For twenty years, the medical profession has wholeheartedly embraced evidence-based medicine. This means using the results of scientific studies published in medical journals to decide how to promote health and to diagnose and treat illness. The alternative is doing things the way “experts” say to do them, or because we’ve always done things this way. Years of experience have proved that expert opinion and past practice are wrong nearly as often as they’re right.

Many of my patients want to know what to do to lose weight, maximize their health, improve their sleep, or lower their risk of cancer and heart disease. The scientific evidence of the past fifteen years is clear: nothing beats exercise.

Many people consider “exercise” a 4-letter word you spell with eight letters. But only exercise can help you live longer — with less illness, less pain, more energy, and better function. The science is overwhelming: nothing else comes close.

Regular exercise reduces your risk of a heart attack, most cancers, and Alzheimer’s disease by about half. Exercise alters your metabolism, so you burn fat. It lowers insulin levels, reducing blood sugar and the risk of diabetes. Sufficiently intense exercise helps your brain grow new neurons, improving memory and concentration. You get more done, so the time you spend exercising is repaid during the day with improved productivity. Studies have shown that for many people, exercise works as well as psychiatric medications to reduce anxiety and depression.

Many of my patients have found they could never get around to exercising or didn’t like the results. Here are some of the problems they encountered:

  • I have to leave for work early and/or get home late. There’s no time!
  • Exercise is boring.
  • I hurt worse if I exercise.
  • I don’t feel safe exercising outdoors.
    I live in a hilly area, and I’m too weak to walk up and down all those hills.
    I hate the meat locker atmosphere at the gym.

Let’s take these one at a time.

First, we’ll start with the precautions. Just as there is a tiny risk of injury in getting out of bed — and even greater likelihood of illness if you always stay in bed — exercise can cause harm. You can almost always mitigate this risk if you plan ahead. But if exercise makes you feel bad, don’t do it without a doctor’s supervision. In particular, if you develop chest pain/pressure or severe shortness of breath, have a physician check you out.

Don’t emulate Jim Fixx, the famous runner. Jim dropped dead in 1984 while on his daily run. He knew he was at risk from heart disease — his family had a horrible history of premature death — and he had chest pain whenever he ran. He was so certain running completely prevented heart disease risk, he never consulted an MD. He kept exercising until he dropped. Autopsy showed severe coronary disease.

Thankfully, few of my patients are at any serious risk from exercise. Most of the time, the problem is a little different: people have fixed ideas about exercise they’re reluctant to evaluate or give up. To them, exercise means walking, or going to the gym, or riding your exercise bicycle, or doing something else you hate and makes you feel bad. No, no, no, no!

I like to think of an exercise program as a creative act: something from the smartest, most loving, and most wonderful part of you that you do for yourself. Because this is a field with relatively little science and a lot of “experts,” you should probably ditch the rules and figure out what works for you. Nevertheless, there are some good basic rules of thumb worth considering.

The basic rules are simple. Figure out what makes you feel good and makes you pant and sweat. Don’t do stuff that hurts, aside from the pleasant muscle aching from working out. Plan your exercise schedule and location so it’s convenient and no hassle. Be smarter than your limitations. Most importantly, do what you enjoy!

Unless you have a limiting medical or pain problem, it’s important to exercise with the right level of intensity. You should feel better after you’ve worked out. Pant and sweat during your workout. It should take time to cool down afterwards, at least ten minutes after stopping. As you become fit, your metabolic rate increases, and you’ll find you like the room a few degrees cooler.

Different kinds of exercise

Traditionally we think of exercise as occurring in four different settings: aerobics, strength training, exercising while playing a sport like tennis, and on-the-job exercise from hard labor or running around all day. Certainly manual laborers get plenty of all kinds of exercise and may not need more, though doing something that improves fitness and feels good may be well worth the effort. (But why are the guys most apt to be out playing sports the ones who are the most physically active at work?)

