Psychiatry & Psychotherapy Podcast - Exercise as a Drug for Mental Health and Longevity with Dr. Stephen Seiler

Episode Date: March 14, 2022

Physical activity has been shown to reduce stress reactivity and reduce all cause mortality. Physical activity also results in decreased psychosocial stress. In this episode, Dr. Puder speaks with Dr. Stephen Seiler about the connection between mental health and physical activity. By listening to this episode, you can earn 1 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CME while listening to this podcast. Go to Psychiatrypodcast.com, sign up, sign in, take the test, and the certification is emailed to you in seconds. Hi, welcome back to the podcast. I am joined today with Dr. Stephen. Siler, he is an exercise physiologist, PhD with hundreds of publications, and he's someone that I got to know from watching your YouTube's and sort of my curiosity led me down that rabbit trail of trying to sort of find top world performers in exercise physiology. And so I thought I would bring you on the podcast today, kind of talk about how we can maybe utilize this in

mental health and talk about maybe things like where different training zones are, what elite athletes are actually doing in terms of training. I think that there's like sort of this thought that, you know, if you're an elite athlete, you're always in this high zone of suffering. And you've, you've had some really good papers showing that. Actually, they're training at a lower intensity than we would imagine. So, yeah, welcome to the, welcome to the, welcome to the, podcast. Yeah, well, thanks. And yeah, I'm a, I'm a physiologist and I used to always joke about how that, you know, you start out as an exercise physiologist. You basically try to forget about the brain. You know, you try to pretend like it's not there because you're interested in cardiovascular function,

muscle function and things like that. But as you, as you go and as you progress, you, you are obliged to understand that it's just this beautiful interaction. between the brain and the body. And so most of my physiology friends end up kind of becoming hobby psychologists, you might say. That's cool. So just before we begin, because we offer continued medical education for these, do you have any conflicts of interest to report? No, not that I am aware of.

I do not. Okay. And tell me a little bit about how you got into this, how many years you've been in exercise physiologists, just introduce yourself a little bit to my audience here. Yeah, well, you know, as a kid, I grew up in the United States, grew up in Texas and Arkansas, and I was one of these kids that just kind of had a split personality in a sense that I really love science. I had a laboratory literally under the stairs that my parents let me set up at, I think, age 10. But at the same time, I really love sports. And so in my mind, sports and this science interest and going out and collecting pond water and looking at it under the microscope and things like that.

Yeah. Those just didn't go together. But then I was reading this book called the Complete Book of Running by Jim Fix, probably 1980, somewhere in there. And discovered this chapter called The Scientists of Sport and just seeing those two words in the same line, you know, scientists in sports. you know, science in sport was just, boy, it was just fascinating. And then by the time I'd read that chapter, I thought, oh, now I know what I want to do. You know, I'm going to be a, I'm going to do this, sport science, you know. And so that was kind of the start.

I was 15 years old. And just really, I thought I was going to be a coach. That was the big dream was to become a football coach. But then I realized, nope, it's going to be something a bit different, a bit more theoretical, a bit more cognitively focused. on research and that you know I didn't really know what I was getting into but but I kind of knew the main topic and and that stuck with me for the rest of my career and so I did the bachelor's and the masters and the PhD and all that it all went in

the same direction from there and then you ended up in in Europe yeah I can't say that was part of the plan that was just as Stephen Pinker wrote in a book he said that our life ends up being a combination of careful planning and random chance. And so I had the careful planning down the academic pathway and then the random chance was just meeting a woman from Norway. Wow. That's how I ended up in Norway.

Okay. Yeah. So, you know, I've talked on my podcast several times about the importance of exercise and how I prescribe exercise and as sort of a treatment, especially for people like depression, anxiety. And then recently I came upon this article and I'll show you, I think I said, sent it over to you, I'm not sure if you got this, but it was looking at the association of cardiorespiratory fitness with long-term mortality. And this was a study where they followed,

you know, a small end group of 122,000 patients over 8.4 years. And the amazing thing about this study was the power of fitness, you know, of performance on this treadmill test. predicting all-cause mortality. So on average, you had 11.2% people that died in the bottom group, which was about 30,000 people, you had 23.7% die. And in the elite level, you only had 2.6% die, which is basically like a 10-fold reduction in all-cause mortality. The hazard ratio, moving from this low-prudely,

performance to the elite level, it was about a 500% difference after they controlled for different variables. And just to give the audience a like quitting smoking was a 30% decrease in all-cause mortality. Moving from the elite level to the low level would be like a 500% so 30% for smoking, 500% for exercise. And so I started to think to myself, how do we, how do we help people, you know, basically get more fit? Because it seems like that's the big thing. I don't know. Any thoughts on this paper or have you seen this kind of? Well, this paper, of course, it's a beautiful paper, but it's very consistent with so many over the course of decades that have in different ways demonstrated this.

relationship between physical activity and health, dating all the way back to, you know, the bus driver study of the 50s where looking at the drivers of the double-decker buses in London versus the kind of conductors that would have to be jumping in and off and on the bus and guiding. And just the physical activity of those conductors versus the people sitting and driving, there was a big difference in mortality. So this, for 50, 70 years, we've had epidemiological data that points in this direction, that our bodies are made to be physically active.

Now, there is a bit of a chicken and egg issue here in the sense that if you have preexisting conditions, if you're already sick, you're probably doing less physical activity and you're performing more poorly on these exercise tests. So, you know what I'm saying? So, yeah, it's an extremely powerful health-promoting exercise activity, but we do have to remember that if you're already sick, if you're already damaged, injured, and so forth, then your ability to move is curtailed.

So there is a bit of a cause-effect issue that we have to keep in mind when we're looking at those risk ratios and so forth. But the other big information or big point from that study and from numerous other studies is that you don't have to become an Olympic champion to get the health benefits. And in fact, the biggest, hugest increase is just moving from, you might say, the sofa to getting out the door three days a week. Yeah. Right?

You know, just that basic, it doesn't have to be a, uh, uh, a, uh, a, uh, a, uh, a, uh, a, uh, a, a, a, a, a, a, a, a, a, a, a, a, a severe demanding training program, but it needs to be reasonably consistent and moving and getting some duration. You know, I think that's one of the people, you know, if we move down this conversation, that's one of the things that people misunderstand is that they think the intensity is the key, that I've got to go hard. I've got to be really panting and struggling because then I get the good effect. And they forget the fact that the duration matters, that going longer is also a fantastic way to increase the effect.

Going out, you know, instead of 30 minutes going for an hour, instead of an hour going for 90 minutes. So we have that scope to work with. But people always are personal trainers and instructors and that, they push the intensity because that's, then they can move people in and out of the spinning class, out of the aerobics class. Are you with me? Yeah. But if you don't sell duration because duration is costly and no personal trainer is going to say, well, you know what? The best thing for you to do today would be to walk for an hour and a half in the forest.

You don't need me. No personal trainer ever says that. So that's one of the problems we have is we get pushed down this intensity kind of path. Yeah. Yeah, I think I want to get there and I want to get to your papers that looked at that. but before we do, there was one other sort of article. So kind of thinking about mortality, the other thing that I was thinking a lot about

was like how exercise helps with depression, with anxiety, with all these mental illnesses, as well as people who are on medications for like schizophrenia, often, like once they're compliant, once they're not psychotic, it's like, how do I get them into exercise? And there's been a bunch of studies talking about stress reactivity and how exercise lowers like how we experience stress, stress. And so there's this interplay on how training the body physiologically and progressing the body

to new levels can change the way that the body handles other stress, psychological stress. Have you seen that how what's been the most powerful interplay between these two worlds that you've seen? Well, I'm going to be careful because I'm not a psychologist. You know, but like I said, it's very difficult not to, the brain is a is a psychophysiological, make. you know, a device. And so there are inner overlap and interplay. And so when we exercise, the brain is receiving as it always is, but the brain is receiving

just an amazing amount of information from the body of so-called afferent feedback from the body, telling us where our limbs are in space, the proprioceptive information, telling us about the chemical state around the muscles, noxiceptors and so forth. there is the perception of effort that's both feed forward and feedback, meaning that part of that perception is just the brain kind of in a feed forward way knowing how much muscle it is recruiting to do the job, but also there's some feedback signals that are influencing all of that.

So all of this interplay is going on during movement, during exercise, and it promotes a kind of a conversation between mind and body related to how do I feel? How much longer can I go at this intensity? So there's, it's been called teleo anticipation. We can, athletes can do this really well, but it doesn't take very long before we can all do it once we start exercising, is that if I say to you, I want you to find a pace that you can hold for one hour that's pretty tough, but you can make it an hour. Within five or eight minutes, you're there.

You found that pace, right? So your brain is already projecting out some rate of fatigue, and it's making a calculation. It says, this is a pace I can hold. But this would be too hard. That's quite an amazing mathematical process of projecting of fatiguing processes and so forth. So the brain learns amazingly, rapidly about these issues, about the body. And I think in doing so, part of that process, the learning kind of builds a,

what we might call it a physical courage or, you know, you become more comfortable with some of the discomfort. Yeah. That there is some discomfort in exercise. If you go long enough, if you're pounding the pavement for a long enough period, your legs start to hurt a bit. And so there's a conversation between your mind and your body that you, you, got the runners high going on, but at the same time, your muscles are saying, yeah, but I'm

running out of fuel here. And I'm taking a beating. And so, so as athletes, when I work with athletes, we talk about that conversation, the conversation, meaning that, you know, you develop, there is a conversation going on. And in anticipation of fatigue, my brain will start to develop strategies. for, you know, saying, you know what, I know this is coming. I know at some point my body's going to say, don't do this. And I'm going to want to keep doing it because I'm going to be racing. And so my brain develops strategies for, you know, resisting or handling that negative feedback, you know. And so that's part of the process of training.

