Again, we venture into the realm of exercise to explore its linguistics that impact medicine. The first requirement for any discussion about exercise is to define it:
Exercise is a process whereby the body performs work of a demanding nature, in accordance with muscle and joint function, in a clinically controlled environment, within the constraints of safety, meaningfully loading the muscular structures to inroad their strength levels to stimulate a growth mechanism within minimum time.
[The derivation for the definition is best explained in The Renaissance of Exercise—Volume I ROE-1 and the best analysis and breakout of its parts is found in Critical Factors of Practice and Conditioning Critical Factors.]
The definition is our anchor. Without it, we merely babble about exercise.
The essence of exercise revolves around the special usage of inroad as it is meant to represent the momentary fatiguing process that occurs en route to stimulating the desired changes in muscle. Other words within the definition become more prominent as we discuss kidney disease.
In the United States, 10-14% of the population has chronic kidney disease (CKD). It is a major cause of death. And like hypertension and diabetes and heart disease and many cancers, many who have it, do not know they have it. If 10 out of a 100 people that you could randomly get into an auditorium have CKD, 9 of those 10 don’t realize that they have this deadly condition.
{This is another case where I believe condition is the best descriptor for what is called a [kidney] disease. However, I will remain hypocritical as I reluctantly stick with common parlance.
Note that my acute kidney injury was a condition indirectly caused by a disease—streptococcal infection. One was a cause and the other was the effect of that cause. If only the medical community could be consistent with their language.}
For a good understanding of CKD, I recommend books and YouTube videos by nephrologist, Jason Fung, and Dadvice TV (James).
Many conditions are reversible even when a medical doctor asserts that they are not.
I was diagnosed with diabetes and told that it was a permanent condition for me. I reversed it with intermittent fasting.
I was diagnosed with chronic kidney disease (after the acute kidney injury had apparently healed) and told that it was a permanent disease. I reversed it with intermittent fasting.
I was diagnosed with hypertension, I reversed it with the same intermittent fasting.
[Note that heart disease, CKD, and diabetes (type II), makeup some of the conditions of what is called metabolic syndrome. Its components are interwoven.]
Focusing on the CKD, there are special recommendations for allowing the kidneys to rest and repair. Some of them commonly expressed are:
Avoid sugar and reduce carbohydrates
Avoid phosphorous (especially that found in dark carbonated drinks)
Avoid creatine supplementation
Avoid excessive protein, (especially animal protein)
Avoid excessive sodium intake
Avoid excessive potassium intake
Get adequate sleep
Avoid dehydration
Control blood pressure
Avoid intense exercise
Avoid tobacco products
Avoid alcohol
Note that the late Ray Mentzer died of CKD. Supposedly this was due to a more rare form of nephropathology known as Berger’s disease. Nonetheless, how many of the above-listed recommendations was Ray violating?
[Although I know that the recommendations above are for repairing faltering kidneys, I suspect that they are also preventive measures for CKD.]
I don’t know if Ray smoked cigarettes, but I witnessed his brother, Mike, chain smoke cigarettes at the convention where we and Doug McGuff, MD presented in 1998. [When outside the venue during breaks, Doug and I sat well away from Mike to avoid the smoke from his cigarettes.] And I know that Mike and Ray lived in the same apartment in which Ray was at least around second-hand smoke.
And did Ray take creatine as many bodybuilders do?
And we know that both Ray and his brother were heavily muscled and worked out very intensely.
Intensity is not an understood term to the medical community, although they loosely throw it around with the assumption that they command its specialized meaning in exercise. What’s worse, the exercise physiologists—who are deferred to by the doctors as exercise authorities—don’t command its meaning either. A cross-platform solidarity of this concept is fundamental to a semblance of science about exercise, but intensity talk is a murky pool of ignorance. It borders on mysticism.
Going back to the definition of exercise, note that one worthy definition of intensity is anchored to inroad. It is expressed as inroad/ time. Another allowable definition of intensity is the degree of momentary effort. These definitions are crucial for many reasons, but especially for the CKD patient.
When doctors—and almost all others—mention exercise intensity they abuse its distinctive meaning. And I have incessantly harped, without distinctive meaning we invoke gibberish. And this gibberish prevents them from making valid recommendations to their patients.
[I must admit that having two acceptable definitions for intensity apparently disturbs the required distinctiveness. Fortunately, these two definitions are cross reinforcing. They mirror each other and represent different perspectives on the same concept.]
When these “almost all others” mention intensity, they actually ramble about exercise volume which is an opposing (not its exact opposite) factor of intensity.
As exercise volume increases—a la Arthur Jones—exercise intensity must decrease. And as intensity increases, volume must decrease. At least this important relationship holds beginning at some minimum threshold of significance of both factors.
