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James Loy: This is Reframe, the podcast from the College of Education, Health and Society on the campus of ºÚÁÏÉçÇø in Oxford, Ohio. Today on the podcast, we have a really fun episode. Now, often we talk about subjects of health and wellness on Reframe. Today, I'm going to turn the podcast over to a very special guest. Can you introduce yourself?

Amanda Valentine: Yes. My name is Amanda Valentine and I've had a weight loss journey myself losing over a hundred pounds after a lifetime of obesity and yo-yo dieting and I've been maintaining for eight years now. And over the past two years, I've started a daily podcast called Pound This, where I focus on health, wellness, and fitness.

James Loy: Your podcast is very successful. Thank you. We're very excited you're here. Thank you for being here. And I know one of the things that you've talked about is this concept of inflammation, anti-inflammatory effects, anti-inflammatory things. There seems to be this buzz around it now. Correct? And that's something you're interested in learning more about?

Amanda Valentine: Definitely. I mean, especially if you're in the social media space, you see that term get thrown around a lot. What exactly does that mean? Why is that important and what do we need to do?

James Loy: Here at Miami, there is a researcher in our department of kinesiology and health, Dr. Kyle Timmerman, he's an exercise science professor and one of his main things of research is all about inflammation. What it is, why it's good, why it could be bad. We connected you with him for this conversation, but you also brought along someone with you. Who is that?

Amanda Valentine: That is my friend and personal trainer, Josh Garrett, who is the owner of Cincy 360 Fitness, who is a professional personal trainer, runs a gym with personal trainers, and deals with the everyday public and their inflammation.

James Loy: This is a really fun conversation. It was not only about just what inflammation is and what we can do with that information. I loved how he talked about how that information that they discover in the lab gets out of these academic journals and actually into the general public, to people like Josh who can help people through this or people who are health conscious that actually can use this information. But you guys also talked about how to set a reasonable attainable goals, like a healthy perception of what health actually is and there's a lot of hard science mixed with practical advice here.

Amanda Valentine: Yeah, it was awesome. I know Josh was very, very excited to have this conversation with Dr. Timmerman. And I think it's just important to note, to people that do talk to the general public that's trying to lose weight or live a healthier lifestyle like myself, I do with my podcasts, like Josh does as a personal trainer, to know just what exercise means and the large benefits it has, just even small amounts of exercise, like Dr. Timmerman brings up.

James Loy: And one of the reasons why I'm talking to you now is because you guys were so excited to speak to him from the moment he walked in to the moment he left. There was really no beginning or end to the conversation. It kind of just like flowed on. We're going to set this up right now. This is Amanda Valentine and Josh Garrett, both from the Pound This Podcast, special guests hosts here on this episode of Reframe, speaking with Dr. Kyle Timmerman.

Josh Garrett: What do you teach here?

Kyle Timmerman: I teach-

Josh Garrett: Which this may be part of the podcast now. And we're on.

Kyle Timmerman: He's like I've been recording you guys for five minutes.

Kyle Timmerman: So, exercise test and prescription class. For folks who want to go to become cardiopulmonary rehabilitation specialists or physical therapists. And then I do exercise physiology as well, which is my favorite one because that more aligns with what my area is. And then I do some research methods classes at the graduate level too.

Josh Garrett: Okay.

Kyle Timmerman: Yeah.

Josh Garrett: Cool.

Kyle Timmerman: It's fun.

Amanda Valentine: I'm just going to just do, I mean, we'll still keep this the same exact vibe. I just wanted to just like introduce ourselves, that we're doing Reframe and then I'm just going to just ask you about you and your research and what you do here at Miami. Talk to me like I'm five, questions about inflammation and then I just want to have a round table discussion about what does that mean for all of us.

Kyle Timmerman: Yeah, no. I was just initially, I love that you guys said, hey, I'm interested in it. I'm like, oh, it's great because it's always such a misunderstanding. Or with ºÚÁÏÉçÇøs and just for the general population. I always ask my ºÚÁÏÉçÇøs who thinks inflammation is a good or bad. 99% of the hands go up for bad. So that gets to your first question. My research is focused on chronic low grade inflammation with aging. So we know that as we age, that our baseline levels of inflammation creep up and that's in reality, when we talk about inflammation, the bad context. It's when our baseline levels of inflammation start to creep up and it predisposes us to you name a chronic disease. And maybe we'll talk about some of the specific ones over the course of the podcast here.

