Month: May 2024

Ozempic for weight loss: What coaches (and clients) need to know about GLP-1 drugs

Angela Fitch’s family history of obesity caught up to her at age 40, when she was pregnant with her first child.

As a physician and obesity medicine specialist, Dr. Fitch knew the lifestyle levers to pull—and she had the financial means to yank them hard.

After giving birth, she lifted weights with a trainer twice a week. She sweated through one Peloton workout after another and tracked her food intake on MyFitnessPal.

Nevertheless, for the next decade, Dr. Fitch lost (and regained) the same five to ten pounds. Her blood pressure crept upward. Then came a sleep apnea diagnosis.

As her 50th birthday neared, Dr. Fitch decided to take the advice she gave her patients. She went on medication. (And, she lost 30 pounds.)

In the years since, Dr. Fitch has occasionally stopped her meds. For a few months, she maintains her results.

Eventually, however, the scale climbs back. For now, she’s decided that she’ll be on medication long-term.

If you’re a coach, how does this story land with you?

Does it…

… Make you feel disappointed? Does this seem like a story of someone “giving up” or “not trying hard enough”?

… Inspire you with a sense of awe? That modern medicine has figured out how to treat yet another chronic disease?

… Bring up questions? Like wondering about the effects of being on medication—potentially long-term? (Or if weight loss is even that relevant—so long as a person is eating healthy and exercising regularly?)

Dr. Fitch is now president of the Obesity Medicine Association and chief medical officer of Known Well, a primary care and obesity medicine practice in Needham, Massachusetts. Regardless of how you feel about her story, it illustrates what can initially seem like an inconvenient truth for those of us in the health coaching industry:

Behavior change on its own isn’t always enough.

For many people with obesity, semaglutide (Ozempic, Wegovy, Rebelsus), tirzepatide (Mounjaro, Zepbound), and other glucagon-like peptide-1 receptor agonists (GLP-1 RAs) serve as valuable tools that make significant and lasting weight loss possible.

But for health coaches, these drugs can seem like an existential threat.

You might wonder:

‘Who needs a nutrition coach or a personal trainer when people can get faster, easier, and more dramatic results with drugs?’

However…

People need health coaches now more than ever.

In this story, we’ll explain why—and show you how to turn “the golden age of obesity medicine” into a massive career opportunity.

With fat loss, there’s no such thing as an “easy way out.”

To manage diabetes or treat cancer, most people consider it normal and natural to combine lifestyle behaviors with prescription medicine.

No one would tell someone with cancer, “You’re on chemo? Way to take the easy way out!”

However, that’s what many people with obesity hear when they mention medication or surgery.

For decades, much of society hasn’t viewed obesity as the disease that it is.

Instead, people have seen it as a willpower problem.

The remedy: “Just try harder.”

However, rather than motivating people to succeed, this “remedy” often encourages them to give up. (More importantly, the willpower theory isn’t based on science.)

In reality, people with obesity likely have as much willpower as anyone else.

However, for them, fat loss is harder—because of genetics and physiology, along with social, cultural, behavioral, and/or environmental factors that work against them.

Why is it so difficult to lose fat?

Imagine life 150 years ago, before the invention of the automobile. To get from point A to point B, you had to walk, pedal a bicycle, or ride a horse.

Food was often in short supply, too. You had to expend calories to get it, and meals would just satisfy you (but not leave you feeling “full”).

Today, however…

“We live in an obesogenic environment that’s filled with cheap, highly-palatable, energy-dense foods [that make overeating calories easy, often unconsciously], and countless conveniences that reduce our physical activity,”
says Karl Nadolsky, MD, an endocrinologist and weight loss specialist at Holland Hospital and co-host of the Docs Who Lift podcast.

You might wonder: Why do some people gain fat in an obesity-promoting environment while others don’t?

The answer comes down to, in large part, genetics and physiology.

(Obesity is complex and multifactorial. As we noted above, there are other influential factors, but your genes and physiology are mostly out of your control, and so medication might be the best tool to modify their impact.)

Genetically, some people are more predisposed to obesity.

Some genes can lead to severe obesity at a very early age. However, those are pretty rare.

Much more common is polygenic obesity—when two or more genes work together to predispose you to weight gain, especially when you’re exposed to the obesogenic environment mentioned earlier.

People who inherit one or more of these so-called obesity genes tend to have particularly persistent “I’m hungry” and “I’m not full yet” signals, says Dr. Nadolsky.

Obesity genes also seem to cause some people to experience what’s colloquially known as “food noise.”

They feel obsessed with food, continually thinking, “What am I going to eat next? When is my next meal? Can I eat now?”

Physiologically, bodies tend to resist fat loss.

If you gain a lot of fat, the hormones in your gut, fat cells, and brain can change how you experience hunger and fullness.

“It’s like a thermostat in a house, but now it’s broken,” says Dr. Nadolsky. “So when people cut calories and weight goes down, these physiologic factors work against them.”

After losing weight, your gut may continually send out the “I’m hungry” signal, even if you’ve recently eaten, and even if you have more than enough body fat to serve as a calorie reserve. It also might take more food for you to feel full than, say, someone else who’s never been at a higher weight.

