Exercise Enhancement and Risk Precautions

It is better to prepare than to repair. Knowing this, it is important to incorporate some form of exercise into your weekly routine. Moderate exercise on a consistent basis can make a significant improvement in your mental and physical health.

To achieve the national health objective for increasing leisure-time physical activity, comprehensive public health efforts are needed to improve reported levels of leisure-time physical inactivity for all population groups for all months of the year. Examples of strategies and approaches to increase leisure-time physical activity include encouragement to climb stairs and to avoid the use of labor-saving devices (Blamey et al. 1995).

Physical inactivity increases the risk of many chronic disorders such as diabetes, obesity, cardiovascular disease, and many types of cancers. Studies have proven that maintaining moderate levels of physical activity (e.g., brisk walking 3 hours a week) greatly reduces the incidence of developing many chronic health conditions (Chakravarthy et al. 2002). Despite these findings, approximately one-third of adults in the United States report no leisure-time physical activity, and the prevalence of leisure-time physical inactivity is highest among those who are older (MMWR 2002).

Physical activity does not need to be excessive or overbearing (as in over - training). Sometimes less is better: Doing things in moderation and pacing yourself is important. Although we know the important benefits of regular physical exercise, there are certain downsides on the molecular affects that overexertion places on the body in the short- and long-term. This protocol will enlighten the physically active enthusiast about how to enhance the effects of exercise, protect against negative effects, and increase energy levels, so that you will have more productive workouts. If you are physically inactive, you may be encouraged to begin even a modest exercise regimen.

The Many Upsides of Exercise

There are many studies documenting the fact that engaging in consistent exercise on a regular basis can have a significant impact on how long one will live. Exercise will also improve the quality of that life. Although exercise throughout life is optimal, studies have shown that as little as two sessions of training a week can increase muscle strength and muscle volume by more than 30% in aged people (Lacour et al. 2002).

In older Americans who are not physically fit and who do not exercise regularly, regular physical exercise can increase the body's metabolism and make it more efficient in burning calories. Physical fitness also makes respiration more efficient. Evidence suggests strongly that physically fit people live 2-3 years longer and have a better quality of life than sedentary individuals. Anytime is the best time for a person of any age to start exercising. Exercise is movement: dancing, walking, lifting a weight, and using the body. Physicians who prescribe exercise should help the patients create programs that are interesting, fun, and geared toward their individual needs. Strategies include the stages of change model, individualized behavioral therapy, and an active lifestyle. Exercise should be geared toward strength training, aerobic exercise, and balance and flexibility. Physicians can help motivate their patients to participate in exercise by recommending exercises that are fun, straightforward, and geared toward the individual's needs. By providing proper motivation, more patients will comply (Nied et al. 2002).

Along with a good diet and supplement regimen, regular exercise can:

• Help build healthy bones and muscles
• Improve strength and endurance
• Reduce body fat and help to control weight
• Reduce anxiety, stress, and improve mood state
• Improve blood pressure and cholesterol
• Slow down negative cognitive changes that may accompany aging
• Improve the immune system
• Greatly improve glucose metabolism and insulin sensitivity

Many studies have shown exercise to improve mental acuity in the old and the young. (Venjatraman et al. 1997; Nieman et al. 1999). Studies have shown that exercise can increase brain-derived neurotrophic factor (BDNF), which enhances synaptic plasticity and neuron functions of the brain and growth factors, stimulates neurogenesis, increases resistance to brain insults, and improves learning and mental performance. Therefore, exercise is not just important for our bodies, but also our minds (Neeper et al. 1996; Berchtold et al. 2002; Cotman et al. 2002).

The Downside

Like most things in life, there is always a downside to any upside, and exercise is no exception. Although the benefits of exercise clearly outweigh the risks, we must acknowledge the potential downsides and look for ways to minimize them. Although moderate exercise has been shown to improve immunity, extreme and prolonged exercise has been shown to suppress the immune system (Fitzgerald 1991). This is commonly called overtraining syndrome (OTS) and is common with athletes who train too long and too hard.

A study reported in the Review of Environmental Health showed that various parameters that measure immune response were actually suppressed during vigorous and prolonged heavy exercise. The researchers found that phagocyte activation, suppressed NK-cell function, impaired lymphocyte proliferation, decreased in vitro immunoglobulin production, and activation of pro - inflammatory cytokines to be present in active muscle of individuals engaged in various forms of heavy exercise. The researchers concluded that average athletes should take the antioxidant vitamins C and E and nonsteroidal anti-inflammatory drugs (NSAIDs) for muscle inflammation (Shepard et al. 1996).