You can't do it every day. But some of those tough workouts, some of those races, we go into that headspace. and we we develop this kind of courage, this, you know, or tools. We develop tools for dealing with that discomfort, that pain of exercise. Because it's sometimes, yeah, it hurts, you know. So don't misunderstand, you know, elite athletes, there's pain involved, there's hurt, there's struggle, there's discomfort, but it's not a daily thing. You can't do it every day.

And that's kind of one of the other issues is that, yeah, there is pain. There is sometimes we need the pain to get the gain, but not every day. And most workouts shouldn't be painful. Yeah. So I think this goes to kind of like my observation of, you mentioned it, you alluded to it earlier. It's like there's these gyms now that it's super high intensity every time you go. And what I see is I see people start it two months, three months. in, they're either injured or they just find some reason to stop and there's not like that

consistency over time, then they kind of like will stop for like six months and then maybe restart when the guilt increases enough that they should be doing something. And one of the biggest contributors that I've seen you add to the to sort of the scientific data is when you looked at what professional athletes actually do. And you spent several papers, of looking at and detailing, actually professional athletes are living under this, like, Zone 2 area for the majority of their workouts for like 80% of their workouts.

Can you talk a little bit about how you kind of discovered that or how you kind of decided to zoom in on this? Yeah, it's probably reasonable to first talk a little bit about defining what we mean with these Zone 2, Zone 1, 3. Physiologically, we often use three zones because we can identify some physiological kind of threshold holds and we end up with the zone one, a zone two, and a zone three, where zone one is very aerobic. It's, it's, we call it often talking pace. If we measure blood lactate, that blood

lactate is quite low. So it's below, it's below two millimals. It's below two. It can be even below one for highly trained athletes with really low, really high slow twitch fiber composition. So it, so two millimolar is not a, it's not like a hard. It's not. It's not like a hard. number, but it's an approximation. And then you have this so-called threshold zone where you can hold that intensity pretty long time, but it's tough. And there's perceptually, it's more, it's more stressful. And it's, you don't really want to be in a conversation when you're there.

So it's not really talking pace. And then you have that third zone where you're above this point of no return, where if you stay there long enough, you will fail. You will fatigue. You will stop because the fatiguing processes are accelerated. Blood lactate climbs. There's lots of different things we can talk about. But it's perceptually very tough, very high ventilation.

You know, you're, that's where you're at. So that's zone three. So then using that framework, you know, then we found that about 80% of the training sessions and maybe as much as 90% of the training duration of, elite endurance athletes is spent in zone one in that talking pace purposeful but but reasonably comfortable intensity and they're there a long time they're collect they're you know accumulating a lot of hours every week there and then there's some in those in zone two and zone three and those those sessions in those higher zones they're important but that relationship that

ratio seems to also be really important. Yeah. So about a year ago, when I was, I came to Florida and I started rowing again. I used to row in college and I had watched your YouTube and it really, you did a YouTube on, it was a TED Talk and you were talking about how actually living in that zone one under two millimole of lactic acid can kind of train you physiologically over time. And so as a former, you know, athlete, I had all this sort of guilt like I needed to go harder or I needed to do more. And so there was something about that that sort of allowed me to go out and just enjoy like being out on the water, you know, trying to get out there and just not like feeling like I had to kill myself out there, but just kind of like, okay, the work I'm doing is important at this lower intensity. In fact, it's amazing because rowing, you know, when I was collecting all this data and trying to make sense of things and that it was some of the rowing data was part of what convinced me that, you know, this is this is important to get out there because the elite rowers, the best rowers in the world, that's what we were seeing is that they were doing so much of their work at, you'll appreciate this, you know, 17 strokes per minute, 18 strokes per minute, low, low stroke rates, low lactate, just, whoosh,

whoosh, you know, that beautiful rhythm of the boat and doing that for, you know, 80, 90 minutes, 100 minutes,

two hours, and then, you know, and then getting out of the boat coming back later in the afternoon and doing it again. And then maybe tomorrow

they would do high intensity a bit, but 90% of their kilometers of rowing, world champion rowers, I mean, beasts, aerobic beasts,

most of their time was spent in that that aerobic zone and don't get me wrong i don't people must say oh that just sounds you just you're making it all sound like they never do any work but that's not true it's it's it's a it's also demanding to row with with intent with purpose with focus for two hours at that low intensity or to cycle for four hours or to you know to run for two hours out in the forest so we shouldn't we shouldn't say that that's easy but it's a different kind of effort It's a different perceptual.

In a given moment, it's not like, you know, out of the 10-point scale, you know, your RPE scale, it's like it's maybe two to three out of 10, right? It's like you're. Yeah, and it will climb during two hours. You know, if it started at two, it may end up at four. It may end up at five. You know, you can go too long. If I, you know, I've got my air quotes going.