Enter: GLP-1 drugs

In 2017, semaglutide—a synthetic analog of the metabolic hormone glucagon-like peptide 1—was approved in the US as an antidiabetic and anti-obesity medication.

With the emergence of this class of drugs, science offered people with obesity a relatively safe and accessible way to lose weight long-term, so long as they continued the medication.

How Ozempic and other obesity medicines work

Current weight loss medications work primarily by mimicking the function of glucagon-like peptide 1 (GLP-1), which is a hormone that performs several functions:

In the pancreas, it triggers insulin secretion, which helps regulate blood sugar.
In the gut, it slows gastric emptying, affecting your sensation of fullness.
In the brain, it reduces cravings (the desire for specific foods) and food noise (intrusive thoughts about food).

In people with obesity, the body quickly breaks down endogenous (natural) GLP-1, making it less effective. As a result, it takes longer to feel full, meals offer less staying power, and food noise becomes a near-constant companion, says Dr. Nadolsky.

Semaglutide (Ozempic, Wegovy, Rybelsus) and medicines like it flood the body with synthetically made GLP-1 that lasts much longer than the GLP-1 the body produces. This long-lasting effect helps increase feelings of fullness, reduce between-meal hunger, and muffle cravings and food noise.

Interestingly, by calming down the brain’s reward center, these medicines may also help people reduce addictive behaviors like problem drinking and compulsive gambling, says Dr. Nadolsky.

The growing effectiveness of weight loss drugs (especially in combination with lifestyle modifications)

Researchers measure a weight-loss medicine’s success based on the percentage of people who reach key weight loss milestones.

For example, most people start to see health benefits after losing five percent of their weight—and remission from disease after losing around 20 percent.

As the chart below shows, weight loss medicines have become increasingly effective at helping people to reach both milestones.

Medicine
% of people who lose 5% of their weight
% of people who lose >20% of their weight

First-generation weight loss medicines (Qsymia, Contrave, Metformin) 4 5 6
53-80%
10-20%

Semaglutide (Ozempic, Rybelsus, Wegovy) 7 8
86%
32%

Tirzepatide (Mounjaro, Zepbound) 9 10
85-91%
50-57%

Retatrutide (not yet FDA approved) 11 12
92-100%
80-83%

How do weight loss medications compare to traditional interventions?

In the past, weight loss interventions have focused on lifestyle modifications like calorie or macronutrient manipulation, exercise, and sometimes counseling.

Rather than pitting lifestyle changes against weight loss medicines or surgery, it’s more helpful to think of them all as tools.

As the graph below shows, the more weight loss tools someone uses—including coaching—the more significant the results.13 14 15 16

Fat loss often comes with powerful health benefits

For years, the medical community has told folks that losing 5 to 10 percent of their body weight was good enough.

Partly, this message was designed to right-set people’s expectations, as few lose much more than that (and keep it off) with lifestyle changes alone.

In addition, this modest weight loss also leads to measurable health improvements. Lose 5 to 10 percent of your total weight, and you’ll start to see blood sugar, cholesterol, and pressure drop.17

However, losing 15 to 20 percent of your weight, as people tend to do when they combine lifestyle changes with second-generation GLP-1s, and you do much more than improve your health. You can go into remission for several health problems, including:

High blood pressure
Diabetes
Fatty liver disease
Sleep apnea

That means, by taking a GLP-1 medicine, you might be able eventually to stop taking several other drugs, says Dr. Nadolsky.

Experts suspect GLP-1s may improve health even when no weight loss occurs.

“The medicines seem to offer additive benefits beyond just weight reduction,” says Dr. Nadolsky.

Research indicates that GLP-1s may reduce the risk of major cardiovascular events (heart attacks and strokes) in people with diabetes or heart disease.18 19 20 In people with diabetes, they seem to improve kidney function, too.21

The theory is that organs throughout the body have GLP-1 receptors on their cells. When the GLP-1s attach to these receptors in the kidneys and heart, they seem to protect these organs from damage.

For this reason, in 2023, the American Heart Association listed GLP-1 receptor agonists as one of the year’s top advances in cardiovascular disease.

Ozempic side effects

You’ve likely heard that slowed gastric emptying from GLP-1s can lead to nausea, constipation, and other GI woes.

That’s all true.

However, for most, these side effects are manageable, especially with the help of a few key strategies (which we’ll cover later).

For now, however, we’d like to hash out a particular downside you’ve likely heard about from the media—because it offers a huge opportunity for health coaches.

When people take GLP-1 weight loss medicines, about 30 to 40 percent of the weight they lose can come from lean mass.22 23 24

Put another way: For every 10 pounds someone loses, about six to seven come from fat and three to four from muscle, bone, and other non-fat tissues.

This statistic has been broadcast among many media outlets in recent weeks as a dire warning against taking Ozempic, Wegovy, or Zepbound.

Such stories often fail to mention two important caveats:

Caveat #1: People with severe obesity generally have more muscle and bone mass than others.

To understand why, imagine you were forced to wear a 100- or 200-pound body suit every day for a year. Everyday activities—getting in and out of chairs, walking to and from the mailbox, climbing steps into a building—would feel like a resistance workout.

That’s likely partly why bariatric surgery patients experience a nine-year extension on their life expectancy, despite 30 percent of their weight loss coming from lean mass. They have more muscle than average to begin with, and therefore can safely lose some.25 26

For people with severe obesity, the health boost from body fat loss offsets the health risk of muscle and bone loss, says Dr. Fitch.