One study found that a group of runners who trained for a marathon, but did not compete, were much less likely to get upper respiratory infections than the runners who completed the race, demonstrating how much such endeavors can take out of a person. The old saying "too much of a good thing can be bad " rings true with exercise also. Long-term repetitive and impactive exercise is also associated with cartilage degeneration, and that is the last thing people, especially older people, need (Nieman 1999).

One well-known effect of exercise is that it raises oxidative stress and increases free radical production. Although exercise has been shown to improve antioxidant mechanisms, these defenses can be overwhelmed over time. The risk of increased free radical production, including damage to DNA and a host of pathologies, is best avoided. The issue of free radical production and oxidative stress is made more important when we factor in our various lifestyles and environment. For example, it has been shown that ozone greatly increases oxidative stress and is made even worse when we exercise in areas with high ozone levels (Mudway et al. 1999; Corradi et al. 2002).

Most major cities, and many rural areas surrounding major cities, have highly elevated ozone levels at certain times of the year, and people are told not to exercise at peak ozone times. Poor diet, smoking, certain drugs, and other lifestyle factors greatly increase oxidative stress. Therefore, exercise combined with poor lifestyle habits could do more harm than good, although most studies do not show that effect as much as one would expect. In other words, of all the terrible things a person can do to themselves on a daily basis, exercise still appears to be a positive rather than a negative in improving overall health.

The trick is to make exercise work for you. That is, to have the highest benefit with the lowest risk, incorporate the proper nutrients into your daily life that are specific to the issues of exercise raised above.

Nutrients for Athletes
or Weekend Warriors

No matter whether you are a casual exercise buff or a serious athlete of any age, there are nutrients you can take to prevent the problems mentioned above, improve the effects of exercise, and to improve performance. For example, although it is prudent to avoid exercise at high ozone times of the day in places known to have ozone problems, even small amounts of ozone are known to affect lung function and oxidative stress. As just about everyone knows by now, antioxidants are the treatment of choice for combating free radicals and oxidative stress.

Preventing Oxidative Stress
Studies have confirmed the toxic effects of ozone on lung function and yet more studies have found adding antioxidants reduces the power of ozone to damage lung tissue. Even the simple addition of vitamins C and E to the diet of trained cyclists was shown to improve lung function. Dutch researchers gave 500 mg of vitamin C and 100 mg of vitamin E to well-trained cyclists, and another group took a placebo (using a classic double-blind placebo protocol, neither the researchers nor the athletes knew who was getting the antioxidant vitamins). The researchers found that even small amounts of ozone affected the athletes' lung functions and the addition of the antioxidants greatly reduced the negative effect of ozone on lung function of the athletes. It is well-known that the lungs are particularly sensitive to oxidative stress. The researchers theorized that the vitamins may protect the lungs against some of the effects of ozone by reducing the lung's inflammatory response to air pollution (Grievink et al. 1999).

If the simple addition of vitamin C and E can have this effect, imagine what other antioxidants or antioxidant-supporting nutrients such as N-acetyl-cysteine (NAC), whey protein, bioflavonoids, and so forth, can do. Clearly, a good all-around antioxidant-rich multivitamin formula is a must for people engaged in exercise, and the additional intake of vitamin C, E, selenium, NAC, and whey protein is highly recommended both pre- and post - workout.

Of course, antioxidants have many functions in addition to combating ozone damage such as improving immunity, a concern to athletes who may suffer from OTS. Whey protein has been shown to improve the specific areas of the immune system depleted by intense exercise. In particular, several studies have shown whey protein increases glutathione, the body's most important water-soluble antioxidant that is essential to immunity (Micke et al. 2001).

Preventing Mineral Depletion and Improving Joint Health
Studies have shown exercise increases the use and excretion of minerals. Mineral status is particularly important to older individuals, and a good mineral supplement containing highly bioavailable forms of calcium, magnesium, potassium, and boron combined with a good diet is recommended (Clarkson et al. 1995). Of course, healthy joints are needed to exercise or to be functional throughout life for that matter. Nutrients known to improve joint health/function, such as glucosamine and chondroitin, SAMe, hydrolyzed gelatin, omega-3 fatty acids, GLA, and antioxidants can be added into the diet of people who exercise and are concerned about joint health. These nutrients are particularly helpful to active people who already have joint problems they wish to address.

