Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Exercise as Medicine for Women
Unlock the secrets to treating exercise as a potent medicine for women’s health with our insightful guest, Dr. Matthew Kampert. Learn how you can harness resistance training and load-bearing activities to bolster bone density and combat age-related bone and muscle loss.
Dr. Kampert highlights the need for integrating adequate protein intake and exercise to preserve muscle mass while managing weight. Listen in for a comprehensive discussion that promises to enrich your understanding of exercise as a transformative tool in women’s health.
To learn more about Dr. Kampert, visit clevelandclinic.org and youtube.com.
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Welcome to the Speaking of Women's Health podcast. I'm your guest host, Leigh Klecker, the producer of the podcast, and I'm happy to be back in the Sunflower House for a new podcast episode with Dr Matthew Kampert. I'm talking with Dr Kampert in this new episode about exercise as medicine for women. First I'd like to share a little bit about his professional background and then we'll dive into the episode. So Dr Kamper received his undergraduate degree from West Virginia University. He went on to earn a graduate degree in exercise physiology at West Virginia and he then attended Lake Erie College of Medicine for his medical degree and went to Cleveland Clinic, South Point Hospital for his residency in family medicine. Then he decided to do a fellowship in sports medicine at Cleveland Clinic and was appointed to Cleveland Clinic shortly after, in 2020, in the sports medicine department. So welcome, Dr Kampert.
Speaker 2:Thanks for having me.
Speaker 1:Of course. So, as I mentioned, we're going to be talking about exercise as medicine for women in this episode, and we've done several previous podcast episodes about food as medicine, so I think this is a great topic. As we're, all you know, in this new year hope, maybe setting some resolutions and thinking about maybe some ways we can live healthier, or maybe a new exercise regime and, as we know from several other podcasts with our guests and Dr Thacker, women who exercise they regularly have a lower risk of death from all causes, including cardiovascular disease, and we've also discussed many times on this podcast how exercise can help with mood, as it releases endorphins and helps you to feel happier, maybe more relaxed, and so these are just a few examples of how exercise is beneficial to our health, but I think we're going to start with bone density and osteopenia and osteoporosis. So, dr Kampert, how can regular exercise help strengthen our bones or prevent bone loss, and do you want to talk a little bit about bone density and how that all kind of works together?
Speaker 2:Yeah. So exercise plays a huge role and really across the lifespan. So you only have so many years to really lay down bone density. Usually around age 26 is peak bone density for females, and then your hormones and things change and then really the goal is to minimize bone density loss. You can always try to add a little bit and there's medications that help with that. I won't go into much of that.
Speaker 2:But really the type of exercise is resistance training or things that load the bone. So not all exercise is created equal and with the approach that exercise is medicine, you have to have the right dose and the right prescription. So you need to load the bones. Aerobic exercise you get a little bit of loading of the bones with running, but cycling you really don't load the spine. You can stress the long bones and then swimming's great exercise, but you're really not loading the joints or the bones or the spine. So you could actually lose some bone density in the spine from cycling and lose bone density from swimming.
Speaker 2:If you think about space travel, one of the things they worry about is muscle loss and bone density loss because you don't have the effects of gravity. So your body really does like the bones to be stressed appropriately and then they respond. So by doing things like resistance training or load-bearing exercises, even proper squatting mechanics and loading that spine or rucking, you can increase the bone density in the spine and throughout the whole body and you want to make sure that you have adequate calcium and vitamin D also with that process that you have adequate calcium and vitamin D also with that process, right?
Speaker 1:So you said that running could be considered a resistant exercise. What other examples can you provide? Anything?
Speaker 2:that where the body's being loaded. So why running does? It is because you have the effects of gravity and then when you're running you have the impact forces, so all that jarring of the joints and everything. But really resistance training where you're really loading the muscles, so where you're lifting heavier loads, so more than your activities of daily living, so you could carry bags around throughout the day. But if you're lifting weights weights you can only do a certain number of repetitions, so it's a heavier load, it's a larger stress on the bones, but not the type of stress you will want all day. So any type of resistance training will help the bones and the joints that you're loading. But if you're only doing things for the lower body, like leg extensions and leg presses, you have to remember you're not loading through that spine and you're only doing things for the lower body, like leg extensions and leg presses, you have to remember you're not loading through that spine and you're not loading the bones of the upper extremities.
Speaker 1:So yoga, would that be a good one, Because you kind of seem to be using your whole body.
