How to Tailor Your Fitness Routine if You’re Overweight or Suffer from Metabolic Syndrome

Training Overweight

The hard way

Do you want to exercise to lose weight? Or to control diabetes? Then you should know there’s a difficult way… And an efficient way. And they’re complete opposites.

The difficult and inefficient way? That’s trying to follow the failed advice of just moving around more while eating less. That rarely works in practice. Following that advice makes you hungry and tired, and demands unyielding willpower every day for the rest of your life. It’s the hard way.

The smart and efficient way? Let our expert guide you through the maze of exercise tips and routines.

Jonas Bergqvist is a licensed physical therapist who’s worked with dietary, exercise and lifestyle coaching for many years. He currently runs a combined health and education centre with courses in, among other things, LCHF and paleo dietary advice. He’s also a popular diet guru and has written several diet and exercise books, including (in Swedish) “LCHF and Exercise”.

Now it’s time for his best advice on the topic of exercise for weight loss and improved health:

Guest Post

Jonas BergqvistThis second exercise-themed post is going to deal with the issue of how best to exercise if you’re overweight or are suffering from metabolic syndrome.

It should be stated immediately that any kind of exercise is better than no exercise. Also, the more the better, if you keep it at an amateur level. So the first step is all about establishing regular exercise sessions. It’s the accumulated volume of exercise over time that brings health benefits, not the effect of single workouts. However, that’s not to say that the individual workouts can be any old way you feel like. You can choose to exercise more or less effectively, and that’s what this post is all about.

Just to make my terminology clear: when using the term “diabetes” in this text, I’m referring to type 2 diabetes.

There are four pieces of the lifestyle puzzle that have powerful potential to decrease our blood sugar and insulin. As you may know, the latter two are precisely what’s elevated in diabetics or people with other metabolic disorders. The four puzzle pieces are:

  1. A low carb diet
  2. Fasting
  3. Exercise
  4. Healthy stress levels and enough sleep.

These big four are shown in the picture below. The strongest effect can be achieved from eating a low carb diet or fasting, which is why you may want to straighten out those parts before turning to exercise. Nevertheless, this post is focused on exercise and how it can be adapted to suit those who are overweight or have diabetes.

bloodsugar

Four lifestyle puzzle pieces

The core in chronically elevated blood sugar and insulin — and hence diabetes — is insulin resistance. This means an inability in the body to properly use the hormone insulin. This is why I’m going to specifically address how exercise affects insulin resistance. Even dysfunctional mitochondria and lower mitochondrial density is associated with diabetes. I’ll be looking into that, too.

I’ll be referring to several scientific studies throughout this post which I use to support my ideas, but you can also use them as guides if you want to delve into the subject for yourselves.

When discussing the benefits of exercise, a distinction can sometimes be made between health and performance benefits. On a professional athletic level, there is a point in discussing the balance between them. But on an amateur level, health and performance often go hand in hand. When you exercise regularly and perform better, your health improves. For example, it has been shown that insulin sensitivity is higher in fitter individuals (1).

Exercise for weight loss

The combination of a low carb diet with strength training is just the diet/exercise combo that gives the biggest decrease in fat mass in both women (2) and men (3). Even if you were confused enough to go for a low-fat diet, your fat mass loss would increase if you were to do cardio workouts, and then even more so if you were to do strength workouts to boot(4). Brought together, these studies show the value of eating a low carb diet and doing strength training to lose fat mass and weight. Remember though — overweight is only indirectly unhealthy: it’s a indicator of unhealthy processes going on in your body, the kind that could increase your risk of diabetes and heart disease.

Exercise to reduce insulin resistance

Traditionally, endurance (cardio) workouts have been associated with better heart health while strength (resistance) training has been associated with stronger muscles and bones. A more modern perspective on these two exercise forms is that they have many similarities, and that combining them is extra valuable (confirmed by the above study). The fact is, an American study from 2012 showed that strength training also gave a good effect on insulin sensitivity, that strength training decreased the risk of developing diabetes, but above all, that a combination of strength and cardio exercise lowered that risk even further (5). It’s not too radical to assume that the same thing applies to people who already have developed diabetes or other form of metabolic disorder. So strength training appears to bring health benefits, although it is perhaps not as potent as cardio. Strength training may however pack the more powerful punch in view of the hormonal responses it triggers. Being strong will also give you a better foundation for your regular cardio workouts, will decrease the risk of injury, increase performance and through this also health.

Strength training will increase the anabolic hormones in your body. These help to burn fat, to maintain or gain muscle, and this leads to a higher carbohydrate tolerance and therefore higher insulin sensitivity.

Exercise for more and better mitochondria

The amount of mitochondria and their function is related to both heart disease (6), insulin resistance and type 2 diabetes (7). It seems that the mitochondria produce an excess of free radicals in diabetics (8), something which can be a cause or an effect of insulin resistance, because an excess of free radicals impairs the insulin receptor.

Doing cardio when the glycogen levels in your body are low gives more functional mitochondria, as well as a higher count of mitochondria (9). In principle, there are two ways to deplete your glycogen levels — either you can do a glycogen-burning workout, rest for a few hours and work out again, or you can skip a meal or two, and fast. The first alternative might be an option if you’re a high-level athlete who’s comfortable with two workouts a day, but is probably not an option for those of you who work regular jobs. The latter option is therefore more appropriate for amateurs.

Summary

To sum up exercise for weight loss, insulin sensitivity and mitochondria count and function, the game plan doesn’t look much different from the recommendations I would give the healthy population in general. There are, however, some details to keep in mind if you are overweight or have any metabolic disorder:

Forget the conventional exercise advice built on the eat less/run more philosophy. A proper diet is the foundation of weight loss. Exercise will give you a bonus effect. Cardio workouts for the overweight or metabolically disordered should preferably be high-intensity. High intensity interval training has been shown to give similar effects to constant heart rate-type endurance training (10). However, interval training has been reported as less tiring than sustained regular cardio by both healthy women and women with diabetes (11). High intensity interval training is therefore acknowledged as a form of endurance training which is more tolerable and time-efficient (where the latter is sure to appeal to our stress-riddled society). A possible drawback is that the risk of injury is extra high if you’re inexperienced. Make sure to choose the type of cardio workout that suits you.

You should also remember to lift heavy. The hormonal effects of strength training become all the more crucial if your goal is to lose weight and regain metabolic balance. Of course, the neuromuscular benefits of better posture, body control and muscular function that you would have gotten from functional training will be foregone, but if you prioritise weight loss and metabolic balance you should channel your efforts accordingly. Skip the difficult, functional exercises. Choose easier exercises that allow you to go heavy without a long learning curve.

You may also want to consider fasting, or rather, exercising on an empty stomach. This will give a big metabolic effect when you’re aiming for weight loss and metabolic balance.

Do this

  • Aim to combine strength and cardio.
  • Aim to combine sustained cardio and interval training in your endurance workouts.
  • 1 strength session, 1 pure cardio session, and one combined session a week is a good way to start.
  • Pick 5 strength exercises that let you ramp up the weights without risking injury.
  • For your combined workout, you can reduce the number of sets in your strength routine so that it takes 20-25 minutes. Then you can go for an interval workout consisting of 20 seconds of high intensity activity immediately followed by one minute’s rest. Doing this 10 times gives an interval workout time of 13 minutes. Start on a bike or a rowing machine if you’re overweight, and switch to carrying your body weight running when you get close to your target weight. Or why not try kettlebell swings or burpees?
  • Fast for 14-16 hours before one or more of these workouts for the best possible results.

Good luck!
Jonas Bergqvist
jonas@mfgruppen.se

The next part is coming soon!

Thank you for the second part Jonas!

Here are the references to the scientific studies cited throughout the text.

The third part is going to be about how you can overcome the two-month slump in exercise motivation.

The MF Group where Jonas works has many things to offer: educational courses, rehab, personal trainer services, health and exercise-related books and fitness tests. However, their website is currently available only in Swedish. If you’re interested in just taking a look, here’s their site translated by Google:

mf-group-400x244

Previous posts

Kickstart this Year’s Exercise — Properly

The Best Way to Exercise for Beginners

More

30 comments

Top comment

  1. Dr Jason Fung
    I treat about 250 women (and same#men) with fasting. I notice little appreciable difference between men and women. My top 2 or 3 performers were women. Literature on sex difference very sparse, but most studies done on less than 10 people.

    I am a metabolic, weight loss professional, and I give both men and women the same advice. It is almost EXACTLY what is posted here.

    1. LCHF
    2. Fasting
    3. Exercise
    4. Stress control, adequate sleep

    Brilliant!

    Read more →

All comments

  1. Jennifer Snow
    I'm highly suspicious of anyone who would give the same advice to women and men, particularly about fasting. I know quite a few women who have had SPECTACULARLY poor results (and basically nuked their thyroids) by fasting. Women don't lose weight the same way men do, and anyone who is actually a metabolic, WEIGHT LOSS professional who has helped many men AND women lose and keep off a lot of weight would NEVER give the same advice to both groups.
    Reply: #9
  2. Dawn McVey
    I agree Jennifer. And the ball ache is that when I lo carb with my partner - guess who loses the most weight.
    Most research is carried out on men, they seem to forget that there is a whole other group out there - women, and we are certainly different.
    Doubt there will be a response to this tho'.
  3. Freddie
    What about people like me, for whom exercise actually raises blood sugar? I'm a Type 2 diabetic and I exercise because it makes me feel good, but my sugars typically rise 15-20 points post-exericise.
    Replies: #4, #8
  4. Zepp
    Blood sugar shall rise as a demand of your energy demand.. and do measure FFA to, its rises too.

    What you see post excersice is a lagg of hormonial adaption to your energy demand.

    If you do a smother down excersice it diminsh.

    But of course, type 2 make it more dificult anyhow.

    However.. excersice is often a good thing for almoste everybody that live a sedentary life.. it uppregulates ones capability to use stored energy.

    That whats it mean for moste people.

    Fasting is another thing to try.. to upregulate ones capability to use stored energy.. and to reduce insulin resistance.

    Hyperinsulinemia is the cause, but insulin resistance is the thing to get rid of.

    More muscle cells, more GLUT4, more mitocondrias, better ability to use stored energy and a higher TEE is the result of excersise.. if done right.

    Its mostly best for us sedentary living.

  5. Daytona
    Yeah... I am not really sure this is great advice to give to diabetics without qualifications.

    1. Fasting for that many hours can actually cause much higher blood sugar due to dawn phenomenon. For example, if I fast in the morning, my blood glucose can easily go from 120 to over 200 by lunch time, even when fully keto-adapted.

    2. Some people have trouble maintaining a stable blood sugar with exercise and have to carefully monitor how they react to avoid wild swings and hypos. Yes, even T2s. Will it kill you? Probably not, but it will make you feel awful and not really serve the greater purpose.

    3. As others have pointed out women don't usually respond to diet or exercise the same as men. I tried fasting before working out and it ended up setting me back months with respect to my female hormones and endometriosis pain management. It didn't help with my weight and instead set me on a path towards failure.

    I am not saying that all things that happened to me will happen to others. Just wanted to throw out some pointers to anyone reading this that if this advice doesn't work well, that you aren't alone!

    Reply: #10
  6. Chris the Barbarian
    I always have my best performance when I train in a fasted state, you are spot on. I just thought because I have nothing in my stomach / gut, I have more power for working out :).

    LCHF and fasting go hand in hand in my case anyway.. I think I could fast for days and not even get hungry - and I mean experience real hunger. Sitting on my behind, watching netflix, doing nothing, looking at fast food ads ... and fasting suddenly doesn't seem so cool anymore :). But if I am busy, it is really easy.

    16h/8h fasting does wonders for lowering chronic elevated insulin, and getting your blood sugar low. leangains.com is the go to site for your fasting needs, tons of info.

  7. Anthony
    Thanks for the great advise. I did this a year ago and have easily kept the weight off and reversed my diabetes. My HIT is only 3 bursts of 30 seconds , but seems to work for me.
  8. Andrew
    Watch more TV ;)
  9. Dr Jason Fung
    I treat about 250 women (and same#men) with fasting. I notice little appreciable difference between men and women. My top 2 or 3 performers were women. Literature on sex difference very sparse, but most studies done on less than 10 people.

    I am a metabolic, weight loss professional, and I give both men and women the same advice. It is almost EXACTLY what is posted here.

    1. LCHF
    2. Fasting
    3. Exercise
    4. Stress control, adequate sleep

    Brilliant!

  10. Dr Jason Fung
    You will notice that there are 4 different paths that all lead to the same goal of lowering insulin. If fasting does not work for you, then you can use the other three. This is precisely why this post is so brilliant.

