Hi, I'm Dr. Karen Basen-Engquist, a researcher
in our department of Health Disparities Research at MD
Anderson Cancer Center with a focus on physical activity
and weight management for cancer survivors and high-risk
individuals. And I'm here today with another researcher
from the Health Disparities department, Dr. Scher Mama.
So, welcome, Scher.
And this is the Cancerwise podcast.
So glad that you have agreed to
have another one of these conversations, Scher.
This is a lot of fun. And we're here today
to talk about exercise snacks.
So, can you tell me a little bit about, what
are exercise snacks? When I have mentioned this to other
people, they say, "Are those the snacks we eat when we
exercise?" Because there are, you know, everybody was
always very excited about eating more.
Yeah, everybody's always excited about snacks, right?
Well, thanks for having me, first of all.
This is a really great topic.
So, I'm really excited to be here.
And contrary to popular belief, exercise
snacks are not actually snacks you eat while exercising,
before exercising or after exercising.
An exercise snack is a structured bout
of exercise that can be dispersed throughout your
day. It's supposed to be easy and digestible, right?
So, they can be as short as 15 seconds.
They can be as long as ten minutes.
They usually don't exceed like that length of time, because
we want it to be something you can incorporate rather
easily into your day.
So, the term "snacks" means it's more approachable,
right? You don't necessarily have to set aside a long
period of time to go to the gym, have a ton of equipment
with you, or have a special outfit
or go somewhere special.
It's sort of this idea of, can I do something small
throughout the day? And that can build up toward maybe
doing more exercise later.
So, kind of like a "gateway drug" to doing
more exercise, if we could call it that.
And I think exercise snacks, the beauty of them is that can
target multiple components of fitness, right?
So, it doesn't have to be one thing or the other.
It could be aerobic, it could be muscle strengthening, it
could focus on flexibility, it could focus on balance.
So, targeting multiple components of fitness and
multiple intensities. They could be light intensity, it
could be moderate intensity, it could be vigorous.
So, really, like, there's any combination.
It's kind of like the wild wild west of exercise right now.
We're still kind of working on it, but just little things
that you can do. A good example would be something like,
let's say you want to work on your aerobic fitness, maybe
doing some jumping jacks during commercial breaks, right?
And maybe not every commercial break because I feel like
they're getting longer and longer.
But maybe, you know, pick two commercial breaks during a
60-minute show to do some jumping jacks, or
one that I heard recently was somebody who said she
does 5 to 10 pushups every time she uses the restroom.
And I was like, well, every time I get up to go to the
bathroom, I will be Diesel at that
point. But, you know, that's another good example of a of a
short bout of exercise that you can do.
And it can target lots of things to different types of
fitness, different lengths of time, different intensities.
Really, you know, the world is your oyster.
And I love that. And I think an exercise snack sounds
like a lot more fun than a long, grueling workout.
So, I can see where it's more approachable, especially for
people who are just getting started.
And those are some great examples.
I also think about, like getting up and dancing
to a song a few minutes, right?
Just getting your body moving, I think is
a great way, you know, to do something fun,
and get some fitness out of
it, for sure.
Yeah, totally.
I guess one question that comes up is, like, do
exercise snacks really work?
So, that's like kind of like a loaded question, right?
Overall evidence shows that they are safe.
They are feasible, meaning people are willing to do them.
That's the important part right.
Any exercise, like, what's good exercise for you?
Anything you're willing to do, right, to move your body.
And then, safe I think I said, but also, like,
you're willing to adhere to it, so it can build up to good
exercise habits long-term, or maintaining exercise
habits over the long run.
And then, that cumulative effect of doing exercise
more regularly throughout your day, or throughout the week,
or throughout a month can lead to some pretty significant
health improvements, right?
Lowering your risk of cardiovascular disease, or lowering
your risk of cancer, or risk
of morbidity, developing other complications or health
conditions. And then, ultimately, you know, the goal is to
reduce your risk of premature death.
