Exercise is important to all aspects of our health. Daily exercise helps slim the waistline, keeps us fit, reduces the chances of heart disease and high blood pressure, helps us sleep better, and gives us more energy. Thirty minutes of exercise daily will rev up the metabolism and improve moods.

Exercise is also important for our mental health. Moving our bodies releases neurotransmitters and endorphins which are known as “feel good” chemicals. It also reduces chemicals that can cause depression to worsen. Working out improves our appearance, which helps boost confidence.

Stress has been known to cause depression in people and animals. Mice were put to the test in a study done in Stockholm. After 5 weeks of putting the mice in some mild stressful situations, they showed signs of depression. Doctors know that exercise before stress occurs reduces depression due to an enzyme produced known as PCG-1alpha1, so they bred mice that contained high levels of that enzyme. They then exposed these mice to 5 weeks of stress, and while they showed signs of worry, they did not become fully depressed. Continuing the study on people, those put through 3 weeks of endurance training showed high levels of the enzyme in their muscles, proving the theory that exercise reduces depression.

While that is great news, those who struggle with long-term depression, chronic pain, arthritis, and high amounts of stress, have a difficult time just finding the motivation to begin to exercise. Fibromyalgia sufferers have pain in all parts of the body, making basic movement difficult, let alone jogging, or riding a bike.  Those with fibromyalgia are three times more likely to have depression, much of it having to do with the length of time it takes to diagnose.  Fibromyalgia is not well understood and hard to treat. Compounded with chronic pain and fatigue sufferers tend to withdraw from friends, have more anxiety, and exercise less.

Frozen shoulder is another issue that has not been studied in depth and is misunderstood. It often occurs for no reason, and causes capsules surrounding the joint in the shoulder to shrink and form scar tissue. This causes lowered range of motion and pain. There are three stages to frozen shoulder: freezing, frozen, and thawing.  The freezing stage causes pain and limited range of motion, pain and motion decreases during the frozen stage, and the shoulder begins to improve during the thawing stage. Each stage can last up to 6 months, so this is around 18 months of pain and limited range of motion, which causes depression and inactivity.

Exercise does not have to be painful, grueling, boring, or cringe-worthy. Finding an activity you enjoy is the first step. Start small, do little things like walking around the block, taking the stairs instead of the elevator, parking farther from the door in a parking lot, washing the car, or pulling weeds. Anything that gets you moving around will greatly improve your mood, and help you feel better in and out.


Exercise can lead to knee injury or hip pain if done so with poor technique.  This is commonly seen with weight lifting and shoulder pain.  It is common for the recreational gym enthusiast to ponder whether to lift and then bike or vice versa.  Recent research indicates that lifting weights before or after engaging in cardio exercise can be beneficial, according to a New York Times “Well” blog.

The evidence is contrary to the advice many people have received. It is widely believed that workouts involving both types of exercise are not as effective as doing cardio and resistance training separately.

A study the Journal of Applied Physiology published in March involved people riding stationary bicycles with one leg, then doing resistance exercises with both legs. Some of the participants performed the two kinds of workouts in the opposite order.

Researchers looked for differences between the leg that did both exercises and the limb that only lifted weights. They found that, after five weeks, both legs had gained similar amounts of muscle and strength. Cycling before lifting weights did not adversely affect the benefits of the resistance workouts. The same results were reported for participants who did resistance training before cycling.

Biopsies were performed on the subjects before and after weight training to assess the size of the vastus lateralis and quadriceps muscles in both legs. The researchers took muscle samples to assess citrate synthase activity and glycogen concentration. Muscle size increased at a greater rate in participants who performed both types of exercise, compared with those who did only resistance work.

Another study, conducted in 2012, showed that inactive, middle-aged men had good results combining cardio or aerobic exercise with weight lifting. The research failed to show that one type of exercise diminishes the value of the other kind.

The lead researcher was kinesiology professor Stuart Phillips of McMaster University in Hamilton, Ontario. He reported positive changes in myofibrillar and mitochondrial protein fractional synthesis rates, and other indicators, for the eight men involved in the study.

The participants did leg-extension repetitions, followed by riding stationary bicycles. Biopsy analysis suggested no “interference effect on muscle protein subfractional synthesis rates, protein signaling or mRNA expression,” the researchers wrote.

While the medical terminology is complicated, the message is clear: Combining cardio with weight training does not reduce the effectiveness of either workout. The research indicates that doing both can produce positive outcomes, regardless the order in which the exercises are performed.

If you have sustained an injury while lifting weights or during a cardio workout, contact our top notch orthopedists at San Diego Orthopedic Surgery Clinic.


At San Diego Orthopedics we strive to promote a healthier lifestyle and in our quest we not only write about dealing with knee pain or shoulder injuries but also about leading a healthy lifestyle.

Anyone hoping to read that heart attacks in men (and women) can be prevented by eating fast food, smoking a pack of cigarettes a day, drinking moderately, and living a sedentary lifestyle will be very disappointed by the next few paragraphs. Everything we know that is bad for us, is bad for us for a reason. Smoking cigars or cigarettes, along with eating poorly, causes a myriad of problems, compound that with little or no exercise, and you are a ticking time bomb for a heart attack. While you may have a perfectly healthy 99 year old uncle that has eaten a pound of bacon and a bottle of whiskey every day for 70 years, he is very much the exception.

Believe it or not, but 4 out of 5 heart attacks can actually be prevented by eating healthier, managing weight, cutting out cigarettes, and keeping alcohol to a minimum. It looks easy on paper, but in reality, it is difficult to maintain and often requires conscious effort. Less than 2 percent of Americans actually make healthy life choices on a daily basis. An unhealthy lifestyle can lead to more than just heart attacks. Extra weight on the body can cause knee pain and back pain, along with high blood pressure, high cholesterol, and other chronic diseases.

A study done in Sweden on 20,000 men over 11 years showed that not smoking lowered men’s risk of heart attacks by 36 percent. Eating healthy lowered the risk of heart attacks by 18 percent, the risk for men having less than a 37 inch waist was lowered by 12 percent, and those who exercised about an hour a day had a 3 percent lower risk. If a man does all of the above combined, his percentage of a heart attack decreases by 69 percent.

Not only will keeping a healthier lifestyle reduce risk of heart attack, high blood pressure, and high cholesterol (which clogs arteries and causes heart attacks), but it will keep the bones healthier and stronger. Extra weight puts pressure on the knees which can lead to a trip to an orthopedist for pain due to knee osteoarthritis, which can eventually turn into a knee replacement.  While older men may put off knee replacement surgery due to their age, having it done can be a literal lifesaver.

Think about this: an overweight, older man who smokes and is not very active begins to have knee pain. The knee pain grows worse, which causes the man to move around even less. His sedentary lifestyle leads to more overeating, overeating leads to more weight gain, and now there is even more pressure on the knee. The risk of heart attack is increasing each day.

If you are a gentleman 45 years or older your risk of having a heart attack becomes greater every year. While leading a healthier lifestyle seems like hard work now, your heart will thank you in the end.


© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow