sitting around lazy" the rest of the day.

Figure 1: "Energy expenditure" in the exercise and control trials of the three studies (Thivel. 2013)

In order to appropriately interpret the data we  have to remind ourselves of what the scientists actually measured in the different studies. Study 1 used accelerometer and heart rate data and did thus access a mixture of metabolic and physical activity. Study 2 used just the SenseWear Armband with a build-in accelerometer, which - despite being more sophisticated than a simple pedometer, still measures only physical activity. Lastly, in study 3, the metabolic chamber actually measures the "true" energy expenditure irrespective of whether that's due to an increase / decrease in metabolic rate or in response to exercise / sitting around.

• Let's start with the third study, since it's the most sophisticated one. What do we see in the middle of figure 1? Right, we see that conducting a 30min HIIT workout reduces the energy expenditure during the afternoon (-9.2%), but the total daily energy expenditure in a well-controlled scenario and measured with sophisticated equipment is still 8.9% higher than in the non-exercise scenario.
• So what about study two then? There is no debating that the afternoon energy expenditure in the obese groups dropped, but wait... what do we actually measure here? Right. That's not necessarily the amount of energy the obese youths actually expended. It's just a measure of their physical activity. It is thus not sure, if the obese youths did, as the scientists imply, not still end up with a higher daily energy expenditure. After all, the heart rate remains elevated after a workout in unfit vs. fit individuals. Plus, even with the "physical activity only" measure the exercise trial yielded a marginal, but statistically non-significant higher total energy expenditure for the day. In the lean subjects the exercise advantage amounted to 233kcal and was thus clearly significant - irrespective of the (imho) inadequate measuring method.
• The results of study one actually speak for themselves: The energy expenditure, which does, as we have noted before, include both, physical activity (accelerometer data) and metabolic rate (heart rate data), simply does not decline after the morning workout.

I guess, I actually don't have to "summarize" the above even more, but since I understand all of you who have been complaining about missing "summaries" in many of the older SuppVersity posts I still will provide you with the obligatory bottom line.

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Now that you know it's not bad for you, read up on all previous HIIT articles at the SuppVersity.

Bottom line: "High intensity" exercise is not useless and it does not (in the presence of adequate nutrient intakes) shut down your metabolism. It may be true that especially people who are not used to working out and will thus be correspondingly fatigued after a by no means "high" intensity "HIIT" workout at 70% of their VO2max (actually this is more of one of those stupid "fat burning workouts") tend to decrease their activity levels during the rest of the day, but the beauty of high intensity workout is that they increase your conditioning and as you are getting fitter, this behavioral but not metabolic compensatory effect is going to decline.

And best of all, as long as you don't succumb to the "I worked out, so I can have my cream pie today" idiocy, you are going to lose weight even while this adaptation process is still taking place. Why? Well, the two studies that don't rely on physical activity (study 1 & 3) only to determine the energy expenditure are telling me that you spend ~9% more energy if you work out for half an our at a not too intense pace in the morning. Whether this will help you to escape the detrimental health effects of sitting around the rest of the day is yet questionable, because health in not determined by the difference between caloric intake and expenditure... but whom am I telling that? You know that anyway, right?

References:

• Donnelly JE, Kirk EP, Jacobsen DJ, Hill JO, Sullivan DK, Johnson SL. Effects of 16 mo of verified, supervised aerobic exercise on macronutrient intake in overweight men and women: the Midwest Exercise Trial. Am J Clin Nutr 2003; 78: 950–956. 
• Goran MI, Poehlman ET. Endurance training does not enhance total energy expenditure in healthy elderly persons. Am J Physiol 1992; 263: E950–E957.
• Kriemler S, Hebestreit H, Mikami S, Bar-Or T, Ayub BV, Bar-Or O. Impact of a single exercise bout on energy expenditure and spontaneous physical activity of obese boys. Pediatr Res 1999; 46: 40–44
• Morio B, Montaurier C, Pickering G, et al. Effects of 14 weeks of progressive endurance training on energy expenditure in elderly people. Br J Nutr 1998; 80: 511– 519.
• Thivel D, Aucouturier J, Metz L, Morio B, Duché P. Is there spontaneous energy expenditure compensation in response to intensive exercise in obese youth? Pediatr Obes. 2013 Feb 28.