So, there is evidence supporting that exercise snacks
can really make a difference.
Again, this is kind of a new area, right, which is kind
of why we're talking about it.
But, so it's limited.
But, it's suggestive that these could be a really good way
particularly for inactive people who are just figuring out
a way to start, like, how do I get started, you know?
And thinking of doing 150 minutes of
moderate intensity physical activity, which is what our
physical activity recommendations say, or 75 minutes
of vigorous intensity activity.
That seems a little daunting sometimes, right?
So, how can I break it up into a small, digestible piece
that I could do more regularly, and maybe build up
to the health benefits of regular
physical activity that we know from the vast majority of
the research?
I was just going to add, I think it's, the
benefit for people who maybe are just getting started is
really obvious, right, because it's much more approachable.
But, it seems like with what we're starting to learn about
the dangers of too much sitting, too much sedentary
behavior throughout the day.
Seems like it also would be good for people who maintain a
regular exercise routine.
So, even if you are getting up and working out for 30, 45
minutes every day, but then sitting all day long,
that can have its own risks.
But, you know, to your musculoskeletal system and
just in terms of like the mental fatigue of
sitting still all day, it seems like exercise snacks would
be a good solution for people who, even
people who are exercisers.
I think that is where the vast majority of the evidence
lies too, right, in inactive adults, older,
younger, you know, doesn't matter.
And I think there's a lot actually in workplace settings,
right, where you are trying to break up prolonged bouts
of sedentary behavior, sitting.
And then, you know, I know I do it, right?
And your Fitbit watch or your Apple Watch
and you know, all tell you to do these things too, right?
You know, "You have 250 more steps this
hour to call it an active hour."
That's an exercise snack, right?
Two hundred fifty steps is a snack.
So yeah, it definitely could help break up sitting time.
And we know, you know sitting is the new smoking.
And so this could definitely help with that.
Certainly there are a lot of tools on our wearables and
phones and so forth to help us integrate exercise
snacks. So, are there some examples of studies
where they've actually looked at benefits of exercise
snacks or short, really short bouts of activity?
I think the research in this space is relatively
new, but also like, quite compelling, right?
People use very different definitions of what an exercise
snack is, right?
Sometimes the snack includes only your body
weight. Sometimes the snack includes a resistance band.
Sometimes it's walking, sometimes it's climbing stairs.
You know, something along those lines.
So, that kind of varies.
And then the intensity of the snack can vary over time,
right? Is it light?
Is it moderate? Is it vigorous?
There's actually more data on, like, vigorous,
high-intensity exercise snacks, right?
So, like a "snack sprint" or something
along those lines.
But it could be as little as, you know, again, 15-second
snack or a ten-minute snack.
It just really depends.
So, lots of different definitions.
And I think then it's also been done in lots of different
populations. So, we talked about some older adults, adults
who are physically inactive and are building up maybe
to regular activity, adults with diabetes or prediabetic
adults, older cancer survivors.
But, I think regardless of what the exercise snack is
or who the population it's targeting,
overall, the studies are showing that these are safe,
they're feasible and people are willing to do them.
And actually, like, you and I have been doing exercise
interventions for quite some time.
And one of the biggest barriers we have is adherence,
right, and getting people to adhere to an exercise
protocol is quite challenging.
I mean, you can just think of it from, I know from my own
perspective, right? Like, I have a hard time sticking to an
exercise routine. And so, but these exercise snack
studies are showing adherence rates of like 80%, 90%,
96%. I'm like, maybe I need to do, yeah,
exactly. Maybe I need to do one of these.
So, I looked at one study that I was really interested in,
and it was exercise snacks that included body weight
exercises plus tai chi exercises,
which tend to be a little light intensity.
So, not too rigorous, you know, didn't require
any equipment, and it was done among physically
inactive older adults.
