Do Zones and VO2 Max Matter?

Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Courtney Allison.

As we enter this new year,  a lot of people, including myself, are thinking about how we can get more exercise in our life.

It can be really hard to stay motivated to exercise. But one of my favorite ways to stay active is to go on a run with a friend. So on a morning not long ago I headed out to Prospect Park for a run with a colleague, Mark, who is also a runner.

Courtney (in tape): I definitely wouldn’t have come out today if we didn’t have a plan. Because, like, a plan and accountability is what gets me out the door. So thank you, Mark, for getting me out for this run today.

Mark: How far do you want to go today?

Courtney: Honestly, I’m not in the best running shape. If I do a mile today, I’d be really proud of myself.

Courtney:  It was really cold outside, but it was so much fun running with a friend, and even though I struggled through the run a little bit, I felt really proud of myself after.

Mark: We just finished our run. How do you feel?

Courtney: I feel so good. I’m so glad we did this. I promise myself chocolate milk after every run because it’s a really good recovery drink, so chocolate milk sounds good right now.

So this week Dr. Sonia Tolani, a cardiologist at NewYork-Presbyterian and Columbia, joined me to talk about the importance of exercise. Dr. Tolani explained what it means to increase our heart rate and hit our zones, and what measurements like VO2 Max actually tell us. She also shared tips for how to reframe your relationship with exercise and make it part of our everyday lifestyle.

Courtney: Hi, Dr. Tolani. Thank you so much for coming back and being such a friend to our podcast.

Dr. Sonia Tolani: Of course. Thanks for inviting me.

Courtney: So Dr. Tolani, the last time we spoke to you, you were training for the New York City Marathon! I’d love to hear how that went for you.

Dr. Sonia Tolani: Well, the marathon was a really big accomplishment for me. In middle age, it was nice to show my kids that you can still kind of always be doing things. I will say I did take a little bit of a break from running, but not a huge break and I’ve tried to keep up with it. And I actually have a group of friends, we call ourselves the WOG women, which is walk-joggers ‘cause not all of us are runners. And we have like a little group chat so that’s been one way that I’ve kept it going.

Courtney: That’s amazing. So you shared a little bit about what keeps you working out – your community. Anything else that keeps you going?

Dr. Sonia Tolani: I think the most powerful motivator is, as a cardiologist, a lot of my patients are older age and what’s really struck me is that the patients of mine that are living life to the fullest, that are doing well, that are independent, that are traveling, they’re the ones who are regular exercisers.

It was like a part of their life. They’ve always been exercisers. They’re still exercising. I mean, I have people in their 80s that are going to the gym like three or four times a week. I have people in their 80s that are still running.

I think a lot of us can live into older age, but I think what we’re starting to realize more now is that we don’t want to just live longer. We want to have those years that we’re older be pain free and independent and enjoyable. And that’s not going to happen if we don’t take care of our bodies.

Courtney: Yeah, absolutely. I read somewhere recently that if exercise was a pill, it would be the most sought after pill in the world…

Dr. Sonia Tolani: A hundred percent!

Courtney: …because the benefits are just so great.

Dr. Sonia Tolani: Yeah. Like we know that not only is it good for your heart health, it lowers rates of dementia. It’s good for osteoporosis. I think the two things that people generally start worrying about, that are somewhat in our control are, having a heart attack or a stroke or getting dementia. I think cancer is also always a worry. And I think there are some studies that show exercise reduces certain types of cancers as well.  

Courtney: So, for those who exercise, you hear a lot about the zones, or maybe people are looking at their smart watches and seeing they are in Zone 1, Zone 2. Can you elaborate a little on what those zones mean? And how might your fitness level determine the way you feel in each zone?

Dr. Sonia Tolani: A lot of it is that this newer concept is just to, like, stay in a low heart rate zone, right? So sometimes you’re pushing yourself to a point where you’re uncomfortable because maybe you haven’t worked out in a while.

Zone 2 tends to be that sort of more comfortable heart rate. It’s probably what I would define as probably moderate exercise. You’re not getting overly winded. You know, you’re staying in that aerobic sort of threshold, you know, when you get into the anaerobic threshold is when you start building up lactic acid and you start getting sort of those side cramps and all those things.