That said, there’s a caveat to the caveat: People who are only 30 pounds or so overweight may not be starting out with muscle and bone mass to spare. Especially if they’re older, they may begin their weight loss journey already under-muscled, with relatively low bone density. In those people, another drop in lean mass and bone density can add up to big health problems.

However…

Caveat #2: Muscle and bone loss aren’t inevitable.

As Dr. Nadolsky puts it, “Muscle loss isn’t a reason to avoid treating obesity [with medication]. It’s a reason to do more exercise.”

This is where coaches can shine.

By showing clients how to adopt muscle-building behaviors like strength training, combined with adequate protein consumption, you can help people offset the worst of the side effects when taking these medicines.

The yo-yo problem

GLP-1s are expensive, costing roughly $1000 USD a month. As a result, many insurers either refuse to cover them or limit their coverage to a year or two.

Once the money runs out, people tend to go off the meds—and the hunger and cravings return.

If they’ve done little to change their foundational eating habits, this puts them at a significant disadvantage. If they’re not eating slowly and mindfully and improving satiety with veggies and lean protein, the return of hunger and food noise can be overpowering.

That’s likely why, in one study, participants who stopped taking semaglutide regained, on average, two-thirds of the weight they’d lost.27

Again, here’s another opportunity for coaches…

Use weight loss medicine as a key that unlocks lifestyle changes.

Weight loss medicines don’t render behavior-based strategies obsolete; they make them more critical.

When GLP-1 medicines muffle food noise and hunger, your client will find it easier to prioritize protein, fruits and veggies, legumes, and other minimally processed whole foods. Similarly, as the scale goes down, clients feel better, so they’re more likely to embrace weight lifting and do other forms of exercise.

According to a 2024 consumer trends survey, 41 percent of GLP-1 medicine users reported that their exercise frequency increased since going on the medication. The majority of them also reported an improvement in diet quality, choosing to eat more protein, as well as fruits and vegetables.28

This is great news, because, as mentioned above, lifestyle changes are critical to preserving lean mass and preventing regain, should clients choose to discontinue medication.

When working with clients on GLP-1s, keep the following challenges in mind.

Coaching strategy #1: Find ways to eat nutritiously despite side effects.

The slowed stomach emptying caused by GLP-1 drugs can trigger nausea and constipation.

Fortunately, for most people, these GI woes tend to resolve within several weeks.

However, if you’re working with a client who’s experiencing a lot of nausea, they won’t likely welcome salads into their lives with open arms. (Think of how you feel when you have the stomach flu. A bowl of roughage doesn’t seem like it’ll “go down easy.”)

Instead, help clients find more palatable ways to consume nutritious foods. (For example, fruits and vegetables in the form of a smoothie or pureed soup might be easier.)

Dr. Nadolsky also suggests people avoid the following common offenders:

Big portions of any kind
Greasy, fatty foods
Highly processed foods
Any strong food smells that trigger a client’s gag reflex
Sugar alcohols (like xylitol, erythritol, maltitol, and sorbitol, often found in diet sodas, chewing gum, and low-sugar protein bars), which can trigger diarrhea in some

Coaching strategy #2: Prioritize strength training.

To preserve muscle mass, aim for at least two full-body resistance training sessions a week.

In addition, move around as much as you can. Walking and other forms of physical activity are vital for keeping the weight off—and can help to move food through the gut to ease digestion.29 30

(Need inspiration for strength training? Check out our free exercise video library.)

Coaching strategy #3: Lean into lean protein.

In addition to strength training, protein is vital for helping to protect muscle mass.

You can use our free macros calculator to determine the right amount of protein for you or your client. (Spoiler: Most people will need 1 to 2 palm-sized protein portions per meal, or about 0.5 to 1 gram of protein per pound of bodyweight per day.)

Coaching strategy #4: Fill your plate with fruit and veggies.

Besides being good for your overall health, whole, fresh, and frozen produce fuels you with critical nutrients that can help drive down levels of inflammation.

In addition to raising your risk for disease, chronic inflammation can block protein synthesis, making it harder to maintain muscle mass.

(Didn’t know managing inflammation matters when it comes to preserving muscle? Find out more muscle-supporting strategies here: How to build muscle strength, size, and power)

Coaching strategy #5: Choose high-fiber carbs over low-fiber carbs.

Beans, lentils, whole grains, and starchy tubers like potatoes and sweet potatoes are more likely to help clients feel full and manage blood sugar than lower-fiber, more highly processed options.

(Read more about the drawbacks—and occasional benefits—of processed foods here: Minimally processed vs. highly processed foods.)

Coaching strategy #6: Choose healthy fats.

Healthy fats can help you feel full between meals and protect your overall health. Gravitate toward fats from whole foods like avocado, fatty fish (which is also a protein!), seeds, nuts, and olive oil—using them to replace less healthy fats from highly processed foods.

(Not sure which fats are healthy? Use our 3-step guide for choosing the best foods for your body.)

Coaching strategy #7: Build resilient habits.

It may go without saying, but the above suggestions are just the start.

(There’s also: quality sleep, social support, stress management, and more.)