Reducing Inflammation
Natural supplements have been shown to decrease the systemic inflammation that is found in many disease states and that may accompany sustained physical activity. Vitamin K helps reduce levels of IL-6, a pro-inflammatory messenger. Vitamin K also helps in the treatment of osteoporosis by regulating calcium and promoting bone calcification, a factor that is also important for athletes. The docosahexaenoic acid (DHA), a fraction of fish oil is the best documented supplement to suppress TNF-alpha, IL-6, IL-1(b), and LTB(4). Studies on healthy humans and those with rheumatoid disease show that fish oil suppresses these dangerous cytokines by up to 90% (Khalfoun et al. 1997; Weber 1997). Chronic inflammation can also be mediated via diet modification. Foods that may contribute to chronic inflammation are foods with a high glycemic index (things that digest quickly), such as fruit juices or rice cakes, foods heavy in polyunsaturated or saturated fats, and foods high in arachidonic acid, such as red meat. Arachidonic acid is a precursor to both prostaglandin E2 and the pro - inflammatory cytokine leukotriene B (Kreisberg et al. 1983; Pajari et al. 1998).

Performance

The subject of enhancing athletic performance could very well be the most confusing and controversial section of this protocol. There is an extensive, virtually endless list of nutrients claimed to improve athletic performance. We will address some of the more well-known supplements here, and their effectiveness in improving athletic performance.

Maintaining Mitochondrial Health
Many of the supplements on the market reported to increase performance do improve overall health, but have not been substantiated to improve athletic scores. For example, although alpha-lipoic acid, L-carnitine, and c C oenzyme Q10 (CoQ10) have been pushed as performance enhancers by some companies, none of them has any convincing research to show any effects on performance. The importance of CoQ10, alpha-lipoic acid, and carnitine, however, lies in their ability to prevent age-related mitochondrial exhaustion. Intense exercise generates lots of free radicals that are especially damaging to the mitochondria. This means that athletes and active people should supplement with at least 100 mg a day of CoQ10, 1000 mg a day of L-carnitine or acetyl-L-carnitine, and 250 mg a day of alpha-lipoic acid.

A few studies suggest that antioxidants can improve performance, although others show no benefits. Yet, as previously stated, many supplements that are lacking in data showing that they improve performance are clearly good for you and should not be overlooked. However, taking these supplements may not necessarily make you run faster or lift more weight (Vargiu et al. 2002).

One supplement that has been shown to increase strength and lean body mass is creatine monohydrate. Some studies show clear-cut performance enhancement from creatine, although some do not. The general consensus is that creatine is best for activities that require explosive short duration activities, such as weight lifting or sprinting, but some endurance athletes do feel they benefit from using creatine even though the research has been contradictory on that point (Preen et al. 2001; Cox et al. 2002).

Creatine
One supplement that has been shown to increase strength and lean body mass is creatine monohydrate. Some studies show clear-cut performance enhancement from creatine, although some do not. The general consensus is that creatine is best for activities that require explosive short duration activities, such as weight lifting or sprinting, but some endurance athletes do feel they benefit from using creatine even though the research has been contradictory on that point (Preen et al. 2001; Cox et al. 2002).

Creatine may also have several crossover uses into health other beneficial uses. Several studies have confirmed it appears to lower s cholesterol levels by up to 15% by unknown mechanisms. Just as promising, several studies suggest creatine can be helpful in diseases that attack the neuromuscular system (Wallimann et al. 1998). Several researchers are already making recommendations for using creatine with such diseases. Creatine and several creatine derivatives may also be useful in certain pathologies of the heart in which energy production of the heart muscles are affected. Creatine may also be beneficial for those afflicted with certain diseases that cause muscle wasting (such as amyotrophic lateral sclerosis ALS), but more research is needed for any definitive recommendations to be made (Klivenyi et al. 1999; Mazzini et al. 2001). Studies have also shown that creatine may improve exercise performance and metabolism (Romer et al. 2001; Volek et al. 2001; Yquel et al. 2002). Although creatine has been shown to be an exceptionally safe supplement in all the research studies to date, it may not be appropriate for everyone. People with impaired kidney function might be wise to avoid creatine supplements at this time.

Whey Protein
Whey protein has been the protein supplement of choice for athletes and active people and for good reason. Although performance would probably not be affected by the simple addition of whey to a person's diet, active people, certain athletes, and older individuals are known to require additional protein. Considering that whey has the highest biological value of any protein yet studied and offers additional health benefits, it is no wonder it is the number one selling protein supplement on the sports market. Whey is a true crossover product. Although it has become a staple for most athletes, its confirmed ability to prevent cancer in animals, increase immunity, raise glutathione levels, and possibly retain muscle mass makes it a true health product in its own right. People would be wise to see it that way.