Speaker 2:Yoga has a lot of health benefits, but I wouldn't identify that as one of the key ways to build muscle or to load the bones. I mean because you're really not increasing the forces much more than the force of gravity.
Speaker 1:So weights and then, but making sure, like you said, just don't stick to. You know legs all day, or legs every day, whatever the saying is, but you know arms, shoulders all day or legs every day, whatever the saying is.
Speaker 2:but you know arms, shoulders, you want to load all the bones of the body appropriately, without overloading them, because then you can get stress, injuries or stress reactions or even stress, fractures?
Speaker 1:Sure, okay, and then how often do you recommend these exercises be performed to? You know, keep that bone loss from happening.
Speaker 2:Be performed to keep that bone loss from happening. You really want to do resistance training at least two to three times a week. But different activities. You want to be active. So just being active helps protect against bone and muscle loss. If you're ever bedridden or you're not up and about, that's going to be detrimental in and of itself. But from a standpoint of trying to actually add some bone density, you would want to do at least two to three times a week of structured resistance training.
Speaker 1:Okay, great. And then of course, probably, like you're saying, just move as much as possible. You know if you maybe have a job where you're at the desk all day trying to get up and just you know, move that. So you're not sitting all day.
Speaker 2:Break up the sedentary periods.
Speaker 1:Yeah, I know I struggle with that. You know a lot of my job is writing, so I'm sitting at that laptop and you know you kind of get in a groove sometimes and then you realize, wow, I haven't gotten up in a couple hours. It's achy and it doesn't feel so good. So if a woman is new to weight-bearing or they've never done any sort of resistance exercise, maybe they've always just either walked or swam or did something a little bit more low-impact. You know, walked or swam or did something a little bit more low impact how could they get started on adding that into their you know, exercise and their lifestyle.
Speaker 2:Yeah, that's a good question. So I think the easiest way to do it is with machines. So with free weights you have to develop that muscle, mind, muscle control to really stabilize them. Develop that muscle, mind, muscle control to really stabilize them. But with the machines they're pretty simple to where, if you set the seat height and the arm settings to the the right height, it's really just pushing through the movement and you don't have a whole lot of stability issues. And that's a nice way to start because that then you can load appropriately with less risk of injury and then you can kind of progress from there.
Speaker 2:If you don't have access to machines, you could always pick up some bands, elastic bands, and that's a good way to get started. Body weight movements are always an option, but sometimes, if weight's an issue, you want to be careful of how you load the joints because you can't really modify your body weight, whereas if you're doing something with a machine you can lighten the load. Body weight stuff you have what you have, and if it's too much of a load you could get an injury. So I would suggest really investing in a membership to somewhere that is convenient geographically.
Speaker 1:Yeah, I know my mom. She was always a walker and a spinner, or more like riding the stationary bike, but after she retired she was able to, at a certain age age to get and I can't remember what it's called and I apologize to our listeners, but when?
Speaker 2:I find out.
Speaker 1:Yes, that's it, yeah, and it's several dollars a month, maybe five, and she gets access to the local Y here as well as like a community senior center they have where they also have, so that's a good option for those looking for that and they have a lot of the machines.
Speaker 2:Yeah.
Speaker 1:Yeah, great, so say someone is already diagnosed with osteopenia Now. So that is the like, a pre-osteoporosis, correct?
Speaker 2:Correct, it's based on the bone density and there's different levels. Once you reach certain ranges of decreased bone density, then you get into the osteopenia range and then the osteoporosis.
Speaker 1:Okay, so if they've already been diagnosed with osteopenia not quite osteoporosis, what can they do to maybe help prevent getting osteoporosis in regards to exercise or lifestyle?
Speaker 2:Yeah, the same things you would do to build it. You just want to be more cautious and not overly aggressive, because if you have osteopenia or osteoporosis, it does mean that your bones are thinner, they're not as dense. So if you're too aggressive you're more at risk for a frailty fracture, Not so much with the osteopenia but osteoporosis, depending on how severe it is. So you just you want to gradually increase and if you do it gradually and you allow adequate rest, it's very safe to do but really loading the bones and making sure that you're optimizing from a dietary standpoint with your calcium and vitamin D, and it's best to get that from foods.
Speaker 1:Right, yes. And for our listeners out there, you know if you've been listening to us for the last your calcium and vitamin D and it's best to get that from foods Right, yes, and for our listeners out there, you know if you've been listening to us for the last two seasons, we have, you know, calcium calculator and lots and lots of information about vitamin D on our website. So that's speakingofwomenshealthcom. So I guess the same would go then for osteoporosis if you're already diagnosed with it, you know, start off slow. Talk with your you know physician about. You know how you can build up and then get to.