Kyle Timmerman: And then we also know that people that are more physically active avoid that. So it's not just one of those things like, oh, I'm getting older, my inflammation levels have to increase. It's a host of things. It's kind of like you were saying when we were talking a little bit ago, that health is kind of multi-factorial, so being more physically active can, we know, can help prevent this increase in chronic low grade inflammation. We know that a healthier body composition can do that. Different aspects of diet can influence it, but we don't really know what it is about physical activity that's reducing that inflammation. That's kind of where my research is at and that's what's fun about just science in general. It's like, okay, we know there's this benefit but we don't really understand why it's occurring. So that's the general focus of our, of our research right now.

Amanda Valentine: So I guess it's just to totally dumb it down for a question of like, oh, what is general inflammation in the body mean? Like where is it? Why is your body getting an inflamed in a negative way?

Kyle Timmerman: Yeah, so it's just, kind of start with when we think of inflammation. People are like, oh my achy joints or you'll hear about the pain, redness, swelling, and so it's all those things. So all of us, even if we're healthy right now, we don't have any sickness. We have some level of inflammatory proteins in circulation and an in our tissues. But that's pretty low when we're absent of any illness at that time or any injury, our based on those inflammation are pretty low. But if we do get sick, we see a spike in inflammation, acute spike, and that's critical, critically important I should say. It's actually part of the immune response that helps resolve the infection. Think of it as kind of like the fire alarm for, hey, we've got some infection in this part of the body or we have a systemic infection of bacteria or virus.

Kyle Timmerman: And so inflammation helps recruit cells of the immune system. It helps make those immune cells mature and helps resolve that infection. And then you'll see the levels of inflammation go back down. Now people always ask me why do my joints ache? And kind of as we age, the increased risk of osteoarthritis and inflammation is there too because inflammation is critically important to tissue repair. So when we're young, if we injure our knee or injure our hip or injure our back, we've damaged some tissue and inflammation levels will spike locally and actually helps repair the tissues. So it actually helped degrade the damaged tissues and initiate repair of those tissues. And so I don't know about you guys when I was 20, that would take, it felt like 30 minutes and the tissue would repair. But as we age, if you damage your hip or your knee that inflammation will be initiated. But then maybe now your body can't repair that.

Kyle Timmerman: And so what happens if inflammation just stays elevated in your hip or your knee and it stays elevated. And with that continued elevated inflammation, it's preventing ... we want that inflammation there to clear away damaged tissue and then the inflammation will drop and then synthesis will occur. But if we're not able to repair that tissue, inflammation just remains elevated and repair never occurs. So it's just that high inflammation then just starting to even, not only degrade damaged tissue, but it's starting to degrade healthy tissue as well.

Amanda Valentine: Well, just as a personal example, like for me, I've been having all these problems specifically with my right knee. Had to get an MRI. I'm told I have had pretty much bone on bone. I have arthritis, I have an ulcer in my knee, and yet I have a lot of inflammation going on. So at what point is ... where do I use exercise in there because it's hurts and it's painful. So at what point am I helping reduce inflammation or just making it worse and grinding my knee out?

Kyle Timmerman: Yeah. So that sounds like classic osteoarthritis, right. And so we've got to find ways to try to reduce that inflammation. So sometimes the doc will say, okay, we're going to go in and we're going to do a cortisone shot, right, to try to artificially reduce that inflammation.

Amanda Valentine: Yeah.

Kyle Timmerman: And sometimes people would be like .. I have a hip issue myself. And so I've had those injections. I'm like, I'm cured. For three months, I'm like, this is amazing. And then three months later, that wears off and the inflammation returns. Now for exercise, that's an excellent point. Exercise should be anti-inflammatory. We know from research that people that are more physically active or who have arthritis and begin exercising, it reduces pain, it improves function. But you have to be mindful of what you're asking them to do.

Josh Garrett: Right.

Kyle Timmerman: So you can't just say, some people are so focused on, okay, the ACS, American College of Sports Medicine recommends 150 minutes per week of aerobic exercise. So go on a treadmill. It's like, well, maybe for you, with your knee like that, that doing aerobic types of exercises that are less weight-bearing. I think you said, when we were talking earlier, went to a-

Amanda Valentine: A water aerobics.

Kyle Timmerman: A water aerobics class.

Amanda Valentine: Yeah.

Kyle Timmerman: And so that would be kind of recommendations you would make for somebody in your case that said, hey, we know if you were to exercise, we can help reduce that inflammation. We can improve your function, reduce your pain, but you got to be smart about it. If I had to say to you, okay, I think I'm going to have you start just jogging on a treadmill like crazy, that's going to be your exercise. That's not going to help. That's going to have more bone on bone and going to cause some more of that localized inflammation.

Amanda Valentine: Yeah.

Kyle Timmerman: So exercise is an anti-inflammatory. Exercise training, I should say. So, yeah, it can help. You have to be mindful of what the exercise is that you're asking somebody to do.

Josh Garrett: So when you refer to exercise, I think that's such a broad topic that so many people put a negative connotation to that, right?

Kyle Timmerman: Yeah.

Josh Garrett: It's like, oh, I'm just going to go in there and get destroyed in the gym.

Kyle Timmerman: Yeah.

Josh Garrett: That's not what you're referring to.

Kyle Timmerman: No, no, no, no. I guess I should say more specifically physical activity. And I talk about this with my ºÚÁÏÉçÇøs as well. People look at exercise, jokingly say like a four letter word, right. And if you package it better and say physical activity, that's much more, kind of manageable for them and talk about activities that they like to do, that they'd be capable of doing given any conditions they might have. So yes, when I say exercise, I'm not saying, hey go get a gym membership at 24 Hour Fitness or hit the rec center all the time. Majority of the population could get the exercise they need outside.

Josh Garrett: Yeah.

Kyle Timmerman: Outside of a facility.

Josh Garrett: Parking a little further away.

Kyle Timmerman: Yeah, exactly. And all the studies showing that physical activity reduces chronic disease, the majority of those studies have the exercise of doing is just walking and just not walking on treadmills. Just hey, try to get up more during work, take a five minute break before or after lunch. There's some really cool studies out now that show that even smaller bouts, just two minutes of exercise provided that it accumulates over the day to, 30 minutes or so total, can have the same benefit as, hey, hop on the treadmill, go for 30 minutes in one chunk.

Josh Garrett: So instead of checking Facebook, you could take a walk up the steps.

Kyle Timmerman: Yeah. Oh yeah, yeah, yeah, absolutely. And just encouraging people just to ... there's a compelling body of evidence out there, it's like... You are drastically reducing your risk of chronic disease if you, like me, I sit six hours a day writing about the benefits of physical activity in my office. And so it's just being mindful of getting up periodically. And studies have shown, yeah, that helps. That really helps.

Amanda Valentine: Well, it's like, I think that anti-inflammatory seems to be such like a buzz word now. So with doing all of this research, I think that's important. And even like I say all this buzz words of anti-inflammatory, for me, just as a random person, I haven't heard all of this research about exercise. So how are you getting your research and everything that you've known and all this proof of that exercise helps in this, how are you making sure that people like Josh, who is training people has that information so that you can pass that along of how important exercise is?

Kyle Timmerman: I mean you hit on a really important topic because in science and research, a lot of us are just like...I'm over in Phillips Hall and I'm down in a little dungeon. We had no windows down there. And we're playing in our labs and we're finding these results that suggest that physical activity or exercise are anti-inflammatory. And then we're writing it to the Journal of Applied Physiology. But how often do you see at the doctor's office, the Journal of Applied Physiology beside a table or when you're checking out a Kroger.

Amanda Valentine: Oh, I read it all the time.

Kyle Timmerman: I know right? And so you're right. One of the things we struggle with in science is disseminating our findings to folks. So I do try to make a point of ... I speak at older adult centers quite a bit, so the Knolls of Oxford, Oxford Senior Center. I'm going down to a conference in Tampa in March to talk to a panel of clinicians and older adults about the benefits of physical activity as it relates to inflammation in older adults. So we do need to try to find avenues to do that rather than just publishing papers in scientific journals and presenting at scientific conferences. Because at the end of the day, we do hope that, you know, patients and folks like Josh that are working with people do find out what we're doing, because that's the whole point of it in the first place, right?