Thermogenic Compounds
One of the perhaps more controversial supplements, ephedrine/caffeine (EC) mixture, has been shown to improve performance in several ways. Athletes and active people like to take an EC mixture prior to exercising for increased energy levels. There is also no doubt that it improves fat loss when a person is on a reduced calorie diet, and studies that looked at the combination show it clearly helps to reduce body fat while preserving muscle mass (Astrup et al. 1992a; 1992b). Some studies suggest that the addition of aspirin to the EC combo enhances the thermogenic effect, however, a head-to-head comparison has yet to be done.

Although the potential side effects of the EC products have been greatly overstated by the "don't confuse us with the facts" media, EC products are not for everyone. Studies have shown the side effects to be usually mild, transient, and short-lived (Greenway 2001). Because EC products and pseudoephedrine are stimulants, anyone with high blood pressure, persons using MAO inhibitors, pregnant women, and men with benign prostate enlargement are warned to not use EC products. at this time. It is also important not to take more than 16 mg of ephedrine and 40 mg of caffeine in any one dose before exercise. As already mentioned, persons with hypertension should not take any EC product before heavy exercise. Pseudoephedrine is now available in place of ephedrine.

The proper use of natural thermogenic compounds, such as ephedrine , pseudoephrine, and caffeine, may be as an energy "pick-me-up" prior to exercise or as an adjuvant during a weight-loss program. However, t T hese compounds should be used prudently and are not for everyone, although the research to date has shown them to be quite generally safe (Boozer et al. 2002; Kalman et al. 2002). It is important to understand that L l osing weight using EC products is a gradual process that takes about 3 weeks of moderate dosing in order for the body to start burning significant body fat.

Ephedrine has currently been replaced by pseudoephedrine in the over-the-counter market. Ephedrine is still naturally available in herbal products such as Ma Huang.

Exercise has its ups and downs. The key to making it exercise work for you is to understand the benefits that lifelong exercise can offer, and evaluate the many options available to those looking for a supplement regimen that may help offset the risks involved with such activities. The following supplements can help protect the body against the adverse effects of exercise and improve performance.

1. A multinutrient formula called Life Extension Mix provides optimal potencies of N-acetyl-cysteine, bioflavonoids, vitamins E and C, and magnesium, along with other nutrients that can help protect against excess production of free radicals generated during exercise. The suggested dose is 3 tablets three times a day.
2. In addition to Life Extension Mix, 1 capsule a day of Gamma E Tocopherol/Tocotrienols should be taken to provide the critical gamma form of vitamin E need ed to balance the alpha form contained in Life Extension Mix.
3. Enhanced Whey Protein (with added lactoferrin) is an immune booster, which helps to increase glutathione levels and enhance antioxidant action, as well as will provide the additional protein that is needed for physical exertion and endurance, 2-4 scoops daily for athletes and body builders. Each scoop supplies about 20 grams of whey protein isolate.
4. To improve joint health and function, the following supplements may be taken:
   • Glucosamine/Chondroitin 500/500-mg capsules, 2-8 capsules daily
   • SAMe, one 400-mg tablet daily
5. Essential fatty acids will help protect joints by lowering levels of damaging inflammation. Super GLA/DHA contains a balanced formula of gamma-linolenic acid (GLA), docosahexaenoic acid (DHA), and eicosapentaenoi n c acid (EPA); 6 softgels daily are recommended.
6. Vitamin K helps reduce inflammation and promotes bone health; one 10-mg Super K softgel daily.
7. Essential trace minerals are often lost during strenuous exercise. While Life Extension Mix provides most of these minerals, it would be advisable to supplement with 1000-1500 mg of elemental calcium. This could be accomplished by supplementing with 5 capsules a day of calcium citrate.
8. The following supplements will enhance mitochondrial energy:
   • CoQ10, 100-200 mg daily
   • L-carnitine (or acetyl-L-carnitine), 1000-2000 mg daily
   • Alpha-lipoic acid, 250-500 mg daily
9. Creatine monohydrate in micronized form is recommended in maintenance doses of 2-5 grams a day. Athletes sometimes take 10 grams a day of creatine before explosive exercise of short duration. (Avoid creatine NGH if there is kidney impairment.)