Exercise as a pill

Scientists have been studying exercise for a long time, desperately trying to decipher what mechanisms are involved in the overwhelming health benefits associated with exercise of any kind, from the 10 minute walk, to the 42 km marathon, and everything in between.

If they could just crack the code, then maybe, just maybe they could encapsule it in a pill for everyone to take. Unfortunately, it’s not that simple. Exercise and the mechanisms involved in health and longevity are too numerous and complex to be pillified. I’m sorry. That being said, exercise is probably the most important “drug” in terms of increasing longevity and quality of life, such that being sedentary should be considered a major health risk factor, much in the same way we see smoking, diabetes, hypertension, high cholesterol and overall unhealthy dietary patterns.

Living an active life has been shown to reduce mortality by up to 30-35%, some studies even suggest a 50% improvement, when comparing physically active people to inactive ones. One study looking at VO2 max, a measure of cardio respiratory fitness, saw a 500% difference between participants with the lowest VO2 max when compared to elite athletes. Compare this to the 15% reduction seen in the AHS-2 study looking at health conscious vegans versus health conscious omnivores. We know that plant-based nutrition is the evidence based way to live longer, but why do we avoid talking about the almost two-fold longevity benefits of exercise.

In terms of how, how much and what types of exercises confer the greatest benefits in terms of quality and quantity of life, I’ll review all of these here! In a nutshell, we’ll talk about the foundational pillars of exercise: balance, resistance training, aerobic and anaerobic training. An exercise program including those 4 components are sure to improve the odds of living a longer and happier life.

The Era Of Health Misinformation

It’s funny how social media is a platform where people can anonymously critique others without consequence. If people were spending even 10% of that time moving their bodies, the longevity benefits would be insane. I really don’t think people understand how much exercise is beneficial to prevent disease and to extend life. Here I am, spending so much time talking about nutrition, when physical activity, exercise, resistance training and simply moving your body in any way you like, remains a greater predictor of health and longevity.

As a lifestyle medicine advocate, I preach about how most medical conditions are a result of our own poor lifestyle choices. My goal is simply to educate you on how simple and practical choices and changes might translate to added years of disease-free living. Whether it’s nutrition and physical activity, or stress management, getting adequate sleep, avoiding or reducing known carcinogens, like, meat, smoking and alcohol, and forming bonds and living out your passions, all of these will add years to your life and life to your years. Although all of these 6 lifestyle pillars are scientifically proven to increase health and longevity, some are more powerful than others. Dare I say that physical activity may be amongst the most potent of those longevity predictors.

Exercise As Medicine

Spending time on social media has its pros and cons. It helps us connect, interact and share valuable information with each other at little to no cost. On the flip side, misinformation runs rampant and people spend way too much time arguing about the healthiest fruit, the latest health hack, or the best type of exercise, when the science says that the best exercise is the one you love to do the most, the healthiest fruit is the one you're most likely to eat consistently over the long term and the best diet is one where you minimize ultra-processed foods and meat and maximize whole plants. Every single argument about the variants of these basic principles is almost irrelevant. If your goal is simply to be healthy and live a long and happy life, then simply staying active and eating a mostly a whole food diet is probably going to get you there. If your goal is to squeeze every single drop of magic out of your lifestyle choices, then there a specific foods and exercises that may be better than others.

Longevity and Exercise

In terms of factors that will impact the quality and length of your life, we can list exercise, nutrition, stress management, sleep, emotional health and exogenous substances. That's pretty much it, and except for exogenous substances, like medication that might add years to your life, or alcohol and cigarettes, which will take some away, the rest of the factors affecting longevity are often debated in terms of which one is more important. Honestly, they’re all important, but I do think we underestimate the power of exercise. Here’s how the four main pillars of exercise affect your ability to live a longer and healthier life. Keep in mind that here, I’ll be talking specifically about exercising for longevity, which is very different than exercising for performance.

ROM and Balance Training

By ROM, I’m talking about range of motion, or mobility training, and by balance training, I’m referring to stability training. Falls in the elderly are a huge cause of morbidity and health complications. Simple injuries, like acute back pain and tendinitis are also main sources of disability. Core strength also helps you prevent injury during resistance training.

