As regular readers know, I’m a big advocate of exercise. I’m also non-dogmatic about the topic. Since people are much more likely to do well with – and stick to – a program they enjoy, I think it’s more important to regularly move your body in some way than to rigidly advocate for a specific program. If you love running, you should run. If you go to a yoga class that you really enjoy, you should do yoga. If you like lifting heavy things, you should strength train.
That doesn’t mean however that there aren’t specific benefits to different types of exercise, nor that you aren’t better off with a well structured approach to fitness. The “best” fitness program includes components of strength work, of mobility work, and of various types of cardiovascular fitness. If you enjoy all types of exercise and/or will stick to whatever plan is “the best” without regard for your personal preference, then a mix of something like yoga, weight lifting, and running is probably better than doing only one of those activities. But if the only exercise you will consistently do is to take long bike rides, I’d much rather you ride your bike regularly than do nothing at all because you are bored or overwhelmed by the other options.
On the topic of “the best” exercise program, I’d like to get a bit more granular today and review one question regarding exercise in particular: what is the “best” workout program to lower blood pressure.
In recent years, High Intensity Interval Training (aka HIIT) has become quite popular. If you aren’t familiar with the concept, HIIT involves alternating brief rounds of very intense cardiovascular exercise with lighter activity. For example, instead of going for a light jog for 30 minutes, a person engaging in HIIT might sprint as hard as they can for one minute, then walk for one minute, and repeat the process five times for a total ten minute workout.
There are many, many, different HIIT protocols, with perhaps the most famously brief one being a “Tabata”, in which a person does intense exercise (say pedalling as fast as possible on a stationary bike) for 20 seconds, pauses for 10 seconds to catch their breath, and then repeats the process eight times for a total four minute workout.
The advantages of this type of exercise are obvious to the time-crunched person, and I indeed frequently recommend doing a “Tabata” a few times per week to the patient who tells me they have no time for exercise. There is also a psychological appeal to HIIT training for the person who doesn’t feel like they are getting a good workout unless they leave the gym soaked in sweat. Crossfit for example has long incorporated a lot of HIIT work into their programs, and if you know any Crossfitters you will be aware these are not the type of people who are content to just go for a light walk or a gentle yoga class. (That’s not a knock on CrossFit nor the people who enjoy doing it by the way – the world contains many different personality types, and it’s great to have different fitness modalities that cater to these differences. It has simply been my experience that CrossFit tends to attract the “type A” personalities of the fitness world, people who really enjoy a workout that pushes them to the absolute brink of what they are physically capable of on a regular basis).
I recently came across a paper that was published almost ten years ago (2017) but which I think is highly relevant and very interesting. But before I get into it, let me give a bit of context.
Here’s a quick review of an older study (from 1997). In the study, they took middle-aged diabetics and randomized them to do either nothing, or to do 45 minutes of vigorous cycling on a stationary bike twice per week, plus one session of high-intensity interval cardio training (consisting of two minutes of vigorous exercise followed by three minutes of light exercise for five cycles, for a total of 25 minutes).
After two months, the people who did the exercise had lost 48% of their visceral fat, and significantly improved their insulin sensitivity and blood glucose numbers, even though they didn’t lose a significant amount of weight overall. You can read the full study by clicking here.