Amanda Valentine: Yeah.

Kyle Timmerman: Is to say, hey this is beneficial. We want to see that health professionals then are utilizing this information to benefit their patients?

Amanda Valentine: Josh, how often do you see with just the clients that you have every day there or they come into the gym that they have issues of inflammation. Like with me and my knee, I know I'm a case because I go to your gym. But where you know that you have to implement exercise in order to help fix this problem but not make it worse?

Josh Garrett: Yeah, I think that in regards to the general population, that's everybody. We've put a lot of mileage on the chassis, kind of thing. We've all played sports or we've done something repetitively, a movement pattern that's made the body imbalanced in some way and that causes some aches, pains and we got to kind of find the right exercises to make ... not exacerbate that, but work around it, so to speak.

Kyle Timmerman: Yeah.

Amanda Valentine: Well with all of the research that you've done with this study and other ones, how little actually makes a big difference, especially when it comes to inflammation? Is it just going for a five minute walk going to turn the tables for you?

Kyle Timmerman: Yeah, so again, the biggest bang for your buck is from taking from people that are relatively sedentary to anything beyond that.

Josh Garrett: Yeah.

Kyle Timmerman: That's when you're going to see the biggest one. You can convince those people who are really not physically active at all to begin doing that. More specifically to your question, it's absolutely appears to be dose dependent. So we've known that for a while. If you look at some classic studies like the Harvard Alumni study or the Aerobics Center longitudinal study that looked at incremental increases in regular physical activity, ranging from no activity at all to 250 or just 500 calories per week, which is not that much of physical activity, that you see risk of mortality, risk of chronic disease rapidly drop. And then if you can get somebody just to do as little as like a thousand calories per week of physical activity, which translates to about 150 minutes per week of exercise, you can see -- and again I'm probably citing the percentage a little bit off. But in the Harvard Alumni study I believe that they showed about a 20% reduction in mortality, once you see those people that are doing at least a thousand calories per week versus those that are relatively sedentary.

Kyle Timmerman: And then regarding dose, again, that 150 minutes per week used to be packaged as five days per week, 30 minutes on those days. Now researchers are looking at what if it was only like you just do two minute bouts during the day to add up to 20 or 30 minutes. Is that as effective as if I do 30 minutes all at one go on that day? And it appears to be, in terms of reduction of risk of disease. And again this is relatively new that they're looking at ... They used to say had to be 30 minutes or break it up into three 10 minute bouts. Now research is like, hey-

Josh Garrett: Just get it in.

Kyle Timmerman: Yeah, just get it in. If you can get two minute chunk here, five minute chunk there, as long as it adds up to about 30 minutes per day over the course of the day. The benefits, again in terms of reduction of risk of chronic disease appear to be the same as if you would do a 30 minute bout of that same intensity on that day.

Amanda Valentine: Well I don't know if you want to answer this question or not, but being that this is your job, what does your exercise routine look like?

Kyle Timmerman: Yeah, yeah. So I think I told you that I sit for the majority of my day writing about physical activity. And so I'm excited about the fact that there are studies that show, even if you have a lot of sedentary behavior, physical activities kind of trumps sedentary behavior to a certain extent. So you could have a lot of sedentary time, and a lot of us are going to as part of our jobs. But if you can get that physical activity and that's, again, a more powerful lever than being sedentary. Being sedentary is not good, obviously. But just getting any amount of physical activity is good. So me personally, I do three days per week of resistance training. I enjoy that more than aerobic exercise training. And then in term of packaging, this is for me selling it to myself to do, I know it's important for me to do aerobic exercise, but I hate doing it. And I used to get it from like sports.

Josh Garrett: Yeah.