Mental health correlates with pain, activity level and functionality and so maintaining the capacity to successfully complete our activities of daily living without injury, whether it's mowing your lawn or pushing a shopping cart, are of utmost importance. I personnaly sprinkle mobility, balance and core training in most of my workouts. Typically, I warmup for 10-12 minutes, then work on mobility for about 10 minutes making sure that each of my joints are put through their full range of motion. There's no need to force, or stretch, a limb of joint in an uncomfortable position. The goal should be to maintain function, mobility and core strength over the long term, in order to prevent injury. A simple stretching routine that takes a max of 10 minutes to implement gives you the best bang for your buck without taking away from other more important exercises. Then, between sets of resistance exercises is usually where I do my core stability and balance training. Something as simple as standing on one leg for 30 seconds can be surprisingly challenging. Now, I do it on either a wobble board or on my balance board, that you can find online for a few bucks. These types of exercise require a minimal time investment, but do require long term compliance to achieve maximal benefits.

Resistance Training

Muscle mass decreases with age and mortality seems to correlate with it. When talking about the benefits of resistance training, I’m not talking about body building, I’m referring to maintaining a decent amount of muscle mass in order to accomplish the activities of daily living, like getting up from a chair without pushing off with your arms, or absorbing a fall to minimize the risk of fractures. Resistance training strengthens bones along with muscles and reduces the rates of falls and fractures, two leading causes of morbidity and mortality. Some studies looking at hip fractures suggest that the risk of dying in the year following a hip fracture can be as high as 40-50% percent. So even if you’re not looking to add muscle mass for cosmetic reasons, you should consider it for its functional advantages. Sarcopenia, or loss of muscle mass, is real and contributes to great reductions in quality, as well as quantity of life. You don’t need to be bench pressing your own body weight to see benefits, but simply to move your body against resistance, either using gravity, or weights. By now, those who have been following my fitness journey know that sports are my life, and that I've been doing calisthenics and rock climbing for years. In fact, a few years ago, my training regimen included mostly body weight exercises, all in order to excel at my new sport and passion, "ninja warrior". This up and coming sport is a blend of calisthenics, bouldering, rock climbing, OCR and playing on monkey bars. In July 2022, I had the honour of representing my country as the only athlete from the Maritime provinces at the UNAA World Ninja Championships in Las Vegas, where I competed in the Masters category as a 41 year old plant-based athlete.

Aerobic, or Zone 2, training

You might have heard about “training zones” in the past. Basically, zones describe the energy systems that are primarily fuelling the activity in question. For those unaware of energy systems, it’s important to note that in zone 1, where we spend most of our lives, we mainly burn fat through mitochondrial oxidation, but still burn a little bit of glucose, also through mitochondrial oxidation (also called oxidative phosphorylation). As exercise intensity increases, we enter zone 2, where fat oxidation in mitochondria increases dramatically. Once activity and energy demands are more than what the fat burning energy system can provide, we switch into zone 3, where fat burning drastically decreases and the body switches to another energy system, which is using glucose as a substrate for energy production. In the other zones, net lactate accumulation starts to occur. Lactate combines with hydrogen to form lactic acid, which acidifies the cell’s micro environment and negatively impacts performance with time. In training zones after zone 2, energy production starts to happen outside of the mitochondria, the cell’s powerhouse. Since mitochondrial function is directly related to the individual’s metabolic health, training in zone 2, where the energy system that is being trained is mitochondrial oxidation, will lead to improved mitochondrial function and metabolic health. Over time, mitochondrial function will improve, and since they help in fat burning and lactate clearance, not only will this improve metabolic health, but will also improve lactate clearance and performance in more intense training zones, where lactate accumulation will occur more rapidly.

It’s funny, most people think that working out means going all out, to full exertion until you can’t do anymore. It turns out that when we’re talking about health and longevity, working out in a zone 2, where you’re likely at 70-75% of your max heart rate, is going to benefit you more than an all-out sprint. At this zone, you should be able to maintain a conversation, yet still feel like you’re working hard.