Speaker 2:Maybe you know correct and then when you get to the like actual osteopenia and osteoporosis, you want to talk with your physician about medications that might be appropriate for you. They can actually slow down bone loss or actually they're anabolic agents that can actually build some bone density. But that's really a discussion that you want to have with your provider. Depending on other medications you might be on comorbidities everything's risk versus benefit and you want to have an informed discussion.
Speaker 1:Everything's risk versus benefit and you want to have an informed discussion. Can you sort of reverse osteopenia or osteoporosis with exercise, Sort of aside from maybe?
Speaker 2:the medication part. But Depending on your age and the degree and the underlying reasons, you can increase bone density, though it's much more effective to do in early age. But regardless, you definitely want to incorporate because of the health benefits but also the bone density benefits.
Speaker 1:Right. And then you know, as we get older, you know the amount of fractures falls and that you know. So if you can stop that before it becomes a problem and having to do surgery, so well, this is great. So the next subject I think we want to explore is sarcopenia, which is sort of the muscles. Right, am I correct? You're losing muscle as you get older, or can you explain a little bit more about what that is?
Speaker 2:Yeah, so age-induced muscle wasting. As you get older you start to lose muscle mass also. So your cells are older, your hormones change and you don't have that anabolic effect to maintain muscle mass. One thing that really helps with slowing that rate of muscle loss is resistance training, because you load the muscles, the muscles are an endocrine organ of their self where they'll actually release myokines and they'll activate growth pathways. And that's a big thing to think about when you're thinking about body composition.
Speaker 2:If you're not exercising and you're eating calories, what do you think you're telling your body to do with those calories? To store those calories in your fat cells. But if you're doing resistance training and you're loading the muscle and you're eating calories and specifically adequate protein, you're sending cellular signals to build muscle, to take those nutrients and actually build and repair and make larger muscles. So it really kind of communicates with the rest of your body to try to build muscle rather than letting the muscle kind of deteriorate as you age. And it's not just the muscle mass.
Speaker 2:So you do lose muscle mass as you age, it's really the strength. You actually lose strength at a higher rate than you lose muscle size and that's the important factor to look at and it's overlooked a lot because it's not often assessed. So bone density you can get DEXA scans and then you can get scans with bioelectrical impedance where they measure body composition. They'll give you muscle mass. But not too often are people getting strength assessments. That's something that we offer at the Cleveland Clinic, where we do one rep max strength testing for all the major muscle groups before we put together an exercise prescription, and your exercise prescription is based off of those strength measurements and then we'll reassess you at three months, six months, nine months, 12 months and then to actually see the improvements in strength and function.
Speaker 1:So what kind of tests are those? I mean, I've heard grip strength before. Is it sort of something like that how you test the muscle strength.
Speaker 2:Well, we actually take it quite a bit further than that. So grip strength is there's a lot of association with grip strength and the rest of the body whole body strength. More so that as you lose it, so as you lose overall muscle mass and strength, you lose grip strength. But we actually do an assessment. We have programs and equipment where we can measure one rep max strength for each piece of equipment, so similar to the types of machines that we were talking about where you would do a chest press or a bicep curl or a seated row you would do a chest press or a bicep curl or a seated row.
Speaker 2:We have equipment that uses a mode called isokinetic testing Iso meaning same, kinetic meaning speed. So no matter how hard you push or press, the machine moves at the same speed so it can calculate how much force you generate. I don't know about promoting brands or anything, so I don't necessarily want to say the company's name that makes the equipment, but that's information we can share afterwards on the website. But we have a pretty elaborate exercise assessment and prescription program and all that data gets tracked and it goes to a cloud and what we're doing is integrating that cloud with our electronic medical records so all your exercise assessments and training gets pulled into your, your patient charts so that we can really kind of connect the exercise and medicine and really deliver exercise as medicine is a real prescription.
Speaker 1:Right, right, sort of like. What like, do three reps of this on Monday?
