Discovering HIIT

I have spent the majority of my life as an endurance athlete.  I started swimming when I was 5 years old, and as a distance freestyler I averaged 8,000-10,000 yards a practice, 9 – 10 practices a week, starting when I was 12.  I always loved running, and when I injured my shoulder at the age of 13 and needed to stay out of the water for a year, I took up cross country.  Until I started Residency 3 years ago, I was still swimming 90 minutes 5-6 days a week and running here and there for fun.  In my mind, a workout wasn’t a workout unless it took at least an hour.

Swimming, my favorite thing!

Enter Residency.  For those who have never had the privilege to experience it, Residency is basically modern day indentured servitude.  You pretty much lose control of your life.  You work insane hours for meager pay (once, as an intern, I calculated my hourly wage – it was barely above the state minimum).  You are regularly criticized and rarely praised.  Most of your time off is spent studying, performing required research or quality improvement studies, or sleeping.  Finding time to swim or run for an hour a day?  Ha, right.  I think maybe the most dedicated, who don’t live with a significant other, potentially could.  Despite my endorphin addiction and pretty determined dedication, though, I found I couldn’t.  I was getting older and 4 hours of sleep a night wasn’t cutting it anymore.  I was newly married and actually rather liked spending time with my husband.  And I was so terrified of screwing up and hurting someone that I spent any residual time reading about medicine.

I swam when I could and ran when I could, but I started to feel depressed.  Exercise has been such a huge part of my life that without it, I just feel gross and unhealthy.  The one good thing about being a resident is that your job is not sedentary – you run around all over the hospital – so I got a FitBit and felt a little better about myself when I realized that I was walking so many steps and getting in so many flights.

As I moved through residency and graduated from internship, things got a little better.  I became a more confident and efficient doctor, and I passed the torch of intern scut to the new batch of bright-eyed and eager recent medical school grads.  I started having a bit more time to workout, and on certain rotations I was actually able to get back into decent swimming shape.  At the end of 2 months of swimming 1 hour 4 days a week, for example, I was actually starting to make repeat 100s freestyle on 1:10!  I would feel amazing – healthy, vital, fast, strong, and happy.  Then, however, I’d be back on a really hard rotation with more demanding hours, and I would lose that wonderful feeling.

Like all good 30-somethings of this modern era, I spend an inordinate amount of time on Facebook.  Standing in line at the grocery store, sitting at a stoplight, brushing my teeth (yep, guilty!), I “like” and comment and post pictures with the best of them.  It was on Facebook that I, the endurance athlete who scoffs at the idea of a 24 minute “workout,” started to see a lot of adds for this new exercise concept called HIIT – high intensity interval training.  Things like Body Boss kept popping up on my feed, promising better fitness and body tone with just 24 minutes, 3 days a week!  I initially ignored it, but it was so relentlessly in my face that I eventually decided to see what this HIIT stuff was all about.

The concept of HIIT has been around forever.  But for those of you who are new to this concept, the idea is that you pretty much kill yourself with short bursts of really hard exercise with active recovery in between for an average duration of 25-30 minutes.  Because the activity is very high intensity, it’s an efficient way to work out: you burn more calories in a 28 minute HIIT workout than you do in 1 hour on the elliptical.  Best of all, the majority of HIIT workouts require little more than a small rectangle of space to perform, so you can do the workouts, well, anywhere.  According to the American Society of Sports Medicine, HIIT training has been shown to improve:

  • Aerobic and anaerobic fitness
  • Blood pressure
  • Cardiovascular health
  • Insulin sensitivity (in fact, there are tons of publications advocating HIIT training for Type II diabetics)
  • Cholesterol profiles
  • Abdominal fat and body weight while maintaining muscle mass

Hmm…a highly effective workout routine that I can do at home in 30 minutes?  I had to try this!