    Instead of simply saying, you must fast, or you must do LCHF, it acknowledges the fact that there are multiple paths to success. Obesity is multifactorial. There are similarly multiple potential treatments. Fasting. LCHF. Exercise. Stress relief. Pain control. Fiber. Vinegar. Moderate protein etc.

    Fasting must be done carefully in diabetics, though.

  11. Stella
    Please advise what constitutes HIT in a domestic setting? Gym membership is financially out of my reach.

    Also, exercise regimes seem to be geared toward those who would otherwise be sedentary. I work in retail and don't stop moving all day. This includes shifting heavy crates of stock. I spend 8 hours a day on my feet, very little of which involves standing still! How much of this activity counts as exercise?

    Thanks!

    Reply: #12
  12. Jim
    Stella, I suspect "it depends". Even jobs involving much physical activity may not prevent one from becoming insulin resistant. Just look at Peter Attia, who developed insulin resistance despite working out (hard!).

    And, obviously, diabesity is not self-limiting. After all, obese people lift weights all the time - namely their own body weights.

  13. Christian
    hey need help still :/

    does someone take metformin on keto?
    is this safe or does the blood sugar drop to low? or does acidosis occur?

    I just dont know why I dont lose weight anymore.
    Started workout 2x a week and 1x yoga for flexibility.
    changed macros (high fat high prot, high fat+mod protein, etc), kcal (2500, 2200, 2000, 1700, 3000, 2500,etc) and cut nuts, cheese (lactose intolerant) and sweeteners. still nothing.
    also did 3 refeeds on FR evening and 1 cheat weekend for more glucagon and leptin and have more hunger now :/ great^^
    but weight is unaffected... also have now quite the carb creeps on the weekend.. damm..

    does keto reverse insulin resistance or just dampen it because there are no carbs and this could be a reason why there is no loss anymore?

    blood profile is perfect....thyroid a bit low but was before already.. maybe add iodine? only use sea salt right now..

    should I try to reverse diet and add carbs for insulin sensitivity?
    is this usefull or will it reawaken my insulin resistance??

    Reply: #14
  14. Jim
    Christian, did you try intermittent fasting? Increased hunger (despite being overweight) probably indicates that your fat burning is worse than before.

    One could speculate that the carb cheat days did worsen your metabolic health. Or maybe your stress level increased?

    Skipping a meal or two and getting some rest/sleep may help. I also found antioxidants (as in green tea, ...) helpful.

    I don't think even more carbs might help. Concerning thyroid issues: Iodine, well... selenium seems to be more appropriate to me. Maybe get some brazil nuts? And avoid fluorides.

  15. Christian
    I tried a while ago but just felt worse and cold all the time.. also at that time I already was on 1800kcal / day ....so no good idea to combine low kcal and IF I guess...

    I just dont know what to do... I could restart again but what if the weight still stops? also how can I stop the creeps... maybe thats the reason I dont lose now (because the carb binging on weekend stops ketosis) but why havent I lost before (4 months)?? despite different approaches?

    selenium is better than iodine?

    what can I do with metformin? useful or not?

    Replies: #16, #17
  16. Zepp
    Metformin says to be safe.. no hypoglycemia.. and that says low carb doctors to.

    Read Dr Fungs comments above, he treat persons like you.

    Or look at him on Youtube.

    https://www.youtube.com/watch?v=FcLoaVNQ3rc

    Did you read this?

    http://www.fitintegrity.com/uploads/9/5/1/6/9516119/no_sugar_no_starc...

  17. Jim
    Christian, carb cravings are typical signs of impaired fat burning. Diabetics (type 2) crave carbs like hell, because chronically elevated insulin stops fat metabolism and also interferes with glucose utilisation. They are hungry despite being overweight - most of their energy intake is diverted into stores. This even leads to lowered basal metabolic rates.

    If you try IF, then don't count calories! Use decent amounts of protein and, of course, high amounts of fat to boost your metabolism. Preferably medium chain, saturated fatty acids (as in coconut oil or butter) and some Omega-3 (preferably from animal sources such as fish).

    Rule of thumb, even when doing IF: When hungry, eat! But stay clear of carbs. You may want to slowly expand fasting periods.

