Moderate exercise, such as brisk walking, for two and a half hours per week is sufficient to reap health benefits without encountering pitfalls of excessive exercise.
Training at a moderate level, known as zone two training, optimizes mitochondrial health and fat burning, with aim for four to five sessions per week totaling at least two and a half hours.
Heart rate variability (HRV) data collected from wearable devices should be approached with caution, as its clinical benefits and significance in day-to-day wellness are still under scrutiny.
Deep dives
The Benefits of Exercise and the Pitfalls of Excessive Exercise
Exercise is a wonder drug with numerous health benefits, including reducing the risk of cancer, heart disease, depression, and diabetes. Even moderate exercise, such as brisk walking, can have significant positive effects on overall health. However, excessive exercise, typically at the ultra-endurance level, may increase the risk of conditions like atrial fibrillation and coronary calcification. For the majority of people, following the recommended guidelines of two and a half hours of moderate exercise per week is sufficient to reap the benefits without encountering any pitfalls.
Target Heart Rate Training and the Importance of Moderate Exercise
Target heart rate training, often associated with different heart rate zones, can be complex and confusing. However, the main idea is to train at a moderate level where you feel like you're getting a workout but can still maintain it for about an hour. This moderate exercise, also known as zone two training, optimizes mitochondrial health and fat burning. It is recommended to aim for about four to five sessions of moderate exercise per week, totaling at least two and a half hours. While heart rate variability and other wearable data may be intriguing, they often reinforce what we already know intuitively and may not provide significant actionable insights.
The Controversy around Heart Rate Variability and Wearables
Heart rate variability (HRV) is a measure of the variation in time between each heartbeat and has been linked to various health conditions. However, the use of wearable devices in monitoring HRV has raised questions about data accuracy and the clinical benefits of the collected information. While HRV can be a useful marker in certain disease states, such as post-heart attack recovery or heart failure, its general application in day-to-day wellness is still under scrutiny. Patients and users should approach wearable data, including HRV, with caution, as its interpretation and significance are yet to be fully understood.
Heart Rate Variability and the Need for Validated and Interventions
The current challenge with heart rate variability (HRV) lies in the lack of validated data and actionable interventions based solely on HRV measurements. While HRV can serve as a motivator and incentive for individuals to engage in regular exercise and track their progress, there is no specific intervention that can be recommended solely based on HRV data. Validated and clinically proven interventions, such as lifestyle modifications and medications, exist for other important parameters like blood pressure. It is essential to differentiate between parameters that have demonstrated clinical benefits and those that are still being researched for their practical applications.
Apple Watch Study: Limited Benefit in General Population
The podcast episode discusses a study conducted by Apple to evaluate the effectiveness of Apple Watches in detecting irregular heart rhythms. The study revealed that the pretest probability of detecting such rhythms in a healthy and young population was very low. The presence of false positives creates unnecessary anxiety and can lead to additional healthcare costs. As a result, wearing an Apple Watch as a screening tool is not recommended for the general population. However, for individuals with symptoms or those at higher risk, such as the elderly, the Apple Watch may have some benefits in detecting cardiac arrhythmias.
The Hazards of Over-Testing and Over-Medicalization
The conversation delves into the dangers of over-testing and over-medicalization, which can result from the belief that more data is always better. The podcast emphasizes the importance of pretest probability and the potential harms of incidental findings. The example of unnecessary thyroid testing causing harm to a patient is highlighted. The hosts discuss the need for a conservative approach in medicine and caution against excessive testing without clinical indications. While technology like wearables and CGMs hold promise, they should be used judiciously, especially in cases where symptoms are absent or when the benefits outweigh the risks.
Join Dr. Danielle Belardo and her expert of the week, cardiologist and internal medicine physician Dr. Rohin Francis. Rohin is also a writer, comedian, and creator of the YouTube channel Medlife Crisis, where he tackles fascinating and offbeat science topics that don’t get covered elsewhere. On today’s episode, he covers the spectrum of all things exercise and cardiovascular disease related, with a sprinkle of humor (of course), and answers the burning question—is there such a thing as too much exercise? He may also help save you a few bucks as you eye up the latest flashy fitness tracker.
Danielle and Rohin discuss:
How much exercise the average person needs weekly to accrue health benefits
The causes of atrial fibrillation (A-fib) in high-performance athletes
Target heart rate training and the importance of moderate exercise
The advantages and disadvantages of smart tracking health and fitness devices
The data surrounding heart rate variability and what we actually need to worry about
The fascinating results of the Apple Watch study
Harmful physical and emotional effects of medical over-screening
Dr. Rohin Francis is a Consultant Cardiologist and a Doctoral Researcher at the University College London with a passion for science communication and education. Dr. Francis got his MBBS from St George's Hospital Medical School and trained as a physician at the Cambridge Deanery (Cambridge, UK) with a subspecialization in coronary intervention. Currently, Dr. Francis is undertaking a PhD on imaging techniques for acute myocardial infarction at University College London. Rohin has presented around the world and has been published extensively, including in The Guardian and numerous academic journals and websites.
Thank you so much for taking the time to contribute to a generation that values fact over fiction! Be sure to rate, review, and follow on your favorite podcast app and let us know which not-so-wellness trend you’d like to hear debunked. Follow your host on Instagram @daniellebelardomd and the podcast @wellnessfactvsfiction. All studies discussed can be found @wellnessfvfjournalclub. Follow Rohin @medcrisis.
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