So it also depends on your capacity. One of the things I found myself as I got back into endurance training pretty heavily is that my, we use the term durability. My durability has really improved. So now a three-hour cycling session is quite fine for me, whereas when I first started, one hour was plenty. You with me? So I've looked at a bunch of your like graphs that you have on how your heart rate would go up, so you would have like a given watts that you're trying to.

trying to hit and over time initially when you were untrained after you know half an hour hour you're your your heart rate would slowly drift up right and it seems like after you've done your training your heart rate now stays very consistent low at at a given watts for prolonged out of time you can say I'm more durable and that's what we see with with people in general is that if you exercise when you do a lot of that at good basic aerobic training, that your durability increases, meaning that your ability to just sustain a reasonable pace longer without starting to kind of collapse, without your body starting to break down. Because when that heart rate starts drifting up, it's kind of saying, look, I'm running out

of fuel, I'm having to recruit different muscles, I'm having to go into a kind of an emergent emergency modus to continue answering the call that you're asking me to do. And what's happening with more of that training is you're pushing back that point where the body starts to say, you know, you've taken me a bit farther down this road than I'm used to going. And so we all have that point. And of course, there are some athletes that specialize in these ultra events that are particularly good at that long, you know, those amazingly long sessions and they can just push back that

barrier very far, you know. Yeah, there's, okay, so thinking about finding that sort of two-millimal threshold for lactic acid. Yeah. When you're thinking about, like, what is the average heart rate at that place, like let's say someone had like a heart rate monitor, how would you use, what would you say is like pretty normal for that two millimole in someone who's trained versus untrained? All right. Well, I'm going to, I'm going to be careful here. And I'm going to actually assume your audience has a little basic math skills because it's really dangerous to throw out a specific number like a specific heart rate number. So here's what I'm going to tell you. It's really important if you're going to use heart rate as a tool, one, number one,

One, like everything, you've got a start and a stop. You've got a zero and a hundred percent. And so it really is useful to know what is my maximum heart rate. And we're all different. We have, there's a lot of variation. So you'll see these things like use 220 minus your age, for example. Well, that's just wrong. I mean, it's right at a population level reasonably correct.

But it's wrong. It's very often wrong at the end. level. So that would be my first thing to say to your audience is don't fall into that trap of using these standardized equations because at least half of you will be miserably upset because you'll be mistaken and it'll either be making you exercise too hard or too easy because your maximum heart rate is different than what that equation says. So know your max heart rate and there's ways to do that. you know, using intervals and pushing or races or something, and finding out, you know, what's my max?

And being within two or three beats, that's close enough. You know, for example, me on a bike at 56 years old, I've always had a low max heart rate, but my max heart rate is only 165. And I can race and win and do well, so it doesn't have any correlation with performance, but it's not very high, but my resting heart rate is only 36. Wow.

So I have a low, yeah, so. Okay. the second thing you got to know is you need to know your, or it's useful to know your max heart rate, but it's also really useful to know your resting heart rate. And so then now, I know that I got this max heart rate on a bike of 165. I've got this resting heart rate of 36. And so I subtract the one from the other, right? And I get my heart rate range. And that's the number of beats I have to work with, which in this case is what, you know, 129 or something like that. Okay.

So that means that that's what I'm working with. And now, David, I can say, all right, if I want to be at, say, 65% of my maximum aerobic capacity, now what I can do is take 65% of that range that I have, Calculate that with my calculator and then add that to the resting heart rate I have. Now I've got a heart rate number that's going to be pretty well calibrated to actually put me at 65% of my aerobic capacity. Now, that was a lot of math, but it is a much more accurate way. And so what we see is that when we work with endurance athletes, they're spending a lot of their time at a heart rate. that is approximating, you know, 60, 65, maybe 70% of their aerobic capacity, not higher.

So they're doing a lot of that work in that range, which means their heart rate is going to be not usually above 70% of maximum heart rate. Okay? And for a lot of people, you're going to think, oh, my goodness, I've never done a workout in my life that low, you know, because they're always going out hard. But, you know, I literally, I can cycle it 200 wide. and my heart rate is right at 100. You know, I'm at 98, 99, 100, 101,

and I'm at 200 watts for two hours because I've got this low max heart rate, this low rest heart rate, but I'm working. It doesn't feel like I'm doing nothing. And, you know, people say, you can't. 98 heart rate, you're not doing anything. Well, that's not true.

But I could be cycling besides someone who would be at the exact same relative intensity and they might be at a heart rate of 125. You with me? Yep. 130. So this is important. What heart rate for you hits that 2-millimeter place of lactic acid?

About, you know, well, in watts, it's about 220 watts. So about on the bike. On the bike. On the bike. And so 70% of my max heart rate somewhere in there, you know. But what I guess the take-home message I really want people to understand is, is its individual, but it will be often lower than you think. The chances are that if you are a typical exerciser that's in a hurry

and you're walking out the door and you feel like you need to get a good workout in 45 minutes, there's a very good chance that you're ending up spending a lot of your time. It's something more like 85% of your max, 80, 85. You're in that middle zone, that, you know, kind of between red line and yellow. And that's where people do a lot of their training just because we kind of end up there. It's the default or the, it's like a black hole. You know, you get sucked in there.