Speaker 2:Yeah, that's great, yeah, so the equipment's so advanced that once you do the assessment and we make the prescription, it gets sent to your account and when you walk into the gym you scan with your phone and it tells you which machine to go to. It adjusts the seat height. On the prescription, it gets sent to your account and when you walk into the gym you scan with your phone and it tells you which machine to go to. It adjusts the seat height on the machines, the arm settings on the machine, loads your workout arm and it guides you through the rep. So the concentric phase and the eccentric phase, so as the joint angle shortens and as it lengthens. So it teaches you to do resistance training, not just weightlifting. You have to control the load and it's a safer, more controlled way to train.
Speaker 1:Absolutely. I mean, I feel like I hear a lot, you know, at least from my friends and family. They're going on Instagram or TikTok or whatever social media and they're like, oh, that looks like. Oh, look at her, she's got great abs. I'm going to do that workout from this woman and this, you know, these women are girls, you know they're very young and my mom is in her 60s. So I'm like, well, that's probably not the workout you should be doing. So, you know, I feel like sometimes we're doing the wrong things for our body and our age and our muscle strength and our bone density. So it's pretty imperative to always, you know, anytime, before you start anything new, you should, you know, talk to your physician about it and maybe you need to see a specialist like yourself.
Speaker 2:Yeah, and you make a great point. You really don't want to compare yourself to others and you don't want to exercise prescription that was made for someone else or by someone else. It needs to be individualized for you, and the only way to do that is with an assessment, so that you know where you're starting and then it's based off of where you're at and then you can monitor the progression. And that's really the biggest thing is consistency over time, and that's what you hear a lot of comments about. Well, we know exercises work, but it works. But how do you get people to stick with it? It's easy you show them results. That's why people become marathon runners and lifelong runners or weightlifters because they saw the results. So, by getting patients a baseline assessment at three months, they may not realize just how much stronger they got until you reassess them and you show them that and when they see that it's so motivating and rewarding to them.
Speaker 1:Yeah, you know, and I know I've noticed as I've gotten older. I was a runner, you know, through high school and until now, and I'm just, you know, I'm kind of plateauing. You know I'm saying I'm not my body's not even staying at the same weight or muscle mass. I can see it getting worse, but I'm not exercising any less. So, you know, the last, I would say five years, I've started, you know, doing this bar Pilates where we use resistance bands and weights, and I do yoga. But I do that just because I like it, for the calmness and my mental health. But I do see a difference. If I'm not going and doing that resistance training, after you know, if it's been two weeks, three weeks, I can totally tell the difference. I plateaued again. So I think you know, like you're saying, keeping up with it and then, as you hit a certain age, you may have to, you know, change up that routine and as people, they can still build muscle and get stronger.
Speaker 2:The thing is and they can train hard too the difference is they need a little bit more recovery time. So where if for a hard workout when they were younger, they may have been able to train that same muscle group two days later? Sometimes it may take another day as you get older, but if you gradually increase and you're consistent, you can train hard. You just have to make sure that you're also recovering before you train hard again.
Speaker 1:Yeah, that's a good point. That's a good point, so sort of going back. I mean, we've been talking about sarcopenia, but who does it affect? Females, males, certain ages, certain anybody, everyone.
Speaker 2:Okay, so it comes down to age. So really after your mid-30s you start to see a decline in muscle mass and strength, unless you're actively doing resistance training. For women they see a significant decline after menopause and then when you get to like your 60s it kind of accelerates more and more. Men as they age, they kind of have a more gradual loss of testosterone, which is really their anabolic hormone that signals muscle growth, and for women it's the estrogen that's their anabolic component. So postmenopausal, if they're not doing resistance training, they will see a rapid, very rapid decline of muscle mass. And it's actually impressive just how much resistance training can offset that decline. If you would look at two individuals as they go through menopause, if one is doing a well-structured resistance stranding program versus a female who isn't, it really changes how they age.
Speaker 2:Because the thing about muscle mass is there's 2,500 calories in a pound of muscle, there's 3,500 calories in a pound of fat. The more muscle you have, the more calories you burn, because muscle is very metabolically active where fat is not. So if you have a certain amount of muscle and a certain amount of fat and your hormones change and you're no longer maintaining that muscle mass and you're not doing resistance training to maintain it. Now I've been counting the calories you burn through the resistance training. You're going to notice that you feel softer or like you're more fat, because what's going to happen is your body's going to be burning that muscle mass for energy instead of the fat. And for every pound of muscle that the body burns or doesn't maintain, there's 2,500 calories with that. So instead of burning that 2,500 calories worth of fat, it's coming from your muscles. So even if you're not eating more and not exercising less, your body composition can change because you're not supporting previous muscle mass that you did have.