    Concerning selenium: Only very few people really are iodine deficient. Also, iodized salt is all around. But without selenium (needed for most thyroid related enzymes; also to produce antioxidants) iodine won't help, but instead (in higher doses) may act toxic! Many LCHF foods are good sources of selenium.

  18. Lisa
    Question for Jonas Bergqvist,
    I have low cortisol, extremely low, less than 1 all day long according to the 24 hour salivary test I just had done. I'm on bio identical progestorone for my low progesterone as well as low DHEA.
    I have been warned against excercising too much so I only go for walks. Just going up the stairs my heart is beating out of my chest and I'm sweating. I also have candida and NAFLD.

    I'm following paleo, low carb low sugar for the last year. I'm still 30 pounds too heavy. I am seeing an integrative doctor getting supplements, the hormones, homeopathy, I have gone on medical leave to reduce my stress and will only go back part time in May. What can I do to get the weight off?

    Please help.

  19. Cindy
    Can you please share more on the fasting and waht is the best approach on that?

    THANKS!

    Reply: #20
  20. Zepp
    Its the one that works for you!

    Skipping breakfast is the moste comon one, it can be stetched to 16:8.

    5:2 is another.. or 6:1, wich ever suites you.. or go a whole day whitout eating.

    Starving one day isnt dangerus if one eat all what one need the other days.

    Its the time there you have to use stored energy that make it happen.. it force your body to upregulate your capability to provide energy frome fat mostly.

    Reply: #27
  21. Yvonne
    I try intermittent fasting (12-14hrs) , however in the early hours of the morning, I do drink black and bitter coffee. Is this considered breaking the fast?
    Reply: #22
  22. Zepp
    Coffe whit nothing in it is concidered brown warm water!

    As a swede.. I wouldnt live whitout my morning coffe!

  23. Chris the Babarian
    A little bit Milk (or preferably, high fat cream) in your morning coffee won't break your fast, metabolism is not a binary state which changes from only two discrete values (Fat burning - glucose burning), it is much more like a continuum, like most hormone regulated systems :).
    5 - 10 ml heavy cream are more than enough for a cup of coffee, with a negligible amount of carbs and energy. (Maybe 15-30 kcal).

    But then again, if you get hungry after the coffee with milk/cream, it may be better to drink it black instead. As strange as it may sound, you really shouldn't feel hungry in your fast, like Jim stated in his post.

  24. Bill H
    Can somebody give me some LCHF recipes or suggestions for meals?

    I am having difficulty finding LCHF finding out what to eat and I am desperate to start LCHF diet.

    Thank you in advance.

  25. Chris the Barbarian
    There ya go: http://www.dietdoctor.com/lchf

    If this isn't enough, here are more: http://www.reddit.com/r/ketorecipes

    Happy cookin'!

  26. Bill H
    Thanks Chris. Most appreciated.
  27. erdoke
    I believe skipping dinner better matches your circadian rhythm. In case one gets along fine with only two meals per day, a nutrient dense breakfast and an early, also nutrient dense dinner (or late lunch) make it easy to stick to a 8-16 or even to a 6-18 IF schedule.
    Reply: #28
  28. Jim
    I find it pretty easy to skip breakfast. Skipping dinner is much harder.

    This may also interfere with "family rhythm": While we're all in a hurry in the morning (simply no time for breakfast - leave alone a shared one), we meet for dinner.

    And then... shouldn't it be more natural to eat in the evening? After all, hunting/gathering by night is sort of problematic. You don't see much and - even worse - you're sleeping. So no fresh meat or berries for breakfast. Maybe some leftovers from last night? ;-)

    Reply: #29
  29. erdoke
    I fully agree with you on the practicalities as well as on finding fasting into late morning much easier. However, I've recently done some reading in the subject of circadian rhythm and its importance in various physiological/biochemical pathways. I must say the evidence looks convincing that we should align our activities with sunlight, avoid blue light in the evenings as much as possible and also align eating habits with this cycling of light. There appears to be numerous health benefits when the central clock (regulated by light) is in sync with peripheral clocks (regulated mainly by food intake and physical activity).
  30. Amanda
    I have a question about strength training. I am currently doing the "Big Five" at a high level of intensity once per week as recommended by the book "Body by Science." I have been eating LCHF for two months as of today - most of that has been ketogenic - and I have not had trouble with hypoglycemia like I used to...except for when I finish a strength training session.

    Can someone explain why this happens? Thanks in advance!

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