And there's nothing wrong with doing that occasionally. But if that's where you end up with, end up training every day, then you will stagnate. You will think after a while exercise just isn't that fun. You know, so it creates, it tends to result in what you were. referred to earlier that people start exercising and then they kind of fall off the wagon because it's just not particularly fun to do that every day and even harder. It's either that hard or even harder because then they go to the sessions in the fitness center and now somebody's, you know, ramping up the music and saying now we're going to really work hard today. And you've got to

remember that a fitness center, and I've worked there as myself, fitness centers have a business model that is based on getting you in and out the door, right? They don't want you to be there for three hours. They want you to go in, do your 45-minute class, and leave so that they can start a new class, right? No, I'm not trying to be saying anything terrible about the fitness center industry, but we just have to remember they're in the business of trying to make money. And the way they make money is you sign contracts and they put. you through. The best thing that can happen from a financial point of view for them is that you

don't show up at all. You just pay your contract. But let's assume that they want you to show up, well, they don't want you to be there too long. And so the tendency will be that the activities that are promoted by fitness centers are going to be high intensity. And they're going to generally, generally be less right at an hour or less. Okay? Yeah. That's just, normal. And so then you get pushed into a type of training that is pretty high intensity to very high intensity. Whereas if I were your coach and you're wanting to run a better 10K, then most of the time I'm going to say, well, I want you to go out in Central Park or I want you to go out in the forest and run for 90 minutes at a pace that's comfortable where you can hear the birds chirping and

you can feel your breathing and you can just kind of relax and listen to the music, get into a nice rhythm, and you can even talk to the person running beside you. That's really different from what you're getting when you go to the fitness center. Yeah. Yeah, okay, one thing I want to jump and ask you about is this, there's a paper I found looking at kind of how the mitochondria become healthy or unhealthy. It's Sam, San Milan. Have you seen this figure here? Yeah.

They looked at blood lactate. They looked at watts. How many watts someone was producing on a bike? And they basically created curves for three different groups of people. For people with metabolic syndrome or diabetes, for the sort of, you know, active individual who maybe does three hours of exercise a week, and then for someone who's a high-performance cyclist. So one of the things that I've been thinking about was how do I help people move into a place

of producing higher amounts of watts given a similar blood lactate level? So for example, in this graph, and I'll include this on the YouTube version and on my website, if you want to take a look at it. But basically, people with diabetes metabolic syndrome, at 2 milamoles of lactic acid, they're producing around 125 watts. The average healthy person at 2 milamoles of lactic acid is producing 175 watts somewhere around there.

Whereas like an elite athlete at 2 milamol is producing somewhere around like 275. so it's like quite a bit more. Oh, yeah, it can be well over 300 watts. It's just a phenomenal difference, yeah. What is actually happening on a cellular level physiologically that allows this person to produce more watts at a given 2 millimoles of lactic acid?

Right. Well, the fundamental issue is that exercise is a signal for mitochondrial synthesis, So it is, we learned this from Halasi in 1967. It's not that, you know, it's not that long ago, but we learned that endurance exercise promotes just what we call mitochondrial proliferation. The muscle fibers synthesize more mitochondria and more of the enzymes within those mitochondria that aerobically breakdown are able to use. fuel and produce ATP using oxygen.

So you just pack these muscle fibers with more mitochondria, and they become just much more efficient at processing both fats and carbohydrates, and particularly carbohydrates, because then we move the carbohydrate, the pieces into the mitochondria, and we don't produce the lactate. Lactate in itself is not a, it's not a poison. It's, you know, we kind of give it a bad name, but it is just a, it's a small molecule that the body can use to move these energy sources around. So lactate produced in one muscle fiber can be transported out of that fiber and into another fiber where it then is used. It can be transported, converted to what we call pyruvate and into a mitochondria.

So there's this beautiful interplay of fuel sources across fibers and so forth. And elite athletes just have such high mitochondrial density, meaning just lots of fibers packed with mitochondria. And they have lots of capillaries. So the body also constructs more capillaries around each fiber so that we do better at moving oxygen into the muscle at getting rid of waste products, at moving lactate around so that it can be used, produced one place and moved another place and, you know, taken up another place. So, so there's just the logistics of energy utilization is improved. And the processing power is improved within the fibers via lots of mitochondria. So it's a beautiful, it's, it's just this

beautiful upgrading that is signaled by the exercise itself. Okay, so there's the increased mitochondrial density, increased size. They're processing sugar, better. They're more insulin sensitive. So it's like the opposite of insulin resistance. Yeah, and they can use more fat. So they, you know, you always are using a mixture of fuels of using your, your musculature is during exercise.

is using both fat and carbohydrate. And then the carbohydrate it's using consists of both stored carbohydrate, which is what we call glycogen that's inside the muscle, stored in the muscle. And then there's the exogenous or outside the muscle source, which is the carbohydrate, the blood glucose, so that the blood stream, you have glucose in the blood, and some of that can be taken up by the muscle.