And they found some really compelling results.
So, their exercise snacks were ten minutes long.
They were instructed to do it twice a day for one month.
You needed to do this exercise snack.
And during this ten-minute period, one minute on and
one minute off. So, one minute you're doing body weight
exercises, repeating as many times as possible,
and then one minute of rest, and then one minute of maybe
tai chi exercises, and then one minute of rest, and so on
for ten minutes. And they found really compelling evidence
for improving physical function, muscle strength and
balance, also led to increases in physical
activity, reductions in sitting time, which was
really important, and then, overall improvements in
cognition in older adults.
So, I thought, you know, sold.
We should be doing this, right?
But I think that there's mixed research out there because
there's so many definitions and so many different
populations, it's really hard to replicate these findings.
And so, I think just more work is needed in this space.
Sure, sure. It does sound like a really promising area
for research.
Just to sort of clarify, for people who might not be
familiar with the term body weight exercise, so that
refers to something like, any kind of exercise
that uses your own body weight to give some resistance.
So, like a squat, or a sit-to-stand, you know, sitting
down in a chair, standing up, sitting down repeatedly is a
body weight exercise, or a wall pushup or something like
that. So yeah, I think body weight
exercises are kind of great exercise snacks because
they don't require any equipment, right?
Yeah, exactly.
And I think it's something like you can relatively easy to
maintain over time. And I think the number one barrier
for people to being physically active is time, right?
So, these are meant to be like woven into your day, easy
to maintain a routine.
You know, I know you do a lot of work in this space.
So, what are your thoughts on how people can like start or
maintain a routine over time?
Sure. Well, you know, I think the same kinds of behavioral
skill tools that we use in helping people
develop a regular exercise routine can be helpful
for developing an exercise snack routine too.
You know, using skills like like goal setting.
So, in our Active Living after Cancer
program that we offer, we work on both exercise snacks
and regular physical activity.
But one of the main behavioral skills that we teach
is goal setting, right?
So, creating some really, well, both short- and long-term
goals. But with the short-term goals, we particularly
focus on having them be SMART goals.
So, goals that are specific,
measurable, achievable, relevant
and time-bound, right?
So, for example, if you have a goal of,
you know, on five days this week I'll walk outside for
five minutes, three times a day, you know, once in the
morning, once at lunch, once after lunch, once
after dinner or something like that.
So, it's a SMART goal because it's specific.
We talk about walking is the activity.
It's measurable. You can you know yeah put a checkmark on
the calendar or something like that if you did it.
It's achievable.
I mean, at least for me. I know that's something I could
walk for five minutes.
It's something that I could fit into my day.
It's relevant. You know, walking outdoors is great.
It can be, it's a moderate physical activity.
It's a good mood lifter, you know?
Yeah, especially beautiful weather like we're having right
now. And it's time-bound.
You know, I've said specifically I'm going to do it three
times a day, five days this week.
So, making goals like that to help
you achieve, you
know, to really develop that exercise routine, especially
if you haven't done it before, you know, develop
the exercise snack routine, I should say, can be really
helpful. And, you know, another key part of goal setting
is self-monitoring. So, keeping track of
whether you met the goal or not.
And you might even decide you're going to give yourself a
little reward if you do meet that goal.
So, incorporating some behavior change techniques
like that can be helpful in developing a
routine a real habit around exercise.
Last time we were talking about adopting a new like a
walking routine. You know, we talked about how you could
use your trackers or a wearable device or something to help
also keep you accountable.
So, that's great. I've heard about people talking about
habit stacking.
What is habit stacking, and how can it maybe help
you maintain your routine, or maintain
an exercise snack routine or something along those lines?
I'm so glad you asked about that, because I think habit
stacking is really ideal for
encouraging people to do the exercise
snacks, right? In fact, you even mentioned an example of it
earlier with the woman you met who says she does pushups
every time she goes to the bathroom.