Unwilling to pay for something I wasn’t yet 100% sold on, I went to the internet.  Just google “HIIT workout” and you will find hundreds of free workouts for your body-destroying enjoyment.  I pulled up a 28 minute workout from Fitness Blenderinwardly still not entirely convinced.  After a 5 minute warm up, I spent the next 20 minutes performing explosive movements for 20 seconds at a time with 10 seconds of active rest (such as a boxer shuffle) in between.  I squatted, lunged, jumped, and pushed-up until every muscle in my body screamed in protest, my heart pounding in my ears and my breath coming in ragged gasps.  At the end I stood hunched, hands on my knees, dripping sweat onto my living room carpet.  I couldn’t believe it had only been 25 minutes – it had felt like forever!

Okay, I admitted as I obediently performed the cool down portion of the workout.  That was hard.  And I was hooked!  HIIT has become a way for me to feed the endorphin monster, to maintain that strong and healthy feeling, on a minimal time budget.

I created a *free* account on Fitness Blender, which was started by a husband and wife team of personal trainers who thought that fitness should be accessible to everyone, no matter what their income (how can you not already love these people?!).   Fitness Blender has a TON of free full-length workout videos ranging in difficulty from 1-5 and in duration from 20 – 90 minutes.  You can pull up workouts that use equipment, but there are hundreds of workouts that require nothing more than an internet connection and an 6 x 4 ft rectangle of floor space.  I love their workouts because 1) they are both really encouraging instructors, 2) they have a visual and audio timer so you know when to go hard and when to do your active rest, and 3) they have the decency to also get a little tired at the end of a grueling level 4 or level 5 workout.  It’s just nice to know, when you feel like you are about to die, that even the uber fit personal trainer leading your workout is a wee bit winded.

fitness blender
Kelli and Daniel, egalitarian founders of Fitness Blender.

I believe it is still important to do other forms of aerobic exercise.  I haven’t given up swimming, for example – swimming is still my #1 choice for exercise and always will be.  Whenever I have the time to swim, I greedily snatch the opportunity.  Running, too.  However, on those days when I don’t have the time, or when it’s 100 degrees in Redlands and running would put me at risk for heat stroke, I happily log on to Fitness Blender and get my HIIT on, feeling awesome and exhausted 30 minutes later.

If you haven’t given HIIT a try, you really should, especially if you are low on time and want to improve your fitness level.  Let Kelli and Daniel of Fitness Blender make you a convert!






Casual Fitness

I hate elevators.  I truly hate elevators.  And not just because of the feeling of claustrophobia (which I get), or the awkwardness of standing around squashed against strangers (which I feel), or the infuriating inefficiency of standing and waiting around for vertical transport (which my meager attention span can’t seem to tolerate).

These considerations, while significant, pale in comparison my observation that we as a society seem to have forgotten that the majority of us have perfectly functioning lower extremities perfectly capable of carrying us up and down a few flights of stairs.  It boggles my mind when I see people use an elevator to go down a single flight.  I mean, really?!

Now, don’t get me wrong, elevators do serve a noble purpose.  There are those among us with disabilities, injuries, or other conditions preventing the usage of stairs.  In this regard elevators have served to provide equal transport within a building.  As someone who has moved into dorm rooms on the 5th floor of buildings without elevators, the existence of an elevator to move heavy or bulky objects is a blessing.  In my hospital, elevators allow us to move patients to the places they must go to receive care.  These are just a few examples of appropriate elevator operation.

For routine use, though?

Obesity is a scourge in this country, and it has been getting alarmingly worse over the past 20 years.  Obesity rates exceed 25% of the population in most states and is associated with a myriad of health problems.  1 in 4 women who become pregnant are obese, which not only increases the risk of preeclampsia, gestational diabetes, stillbirth, and congenital anomalies, it also makes cesarean deliveries and postpartum recovery more complicated.  Even a lot of adults who are not obese are deconditioned from sedentary lifestyles and white collar jobs that require mental, as opposed to physical, exertion.

obesity 1990
United States obesity map in 1990.  Not too bad, really.