So you have these three sources. of energy. And during exercise, there's always a mix. And what we see is that the highly trained endurance person, the person who does a lot of aerobic exercise, their muscles just become much more adept at using fat and at using glycogen and glucose without an excessive lactate production. So the combination is that high performance athlete,

we saw that they just have this really flat lactate curve where the intensity keeps increasing, but their blood lactate just stays low, stays low, stays low, stays low, and then finally at 300 watts, it starts to tick upward, whereas most people, 300 is closer to already their maximum capacity, and their blood lactate is 10 millimolar. So it is a phenomenal difference, but it is a phenomenal difference that is resulting from a lot of, of low just basic aerobic exercise over time right yeah so one thing that i saw when i started digging into this was that it seems like after doing this low intensity training for a prolonged time you get so much more efficient at using fat as like your like source of fuel where like so i was i was

hearing some podcasts about people who were training in this way, this low intensity way, and then they used less sugar during their races. So they moved, for example, I think one guy was talking about how he went down from like he was doing these like ultra Iron Man. He was initially consuming 400 grams of sugar and then he decreased to 100. I don't know, maybe you were the one that said this. I forget. No, that's not me.

But it's, yeah, but it's part of that. of that equation. It's just, and this is obviously a valuable issue or a valuable adaptation because a limiting factor, let's say you're running a marathon, one of the limiting factors that results in people doing what is called hitting the wall often at about 30K is that you run out of glycogen. You use up the glycogen stores in the muscle. And so a lot of what we talk about with training is the effect we spay. the glycogen. You're kind of saving glycogen by being able to use more fat. And so because when the

even the best athlete in the world, when they go empty, when their glycogen stores are used, they're going to also be in a world of hurt. They're also going to be an experience that their intensity has to go down. So that challenge is true for the world class athlete and for the recreational runner. It's just that it's all happening at different power outputs. It's happening at different speeds. But you will also occasionally see the elite cyclist or the elite runner that, you know, has a tough day and they crack. And often if their nutrition wasn't good, they've had a, they, you know, then they have a bad day in the mountain, cycling in the Tour de France. And it's often, you know, they went empty. Their glycogen levels were too low at the start of the race, maybe. And

they broke. So, so this is, that doesn't ever go away. Greg Lamont said years ago, he says, you never, it never feels easier, you just go faster. So we shouldn't think that the endurance athletes that we see on the television don't feel these things. It's just that they feel them at a much higher speed and power. But they are still having to deal with the same challenges. Yeah. Yeah, I'm having flashbacks to my rowing. as you talk about this. Okay, so in preparation for this, since you talk about lactic acid and that kind of stuff,

I was thinking I would actually run an experiment on myself. I wanna get your thoughts on this. So the last two days, I did some rowing on an ergometer, and I wrote down, I would do like five minutes, record my watts, average heart rate, and then I pricked myself with this lactic acid, that I got and I kind of was trying to find what is what is my given like heart rate for around two milamoles of lactic acid so the first day for example I did like 177 watts and that got me to

1.2 milamoles lactic acid at 209 watts I got 1.3 and then I went a little bit higher at 247 and it was four millimeters. And then the second day, I was at 210 watts, and it got me to 1.67. So I'm kind of trying to zoom in on this one little area. And then I did 219 and I got 2.28. And then I had a hard time pricking myself after the next one. So I said 219 again and I got 1.78. Now, so it's pretty clear.

Like if I were looking at this data, you know, those first two, you get 177 watts. you're at 1.2, 209 watts, you're at 1.3. So that's just saying, yes, those are both clear indicators that you're in that nice aerobic zone. There's essentially no increase in blood lactate. But you get a really clear change from 209 to 247. That's a big hop, but 240 watts is clearly above that break point. Now you're at 4mm.molar.

So just looking at that data, I'd say, yeah, probably for you to 15 somewhere in there is, you know, right where you don't need to go over that when you're trying to do the nice aerobic work. And it also shows that probably for you, two millimolar is not your break point. You may be breaking at 1.7. Does that make sense? You're actually, when we do blood lactate, we look at the delta, the change from some base. baseline. So we don't care about the absolute value. Because if it was a world-class cyclist or rowers, it might be that they're at 0.9 millimolar when they're going along at really low intensity.