I think of the kinds of exercise a little differently: aerobics, strength training, and interval training. I discuss these each in more depth separately (I’m still working on the details of strength training), but here’s an overview:

  • Aerobics (endurance exercise) is what most people think of when they want to get in shape. Walk, bicycle, run, swim, or play a vigorous sport several times a week. Do something that gets your heart going for 20-60 minutes at a time or more. This works well, and aerobics should be a part of any program. With attention to detail, there’s little risk of injury. But there are problems. First, if you’re pressed for time, it’s not very efficient. Second, many of my patients do something half-heartedly for a few minutes twice a week and consider that exercise. Third, because it takes a while, it can easily become boring.
  • Strength training combines several disciplines: calisthenics like push-ups and pull-ups (using your own body weight), lifting free weights, and machines that exercise one particular muscle or joint at a time (usually found in gyms or those giant home exercise contraptions). I like strength training a lot, particularly free weights. It’s extremely time efficient. It may be the best way to lose weight. Strength training takes more planning and organization than aerobics, and it’s important to know what you’re doing. For example, unless you’re a 47-lb weakling, you will derive little benefit from lifting 2-lb dumbbells. On the other hand, if you’re recovering from an injury or have fibromyalgia, light weights may be essential.
  • Well-trained athletes have used interval training for years to improve performance. It turns out this may be the quickest way to become fit, once your aerobic fitness allows it. In theory, interval training is easy: alternate moderate aerobic exercise with short bursts of maximal exertion. Studies have shown that 20 minutes of interval training has the same training effect as over an hour of plain aerobics.

Overcoming barriers to exercise

Let’s revisit the common objections:

  • There’s no time. It’s funny that the busiest, highest achieving executives are the most committed to making time to exercise, because they recognize its benefits. Strength training for 45 minutes three times a week or interval training five days a week for 20 minutes can give you superb fitness.
  • It’s too inconvenient. Roughly half my patients prefer to exercise in a gym, and half work it into their daily routine near home. A few go to work early (avoiding rush-hour traffic) and work out in a gym near work. My rule of thumb is, if you had to go somewhere inconvenient to take a shower, how often would you do it? This is another example of the importance of creatively figuring out what works best for you.
  • It is so BORING. Usually the problem is doing something you dislike and not working hard enough at it. Again, strength training and intervals are more efficient and more interesting, but the chief problem is not using your head. Be creative: find something you enjoy.
  • The place I would normally exercise is too unsafe, unpleasant, difficult, or whatever. This is another example of not thinking it through. For example, I recommend that many of my retired patients go to an indoor shopping mall when it first opens and walk the corridors before it gets busy.
  • I feel worse after I exercise. If exercise makes you feel bad, see your doctor. If you have hip or knee pain, you may do better with nonimpact approaches like water walking (walking in the shallow end of a swimming pool), a stationary bicycle, or an elliptical machine. Exercise is usually the best treatment for those with chronically aching muscles or fibromyalgia, but you may have a flare-up if you do too much too soon. Many patients do best under the guidance of a physical therapist or trainer attuned to their specific needs.
  • I’m afraid I may injure or reinjure myself. You’re less likely to hurt yourself doing aerobics, but strength or interval training can cause problems if you’re not careful. For example, it’s possible to rupture a tendon if you lift weights improperly. If you’re concerned, get help from a physical therapist or trainer.

You may want to hire a trainer

After years of listening to my own advice but just doing aerobic and interval exercise, in 2017 I joined a gym I really like. Well, um, mostly really like, but the people are really nice. And I work with a trainer twice a week doing strength training. I’ve noticed clearcut improvements in strength, stamina, and balance. The best part is I have a lot more energy. It’s well worth the money. Strength training greatly increases the benefits from exercise.

I wish it worked better to lose weight

The science is slowly accumulating that exercise just by itself won’t help you lose weight. It has a thousand other benefits, but the calories burned aren’t that huge. And we tend to rest more and eat more after working out. That said, the increased muscle metabolism and reduction in abdominal fat are totally worth it.