Most importantly, clients need your help to make all of the above easier and more automatic.

And that’s the real gift of coaching: You’re not merely helping clients figure out what to eat and how to move; You’re showing them how to remove barriers and create systems and routines so their road to health is a little smoother.

That way, if they do need to stop taking medication, their ingrained lifestyle habits (that the medicine made easier for them to adopt) will make it more likely that they maintain their results.

References

Click here to view the information sources referenced in this article.

The post Ozempic for weight loss: What coaches (and clients) need to know about GLP-1 drugs appeared first on Precision Nutrition.

Zone 2 cardio: Flaky fitness trend or worthy pursuit?

Reviewed by Brian St. Pierre, MS, RD

“Cargo pants are back.”

This was the news that Brian St. Pierre, PN’s director of nutrition, broke when we met.

(St. Pierre, a father, found this out via his 12-year-old daughter.)

Why does this matter? Apparently, a certain type of exercise is running a parallel cycle: An old trend resurfacing as a new “it” thing.

Cardio’s back, baby.

Specifically, zone 2 cardio—also known as steady state cardio, low intensity steady state cardio (LISS), or what your treadmill may call the “fat burning zone” (more on this term later).

When I got into the fitness industry over a decade ago, cardio was at its peak of being disrespected.

“Are you trying to lose all your muscle??” the naysayers said.

St. Pierre—who’s coached top athletes in the NBA, NFL, MLB, and the NHL—remembered:

“You either did intervals, or you lifted. Maybe both. Steady state cardio was for endurance athletes only.”

Now, as steady state cardio makes its triumphant return, interval training seems to be getting tagged as overrated. (Lifting, of course, is as badass as ever.)

So, what’s the deal? Is there a “best” form of cardio? Is zone 2 exercise worthy of the hype?

In this article, you’ll find out. You’ll also learn:

What zone 2 cardio is (and how to know when you’re “in it”)
How much zone 2 cardio you should do per week to reap the health and fitness benefits
How zone 2 cardio compares to other forms of exercise
What the potential downsides of zone 2 cardio are—and how to mitigate them

Let’s get to it.

What is “zone 2 cardio,” anyway?

St. Pierre struggled to give a simple answer to this question. Not because he didn’t know, but because it’s a trickier question than you might think.

In a nutshell though:

Zone 2 cardio is sub-maximal aerobic training—meaning, aerobic exercise that’s performed below your maximum effort.

But St. Pierre offers some caveats:

“Zone 2 training could mean different things in different contexts,” he says.

“How elite athletes measure and train zone 2 is going to be different from what my mother would be doing.”

Elite endurance athletes use precise (often expensive) tools to ensure they’re in zone 2 (such as lactate meters and power meters). They strive to improve zone 2 fitness to maximize performance.

Regular people, though, tend to train in zone 2 without using gadgets—just some simple body awareness cues—with the likely goal of improving overall health.

Zone 2 cardio examples

Any intentional physical activity that feels stimulating, but still relatively easy—like you could go for an hour, or even hours—counts as zone 2 cardio work.

For example:

Casual cycling
Using the elliptical machine
Hiking or walking uphill
Rucking (walking with a weighted backpack or vest)
Slow jogging on flat terrain
Rowing (using a machine, or if you’re lucky, a canoe on a calm lake)

Zone 2 cardio compared to other cardiovascular “zones”

Different levels of exertion—as measured by heart rate—are categorized into five different “zones.”

(This is a common model, but here are other zone models that have seven zones. And models that are based on power rather than heart rate. See how quickly this can get complicated?)

Each zone will use different energy sources at different rates, and will have unique benefits, as the table below shows.

Zone
% of Max Heart Rate
Main Energy source*
Feels like…
Examples
Benefits

1
<60%
Fat
Comfortable; can nasal breath easily and hold a conversation
Walking or light household activities
Increases overall activity, improves blood flow

2
60-70%
Fat
Can maintain nasal breathing, but not comfortably
Light jogging, hiking, cycling, elliptical
Improves aerobic base without impeding recovery

3
70-80%
Fat and carbs
Tough to maintain a conversation; will need to start breathing heavier
Jogging or cycling at faster pace (but not sprinting)
Improves aerobic and anaerobic fitness, and lactate threshold

4
80-90%
Carbs
Huffing and puffing; might be able to get out a few words
Running, cycling or using a machine for for 1-4 minute sprints
Improves power output, VO2 max, lactate threshold, and overall athletic performance

5
>90%
Carbs
Near or at maximal effort; heart pounding and talking is impossible
Maximal sprinting
Improves VO2 max, heart rate max, and fitness at maximal levels

*Exercise intensity is the most important determinant of which energy source is used during exercise. However, the proportion of energy sources used is affected by several factors, including exercise duration, age, sex, body composition, training status, and diet.

Three big benefits of zone 2 cardio

So, why might you incorporate zone 2 cardio work into your routine (or suggest your clients do the same)?

Let’s discuss three strong arguments for jumping on this trend.

Benefit #1: It builds your aerobic base.

St. Pierre offers this analogy:

“Imagine your overall cardio fitness is a pyramid: The base is your aerobic fitness, and the top is your peak anaerobic fitness,” he says.

“If you only train the peak, the structure is top heavy; it’s not built to last.”