Or it could be there at 1.4. So we're going to establish their baseline. And then we'll often use a 0.5 millimeter shift from there or a 0.4 millimeter shift up from that baseline as the first, that first turn point, right? And then what you might find is if you went up above that first turn point, but then you held the power steady, you might find that your blood lactate went up to four, but then it stabilized a bit pretty, pretty close, you know, four, four point one, four point two. It inched up slowly, but it stayed pretty darn stable. And that's where we would say you're in that threshold zone. And then if you increased even more, then your blood lactate would just keep

increasing, maybe at 280 or something like that. Then you would find that you were just, you know, slowly hitting the wall. You were, you were fatiguing. I don't know, maybe it would be even higher than that. But clearly, you've done some rowing. If you can hold 200 watts at a really low lactate, then you're fit. That's a good, you know, good job. But it's then it's a matter of that, slow in pushing that threshold just a little higher at a time it's not like it's going to go from 200 to 250 overnight it's a it's a patience process and athletes are building that machinery over months and years you know yeah i think um thinking back to when i was a college athlete i could hold these numbers on the rowing machine that were considerably you know faster than my current sort of

ability, right? And so when I go back to try to hold those same numbers, I now realize I'm probably more in that zone two or creeping up into that, even that zone three. You know, like I, for example, I used to hold like 145 on the rowing machine, if you know what that is for like an hour. Yeah, that was like 300 watts. And my peak was like 136.3 or for 6K. You know, that was like, at my senior year. Yeah, so that's good. So you were a good rower. Yeah, and I've been there.

I mean, so I can feel your pain. Yeah. I know what it feels like to be rowing that hard. I was a, yeah, I started rowing when I was a PhD student. So I entered rowing very late, but I was, I ended up being able to being lucky with some other guys. And we won a master's national championship in the United States. So.

Okay. over a thousand meters in the master's level. So, yeah, so I love rowing. And I've worked with rowing. I've been down in Australia with the rowers there. And it's, you know, it's a fantastic sport. And it's that same thing. It's that patience, that, you know, rhythm,

rowers like we were talking about, the rowers spend a lot of their time at a very, you know, what looks like, a very comfortable pace. But it's a lot of work. You know, you know how it is, but they are purposeful. They're intentional, but they're doing the work at a pace that they can maintain for, you know, 90 minutes, two hours. And they're doing it twice a day.

We should also, these elite performers are training two, three times a day. Yeah. And that's one of the things is you can't do that and train hard every workout. It just, it doesn't, the two aren't compatible. So what we see is that top performers, they are pacing their, not only pacing races, but they're pacing their training. So that the training process is sustainable at the level of their ability. And I think that is an important message to carry into the new year and for us regular people is it really, sustainability is what wins the battle here.

You know, I often ask people when I give lectures, I say, okay, how many times are you going to train this year? Think of a number. You know, even your listeners now, think of how many times will I train or will I my athletes train if I'm a coach in 2022? What's that number going to be? If they're recreational folks training three times a week, that number still might be 150, 175 times. if they're pretty hardcore master's athletes age groupers that number can easily be 300 plus and if they're high level athletes that number might be five six hundred training sessions you know in a year 600 sessions but even if it's me at 300 sessions in a year all right now let's ask another question and say all right what would be a david what would be a really good improvement for you for the 2K in 2022. What would you be super happy with if you achieved in terms of a percentage improvement in the 2K?

Give me a number. Yeah, I would say probably like, well, percentage, maybe like 5% or something like that. Okay, yeah. And 5% would be great. I mean, if you achieve that, that would be awesome. Well, five percent is a huge change, you know, for if you're well trained. I think for me, so I, when moving to Florida a year ago, I started rowing again. And I, before that, I was a power lifter for about three years.

So I was doing like squat, deadlift. That's it, right? So I'm like transitioning back into it. So you're on the ascending curve. Yeah. So 5% is, okay, that's reasonable. For me, it would be like, that would be utopic because I've been training pretty good for three years now, steady. But 5%, but the point is, even with.

5% for the 0.05. Now think about what is going to be the average improvement. Let's say you train 300 times. What's going to be the average improvement per training session for that quite impressive 5%. Well, it's just it's infinitesimal, right? 5.05 divided by 300. Do the math and you get this number that is like tiny, tiny, tiny, tiny, tiny, tiny. And I think that is what we need to understand is you don't get better with, it's, it's,

It's not the epic workouts. It's the sustained training. And there are going to be some good days and a little worse days, but the overall trend is going in the right direction. You're staying healthy. You're staying motivated. And you're getting better. That's what good training programs look like. That's what success looks like is it is not super sexy.

It's not super amazing epic workouts. It is just, you know, getting out there. And I also ask people, I say, are you having fun? Are you enjoying yourself? You know, let's face it, rowing on the water is quite a different thing than rowing on an indoor ergometer. Oh, my gosh, night and day. On the water, you feel you get so much sensory information.