Is it Your Neighbor(hood)'s Fault That You are an Obese Couch Potato? Plus: Higher Incomes Increase Obesity Risk in Men, Better Education Decreases Risk in Men & Women

Image 1: If this photo looks as if it was taken in your neighborhood, statistics say that you will have a harder time than others warding off obesity.

If you have not already been aware that the major weightloss obstacles are not so much of physio- than of psychological, or I should say behavioral natural, Monday's blogpost on the inability or unwillingness of the majority of the study participants in the Krebs study should have reminded you that there is more to losing weight than having an "optimal" diet plan. In this context, the results of a recently published paper from the University of Ottawa, Canada (Prince. 2012), comes to mind, in which Stepanie A. Prince and her colleagues report the results of a large-scale cross-sectional multi-level analysis of the association between neighborhoods, physical activity and obesity in Ottawa.

Mislead and misfed, but by no means unable to afford leading a healthier life-style

Although obviously of epidemiological nature, the study is remarkable in that it relies on relatively recent data (2006-2008) from 494,000 residents from 86 neighborhoods in Ottawa, who were part of the Ottawa Neighborhood Study (ONS). My usual advice not to confuse correlation (no matter how "significant") and causation, does yet still apply. A statement like "for each additional km² of park area per 1,000 inhabitants, the odds of being physically active increased by 17% in the female inhabitants of the respective neighborhood" (cf. figure 1, left; respective value: 1.17) does thusly signify that readily available parks areas seem to encourage women to be more physically active in their leisure time. It does not mean that moving to an apartment from which you can see the joggers doing their rounds in Central Park will turn a couch potato into a sporting ace. After all, it is at least as likely that people who like to jog try to make sure that they move to an area, where they can easily pursue their hobby.

Figure 1: Model predictions for the influence of environmental, social and contextual parameters on physical activity (left) and overweight/obesity rate (right) in men and women; * p < 0.05 (data based on Prince. 2012)

Against that background, I decided to include only factors which showed a statistically significant association with either obesity or physical activity in at least one of the two sexes in the data in figure 1. Now, you rarely have a rule without exception, and in this case, I also included the associative strength with the so-called census-based socio-economic status (SES) index, because the non-existent influence of social status on obesity rates goes just about as nicely against the notion that you cannot eat healthy if you are on a budget, as the +39% increased obesity risk of men in households with incomes >30,000$ (cf. figure 2)

Figure 2: Model predictions for the influence of the individual parameters household income and education overweight/obesity rate in men and women; * p < 0.05 (data based on Prince. 2012)

Moreover, the strong negative association -44% for men and -45% for women between having at least a college degree and being overweight/obese, would would support the argument that it is less about not being able to afford a "healthy lifestyle" than about not having learned / not being able to teach oneself to do so... or, if you will, being more susceptible to the misleading information from the food industry and less aware of the pitfalls of shopping in convenience stores (+17% increased risk of obesity in women per additional convenience store for 1,000 inhabitants) and eating at fast food outlets.

Note: Neither the age nor parameters, such as the number of indoor or outdoor recreational facilities, grocery stores, specialty stores and (normal) restaurants which, at least taken in isolation, had no statistically significant influence on either physical activity or obesity rates.

With respect to the +22% and +39% increased obesity risk per additional fast-food outlet (per 1,000 inhabitants), it should also be mentioned that this is only one out of several of the environmental factors, which had statistically significant influence only on obesity rates in women from the respective neighborhoods - a phenomenon, which could yet be a consequence of the fact that men are less likely to be in their respective neighborhood during working hours than women, so that the susceptibility to fast food stores is probably not gender-specific ;-)

The bitter or delighting truth about your neighbor(-hood ;-)

It is nevertheless quite remarkable that the associative strength of individual criteria such as age, income, education etc. showed an overall much more pronounced variation (0.98, p<0.05), than one of the area-specific variables, the variance of which did not reach statistical significance for either of the two study outcomes, i.e. physical activity level or overweight/obesity (cf. figure 1). This would suggest that environmental influences in the area we live in is in fact a more reliable indicator of our likelihood of ending up as an overweight couch potato or lean physical culturist than our incomes, education or say our age. A finding, which I would say is actually quite remarkable, don't you think so?