This is one of the biggest assets of zone 2. Training at the peaks may be fun (in a masochistic way), but it’s not the best way to build your base.

To see how this works, let’s use an example with St. Pierre’s sport of choice: Hockey

On the ice, you’ll be mostly fueled by the anaerobic system.

With a strong aerobic base, you’ll recover quickly between “sprints” on the ice while resting on the bench.

Without a good aerobic base, your body may actually stay in an anaerobic state while you’re bench-warming. This not only inhibits recovery; it also drains precious energy reserves.

(And if you burn through your reserves in the first period, those second and third periods are going to suck.)

This ability to adapt to changes in physical demands is called metabolic flexibility4—and zone 2 cardio is particularly good at enhancing it.

With good metabolic flexibility, your body can toggle between energy sources as needed (instead of using mostly glucose or mostly fat all the time) to power activity, leading to better endurance, power, and performance.

Benefit #2: It’s exercise that gives more than it takes.

Intense workouts are both mentally and physically draining. They also “cost” a fair bit, from a recovery perspective.

Not zone 2 exercise.

“Zone 2 cardio may even help your recovery in between sessions,” says St. Pierre. “At worst, it’s going to be recovery neutral.”

Cycling on a bike at a relatively low intensity for 45 minutes might not be the most fun, but it’ll improve your overall fitness without adding much stress or demanding recovery in the same way intervals would.

If you have time to train five hours per week, but only have the energy to train all out for two to three hours, that still leaves you with time to train—just at a lower intensity.

Many folks have an “all or nothing” mindset and get mad at themselves for not being able to train like a beast for all five hours. But you don’t need to. Three hours of intense training and two hours of low intensity training is amazing.

Benefit #3: It boosts mitochondrial health—which might help you live better, longer.

One of the promises of zone 2 is that it can improve mitochondrial health.

Better mitochondrial health means a lowered risk of many diseases, such as type 2 diabetes, cardiovascular disease, metabolic syndrome, and cancer.5

Zone 2 cardio might be the most effective form of exercise to maximize mitochondrial health6 (though the research supporting this has participants doing many hours of zone 2 work per week).

Fortunately, all physical activity—including interval and resistance training—supports and improves mitochondrial health.7 8 9

Plus, effectiveness is a spectrum. Obsessing over having “the best mitochondrial health possible” is pointless if you can’t consistently perform the amount of exercise it takes to get there.

“How do I know if I’m in zone 2?”

Understandably, many people (including your clients) will ask. There are several ways to assess if you’re in zone 2, ranging from “fancy and high-tech” to “luddite-approved.”

Tracking method #1: Gadgets

If you’re a high level endurance athlete fixated on tracking hard data, a lactate meter will be your most accurate measurement tool.

If you’re just looking to achieve better overall health and aerobic fitness, you can use a heart monitor. (Try a chest strap or a wearable wrist watch that tracks heart rate.10)

Tracking method #2: Math

If you want to use your heart rate to calculate if you’re in zone 2—which is about 60 to 70 percent of your heart rate max—you first have to figure out your max heart rate.

The simplest way to estimate your heart rate max is to take 220 and subtract your age. Calculate 60 to 70 percent of that number, and you’ll get your target zone 2 heart rate range.

For example, if you’re 42 years old:

220 – 42 = 178 beats per minute is your maximum heart rate

0.6 (or 60%) x 178 = 106.8

0.7 (or 70%) x 178 = 124.6

So, if your heart rate is between 107 and 125 beats per minute, that puts you in zone 2.

(Another common approach: Take 180, subtract your age, and that’ll give you the top of your zone 2 range.)

Of course, if you’re in that range and can’t talk, nasal breath, or focus on anything other than just… keep… going, you’ll know you’re not in zone 2.

Sometimes, the body knows best. Which brings us to…

Tracking method #3: Body awareness

Without gadgets or formulas, can tell if you’re in zone 2 if:

You’re doing a form of cardio that requires effort—but also feel like you could perform it for an extended period of time
You can breathe through your nose
You can talk (but perhaps not sing very well)
You could pay attention to a podcast, movie, or have a thoughtful conversation

As St. Pierre eloquently put it:

“When you’re done with your session, you should be able to say you could do it again if not for time and boredom.”

TL;DR: Zone 2 work shouldn’t crush you.

How much zone 2 cardio should you do per week?

The shortest (and most practical) answer: Whatever you can fit in.

If you have more time and want some specificity, the WHO and the CDC suggest between 150-300 minutes of moderate-intensity aerobic activity per week.11 12

Weekly, that could look like three 30 minute-sessions, two 45 minute-sessions, or one longer 90-minute session.

But don’t get bogged down by specifics. Any cardio is great if you haven’t been doing any.

How long should zone 2 cardio sessions be?

You’ll commonly hear sessions need to be at least 45 minutes.

Your aerobic system doesn’t fatigue easily during zone 2 work, so duration is somewhat important if you’re aiming to maximize adaptations.

If you go with the WHO and CDC’s guidelines, two to three 45 to 75 minute sessions of zone 2 cardio per week is pretty ideal. (Note: If you’re a competitive athlete, you’ll probably need more.)

But if you can only fit in 25 or 30 minutes a week total, it’s not pointless.