And when nephrologists recommend that high exercise intensity must be avoided, they really mean, for the most part, that high exercise volume must be avoided. Sure, there are rare occasions where the intensity must be curbed as well, but almost all of the time it is the volume to be curbed, not the intensity.
Part of the confusion is that the medical community promotes non-exercise activity as exercise. Ask yourself if the following activities qualify the definition of exercise:
Walking
Jogging
Tennis
Swimming
Bicycling
Rowing
Yoga
Tai Chi
Of course they don’t. But this is the head trash that is promulgated by health professionals. Yes, some of these activities are sometimes valuable, but they do not serve as practical exercise.
Like anyone else, almost all CKD patients require exercise. And the exercise must be intense to be effective but not voluminous to cause harm. It’s literally vital not to conflate volume and intensity.
Note another part of the definition: …within the constraints of safety. Avoiding danger in exercise most often entails the avoidance of the excessive force that ensues from excessive acceleration. In other words, we must avoid abrupt movement.
But safety for the CKD patient also includes the avoidance of excessive volume.
[And in some rare cases—as already mentioned—we need to curb the intensity. In fact, physical exercise at any intensity can kill some patients.
When I was 23, I nearly killed myself with a relapse of hepatitis incurred by low-intensity activity—jogging.
When my brother was on chemotherapy, he looked forward to his TSC sessions to the point that he begged me to allow him to perform more than two exercises. When I acquiesced to allow the third exercise, he suddenly realized that it was more volume than he could muster as he was completely knackered. It took me several similar sessions to convince him that his tolerance for the volume was extremely small.]
Volume, not intensity, is the bigger issue—a much bigger issue.
Recently, we have received reports from several long-time practitioners of high-intensity exercise who have kept records of their kidney lab markers. Some have noted that their GFR (glomeruli filtration rate), creatinine, BUN (blood urea nitrogen), urine foaming, and proteinuria have greatly improved since reducing their volume and applying very-low-force SuperSlow (dynamic) protocol.
Not only do the kidney markers improve but also does the muscular strength of these subjects who had previously resigned themselves to accept that they were already at the peak of their lifetime physical limits.
Note: We desire anabolism, NOT catabolism.
Unless, I’m missing something, building the muscle does not impact the kidneys as negatively as muscle destruction, thus creating more creatinine. This is why the stimulation via the intensity must be adequately high and the process (inroad time = volume) to the stimulation of the muscular growth must be minimal and associated with low force.
Drew and I have condemned the lame notion that so-called micro damage to the muscle is necessary for growth stimulation. [Drew has more recent information on this than I do.] I believe that future research with TSC will eventually bear out this principle spectacularly.
Therefore, these subjects incur much less muscular trauma (thus exhibiting less blood creatinine and protein in the urine) and reap better muscular stimulation with the added benefit of maximized rest—that interval when the body actually improves. And this rest includes a rest for the kidneys, especially if intermittent fasting is incorporated.
Now consider transitioning these subjects from SuperSlow protocol to TSC. This provides another quantum step down in volume and force with the opportunity for even tighter control of outroading behaviors (undesirable actions such as Valsalva, grimacing, teeth gritting, hand gripping, flailing) that result in useless and extraneously directed volume. And TSC involves virtually no risk of acceleration.
We have yet to see the necessary lab markers to compare dynamic (SuperSlow) exercise with static TSC exercise for the CKD patient. But transitioning to TSC has several other already known advantages. It often does not require a gym full of equipment as it can be performed in a recliner. Also, it is much simpler to learn and/or to instruct.
And Timed Static Contraction (TSC) is the exercise mode that purchases us any degree of intensity desired with a volume of activity (whether or not it truly qualifies as exercise) that is surprisingly small.
TSC is perfect for many CKD patients. Its application for any patient is, of course, dependent on the patient’s degree of debility and other specifics to be determined by a doctor truly knowledgeable about exercise, notwithstanding the fact that finding such a doctor is highly improbable.
TSC is discussed in several of my books as well as in those by Drew Baye. Of mine, I suggest the Critical Factors previously mentioned. Drew has many useful ideas for how to adapt simple furnishings to useful exercise tools using TSC.
The volume reduction with TSC is often two-fold as it includes a reduction of exercises in each workout AND a reduction of workouts in a given month. Workouts for healthy subjects include as few as 4-6 exercises and for early-stage rehab as few as one 90-second exercise. And a month may include as few as only three workouts.
The TSC exercises, and the volume and intensity of the exercises, can be curated with seemingly infinite control to match the needs and tolerance of the subject. And this curation potential exceeds the possibilities of any program that the physical therapists have ever before encountered.
It is common for exercise instructors to market their service to special populations. CKD patients are a special population that is likely to have been overlooked.
Afterthought: Most of the activities that I listed often recommended by doctors are sarcopenic. They promote muscle wasting and, up to a point, can be expected to generate more creatinine with little prospect of muscular anabolism or maintenance.