Kyle Timmerman: And then as I started to have more aches and pains, I can't play basketball as much because a hip issue and tore my achilles right after I turned 40. So I hate treadmills and I hate bikes, but so I get mine from two days a week doing high intensity interval training on a bike. And I'm done fast, even though I don't necessarily enjoy it. I do kind of enjoy that ... I enjoy that vigorous intensity effort and doing it and it's over in a shorter period of time. And I know that I can get the same benefit from doing it two days per week because I'm doing that, the high intensity type that I would get from doing five days per week of walking on the treadmill for 30 minutes a bout, which just makes me sleepy. So that's mine.

Amanda Valentine: No, but I think that's important just because I think that, I mean, I'm sure you can speak to this too, Josh, of being where your profession lies with an exercise, where it's good to be honest of like, I hate doing this kind of exercise. But this is kind of my mental gymnastics I go through because I feel like so many people, like the general population including me, would be like, oh, I don't like doing this, it must be my fault, this is my thing. It's just these other people are just inherently born to love to exercise and grind hard and what's my problem? You know what I mean? So I think it's to be like... You work in this profession and this is something that you're passionate about and that it's not like you're like, Oh my God, all I want to do is exercise.

Kyle Timmerman: No, no, it's not. I enjoy it. And I definitely like feel the benefit of it. But yeah, there's aspects of it that I don't like. I'm sure Josh knows, there's days I'll roll in there and I'm like in there for 10 minutes, I'm like, Nope.

Josh Garrett: Absolutely.

Kyle Timmerman: It's not happening.

Josh Garrett: There's so many times that we've walked into the gym and it's like after you train somebody or you've trained for hours, that's the last thing that you want to do. And people are like, oh, you don't understand, it just comes easy to you. It's like, no, we still got to make those choices too.

Kyle Timmerman: Yeah. Yeah. It is just a matter of packaging because again, I think the recommendations, if people Google physical activity recommendations or exercise recommendations, that 150 minutes per week that you see by the American College of Sports Medicine, American Heart Association, if you just look at that, that can be kind of intimidating to folks. So again, in terms of disseminating to the public, this is kind of the things we'll hope will break through that, hey, you can get it in smaller bouts.

Josh Garrett: And it's subjective person to person.

Kyle Timmerman: That's right. Yeah.

Josh Garrett: It doesn't have to be this intense crazy workout.

Kyle Timmerman: Yeah. And people always ask, what's the best exercise? It's literally the one that you'll do. It's the one that you'll do. And so just finding out what you enjoy. I was told my ºÚÁÏÉçÇøs in class, I'm like, you might be giving grandpa permission to golf more. If you're like, hey, you don't have to go to a gym, just golf more and just make sure you carry your clubs. It's like what, that's it? Yeah.

Josh Garrett: Walk nine.

Kyle Timmerman: That's going to be within, yeah, walk nine instead of do it. There, you packaged it in a way that they're like, oh yeah, I'll go do it.

Amanda Valentine: Do you have any more questions, Josh?

Josh Garrett: I mean, I do have a question.

Kyle Timmerman: Yeah, fire away.

Josh Garrett: I don't know how much you've studied it, but in my area it seems like we have a spectrum, right, we have people that aren't moving a whole lot and then we have people that are using exercise almost in a negative way, right?

Kyle Timmerman: Yeah, yeah, yeah.

Josh Garrett: Like they're going in six, seven days a week. If they don't get their workouts in, they're going crazy.

Kyle Timmerman: Yeah.

Josh Garrett: Is there a threshold that exercise becomes negative on inflammation?

Kyle Timmerman: Yeah. So, well, yes to inflammation and yes to more things than just inflammation. So in exercise physiology, again, not to bore folks with some exercise physiology jargon, but we call it the J-shaped curve right? And so if on the Y axis, if you're looking at risk of infection or inflammation levels, we know that people that are hitting the recommendations are at a decreased risk of disease, probably have lower inflammation than those that are sedentary. But if you start going out to those folks that are doing, like you said, six, seven days per week of high volume, high intensity exercise, now that population is a small portion.

Josh Garrett: Right.

Kyle Timmerman: But there are definitely those. We know that in athletes. So a lot of times this is done like cross country teams that are doing high volume, high intensity exercise, we know that they have increased risk for infections compared to folks that are getting enough exercise and sometimes in case of those that are sedentary. So they've pushed beyond, now they're having a net detriment.