“Any amount of activity improves health, so while yes, more is better, anything you can get in will make a difference for your wellbeing,” says St. Pierre.

You may not get the maximum benefits by doing less, but you’ll experience many amazing health improvements by getting in some cardio.

Factor in your goals.

Don’t get so fixated on zone 2 that you dedicate all your workout time to it and lose the benefits you can get from other kinds of training.

And, consider your fitness priorities.

If you want to build muscle and strength, resistance training should be the focus of your training. (In other words: Don’t cut your strength workouts in half just to squeeze in ideal zone 2 training targets.)

“I hate cardio” and other barriers to zone 2 work

Have you ever seen the show Suits? It’s not the Sopranos, but it’s entertaining and full of tea.

St. Pierre hadn’t seen it—that is until he started watching it while doing zone 2 work on his bike at home.

Zone 2 training isn’t his favorite way to train. With this, he found a way to make it enjoyable.

If you hate cardio, find ways to turn down the suck.

Here are a few ways to do that.

Consume that sweet, sweet content.

Whether it’s watching a fun TV show or listening to an audiobook or podcast, you can offset the tedium of zone 2 cardio with something you enjoy.

Play.

You can also get zone 2 work with sports or various leisure activities.

Personally, I like to shoot around the basketball with my heart rate monitor on. (Yes, there will be times I’m at a higher heart rate zone than what is truly zone 2, but that’s okay. I’m not an elite endurance athlete, so precision isn’t crucial.)

Grab your frisbee, pickleball racket, or ball-of-choice, and have fun.

Make it work with your schedule—and life.

“I just don’t have the time.”

If this is your primary obstacle, incorporate zone 2 cardio in a way that supports your life.

Some examples:

If you can, bike to commute to work. Especially in busier cities with lots of traffic, this can actually be more time efficient than driving or taking transit.
Run your errands with a purpose. Walk briskly to the store (or around the mall), and carry your groceries if you can.
Do domestic chores like you mean it. More laborious house work such as cutting the grass, shoveling the snow, or vacuuming—anything that takes a while and takes some effort—counts.
Run around with other animals. Your kids and your pets are hard to keep up with, right? Make their week and chase after them at the park or local rec center. Alternatively, pull them in a wagon or take a brisk walk pushing the stroller.

If these activities don’t keep you in zone 2 the entire time, that’s okay. These are just ideas for those who simply don’t have the time for more structured cardio.

Start with less.

If 45 minutes of anything still sounds like too much, just start with 10 minutes. You can always build up from there.

Ignore what’s optimal, and integrate what’s practical.

Something is truly better than nothing. (If you’re strapped for time, remember that line.)

Another tool in the kit

Trends in the fitness industry are cyclical. (Kind of like trends in pants-with-pockets.)

Training styles will come and go. When one comes back in, remember this and temper your response. Nothing—no food, exercise, or supplement—is a magic bullet.

The zone 2 cardio trend has been awesome for re-inspiring folks (including myself and St. Pierre) to do more cardio.

It’s also been confusing to some, leaving them even more stressed about how to train “the optimal way.”

At PN, we’re less fussed about what’s theoretically optimal than what’s practically optimal. Do the best you can. Find activities you enjoy. And do those consistently.

References

Click here to view the information sources referenced in this article.

The post Zone 2 cardio: Flaky fitness trend or worthy pursuit? appeared first on Precision Nutrition.

How to live the longest, healthiest life possible

None of us is getting any younger.

Take it from someone who’s old:

You don’t want to reach the Age of Senior Discounts with regrets about all the things you didn’t do to prepare your body and mind.

Fortunately, there’s a lot you can do, at any age.

In the following article, we’ll cover the best practices for aging well—preserving longevity, quality of life, and healthspan. They include:

The very short list of things you should avoid.
The much more detailed list of what you can do to get the most out of the time you have.
The most impactful way to combine a healthy life with a happy life.

Some are easy. Some take more effort. Many are common sense. All are supported by research, some of it going back decades.

But before we get into all that, we’ll start with something more fundamental.

Why do we get old?

Despite centuries of medical breakthroughs, everyone who’s been lucky enough to get old either has died or will die.

There’s a reason no one’s been able to find a loophole.

“Virtually all of our genes, and all of our vital systems, play a role in aging,” says biochemist Charles Brenner, PhD, chair of the Department of Diabetes and Cancer Metabolism at City of Hope National Medical Center.

Because there’s no “lone gunman”—no single gene that goes gray and takes everything else down with it—there will never be a single pill, potion, or practice to stop the process, let alone reverse it.

It doesn’t matter how much money goes into the search for an “off” switch.

“The anti-aging industry has been full of grifters for thousands of years,” Brenner says. “Overpromisers and underperformers.”

The modern roots of the industry go back to 1990, when a study in the New England Journal of Medicine showed promising results from administering human growth hormone to older men.1

It was a small study—just 12 men received hGH, with nine comparable participants serving as a control group.

But the results “were sensationalized by the press in a number of exaggerated reports,” according to biologist Richard F. Walker, PhD.2

That was enough to jump-start an anti-aging “gold rush,” Walker wrote—one that was commercialized from the jump.