So, habit stacking is basically taking something
that you do habitually already, something you do
daily or whatever frequency is appropriate for the exercise
snack, and saying, "I'm going to do an exercise snack in
conjunction with that." So yes, you know,
pushups every time you go to the bathroom would
be an example.
Good habit stacking. There could be bad ones, too, right?
Well, yeah. You know, like eating, a snack
and actually, you know, sugary snack every time you go to
the bathroom. That would be a bad, you don't want to do
that. I try doing squats while I floss
my teeth, so.
That's a good one.
Yeah, it takes some concentration.
My hand-eye coordination probably wouldn't be up to that
challenge.
And I think it also kind of points out, that
example kind of highlights that if you are doing
some body weight exercise or any, even if you're picking up
hand weights or something, if you're doing some kind of
resistance exercise or strength exercise, you do even
though it's a snack, you want to make sure you're using
good form because you don't want to injure yourself doing
an exercise snack. You're going to feel silly going to your
doctor and saying, well, I hurt myself doing an exercise
snack. But at any rate, you don't want to hurt yourself.
And so, take a look, there are some videos
online at MDAnderson.org that show proper form
of some body weight exercises, for example.
Like squats, or pushups or something.
Exactly. So, it's kind of important to pay attention
to that, even though you're just, you think, I'm just doing
this for a few minutes.
I think that's great. Like pointing people to resources as
well, or form and making sure we don't, you know, avoid
injury and things like that because I feel like that's
common. The other one, pushup seems really daunting.
I think when the woman told me she does pushups before she
goes to the restroom, I'm like, she
told me she did 20.
And I was like, I cannot do 20 pushups.
So also, you know, maybe looking up the MD Anderson
resources to see modifications because there's lots of
different ways to use your upper body or increase your
upper body strength that doesn't require you, you know,
always being on your hands in your toes.
Right?
Yeah. It's very important to tailor those kinds of
exercises to your fitness level.
I cannot do 20 pushups.
I would not recommend that for most people who are just
getting started. But, you know, sometimes
we tell people to do wall pushups, you know, to sort of,
stand a few feet away from the wall and do your pushups
against the wall. And it's a good modification for,
you know, people who don't have as much upper body
strength. And most of us do not have the body, at least
most women do not have the body strength to to do 20
pushups every time they go to the bathroom.
So, that's a good thing.
The timing of that is important too, right?
Maybe do after you use the restroom not before.
That's true. Yeah. Think about modifications to the
exercise to make it realistic for
you. You want it to be challenging but not
unmanageable. And you definitely don't want to
find that you're, you know, sore for days and days
afterwards because this is something you want to
repeat frequently.
The sort of incorporating activity into daily life is
something we talk a lot about in Active Living after
Cancer. So, our Active Living after Cancer
program is a 12-session program for cancer survivors to
help them basically incorporate
physical activity into their daily life.
When we teach behavioral skills like goal setting and so
forth, to help them do that. And I know you also have been
studying an approach to sort of, incorporating
short bouts of light activity called
Harmony and Health. Do you want to tell us a little bit
more?
Yeah. Our Harmony and Health program is specifically
designed for adults who are physically inactive.
And so, for the folks who are, you know, think 150
minutes, that's crazy.
I can't reach that goal. I'm doing zero minutes of physical
activity per day.
And so, the idea behind Harmony and Health is, well, can we
at least just get you to sit a little bit less and move
your body more, whatever that looks like, right?
So, it could be light intensity.
It could be moderate. It could be whatever you want it to
be. And the idea is to kind of work up into it.
And we do teach strategies.
I never actually thought about it as exercise snacks, but
we do teach strategies in that program about how to break
up your sitting time, which could definitely be an exercise
snack, right?
Standing, sitting during a commercial
break or something along those lines, right?