Speaker 1:Got it, so can you. So now you're making me want to like, re, really re up my resistance training. But can you do too much of it? You know, if I decided to do it six days a week, is that too much?
Speaker 2:So that's a loaded question so we have to approach that in steps. So I think the biggest concern that females have is they don't want to get too bulky. You won't. It's hard to build muscle, especially if you're in a caloric deficit. If you're trying to lean out and you're in a caloric deficit, it's hard to build muscle. And then for females, you don't have the genetics of a male, so you don't have the testosterone. That's why women they can get comparable leg strength if they really train well, but there's always going to be a deficiency in upper body strength because you have a lot of your androgen receptors in your deltoids and your upper arms and your traps. So if you look at athletes who abuse steroids, they have very large traps and very big deltoids.
Speaker 2:And if you look at females, they kind of have slender arms. That's where the androgen receptors are. So don't be afraid to lift weights. You're not just going to swell up overnight and you may feel that you're bulky. A lot of that is because you're increasing the muscle glycogen stores.
Speaker 2:Okay, so the more you use the glycogen which is stored carbohydrates in your muscle, your body adapts and it stores more glycogen in the muscle and one gram of glycogen holds three grams of water. So your muscles can swell up and that's kind of the pump that you feel when you're lifting that increased blood flow in that pump all up. And that's kind of the pump that you feel when you're lifting that increased blood flow in that pump. So your muscles may become more fuller and you may feel that you're kind of blocky and bulky. But as you continue to improve your diet and lean out, you lose that layer of fat or adipose tissue over the muscle and you realize that you're not bulky and you really want that muscle mass, because as you lean out you don't want to be left with kind of a low level muscle mass. And that kind of gets into a whole discussion about weight loss and some of those GLP-1 medications that we could go into now or later on, depending on how you want to proceed.
Speaker 1:I mean that's really interesting. That's actually a whole podcast episode I do want to have. So I mean I wouldn't mind diving into that, because I know we're getting a lot of questions on our website about women asking about these.
Speaker 2:So with the GLP-P ones, they're great at what they do. It's an appetite suppressant. So when you eat, your, your stomach and small intestines you release these hormones that make you feel full, called incretins, tells your brain that you're full. Now some people they'll eat and they'll always be hungry. It could be because they don't make enough. So when they eat they don't release these hormones and they never feel full. Some people could be resistant.
Speaker 2:So they eat, they release an adequate amount, but they don't respond to it, kind of like in diabetes, people who need insulin because they don't make enough, or people who don't respond to the insulin that they do make. So that's why you have to start at a very low dose, because if you're someone that just doesn't make this hormone when they eat, you're very sensitive to it. So the smallest dose can have a profound effect. And then some people they could be on the highest dose and they really don't notice an effect because they already make a lot. They just don't respond to it and giving someone more of something they respond to is not going to have as much of a profound effect. And the thing is they're most of them are once weekly injections so you can't un-inject it.
Speaker 2:So if you're overzealous and you think, oh, I'm always full, I mean I'm never full, I'm always hungry. I I don't want to start with the low dose. Always start with the low dose, because if you're just someone that doesn't make it, even sometimes a fraction of that starting dose is enough. I mean can Go ahead. No, I was just going to ask.
Speaker 1:So then when they're starting on this and they're not eating as much, not eating as much, so then I mean I would imagine that has to somehow affect, you know, like their bone density or and or their muscle mass, because then, like you were saying, you have to have to intake so many calories to keep up with building that muscle, right?
Speaker 2:So, and that that's kind of the next thing I was going to say um, people say that they don't want to take it because you lose muscle mass.
Speaker 1:Yeah.
Speaker 2:The studies show that the way those studies were all designed by the pharmaceutical companies, there was no resistance component. They told the patients to eat 500 calories less a day and be active 150 minutes. Nothing about resistance training. Be active 150 minutes, nothing about resistance training. So the thing is they lost a lot of weight, but about up to 30%. A third of the weight was lean mass.
Speaker 2:Now it's not the medication's fault. The medication did its job. It suppressed your appetite.
Speaker 2:It doesn't matter if you're, when you're in a caloric deficit're going to lose weight. Whether it's willpower, bariatric surgery, poverty pills, injections, stranded on a desert island, your body doesn't care. It just knows it's not getting enough calories to sustain life. And your body's smart. What it learned was that it wants to make you as efficient as possible so that you live long enough to find your next meal. So the more muscle you have, the more calories you have to consume to maintain that muscle mass.