The money is bigger today, with tech billionaires investing crypt-loads of cash in life-extension startups.3

But the problem they keep running into remains the same, Brenner says:

In terms of lifespan, humans have already exceeded the intended “warranty.”

What he means is that humans evolved to satisfy five basic priorities:

Avoid predation.
Acquire food.
Attract a mate.
Together with your mate, turn food into babies.
Make sure your babies live long enough to produce babies of their own.

If we had stopped there, we would be similar to all other animals. We would live as long as we’re reproductively capable, and then we’d expire.

But in the 300,000 generations since hominids split off from the great apes, we doubled our life expectancy.

That allowed some of our ancient ancestors to become active grandparents, which was a huge evolutionary advantage.4

Life expectancy doubled again in the past two centuries, thanks to breakthroughs in sanitation, nutrition, medicine, hygiene, and public safety.

And yet, despite all those gains in average lifespan, there remains a hard cap on maximum lifespan.

That’s because the aging process begins at birth and never stops.5

Once you get past your growth stage, your body becomes progressively less capable of repairing tissues and maintaining vital structures and functions.6

Two systems in particular drive the aging process.

The first is metabolism.

Your metabolic rate declines about 0.7 percent per year in your sixties and beyond. If you live to 95, your daily energy expenditure will be about 20 percent lower than it was in your late 50s.

That’s according to research from an international consortium of scientists who crunched four decades’ worth of metabolic data on thousands of participants of all ages.7

The problem isn’t just that elderly people lose muscle. Their remaining lean mass also burns fewer calories. That includes energy-hungry organs like the brain and liver. A slower metabolism means you’re more likely to store fat in your muscles, liver, heart, and other places it doesn’t belong.

Intramuscular fat, for example, is linked to lower strength and mobility, as well as elevated blood sugar and higher insulin resistance.8

The second is cognition.

With advancing age comes a long list of declining cognitive abilities:9

You’ll remember things less accurately, and take longer to pull up the memories you retain.
You’ll struggle to learn new words, and to recognize and retrieve words you already know.
New skills will be harder to master. It will also be harder to use your current skills in complex sequences.

The combination of physical and cognitive decline means you’re less able to do what you know how to do, and less capable of adapting to your changing circumstances.

But while the process itself is inexorable, there’s a lot you can do to slow it down.

How to age well: 4 evidence-based strategies

If you asked an expert to make a list of healthy aging strategies, it would probably have two parts. You’d expect the “do this” section to be more substantial, as it is here.

But it’s on the other side of the list that you’ll find your first line of defense against physical and mental decline.

“What you don’t do is at least as important as what you do.”

That’s according to Brian St. Pierre, MS, RD, Director of Performance Nutrition for PN.

You can probably guess most of the potential life-shortening behaviors:

Overeating
Smoking
Drinking to excess
Using non-prescription drugs to excess
Excessive unprotected sun exposure
Inactivity

All those things—along with infectious diseases and environmental pollutants—are what Brenner calls metabolic insults.

They all stress your metabolism and make it more difficult for your body to repair itself. (That’s the focus of Brenner’s research at City of Hope.)

On the proactive side of the list, you’ll probably find aspirational targets like:

Get a minimum of 150 minutes a week of moderate-intensity cardio, and do some form of resistance exercise twice a week.
Get seven to eight hours of sleep a night.
Maintain a “healthy” body weight, defined as a body-mass index (BMI) between 18.5 and 24.9.

The problem is, very few of us have the energy or ambition to check every item on the list. Just 6.3 percent of Americans collect the entire set, according to a 2016 study by the U.S. Centers for Disease Control and Prevention.10

So, from a public-health perspective, you could say the glass is 93.7 percent empty.

Or, from a personal perspective, you could pick and choose which practices and behaviors will have the most impact on your own health—and, by extension, give you the best chance for a long, satisfying life.

Make those your “big rocks,” the things you value most and will continue doing as long as possible.

Healthy aging strategy #1: Move more and preserve muscle.

In studies going back to the last century, participants who increased their levels of physical activity lowered their risk of dying of any cause by 15 to 40 percent.11

What does that mean?

Let’s look at one study:

Starting in the late 1970s, the British Regional Heart Study recruited thousands of middle-aged men. More than 3,000 were still in contact with the researchers 20 years later. By 2016, just over half of them had died, according to public records. 12

Participants who told researchers they increased their activity level were 24 percent less likely to die of any cause, compared to those who reported moving less.

Those who sustained modest activity levels were 17 percent less likely to die than the low-activity group.

Studies show even more powerful benefits when participants push themselves hard enough to increase their cardiovascular fitness.

Simply moving up from the lowest level of fitness—usually the bottom 20 percent of the study population—to a higher level significantly decreased the risk of dying of any cause in the following years.11

Moreover, the protective benefit of cardio fitness appears to be linear. That is, the higher your fitness level, the lower your risk of dying during any particular window of time.13

You don’t need to lose weight to get the benefits of fitness

If you’re among the two-thirds of Americans with a BMI of 25 or above (full disclosure: I’m with you), you can mitigate any potential weight-related disease risk through exercise and diet.

Studies show, for example, that increasing your maximum aerobic capacity (a.k.a. VO2 max), is consistently linked to lower all-cause mortality among participants classified as overweight and obese, even when they don’t lose weight in the process.11

Muscular strength and muscle mass are also correlated with a lower mortality risk.

