Sports Cardiologist, Endurance Athlete
Annual periodicity, or taking a step back and thinking about a full year calendar as it relates to performance and health, is an uncommonly practiced fitness practice that is highly effective. Designating times of high volume/high intensity as well as times of rest and recovery is key to optimizing performance and long term health. Transcript: "Hey Andrew, this is Dr. Baggish. Your question, what uncommon or controversial fitness practice do you believe are highly effective? Really caught my attention, and I wanted to share with you my thoughts. As someone that has the opportunity to work with a lot of high level athletes who are coached by some of the world's best coaches, one of the things I see, not practice with nearly enough attention is the concept of annual periodicity. And this is really stepping back and thinking about a full year calendar and as it relates to performance as well as health. The rough rule of thumb we use in our practice is that when you think about a 12 year calendar, at least three months out of that 12 month year should be spent in a phase of active recovery, which we define as decreasing both volume and intensity by at least 50%. The truth is that most fit people do the same thing over and over, day in day, out week in week out. And while this may help maintain some baseline level of fitness, it really is not the key to optimizing performance nor is it the key to long term health. So in essence, stepping back and thinking about the full year and designating times of high volume high intensity as well as times of rest and recovery is really one of the most controversial and uncommonly practiced things I see. I hope that helps and keep the questions coming."
Inflammation is a response to stress and can be beneficial, but chronic inflammation may not be a great thing. To reduce inflammation, focus on eating antioxidant-rich foods like berries. Transcript: "Hey, Amy. Dr. Baggish here. I saw your question about reducing inflammation and thought I'd throw out my 2 cents. So first off, I think it's important to remember that not all inflammation is bad. Inflammation is a response to stress. And as athletes, when we put in a hard workout, inflammation is actually the recovery mechanism by which our body gets stronger again and adapt. So inflammation is not all bad. However, chronic inflammation, which is there for long periods of time independent of exercise, probably not a great thing. When it comes to reducing inflammation from a dietary perspective, probably the most important thing is to target foods that are high in antioxidant metabolites. Antioxidants help battle oxidative stress, which is actually probably the primary trigger for inflammation. And when it comes to easily-digestible, high-antioxidant foods, there's only one word to remember, and that's berries-- strawberries, raspberries, blueberries, goji berries. Those are incredibly potent from an antioxidant perspective and should really be a staple of all athletes diets. Hope that helps. Keep the questions coming."
If I had to give one piece of medical advice to a masters athlete, it would be to prioritize volume over intensity when it comes to exercise. Reduce high-intensity sessions to one or two at the most per week and focus on volume the other days. This will reduce medical complications of training while also improving performance in certain endurance sports. Transcript: "If I could give only one piece of medical advice to a masters athlete, what would that be? Well, that's a tricky question because I thoroughly enjoy working with masters athletes. And I love giving them just as much advice as they're willing to take. Thinking through all of the different tidbits that I typically try to provide from an advice perspective, if I had to choose one, it would be to think about the right balance of exercise volume and exercise intensity. As we age, our ability to perform high-intensity workouts over a short period of time tends to decrease. While young, highly-competitive athletes can oftentimes get away with three or four high-intensity sessions a week, as we age it becomes much more important that we prioritize volume over intensity. So for masters athletes looking to stay fit and competitive, I would advise them to reduce their high-intensity sessions to one or two at the most per week, and to really prioritize volume on the other days such that it's possible to train six if not seven days a week. But the vast majority of that training should focus on volume rather than high intensity. Not only will this reduce medical complications of training, but it will also actually translate into better performance in specific type of endurance sport. So really, it's a win-win situation."
LDL is the most important cholesterol subtype to measure, and we should focus on getting it as low as possible. High HDL is good for you, but not nearly as important as having a low LDL. Transcript: "Hey, Josh. I saw your question about the HDL LDL cholesterol test and thought I'd try to shed some light on that. So there are basically two types of cholesterol that are commonly measured in clinical practice-- HDL, which is the so-called good cholesterol, LDL, which is the so-called bad cholesterol. And for years the thinking was that it is the ratio of the two that mattered meaning you could offset your bad cholesterol by having a good high cholesterol. And while that makes intuitive sense, science is kind of pushed back on that one. And it's now clear that although you're better off having a high HDL, it's probably good for you, it's nowhere near as important as having a low LDL. So we no longer really rely on ratios but focus solely on the LDL level and shoot, when appropriate, either with lifestyle interventions or with medications to get that as low as possible. The other thing that's interesting, and this is just an aside, is that all of our attempts to raise HDL, whether it's been through lifestyle intervention or through medications, have really not proven beneficial for people over the long haul. So good news is it's gotten simpler. LDL is really the single most important cholesterol subtype that we measure. And that's really where all the targets should be as we think about getting ourselves healthier."
The heart of a sprinter responds to pressure stress by thickening, while the heart of an endurance athlete responds to volume stress by enlarging and dilating. Sports that are a combination of both pressure and volume, such as rowing, cause both thickening and dilation. Imaging tests can be used to determine if an athlete's heart is healthy or not. Transcript: "Hey, Ed. Dr. Baggish here answering your question about hearts of sprinters differ from parts of endurance athletes, which is one of my favorite topics. So the heart is a really smart muscle and it responds to exercise. It remodels, changes shape, changes size, changes function. And indeed, the type of sport we do dictates how the heart responds. Broadly speaking, the heart can feel two types of stress. It can feel a pressure stress or a volume stress. When we talk about endurance athletes who maintain high levels of blood flow through the heart, high cardiac output, their heart really feels a volume challenge. And what volume does is it causes the heart to enlarge and dilate. In contrast, sprinters, power athletes, they experience a pressure challenge in the heart and that causes not a dilation of the heart, but a thickening of the walls. So the pure endurance athlete will tend to have a dilated heart, the pure sprinter, power athlete will tend to have a thickened heart muscle. But in practice, there are sports that are a combination of both volume and pressure. Rowing would be the best example. There's high cardiac output needed to maintain speed on the water, but there's also pressure during the catch phase of each stroke, so you get pressure and volume. So some forms of endurance sport have a combination of both a thickening and the dilation. What's important is that we use that in the office to figure out when an athlete's heart is healthy or not, and we start by asking the athlete what type of sport do you do. And when we look under the hood with an imaging test, say an ultrasound or a cardiac MRI, if we see a different size or shape heart than we would expect for that athlete, then it gives us a sense that something may not be right. So a great question and please send more of these along."
It's a personal preference whether or not to eat before running in the morning. If you prefer to eat, you should have 2 to 400 calories of a combination of easily digestible carbs and some protein along with the right amount of fluid. There is no science to support that women in their 40s should never run fasted. Transcript: "Hey, Christine. Dr. Baggish here. It sounds as if someone told you that as a woman in her 40s, you should never run fasted and so you're looking for some idea about the ideal macronutrient composition prior to easy morning runs. Well, first off I'm sorry that someone told you you should never run fasted. I'm not sure there's any science to support that. In fact, many distance athletes of both genders and across the entire age spectrum prefer to do a morning workout without having taken any food in. It's really a personal preference thing. There's no downside or danger to running fasted. If you find that you feel better eating, typically 2 to 400 calories of a combination of easily digestible carbs and some protein along with the right amount of fluid, something that you enjoy eating, this doesn't have to be some nasty energy bar. It can be some real food alternatives, some grains, some chicken, some fish will really do you well. But again, I want to emphasize the fact that there's no never run fasted science that I'm aware of, and so you should experiment and do what's right for your body."