Kyle Timmerman: Now if you're looking at people for resistance training, they want to increase their muscle mass and function. That recovery is equally as important, right, because you're initiating that damage to the tissue, then you have to break down the tissue and then you have to have inflammation go away so that you can start to have the synthesis of new muscle tissue to stimulate that muscle hypertrophy. And so again, that's kind of the whole concept of overreaching or over-training. And so yeah, again, that's a real small percentage of the population, but can you get too much exercise? Yeah, you can. People can overtrain and overreach and feel sick as part of that.

Josh Garrett: Yeah.

Kyle Timmerman: Especially if your intensity is high on the exercise you're doing and there's not adequate recovery time, then you can start getting some of those detriments.

Amanda Valentine: Yeah, but that does get scary because especially if you look like on the online world, there's like this no rest days, go hard bro, sort of here's pictures of my muscles on Instagram and that's because I live in the gym sort of mentality that kind of puts out that if you don't go hard seven days a week, then you're weak.

Kyle Timmerman: Yeah, yeah. Those are things that ... is one of the things that makes kind of my life harder and probably Josh's life harder is those things like that.

Amanda Valentine: Yeah.

Kyle Timmerman: The perception of what healthy is, right. And so you'll see those folks show their gains in the gym or something like that. And then you'll try to talk people into exercise and they have the perception is: that's what it is?

Josh Garrett: That's what I have to do?

Kyle Timmerman: And that's what my ultimate goal is to look like or to be like. And if I can't get to that, that can be really defeating, right.

Amanda Valentine: Yeah.

Kyle Timmerman: With my ºÚÁÏÉçÇøs, I'm teaching, have reasonable attainable goals. And so for my ºÚÁÏÉçÇøs, I try to let them know how quickly do we expect to see improvements in what they're looking for. So if they're just looking to increase their strength, how quickly can we see that. If they're looking to increase the lean mass, it's good to let them know it's probably going to be three, four months before you see anything noticeable in that regard. And then it's just good to let them know. Otherwise if they've gone, I've lifted for three weeks, I'm looking in the mirror and I'm on the scale, you can tell my body composition hasn't changed dramatically. That's just too short.

Josh Garrett: And that's where I get yelled at.

Kyle Timmerman: That's right.

Josh Garrett: What do you mean?

Kyle Timmerman: But I think if you set their expectations correctly to begin with, then it's more like ... yeah, I completely hear what you're saying. And that's just something we always fight against is that kind of perception of what healthy is and what healthy looks like.

Amanda Valentine: Well, yeah, and that's a discussion that Josh and I have had a lot too, of just this whole, you got to like earn your shower, sweat through your shirt, like every time you exercise it has to be... And that's just a media representation or just on through social media, which again, just speaks to a certain population, not to everybody. But I could see where some people will be like, well I'm not even going to try because if that's what it is, that I have to sweat through my shirt and I have to be dead in order to be active, then I'm just going to stay in my jammies.

Kyle Timmerman: Yeah that's right.

Josh Garrett: For these people, one side of the population, the spectrum we're saying, just park a little further away. Just walk more. Just get some more activity in and then this side of the spectrum we're going, hey, you guys need some rest days, you need to calm down a little bit.

Kyle Timmerman: Yeah. Yeah. I mean again, that's such a small portion of the population.

Josh Garrett: Yes, that's not the bell curve.

Kyle Timmerman: Yeah, but absolutely. I'll have ºÚÁÏÉçÇøs who will freak out. It's like, I exercised six days a week last week. Is that safe? I'm like, yeah, it's safe. We're talking about a really small portion of population that's hitting that overreach and over-training.

Josh Garrett: Yep.

Amanda Valentine: Well this has been a really great conversation. Josh Garrett, Dr. Kyle Timmerman, thank you so much.

Josh Garrett: Yeah, thanks.

Kyle Timmerman: Yeah, it was a pleasure. Thanks for inviting me.

James Loy: Dr. Kyle Timmerman is an associate professor of kinesiology and health at ºÚÁÏÉçÇø. And Amanda Valentine is the host of Pound This, the health and wellness podcast, where Josh Garrett often appears as her co-host. You can find more of their episodes as well as many more episodes of Reframe on Apple Podcasts and wherever podcasts are found.