So is resistance training—the process of trying to increase your strength and size—especially when it’s combined with cardio exercise.14,15,16

Finally, there’s walking speed. It’s one of the least known but most powerful predictors of who’ll live the longest.17,18 Which makes sense: Walking at a brisk pace requires a mix of muscular strength, cardio fitness, balance, and mobility.

You can make all of the above as simple as this:

“Move every day,” says Stuart Phillips, PhD, director of McMaster University’s Physical Activity Centre of Excellence, where he works closely with older adults who live near the campus in Hamilton, Ontario.

“Without daily movement, you go downhill fast.”

The specifics don’t matter nearly as much as the fact you’re doing something.

Healthy aging strategy #2: Upgrade your meal pattern.

A healthy diet, one based on minimally processed whole foods, also helps prevent many of the chronic diseases associated with aging, St. Pierre says.

Those foods include:

A wide variety of fruits and vegetables
Lean protein from both plant and animal sources
High-quality carbs (whole grains, beans and legumes, and tubers)
Fibrous fats (nuts, seeds, avocadoes) and extra-virgin olive oil and other cold-pressed oils

“The biggest thing to emphasize is the overall pattern,” he adds. “Whether you eat more carbs or more fats is a personal preference.”

Getting a variety of foods within each category is helpful. That’s especially true for fruits and vegetables. You’ll not only get an abundance of key vitamins and minerals, the water they contain will also help keep your body hydrated.

That’s important because, the older you get, the greater your risk of dehydration.

“It’s far more common in the elderly, due to medications and a reduced sense of thirst,” St. Pierre says. “And it can impact physical and mental health more profoundly in that group.”

Healthy aging strategy #3: Prioritize high-quality sleep.

Generally speaking, people who sleep less than seven or more than eight hours a night, and who go to bed and wake up at unpredictable times, are at higher risk for pretty much everything—obesity, diabetes, cardiovascular disease, and death from any cause.20,21

Establishing a regular, consistent sleeping-and-waking routine is probably the most powerful way to improve your sleep quality. (Bonus: It also helps to start that routine before midnight.)

One of the most impactful strategies to use to encourage good sleep is to employ a nightly bedtime ritual.

Just like Pavlov’s dogs learned to salivate at the sound of a bell, your body can learn to wind down with a custom-tailored pre-sleep routine.

About 30 minutes to an hour before bedtime, wrap up any stimulating activities (working, doomscrolling, intense exercise) and switch to activities that promote physical and mental relaxation. For example, read, take a bath or shower, do a mini yoga routine, or watch a favorite show.

Dim the lights, and maybe lower the thermostat a few degrees.

If you’re the ruminating type, consider doing a “brain dump.” Take a few minutes to write out a list of whatever’s bugging you: Emails you need to send or reply to, calls you have to make, project ideas, creative thoughts, that thing you should have said to that person…

Whatever’s on your mind, get it out of your head and onto your list.

(For more advice on how to engineer an excellent night’s sleep, check out our infographic: The power of sleep)

Healthy aging strategy #4: Deepen your human connections.

There’s one more key to a long, healthy life.

It’s something you can’t get with exercise, nutrition, or sleep. It’s impervious to wealth, fame, or professional achievement.

Tech bros can’t buy it, big pharma can’t replicate it, and longevity hustlers can’t sell it.

Good relationships, it turns out, are the ultimate life hack.

That’s according to the Harvard Study of Adult Development, which began in 1938 and continues today with the descendants of its original participants—Harvard undergrads (including future U.S. president John F. Kennedy) and teenage boys from underprivileged backgrounds.22

Robert Waldinger, MD, is the study’s fourth director. In his 2015 TED talk, he said it’s this simple:

“Good relationships keep us happier and healthier. Period.”

Participants who were most satisfied with their relationships at 50 were the healthiest at 80.

A 2016 study by Waldinger and his coauthors found that octogenarian participants who felt securely attached to their spouses—they believed they could count on them in life’s roughest moments—performed better on memory tests than those who felt less connected.23

“Think about relationships as something akin to physical fitness,” said Marc Schulz, PhD, associate director of the Harvard study, in a recent podcast interview.

To function, they require not just time and energy. At critical moments you also need to reflect on what is and isn’t working for you and the other person. And that applies to all important relationships—family, friends, neighbors, and colleagues as well as life partners.

Put another way: If you want a longer life, it helps to have a life.

References

Click here to view the information sources referenced in this article.

The post How to live the longest, healthiest life possible appeared first on Precision Nutrition.

Best practices for integrative evaluation and treatment: Exploring the importance of learning different modalities

Integrative evaluation and treatment in healthcare are increasingly valued for their comprehensive approach to addressing a variety of client needs.

The post Best practices for integrative evaluation and treatment: Exploring the importance of learning different modalities appeared first on MASSAGE Magazine.

4 Rules for Alleviating Hand Pain as a Massage Therapist

Gain insights into the proper use of fingers and thumbs, with techniques to minimize strain and fatigue. By integrating these principles and alleviating hand pain, massage therapists can ensure sustained success and well-being in their profession.

The post 4 Rules for Alleviating Hand Pain as a Massage Therapist appeared first on MASSAGE Magazine.