Hypertension Journal

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Physician Heal Thyself: Lead by Example-My PersonalTale of Physical Fitness
  JOHTN
PHYSICAL FITNESS
Physician Heal Thyself: Lead by Example-My Personal
Tale of Physical Fitness
Uday M Jadhav
Cardiologist
Department of Cardiology, MGM New Bombay Hospital, NaviMumbai, Maharashtra, India
Correspondence Author: Uday M Jadhav, CardiologistDepartment of Cardiology, MGM New Bombay Hospital, NaviMumbai, Maharashtra, India,
e-mail: umjadhav@gmail.com
 
ABSTRACT
Exercise is the most effective antiaging pill ever discovered.This is a small commentary on my way of lifestyle modificationfor a better quality and peaceful existence.
To exercise for a physician who preaches lifestyle modificationsis sacrificing professional work and the capital gains.Swimming has some element of aerobic and anaerobic metabolism;as the swim distance increases, so does the contributionof aerobic metabolism. Anaerobic work is best done at thefastest possible speeds. Anaerobic threshold along with aerobicthreshold and VO2max constitutes the exercise physiology thatmake up the aerobic profile.
Shavasana which is an integral part of yoga sets in calmnessof the mind and release of thoughts turning inward awayfrom the more mundane things in life. The physiological benefitsof deep relaxation are numerous, including those on control ofheart rate and blood pressure. The practice of yoga and meditationrecently had an endorsement from the American HeartAssociation in the first ever released guideline on meditation.
Keywords: Exercise, Shavasana, Swimming, Yoga.
How to cite this article: Jadhav UM. Physician Heal Thyself:Lead by Example-My Personal Tale of Physical Fitness.Hypertens J 2017;3(2):64-66.
Source of support: Nil
Conflict of interest: None
 
 

THE EXERCISE MANTRA

Exercise is the most effective antiaging pill ever discovered.
Exercise to me is a primitive pleasure. I exercise forthe complete sense of fulfillment. Nothing to prove tomyself or anyone, nothing to lecture or write about. Norole model stuff, just a passion. Like the old red wine, itgets better with the age.

I learnt swimming 25 years back and have neverlooked back and to the best of my ability never skippeda day. I weighed 76 kg, and wore 34-inch waist trousers.One year down the line, I lost 12 kg and weighed64 kg; body mass index was 22.9, which has remainedunchanged for 24 years. Never lost or gained an inch for 24 years. The pictures over the last three decades haveremained reasonably unchanged as you may notice inFigures 1 to 4. It is a pain at times to search for my 32-inchDockers trouser in the US malls, but so be it. I have beenvery fortunate to have the Mumbai Young Men's ChristianAssociation (YMCA) branch with pool and gymnasium5 minutes from my residence. The consequence issacrificing professional work and the capital gains. It wastough in my younger days of practice-a related struggleto accept this loss. I am happy that at least in one aspect oflife my conviction remained firm. For the last 5 years, I dothe stretches and permissible weights at the gymnasium.The whole active exercise phase is 90 minutes. As we age,it becomes absolutely relevant to keep up the muscle tone.

 
There are as many alternatives to swimming-jog,treadmill, rope skip, badminton, or simple walk.
"Everyone should take their dog for a walk every day,even if they do not have one"-Prof Pers Astrand.

EXERCISE PHYSIOLOGY OF SWIMMING

Anaerobic and aerobic metabolism are both achievedin swimming. Swimming has some element of each; asthe swim distance increases, so does the contribution ofaerobic metabolism. Anaerobic work is best done at thefastest possible speeds.

When lifting weights, you have a pretty good ideahow the work should be done. There need to be certainnumber of repeats with a certain amount of weight repeated in several sets. It may be based on a percent ofthe maximum you can lift or on a history of what youlifted previously. In the swimming pool, it is a differentball game, as it is difficult to judge and have mathematicson how the desired training endurance can be achievedor for that matter, the maximum predicted heart rate.

Physician Heal Thyself: Lead by Example-My PersonalTale of Physical Fitness
Fig. 1: 1980s: Award for nifedipine efficacy inhypertension thesis
 
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Physician Heal Thyself: My Personal Tale of Physical Fitness

Physician Heal Thyself: Lead by Example-My PersonalTale of Physical Fitness
Fig. 2: 1990s: USMLE clinical skill test, market street,philadelphia, USA

Physician Heal Thyself: Lead by Example-My PersonalTale of Physical Fitness
Fig. 4: 2017: After 25 years

Anaerobic threshold, in swimming, is the fastest pacea swimmer can hold over a minimum of 30 minutes (nobreaks), while still being able to process/tolerate thebuild-up of lactic acid. Anaerobic threshold along withaerobic threshold and VO2max constitute the exercisephysiology that make up the aerobic profile. Anaerobicthreshold is the point where the body starts to producelactic acid faster than it can be removed, resulting inan accumulation of lactate and fatigue. Events of 10 to30 minutes duration are often done right at or just slightlyabove the anaerobic threshold.

As one crosses the anaerobic threshold, activationof the more fast twitch (FT) muscle fibers starts. Fasttwitch fibers produce their energy primarily through the anaerobic energy system, resulting in the productionof more lactate than the body is capable of removing.The biggest source of lactate removal is the slow twitch(ST) fibers. Long low-intensity training will improve theability of the ST fibers; the so-called ST fiber fitness, toremove the lactate produced by the feet fibers.