Speaker 2:And, like we talked about, there's 2,500 calories in a pound of muscle, 3,500 calories in a pound of fat, and it doesn't take anything to maintain fat mass and a pound of fat. And it doesn't take anything to maintain fat mass. So your body knows that I can get energy from burning this muscle, but not only that. I can decrease the amount of energy that it requires for me to remain alive. So your muscle, your body, will start burning that muscle. Unless you're using the muscle a lot, you release myokines and basically what your muscles say. Hey, I understand I'm starving to death, but I'm using these muscles a lot, probably to try to find food. Leave the muscle alone and burn the fat okay, and it's.
Speaker 2:You have to remember all the muscles. So if you only train your legs, you're not going to protect your upper body. You have to train the whole body because you can maintain the muscle mass in the legs, but if you're not training the upper body, you're going to lose muscle mass and bone density that way. So that's where the problem is. These medications should never be prescribed unless somebody's in a structured resistance training program. The cardiovascular exercise has its benefits from health benefits and a whole bunch of other stuff. But if you're just doing cardio and you're taking these medications and limiting your diet, those are just increasing that caloric deficit. You're not protecting your muscle mass. So that's the important thing that inadequate protein and what we see with the patients we have in the data, we have in the exercise environment we created with or without these medications. If patients can create a caloric deficit, they'll lose weight. If they follow our structured exercise program or any structured resistance training program, they'll improve strength while losing weight.
Speaker 1:That's great, Thank you, it's really I mean it's really interesting and we should do like a part two about side effects right, who are candidates?
Speaker 1:Because you know we see on a lot of these TV shows and you know celebrities on. You know in the media they're saying they're going on these pills. Well, they sure didn. Tv shows and you know celebrities on. You know in the media they're saying they're going on these pills, but they sure didn't. Or you know the medicine. They sure didn't look like they needed to to begin with. Maybe just a little extra exercise.
Speaker 2:So and the important thing to point out is these medications. Just like I explained, some people don't make enough of this hormone and some people resistant. Like any medication, when the medication binds their receptor that your receptors down regulate, it's called tachyphylaxis. So you get a decreased response to that medication over time and there's some people. That's why you continually increase the dose. You develop a tolerance.
Speaker 2:Yeah, and you've got to think about this long term. If that's the only tool in your toolbox that you're using, what's going to happen when you're at the highest dose and you're still hungry? And worse yet, what's going to happen if you didn't do resistance training? Now you lost fat and muscle. You didn't increase your exercise capacity to protect against that weight regain by being more fit and being able to burn more calories. So now when the appetite comes back, you're going to gain fat back. So you lost fat and muscle and now you're a year older and fat's going to come back. Versus if you maintained your muscle mass and you improved your fitness. And you improved your fitness. So when you first start, you may exercise hard for 30 minutes and may only be able to burn 200 calories as you get more fit if you exercise hard for 30 minutes.
Speaker 2:It's the same duration, the same intensity 30 minutes hard. But hard's relative. You're more fit now. You have different metabolic machinery. You have more mitochondria in your muscle. The reason you can run faster is because you can burn calories faster. So now for that same hard effort, for that same duration instead of 200 calories you can burn 400 calories. And now you don't hate exercise and you have the endurance so you could exercise for an hour. So now you're talking 500, 600 calories. So that's more of a meaningful caloric expenditure to protect against the weight regain that occurs when the appetite returns. Plus you preserve your muscle mass. So again, in no situation should these medications be prescribed. No situation should these medications be prescribed? Because if you do take them and you lose muscle mass and it's years later and the appetite comes back, the patient's worse off than if they never would have met that physician, because at least then they would have had the muscle mass they lost in the process.
Speaker 1:Yeah, oh, it's really, really interesting. So I want to switch gears a little bit and talk about cardio respiratory fitness. I had actually not ever heard that word before, so I'm sure many of our listeners are in the same boat as me. So how does this play an important role in exercise? What is that role? Why is it important?