But that is where getting into your Zone 2 or 85 percent of your predicted heart rate by age. That’s where you can try to target that more for weight loss and for endurance training and people who are endurance athletes, trying to get into zone three of exercise can be helpful and meaningful depending on what kind of training plan or exactly what an athlete might be doing.

It’s not a perfect thing because everybody’s heart rate’s different. So, again, if you’re, if you have not been exercising, if you’re quote unquote out of shape, you’re going to get into a Zone 3 very quickly. Because your heart rate’s going to go up really quickly. So, there is this idea, and it’s more of an exercise physiology philosophy than a medical philosophy to keep, for comfort, to stay in a Zone 2. There’s a lot of different exercise theories.

Courtney: I’ve read more and more about metrics like VO2 Max and ideal heart rates. So we’d love to break that down some more and understand what are the numbers that people should be trying to hit and how often?

Dr. Sonia Tolani: Sure. I’m going to say right off the bat, I don’t think VO2 is helpful for most people. So I think VO2 is something, it’s a measure of your cardiac output and how efficiently your body is utilizing oxygen. That has an important role for people who are elite athletes and they’re trying to achieve a certain training status.

We use it as cardiologists, actually, for heart failure patients to look to see if their shortness of breath is related to their heart dysfunction. We use it as a metric, actually, for when we think people might need a heart transplant. So I think that while it is a metric of exercise, and I know like that watches and stuff do like a kind of a quick and dirty VO2 for personal use, I don’t think it’s very valuable.

Courtney: That’s really interesting to hear about VO2 Max and how it’s used in a clinical setting versus what the average runner might actually need to pay attention to. So what about heart rate monitoring?

Dr. Sonia Tolani: So when we exercise regularly, we become more conditioned. So our heart rate goes up more slowly. So it takes longer for the heart rate to go up.  And then when we stop, the heart rate comes down really quickly. So really conditioned athletes, people that do endurance rowing or biking or running, they may have a resting heart rate in the forties and that’s very normal for them.

And it may take them a very long time to get their heart rate up to a hundred. Whereas someone who hasn’t been exercising and who’s been more sedentary may have a much higher resting heart rate. And there’s always exceptions to this rule. But, maybe having a heart rate in the 80s or 90s, and when they do light exercise, their heart rate’s going up to 130 with very minimal exertion. Right? And then once they stop exercise, it takes a while for the heart rate to come down.

So if you’re just starting an exercise program and you decide that you’re gonna just go running, or it’s been a couple of weeks ’cause you’ve been busy, the holidays – name your distraction, and then you go and try to do what you were doing, you’re gonna feel pretty crappy. Because your heart rate’s gonna go up. You lost that conditioning.

And I saw that when I tried to get back into exercise, is that, whereas my average heart rate, I could see when I was running regularly was maybe in the 130s. When I went back to trying to get back into it was like 160 and that doesn’t feel good. You know what I mean? So I had to modify what I was doing because I was torturing myself. And when it’s not fun, when it’s torture, you’re not gonna want to do it again because you’re like, Oh…

Courtney: Yes.  

Dr. Sonia Tolani: Oh gosh, I’m gonna do that again. That was… of course you feel good afterwards. But while you’re doing it, you’re just breathless. So now I’m like, just walk, just walk-run. And I’ve been doing that a lot, just running for a minute or two and then walking for a minute or two, running for a minute or two, walking for a minute or two, because mentally that’s just, like, easier. And then I’m more likely to actually want to do it again. ‘Cause I don’t feel so terrible while I’m doing it.

Courtney: Yes. That all makes so much sense.

Dr. Sonia Tolani: If you haven’t been exercising and you’re using your heart rate as a guide. Like your heart rate might go up just, like, lightly walking and if you feel fine that doesn’t mean that you back down.  Unless people have heart disease where we haven’t fixed it or there’s some arrhythmia, as long as you feel well It’s not like your body’s gonna let your heart rate go quote unquote too high with exercise without giving you some warning, making you dizzy, making you lightheaded. So, you know for most people there’s no like dangerously high level that they’re gonna get to with exercise as long as, again, they don’t have any underlying heart condition where a doctor’s told them not to exercise.