 
Physician Heal Thyself: Lead by Example-My PersonalTale of Physical Fitness
Fig. 3: 2000: Weekend break doppler training,Colorado, USA

SPEED AND ENDURANCE IN SWIMMING

  • Minimum Endurance Pace (EN1): Almost any distance,with very low rest (less than 30 seconds) betweenrepeats, swum at a sustainable, fairly easy pace.
  • Threshold Endurance Pace (EN2): EN2 pace is the secondof three endurance training zones also named asthe "Threshold pace or 'Cruise' interval." The usualdistance is less than 500 yards with up to 60 secondsrest between repeats, swum at a pace faster than EN1.This type of set takes between 20 and 45 minutes tocomplete, and increases the ability to perform aerobicwork without causing a buildup of waste products inthe muscles. It is recommended to follow a day of easywork to restore muscle glycogen stores.
  • VO2max Endurance Pace (EN3): A pace faster thanboth EN1 and EN2 for a usual distance less than 300yards with rest just above 20 seconds for a durationof 30 minutes or lesser. Recovery phase is required torestore muscle glycogen stores.

My swimming involves 50% EN1 and 50% EN2 withless than 10 seconds for flip over and 0%#37; EN3 for comfortzone, but my recommendation is to do some of each overa week depending on the age and physical endurance. It isimportant to hold the pace for each set. With experience,one can relate the perceived exertion to actual speed anddecide the pace.

What is vital is to keep the body "streamlined" to cutthrough the water effortlessly and keep the body supple and not splay water around. It is all about the technique,not speed. Cruise speed to me is the yoga while swimming.The breathing is in perfect harmony with the limb movements,thoughts are inwards, and there is no distraction.

Hypertension Journal, April-June, Vol 3, 2017 65

Uday M Jadhav

It is good to relax and take it easy in a swimming poolas an evening out just like one does in Jacuzzi, but a wasteof energy to finish a lap and get into conversation at theother end of the pool during a swim workout. It defeatsthe very concept of exercise physiology. The MumbaiYMCA has more of an exercise culture rather than the"club" culture, so it helps. No fancy restaurant and bar,only exercise facilities.

There are days when exercise in the morning becomescumbersome. All of us have experienced it. Muscles arestiff, limb movements laborious, and it is just not the usualday. At a younger age it is easy, later on, it is a signal for arest day and come back on the next or still better just takeeasy in the pool. The usual culprits-too late in the nightbefore, jet in and out for conferences, late night party, poorsleep quality-are unavoidable and potentially avoidable.The most vital aspect in my opinion is good hydrationthe night before and just prior to the exercise. I make it apoint to keep up the fluid volume and consume at least1.5 L of water during the exercise span and before Thathelps in endurance and lessens muscle fatigue. Scoopof whey protein within 15 to 30 minutes of the workoutadditionally helps. I am a believer in a less-carbohydrateand high-protein diet, little extra portion of monounsaturatedfats, and I have no surprise at the findings of thedietary recommendations of the PURE study at the ESC2017 meeting.

YOGA

Swimming is yoga to me. I follow it up by Shavasana inthe quiet of the home. Shavasana (Shavasana or CorpsePose) is done at the end of a yoga practice in lying flat ontheir backs with the heels spread wide and the arms atthe sides of the body, palms facing upward, eyes closedand deep breath with the use deergha (long) pranayama.This reclination is good enough for me as a novice notyet ready for formal meditation. It sets in calmness ofthe mind and release of thoughts turning inward awayfrom the more mundane things in life. The feeling ofbeing very still with light, unconscious act of breath is the serene feeling of when life ceases. It is a perfect stateof sensory withdrawal.

 
The physiological benefits of deep relaxation arenumerous, although may not be scientifically tested bya clinical trial protocol.
  • Decrease in blood pressure
  • Decrease in heart rate and rate of respiration
  • Decrease in muscle tension
  • Decrease in metabolic rate and the cons umption of oxygen
  • Decrease in general anxiety
  • Improvement in concentration and memory

The American Heart Association's first ever guidelinestatement on meditation published online on September 28,2017 has added the proven and much-needed meditationand yoga adjunct to other standard therapies in reducingcardiovascular risk with "biological plausibility" for beneficialeffects on the physiological basal state. Although, in agiven individual, the response of blood pressure reductionmay vary, it still plays a substantial role in hypertension.

FINAL THOUGHTS

I still believe that I am at the lower berth of fitness andonly have to take inspiration from friends and strangers tounderstand life in totality. My biggest regret is not followingthe entire art of yoga and meditation. Probably it is dueto the thought that this is all I can do with the time available(rather than spare) before I start the professional work.Had I had the time available or taken a decent decision toslow down or call it a day, I will have the whole morningto exercise, self-contemplate, and even meditate, all at aleisurely pace. Wishful, secret thinking and when I meetpeople usually out of the medical profession than insidewho live life in this manner, the motivation is stronger.

To this date, I have not had a wakeup call. Eventually,it will come, and I will not wake up. But then, it will notmatter. Dust to dust-no regrets.

ACKNOWLEDGMENTS

The author owes a deep sense of gratitude to Dr PravinGaikwad who held his hand and taught swimming25 years back and motivated him to keep at it over theyears, and his father, who at the age of 90 years, nevermissed his morning walk up the hill.

 
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