You hear the water. You feel the air. You see the turtles and the birds. And, you know, I used to see the turtles last. up on the logs. You got all this. And you just loved it. You just were, you were, it was just a sensory kind of positive experience that would keep you going. So being outdoors is, is good for our brains. And it also makes exercise, I think, easier or more enjoyable. We have to remember that. So, and I'm saying this is a guy who trains a heck of a lot indoors on a swift

cycling program, you know, but, but our brains are kind of wired for all that outdoor, that extra stimulate, the trees and the flowers and the birds and the, man, I remember one time I was rowing. I was rowed really early in the morning. It was still, you know, the sun was coming up and I row under this bridge in Austin, Texas on the way home, and all of a sudden, I'm hearing this guy playing the saxophone. And he's under the bridge playing because of the acoustics. Oh, nice. And I row under that bridge and all of a sudden, I'm here. And, you know, just this, oh my goodness, you know, I can still hear it today. Wow.

It's just this, though, you cannot help. But when you get off the water then or you're finished with a workout, you're feeling better. Right. And I have no, I don't remember that workout. It's not hard. It's just, it's just, it's given me more energy than it takes from me. And most, most of the time, exercise sessions, I think that's one of the ways to see it is, is I, you should feel like the exercise session is giving you more than it takes from you.

Not every time. There will be days, of course, where you eat the cake, you work, you push, you really break barriers, but most of the time, it's about, oh, man, yeah, I feel better now. I'm ready to face the day. That was a good workout or a good way to end the day, you know. And so, and if we can help people to understand that, that it's not about how much pain you experience, how hard you had to dig every day, or it's about, you know, getting up and doing it day after day and developing a sustainable habit, then, man, then that's going to be a good

2022 for lots of people. Yeah, I think that's really helpful. I think I've been looking actually at some data about exercising in nature, and there seems to be some value in how it motivates people to continue to exercise. And also I think there's some benefit, even in like increasing heart rate variability and stuff like that, being in nature, being in green spaces. So I think it's, I like how you sort of end with like,

how do you find exercise that's pleasurable, right, that you will go back to and you enjoy it, that's life-giving, you know, and maybe the first two weeks you do it, it'll be a little bit, more difficult to get back into it if you haven't been doing any exercise for a while. But being patient with the process, I think is key. And I think that's something I've taken away from your work is like, okay, you don't need to go all out right away.

You know, if you're just getting back into it, you could just hit the trails and walk, run, walk, run, you know. Oh, absolutely. Bill Bowerman was doing this in the 60s, you know, with the 50-meter walk, run, and then 100,000. meter walk and then slowly change the ratio. And so I guess my daughter is a runner and she's had a surgery and she's coming back. And this is the key is just saying easy and give yourself a break. Don't compare yourself with you at your best two years ago, but compare yourself with you last week.

You know, and be kind to yourself as an athlete or as an exerciser, except that it's a, it's a, We're in a, it's a marathon. It's not a sprint, right? The exercise process or exercise habits, we can think of them is a marathon. And you don't win a marathon in the first 10 steps. But you can lose a marathon in the first mile by going too hard, right? And cracking. So I think that's the most likely mistake people will make is they go all guns,

full bore in. And then they meet the wall of, soreness and injury and everything. And then they'd say, oh, hell, I'm not doing this. And so pacing is something we need to think about, not only in the race, but also in just the life, in the exercising process. And the other thing is, you know,

I assume that most of the listeners have real jobs and real lives and real problems and real families. And so exercise has to fit into all of that also. And so, you know, and we need to remember, you're the psychiatrist, but that stress is kind of a, you know, we always talk about there's just one bucket. And the stress can be coming in from issues related to family economy or work stress or student stress or whatever. But it's all going into one bucket. And there will be times when that bucket is full from lots of other things. And you have to ease up on how hard you're pushing yourself in the training.

And that's okay. That's not, it's not, it doesn't make you a weak person. You know, we see, for example, student athletes, collegiate athletes with scholarships. You may have been a scholarship rower. During exam periods, they're less, they respond more poorly to training. Yeah. It's documented. They, they're, the stress is high.

their body is not able to absorb as much training and they don't respond as well. So this is just something we need to be aware of. And you don't, you don't double down at that time. You don't take out as a coach, you don't say, well, hell, I'm just going to make you do twice as many intervals because you're not adapting to this. No, you ease off. You say, no, let's get through these exams. Folks, exams are important.

Drop a day, you know, have an extra rest day, take away a workout, you know, do what's necessary so that you find an appropriate balance. And then maybe it's going to feel better. We're going to get past this. And then January, February, we're going to ramp it up a bit. That is, that's how life works and that's perfectly okay. And the athletes that understand that at whatever level, their overall progress will be better. Yeah.

Great. Hey, well, thank you so much for coming on. I think hopefully this will motivate some people to get out and just start and be patient with himself and try to find some pleasure and, you know, get into some green space. Yeah. It's soon spring. It may not feel like it, but even in Norway where I live, the days are starting to get longer. Yeah. And just feel, you know, so I can just feel that it's like a little bit of bubbling under the skin, you know, that this, this, this.

too will pass the winter is soon over so this is a great time to just start easing in getting out there and watching things change out in nature yeah great hey well thank you so much we'll keep in contact maybe have you back in the future uh talk about some more details and uh yeah appreciate you coming on you bet thank you thanks for having me