Speaker 2:It's huge. The American Heart Association released a position statement in 2016 that identified cardiorespiratory fitness as important of a risk factor as smoking, high cholesterol, blood pressure and diabetes. So the other four we put a lot of effort and energy in to addressing, but rarely do we do assessments for cardiorespiratory fitness. But again in our program at the clinic we do that a baseline cardiorespiratory fitness assessment and there's so much that we can talk about from that standpoint, with fuel substrate utilization and everything else. But essentially, cardiorespiratory fitness is a measurement of your aerobic capacity, how efficiently your heart can circulate blood from a good stroke volume, a contraction, how well your lungs can remove carbon dioxide and oxygenate the blood, and how efficient your muscles can extract oxygen out of the blood and utilize it. So it's a whole body representation and what it is is. It's a measurement of how much oxygen you convert to carbon dioxide, and you can get a tremendous amount of information by measuring that. So, um, I can go into more detail or we could do a whole podcast just on that.
Speaker 1:Yeah, so is it like people who are in better shape, or maybe people who do more cardiovascular exercise? Okay, yeah.
Speaker 2:It's a relative term relative to your weight. So you can improve your cardiorespiratory fitness by improving your body composition. So if you lose weight by improving your body composition. So if you lose weight, your VO2 max will go up. So your VO2 max is the maximal amount of oxygen that you consume and convert to carbon dioxide at peak exercise and it's relative to your body weight. So at rest you consume about, on average, 3.5 milliliters per kilogram of body weight of oxygen per minute to sustain life. So the heavier you are, the more oxygen you consume. So if you're more metabolically fit, if you lost 20 pounds of fat and maintained your fitness, didn't change your fitness, your VO2 max would go up. Your cardiorespiratory fitness would go up because your body weight's the denominator. So if you look at simple mathematics, if you decrease that denominator, your overall value goes up. So it's relative to body weight. So you can improve your cardiorespiratory fitness by decreasing your body weight. And that's things that people notice as they lose weight. They can do more and it doesn't feel as overwhelming, but you can get a lot of information.
Speaker 2:So if you do a resting metabolic test which measures how much oxygen you convert to carbon dioxide, different fuel substrates require different amount of oxygen to fully oxidize it. So fat versus carbohydrates. So if you fully oxidized one glucose molecule, it has six carbons in it. That requires six moles of oxygen, okay, and you produce six moles of carbon dioxide. So essentially, when you do the math, the chemical stoichiometry, you divide the carbon dioxide that you produce by the oxygen you consume and it comes out to a value of one. So fat, it's a little bit different. You don't need as much oxygen to burn carbohydrates as you do fat, okay. So the denominator is bigger. So the value is lower. It gets down to 0.7. That's called a respiratory exchange ratio. It gets down to 0.7. That's called a respiratory exchange ratio.
Speaker 2:So at rest you can actually determine what fuel substrate someone's utilizing. If you're burning fat, like you should be when you're fasted, or if you have metabolic dysfunction and you're relying more on glucose when you should be burning fat. And as you fix people's metabolic dysfunction or diabetes, you can see that value improve. And then you also. That's how you figure out how many calories someone actually burns. You measure how much oxygen they consume. For every liter of oxygen you convert to carbon dioxide, you burn five calories. That's where all those estimations come from. There's actual measurements that we do, so you get that at rest.
Speaker 2:So if I measured how much oxygen you convert to carbon dioxide over a 10-minute period and I extrapolate that out over a 24-hour period, I could tell you exactly how many calories you need to sustain your weight without activity. So now it's way more accurate. Now if I did that same type of test on a graded exercise test where I gradually increased the workload, I can watch your fuel substrate shift to where, at low intensity, you're burning fat and as your intensity increases, you start burning carbohydrate more and more. And I could tell you where you start to produce a lot of lactic acid and all these different training zones. So that's where you get these different zone 1, zone 2, zone 3, zone 4, zone 5. And I could find exactly what heart rate and what workload you burn the highest percentage of fat.
Speaker 2:So it's not about exercising as hard as you can, it's really about staying in kind of this fat burn zone, the zone 2. And that's going to stimulate a lot of mitochondrial biogenesis. You make more mitochondria and that's how you would stimulate increasing your aerobic capacity, your VO2 max, your cardiorespiratory fitness. That's why these endurance athletes do these low, slow runs. They don't just walk out the door. Take off running as fast as they can, for as how? As long?
Speaker 2:as they can yeah, it's different athletes, different metabolic pathways, aerobic versus anaerobic. That's why you have elite sprinters and you have bodybuilders and you have ultra endurance athletes. That's why marathon runners don't look like bodybuilders and bodybuilders can't run marathons.
Speaker 1:Right, I mean, I noticed on my Fitbit when I'm running.