Obesity is a complex, multifactorial problem.  However, a major contributor is that most of us Americans have become complacent.  We spend 10 minutes driving around a parking lot to find the closest possible parking space instead of just parking in back and walking.  We take an elevator to go up 3 flights instead of taking the stairs.  We have technology that makes our daily lives easier and more efficient (I love my Roomba), but also provides us more time to sit around.  The American Diabetes Association recommends 10,000 steps a day just to help maintain weight (as opposed to losing weight), and most people fall dramatically short of this goal.  Our cars, technology, and yes, elevators, are not helping.

obesity us
United States obesity map in 2015 with trends by state to the right.  Note the complete absence of blue or green states.  Even in traditionally “fit” states, such as California and Colorado, 1 in 5 people are obese!  This is seriously scary!

Good health is golden. Good health is something to hold sacred, that you can feel grateful for even at those times when the rest of your life seems to be falling apart.  No matter how bad things get, at least you aren’t taking 20 medications to manage all your medical problems.  At least you don’t have to stick yourself multiple times a day to test your blood sugar and give insulin injections.  At least, if you live at the clinic, it’s because you are providing care, and not because you need to see multiple doctors a month for all of your medical conditions.  At least you don’t have to devote a chunk of your income to prescriptions and copays.  In a high stress world, at least you don’t have to be stressed about your health.

Have I made my point?

To live a fabulous life you have to have the health and vitality to really live.  Maintaining good health is a necessity to maintaining balance, and maintaining good health is something in this crazy world of ours that you can actually have some control over.  Part of maintaining good health is keeping your body fit.  Vanity aside, staying fit keeps your heart strong, your muscles lean, your bones free of osteoporosis, and even keeps your mind sharp.  Good fitness ensures you can continue to enjoy the things you love well into your later years.  Who cares if you are 70 if you have the fitness of a 50-year-old?

mom and dad at wedding
My parents.  Aren’t they gorgeous?  Dad is 70 and still runs marathons.  Mom is 67 and swims 3-4 days a week.  Totally healthy, pretty much zero medications, and they look younger than most couples in their 50s.  They are fit and happy and living life fabulously!

Finding time to workout, though, can be tough.  When I work 16 hour days and 90 hour weeks, the last thing I want to do is go to the gym.  I’m sure many of you can relate!  So how to prioritize fitness and maintain balance when the time and energy just frankly doesn’t exist?  Enter what I like to call “casual fitness.”  What I mean by this is figuring out how to build small snippets of exercise into your day.  Here are some examples:

  1. Get a FitBit or some other sort of fitness tracker and set goals for yourself, at a minimum 10,000 steps a day.  Then see how you do.  Having a goal and keeping track will help motivate you to walk more!  These devices keep track in real time, so if it’s 3pm and you’ve only got 2000 steps, then you know you’ve got some work to do before midnight!
  2. Pretend elevators do not exist.  Take the stairs 100% of the time (okay, unless you are going to the 100th floor of a sky scraper or something…though if you’re feeling it, go for it!)  As someone who hates elevators and has a lot of experience taking the stairs, I promise you will not be a sweaty mess in your nice suit after walking up to the 3rd floor.
  3. Stop circling the parking lot at a grocery store or restaurant, stalking the space in front.  Just go to the back, park, and walk.  Even if you are in heels – you know you’ve walked farther in heels before!
  4. Take periodic 5 minute walks throughout the day.  Short of someone coding, imminently delivering, or whatever similar emergency exists in your line of work, there is nothing that can’t wait 5 minutes for you to get up and stretch your legs from time to time.  Get away, clear your head, get some steps in.  By the time you get back you will feel better and likely be more efficient!
  5. No matter how tired your are or how gross you feel, you can always walk.  Take a 15 minute walk after dinner every night (or longer).  Bring your family with you and make it some time to be together without the distraction of technology.
  6. If you live close to your grocery store or place of work, consider walking.  Biking is a good option as well, just be careful of distracted drivers who are texting and not necessarily looking out for you.

You would be surprised how much activity just these small changes can add to your day.  You may not be devoting an hour to a formal exercise regime, but you will be incorporating casual fitness on a regular basis.  I predict in a few weeks you will notice a difference.  So join me in eschewing the elevator in the name of casual fitness and better health!  I’ll see you on the stairs.

What ideas do you have about how to incorporate casual fitness into your day?  I would love to hear your thoughts!