S1 Ep7- Exercise is as Unique as Your Patient

Good Medicine On The Go

We’ve all heard the advice, ‘eat right and exercise’, but it’s often not clear cut what exercise is best for each individual needs, how long we should exercise, and the timing of exercise. In this week’s episode, we discuss practical ways to keep patients exercising safely and effectively. We talk about things to look at on genetic reports, such as inflammatory markers and polymorphisms that can serve as a predetermination for a higher chance of response and injury. We correspond examples of exercise with certain genetic findings and give our own personal examples of how our lives changed for the better once we applied them to our daily routines.

Key Takeaways:

[3:32] When we get the right kind and amount of exercise, we get a huge bump in dopamine that can boost our mood and help with attention and focus. However, if we exercise too much or in the wrong way, that can cause stress, trauma, and inflammation to the body.

[7:42] Recovery and timing are so important in exercise, as we can become even more inflamed when we push the body after it is already deficient in sleep or healthy cortisol levels.

[9:15] Practitioners should speak with their patients about what type of exercise they already enjoy and are called to do because they are more likely to stick with it long term then an exercise they don’t find pleasure in doing.

[12:28] Genetic variance may affect someone’s risk for exercise, but should not preclude anyone from doing what they enjoy.

[13:10] The top thing we look at with genetics when it relates to exercise is the response to inflammation. When a patient has a risk variant for Interleukin 6 and does intense exercise for around an hour, they really do not do well and could actually feel more tired during the day. Patients with this risk variant may do better walking for an hour or experience better results with a 20-30 minute work out rather than trying to do more intense exercise for a longer duration. Switching to low-moderate intensity workouts, they can recover and possibly reduce the chance of harm from an increased inflammation cascade.

[15:06] ACTN3 is a muscle structure gene that tells us about your fast-twitch versus your slow-twitch. If you are a variant for the ACTN3 gene, you may be a better fit for endurance since you are able to get more blood flow to the muscles, and this may explain not feeling your best after interval type exercise. However, if you are practicing HIIT style and loving it, then go on enjoying it. This does not mean the average person has to stop this exercise. Again, referencing the IL-6 genetic variant is important.

[16:53] ACE is really about how our muscles respond and how we recover. We tend to find that ACE can tell us if we have more vasoconstriction, where our arteries contract. And that's going to be more for your sprinters and more for the people that need that quick blood flow. These are the patients who are genetically advantaged to go long distances like riding bikes and marathons.

[17:51] PPARGCA1A -this how well we're going to do with aerobic exercise. And so this could be a leverage point and say, "You know what, aerobic exercise is going to be just fine for you. However, you will also want to cross-reference the SNPs to prevent injury associated with aerobic training.

[20:11] Exercise done correctly in the right amounts actually lowers our IL6 through the vagal nerve and that dopamine. So we really want them to hit that right amount of exercise, which decreases inflammation and does not increase inflammation.

[21:18] The beautiful feature about Pure Genomics is as more polymorphisms are scientifically validated and added to the program, they automatically appear on patients' reports; one test equals a lifetime of information. It’s also easy to correlate genetic information with exercise recommendations.

[23:13] LPL is what Dr. Morris calls a ‘leverage points’; they highlight response to glucose metabolism. If somebody is struggling with keeping their blood sugar down with diet alone, knowing their LPL and LIPC variants help show the patient that doing some exercise, 20, 30 minutes each day, can really help with your glucose.

[23:53] LPL and ADRB2 are two more leverage points. These variants are related to fat burning as a result of exercise. For these patients, exercise a great way to lose this fat as they have beneficial biology for it. We call these “enhanced benefit SNPs”.

[23:13] Not all variants are risk-inducing, which is why the term “risk variant” as applied to genomic testing can be misleading. In PureGenomics, SNPs are now reported as “No Action”, “Enhanced Benefit”, or “Consider Action”. SNPs like LPL, LIPC, and ADRB2 are some of the variants that have an enhanced benefit to the patient.

[27:29] COL1A1 & COL5A1 are variants associated with ligament injury susceptibility and MMP3 for Achilles tendon injury susceptibility. And what all these SNPs show really is that you have problems with collagen and collagen deposition and strength. And so, Dr. Morris says before started an exercise program, you want to reference IL-6 and the injury prevention SNPs, COL1A1, COL5A1, AND MMP3

[33:28] We need to remember that polymorphisms are associated with a risk or a benefit. So even though it says risk variant, there's actually an advantage to having the variant as in the case of the LPL, LIPC, MMP3. This is why PureGenomics moved away from the misleading color coding and clearly marks when there is an advantage to having the ‘risk variant’.

Mentioned:

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Quotes Worth Sharing:

“The timing and telling patients they are off the hook is as important as it is for us to help them add movement into their life.” - Kara Ware[7:29]

“Exercise is just like diet - if we don’t give people the right type and the right time, we can cause more inflammation and injury.” -Dr. Nathan Morris [8:30]

“We all know, in functional medicine, you always go to the gut, and inflammation starts there.” Dr. Nathan Morris[29:22]

“We need to remember that polymorphisms are associated with a risk or a benefit. So even though it says risk variant, there may actually be an advantage to having the variant. Therefore, genes are not good or bad”. Kara Ware [33.28]