So for a lot of it, I think, what’s easier if you’re looking for heart health is to think about it in perceived exertion. To keep your heart healthy, we recommend 150 minutes of moderate exercise. And moderate exercise is a level that it would be hard for you to sing a song, but you could have a conversation. If you do vigorous exercise, the minimum is 75 minutes. And these are minimums, right? So these are for people who’ve never had any heart issue and they just are trying to achieve heart health and stay, stay healthy. So for vigorous exercise, we say it is a level that it would be hard for you to have a conversation and you get to do 75 minutes. So it’s half the time if you do more intense exercise.

For people who’ve had heart attack, strokes, or heart disease or are high risk, it’s double. The recommendation for moderate exercise is 300 minutes. And for vigorous exercise, it’s 150 minutes. And we would recommend, also, that those be done in increments of at least 10 minutes. So it doesn’t have to be one hour of exercise. If you only have time to do 10 minutes, do 10 minutes and then just add it to your tab, your exercise tab. And that might be hard, right? So 150 minutes of moderate exercise is 30 minutes five days a week but if you’re going to power walk from your house to the subway, you know, or you’re going to get off a stop early and do like a 10 minute power walk to work, and you’re going to do the same thing on the way back, then you’ve gotten 20 minutes right then and there.

So there’s ways to do it. You could do a dance party with your kids. Put on a timer, kitchen timer, and just like really run around the kitchen table, or do that yourself. You don’t have to have kids to do that. I still like to dance around in my apartment by myself. So, that counts as exercise. You can get really breathless doing that. You could do jumping jacks. You could go on a walk with a friend. There’s so many things you can do to meet that goal.

Courtney: These are all such great tips. I like what you said, too, about your exercise tab. Just think of adding it to your exercise tab, even if it’s ten minutes.

Dr. Sonia Tolani: There’s, like, a huge misconception that exercise means that you have to go to the gym, that you have to run, that you have to spin, that you have to do this, you know, very intense exercise. And while there probably are greater benefits with higher intensity workouts, that it’s incremental, you know? The amount of heart health benefit and, sort of, general health benefits you get from moderate exercise is amazing. I think there’s, there’s three categories of people. There’s couch potato, there’s active, and then there’s exercisers, right?

So, even going from couch potato or sedentary to being active. These are, like, the step collectors, right? So I have a lot of patients that are like, and my parents, my parents are like, my mom will literally walk around the living room to get to her 10, 000 steps. And I was like, I was like, that’s not the spirit of what the 10,000 steps are, but being up and moving around is better than sitting all day. Right? That’s obvious.

And so people, I think also sometimes feel because they’re on their feet all day. And I’m like this, like I could collect probably 30,000 steps, you know, but that’s activity. That’s not measuring exercise. And while that activity is way better than being sedentary, what I think all of our goals should be is to hit that being an exerciser. I think the ultimate goal is to be a daily exerciser.

Courtney: It’s such a win. Yeah, for me, I try to focus on the fact that I know I’m going to feel so good after, rather than sometimes looking at whatever long term goals I’m hoping to accomplish. If I can just say, Oh, you’re going to feel so good if you do that workout class, you’re going to walk out in such a great mood.

Dr. Sonia Tolani: It’s hard. It’s hard to exercise. but once you do it, you’ve succeeded. Like you can diet and quote unquote fail, but once you do the exercise, you have succeeded. If you did it for 15 minutes, it’s a success. And there’s not a lot of things that are like that. So if you can find these little ways to trick yourself into doing it, then you reap the rewards. You’ve done it. You never regret it.

Courtney: Well, thank you so much, Dr. Tolani. It’s always such a pleasure speaking with you.

Dr. Sonia Tolani: Thank you so much for having me. It’s been my pleasure

Courtney: Our many thanks to Dr. Sonia Tolani. I’m Courtney Allison.

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