How Prescribing Exercise from a Functional Medicine Perspective Affects Blood Chemistry Results

A body at rest tends to stay at rest, and a body in motion tends to stay in motion. Newton’s first law of motion should be recited daily!

Although it’s not always apparent, what we do on the outside affects what happens on the inside.

Adopting a moderate- to vigorous-intensity exercise program can help “tune up” the body physically and metabolically. Too little won’t be enough and too much can cause wear, tear, and inflammation. But doing nothing at all is a prescription for metabolic dysfunction.

For starters, inactivity is associated with an increase in central obesity which in turn is associated with increased inflammation, atherosclerosis, endothelial dysfunction, insulin resistance, and dyslipidemia. 

Fortunately, exercise can have the opposite effect, reducing abdominal obesity and the inflammatory and cardiometabolic biomarkers associated with it.   

The CDC states:

"The evidence is clear—physical activity can make you feel better, function better, and sleep better. Even one session of moderate-to-vigorous physical activity reduces anxiety, and even short bouts of physical activity are beneficial. Being physically active also fosters normal growth and development, improves overall health, and can reduce the risk of various chronic diseases."

As a matter of fact, researchers conclude that inactivity is a significant cause of chronic disease and exercise can be considered primary prevention.  Physical inactivity is considered a contributing cause of 35 chronic disorders including:

• Bone disorders

• Cancer

• Cardiovascular disease

• Cognitive dysfunction

• Connective tissue disorders

• Diabetes, type 2 and pre-diabetes

• Gastrointestinal disorders

• Insulin resistance

• Kidney disorders

• Metabolic syndrome

• Non-alcoholic liver disease

• Obesity

• Pulmonary disorders

• Reproductive disorders 

Fortunately, positive effects of exercise can translate into tangible improvement in blood chemistry biomarkers:

• Improved blood glucose regulation, decreased fasting blood glucose, insulin, and HbA1C
• Improved blood lipids, decreased triglycerides, increased HDL-C
• Decreased inflammatory markers, hs-CRP, TNF-alpha
• Increased adiponectin 
• Increased thyroid hormones and decreased TSH 
• Exercise can also help reduce blood pressure

Optimal exercises

• Aerobic exercises (moderate to vigorous)
• Aquatic exercise, vigorous
• Resistance training
• Strength training
• Walking (brisk)
• Weight-bearing

CDC. How much physical activity do adults need? [https://health.gov/sites/default/files/2019-11/PAG_MYW_Adult_FS.pdf]

Timing and intensity of exercise

Timing of exercise sessions may have some influence on serum biomarkers as well:

• Exercising before a high-fat meal may improve blood lipids postprandially. 
• Exercising after a meal may improve glycemic response, especially for those with compromised glucose regulation.
• Afternoon exercise may be preferable to morning exercise for those with type 2 diabetes for optimal blood glucose control.

Interval training and moderate-intensity exercise have an anti-inflammatory effect. However, prolonged high-intensity activities like marathon running can increase inflammation and oxidative stress.

Excessive strenuous exercise can even increase biomarkers associated with cardiac injury, pulmonary embolism, or heart failure (e.g., cTnT, hs-cTnT, cTnI, NT-proBNP, BNP, and d-dimer). 

Therefore, practitioners must review their patients’ exercise habits during a comprehensive clinical assessment to be sure that strenuous exercise isn’t contributing to abnormal biomarker results.        

Optimal Takeaways:

• Exercise is a prescription for reducing chronic disease risk and improving health and longevity.
• Consistent moderate-intensity exercise can help improve biomarkers, glucose regulation, lipid metabolism, and inflammation.
• A total of at least 75-150 minutes of moderate to vigorous activity is ideal, coupled with resistance/strength training.
• Walking briskly after meals for 20-60 minutes can help improve blood glucose regulation.
• Exercising prior to a high-fat meal can improve blood lipid profiles post prandially.
• Exercise goes hand in hand with healthy eating habits. 
• A comprehensive program can reduce cardiometabolic risk factors including body weight, percent body fat, blood pressure, resting heart rate, serum glucose, blood lipids, hs-CRP, and insulin.