In a perfect world, you’d spend 3-4 hours per week in zone 2, or 2 hours if you’re a beginner. This can be a brisk walk, slow jog, or stationary bike at low intensity. In this zone, you’re actively training your mitochondria to burn more fat, clear more lactate and improve metabolic health, whereas in higher training zones, you’re not using this energy system anymore and losing most of the mitochondrial function benefits.

Anaerobic, or Zone 5, training

Zone 5 is often achieved through high intensity interval training, or HIIT. At this training zone, you’re relying almost purely on anaerobic glycolysis and should be getting close to your max heart rate. This means that you’re burning glucose in the cell’s cytosol, independent of mitochondrial function. You don’t have to spend much time in this zone to reap the benefits. Although many people don’t particularly like training in this zone, it should not be neglected. Ideally, you should be hitting your max heart rate, or close to it, once or twice a week. You can work in this zone by choosing an exercise you like, and go all out to your max HR for 30-60 seconds. Personally, my favorite way to workout in zone 5 is to do a HIIT workout. I accomplish this either through interval training on my stationary bike, through jog/sprint intervals, or through HIIT using burpees. Although training this energy system is important, I’d argue that for longevity, you should focus more on zone 2, and use zone 5 training 1-2 times per week.

When compared to drugs, or any other lifestyle intervention for that matter, exercise reduces all-cause mortality by up to 35%, which is better than any other lifestyle modification that one could make. Although I usually preach about the benefits of plant-based nutrition for longevity, today I wanted to discuss my other passion, physical activity. People need to realize that its benefits in terms of longevity actually overshadow those seen with nutrition.

To benefit fully from the longevity advantages that exercises can confer, you should focus on 4 main components. Start by building a short, but effective core stability, stretching and balance routine. It doesn't have to be complicated, but it does have to be sustained over time. Mine takes 10-15 minutes, and is done either right after my warmup, or between my sets of resistance training. Then focus on resistance training. Working against gravity, against body weight, or any other source of resistance will maintain muscle mass, prevent sarcopenia, increase basal metabolic rate and decrease the damages from an accidental fall. Then, training in zone 2 will help improve mitochondrial function. This has metabolic benefits and will also improve your capacity of clearing lactate. This will be of much benefit when training in higher intensity zones, where lactate accumulation occurs. Finally, training close to your max heart rate once or twice a week will increase the efficiency of this energy system. This will come in handy when running after the bus, your late flight or while pushing your baby's stroller up a hill. These four pillars of fitness will all contribute greatly, yet differently to increasing your quality of life and longevity. Much in the same way that nutrition exerts its protective effects, exercise is guaranteed to add years to your life and life to your years.

If you'd like to dive deeper in the studies cited in this article, take a peek at the references below, or read the recent blog post about how Nutrition and Exercise affect longevity at plantbaseddrjules.com

You can also consider my Nutrition and Supplementation Guide For Athletes, available in the digital downloads section of my website.

Look for me on the socials, @plantbased_dr_jules on Instagram and go like my Facebook Page, Plant-based Dr. Jules. If you’re looking for some fitness motivation and are curious to see what a plant-based athlete can accomplish, follow me, @maritimeninja, on my fitness account on Instagram or check out my fitness group on Facebook, called Maritime Ninja Warrior. I'm a two-time world championship qualified athlete and you can follow my fitness journey there! You can even access the resources section by becoming a member. It's free and there, you can download free resources like my plant-based recipe eBook!

You also check out my YouTube channel here for more tips and tricks on how to embark on a plant-based journey!

Reimers, C. D., Knapp, G., & Reimers, A. K. (2012). Does physical activity increase life expectancy? A review of the literature. Journal of aging research, 2012, 243958. https://doi.org/10.1155/2012/243958

Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Netw Open. 2018 Oct 5;1(6):e183605. doi: 10.1001/jamanetworkopen.2018.3605. PMID: 30646252; PMCID: PMC6324439.