Or if you're in a lecture, or you're sitting through your
workday getting up and taking a lap around your office or
something along those lines. And so, yeah, Harmony and
Health focuses on that. We also incorporate breathing,
stretching and guided relaxation to kind of
also touch on mental health and
stress management and how important that is for,
you know, increasing your exercise over time.
Exercise can help with that.
But if that's your barrier to being physically active, then
that's also something we want to make sure we address as
part of the program.
That's right. We could all use more stress management, to
be sure. For sure.
As we talked to people, cancer survivors and others who are
trying to be more physically active and are interested in
exercise, we do sometimes hear about some interesting,
well, fads or trends in exercise.
Everybody's kind of looking for the new thing, the new
type of exercise they should be doing.
So, two of the things I've been hearing a lot about
from people are weighted vests for walking and
also these lymphatic vibration plates.
So, what do you know about those? Are those effective or
are they helpful to people?
Yeah, that's a really great question.
I mean, they're all over social media, right?
So, social media will lead you to believe that there's
substantial evidence, but there's really not
a lot of studies. So, weighted vests, for example, they'll
help you burn calories, right?
I think there's been some research in like bone
strengthening or bone density.
But other benefits, like if you're trying to lose weight
or, you know, burn calories or, you know,
musculoskeletal benefits, I think the findings
are mixed, right?
And I think it just depends your goal, right?
We talked about exercise snacks could be used for multiple
components of fitness.
If this matches your goal, by all means do it.
I think we've had this conversation before, right?
Weighted vests are one example.
Ankle weights are another example.
Or weighted belts when you're walking.
And at the end of the day, if you're willing to be
like active, if this is going to help you to be active or
motivate you to get out and go for a walk.
By all means, put on that vest.
Put on those weights. Go do it.
But if it starts becoming a deterrent to being physically
active, maybe it makes your ankle sore, your
wrists sore, or something else, right?
Maybe you don't have your vest. So, you're like, I don't
have my vest, so I'm not going to go for a walk.
I'm sometimes guilty of this, you know, with my Fitbit.
I'm not wearing my Fitbit today. I forgot to wear my Fitbit
today, so I'm not going to do activity.
It doesn't count.
If it does any of that, don't do that.
Right?
Right. Yeah. If it discourages you from being active in any
way, I could see where, you know, if
it provides you with that extra challenge.
You know, sometimes people say, like walking just doesn't
feel physically challenging enough to them.
So, I think it can be helpful.
But for some people, walking is plenty challenging,
especially if you're living in a place with a lot of hills.
We happen to live in a very flat
place, so sometimes people might need that extra challenge.
But if it starts to feel too challenging and
like you said, makes it less pleasant and enjoyable
so that you're less likely to do it or you just won't do it
if you don't have your best with you, then maybe it's not
such a good thing.
Right. Don't let it be a barrier. I think the lymphatic
vibration plates are another interesting one, right?
There really isn't a lot of evidence on them.
But you know, I know people are using them again for
different reasons.
So, this is just a plate that vibrates that you stand on?
Yeah. It's just a vibrating plate.
It's like a board, a flat board, and you stand on it, and
it goes, and shakes everything in your body, right?
And I think, you know, that's great and maybe
good for some things, right?
They might just be relatively fun.
I bet it has something to do with like improving balance,
right, you have to stay on this shaking board.
So, I think that there could be benefits to it.
But I think at the end of the day, it's not a good
substitute for physical activity.
You still need to be physically active to really achieve,
you know, optimum health benefits, right?
And so, I think no matter what people try to decide
to do, you know, again avoiding injury,
make sure that it's motivating you and isn't creating a
barrier, and then, you know, you can do all of
these things, but you also need to be physically active,
regularly incorporate that. And I do think exercise snacks
can help with that, right? Just helping you to build up to
that regular physical activity that we want people
to achieve for good health.
Well, this has been a great discussion today.
Thank you so much for engaging on this topic
and and sharing it with everybody.
And thank you so much for tuning in.
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