Speaker 2:I will, it'll, it'll say sort of what you're saying, some of these terms, um, but it'll very inaccurate, okay, and they keep running equations based off of the workload that you're doing and what your corresponding heart rate is and your age and all these things, and it just makes guesses yeah, the real way if you wanted accurate data would to be um, to have a metabolic assessment done with a metabolic cart where we actually measure that.
Speaker 2:So we would measure with a mask how much oxygen you convert to carbon dioxide and be real data. And during the test, if you'd have a heart rate monitor on, so then we would have a heart rate to correlate with all those values so we could tell you to train at these heart rates.
Speaker 1:Yeah, I mean, I mean, goodness gracious, if we're all exercising and putting all this time and effort and I'm not even doing it to the most best way I possibly can to either lose fat, then I mean that's really frustrating.
Speaker 2:You know, it's making me really mad right now that that I don't know that because some people could could be training too hard and out outside the zone and that's really fatiguing yeah, I mean there's certain benefits that you get from that, but it may not be what you want. You may want to stay in that low zone too, where you can do it for a prolonged period of time and you're not as fatigued yeah but when you increase the intensity it puts a much larger stress on the body.
Speaker 2:That's why you can't sprint indefinitely. It's a big stress on the body but you could walk for prolonged periods of time, but walking may be too low intensity. You want to find at what heart rate, at what workload the percentage of fat is oxidized and that's your fat max zone.
Speaker 1:And the only way to really get that, as you said, is through this metabolic test.
Speaker 2:The only accurate way. Otherwise you're just making guesses and estimates. Even your heart rate max based off your age, those huge standard deviation variations to where, for 95% of the population, there could be someone that could be. The number you're telling them is off by 24 beats, either too high or too low. For someone it's going to be just right. But you have to look. It's a bell-shaped curve.
Speaker 1:Yeah, so it depends, how lucky you are.
Speaker 1:Yeah, wow, great. Well, I know we wanted to talk about female athlete triad, but we're getting. I know I'm going over my time limit with you, so we'll have to have you back on the podcast to talk. You know even more about this and we'll talk about you know more. You know on these weight loss tips using you know various other methods. But before we wrap up, are there? Is there anything else or any other words of wisdom for our listeners that you would like to share, dr Kampert?
Speaker 2:I think consistency is the key. A lot of times people will get real motivated and they just want to make up for lost time and you put too much of a stress on your body so you can't burn the candle at both ends. You don't get stronger or more fit while you're working out. It's actually the opposite. It's when you recover. So you have to make sure you have structured recovery so otherwise you're going to get an overuse injury and you lose that fitness quickly. So you can lose a month's worth of work by being injured for a week. So if you get injured and you can't work out for months, not only do you miss out on that progress, you lose a lot of the gains that you have.
Speaker 2:So the key is to stay injury free and to be consistent. And from a dietary standpoint, if you have a bad meal, don't turn it into a bad day. You can undo a month's worth of hard work with one bad week of eating. So I mean, you just see it for what it is that you did something you didn't want to do and then get refocused. And sleep plays a big role in your ability to regulate your appetite, your mood, everything. So you really want to prioritize sleep and stay hydrated.
Speaker 1:That's great. Yes, very true. And if our listeners were interested in making an appointment with you or learning more about you, how can they find you online, or is there a phone number that they can? Reach you at.
Speaker 2:So the clinic does a great job of promoting us. So they have, if you Google like Cleveland Clinic and then my name, matthew Campert sports medicine, you'll get a video come up eventually on google that has like our profile and, um, even a video um of us kind of talking a little bit about ourselves and our practice. As far as social media, I don't get too involved with that. I do have something on linkedin where I'll post like articles and things that we publish, um, but yeah, from an appointment with I, the best thing would just be to look online and I, the the local news has done a couple new stories on the gym and the equipment, so I can provide those links to you If that's something you would want to share. It'd be really informative and you can see some of the patients that they interview and the outcomes.
Speaker 1:Yeah, that's great and yeah, and I'll put uh for our listeners in our show notes. I'll put the link that Dr Campert is referring to on the Cleveland Clinic website where you can find his video and his information and phone number. So well. Thank you so much, dr Campert, for joining me on the Speaking of Women's Health podcast and it was a very enlightening episode and we'd love to have you back and we do appreciate your time and your tips. And thank you to our listeners for tuning in to another episode and be sure to subscribe to our podcast if you already don't, and it's free and you can subscribe wherever you listen to podcasts. Thank you and we'll see you next time in the Sunflower House. Be strong, be healthy and be in charge.
