A few weeks ago I read an article (requires subscription) in the New York Times about how many people who were consumed with doing aerobics back in the 80s were now hobbling around on bum knees and bad hips–those that is who haven’t had their knees and hips replaced.

Mrs. Siemens, 54, a jewelry designer in Berkeley, Calif., said she often took as many as six aerobics classes a week in the ’80s when, she said, ”aerobics was new and everywhere and my friends and I all did it with a vengeance.” Sipping a drink from Jamba Juice, she added: ”I was jogging in place with Jane Fonda. I did my jumping jacks and high knee lifts with Richard Simmons. I twirled my arms and punched the sky while hopping on one foot to the music of Olivia Newton-John. It was supposedly all about staying in shape, but look at me: I can hardly walk.”
Mrs. Siemens isn’t the only possible casualty of the early aerobics craze that took millions of Americans to group exercise classes for the first time. The hordes came, believing that nonstop jumping, kicking and running in place to (bad) throbbing music was the ideal way to raise one’s pulse.
”I was on the concrete floors in bad tennis shoes jumping with everyone else,” said Jay Blahnik, a spokesman for the IDEA Health & Fitness Association, a trade group. Mr. Blahnik, 38, now teaches rowing, running and cycling in Orange County, but he spent a dozen years leading aerobics classes. ”A lot of people doing aerobics back then can no longer do any jumping whatsoever,” he said. ”They have problems with their backs, feet and hips.”
Some of the damage is severe. ”It’s not uncommon for us to see acute and overuse injuries from high-impact aerobics,” said Dr. Jordan Metzl, a sports medicine specialist at the Hospital for Special Surgery in New York. ”It’s part of the reason that aerobics classes are on the wane.”

Although these damaged backs, knees, hips, and shoulders are the legacy of the aerobics of the past, that’s not to say that more immediate damage can’t occur as well. All those people you see complacently loping away on treadmills with earphones plastered to their heads are only moments away from disaster. Some of them take nasty falls. Here is an example.
A treadmill fall in 5 stages:

STEP 1: The Trip. I’m not sure how it happened. Maybe her foot hit the front of the machine or maybe tripped or maybe she’s just clutzy. I don’t know. But it happened, and for the purposes of this story, I’m glad it did.
STEP 2: The Struggle to Stay Upright. Much like in the 5 stages of grief, one of the stages of the treadmill fall is denial. She didn’t want to believe it was happening. So after the trip, she’s halfway bent over and holding on for dear life – her poor little legs doing their darndest to keep up with the speed of the belt. She knows her very pride is at stake.
STEP 3: The Brace. This is also similar to one of the grief steps, acceptance. The belt is going too fast, the legs can’t keep up, she’s going down and she knows it. At this point she just gives into the inevitability of the fall. It’s a sad act of contrition.
STEP 4: The Fall. She braces for it, but she must not have been much of an athlete. Because the belt takes her feet backwards and causes her face to go forward – she’s not prepared for what is a nasty face plant. But God Bless her, even down on the canvas and in what must have been serious pain, she tries to grasp at the front of the treadmill to keep herself from getting pulled backwards and dumped on the floor. It’s like a scene from Sylvester Stallone’s mountain climbing epic “Cliffhanger”. But alas, we lose her. She can’t hang on.
STEP 5: The Unceremonious Dump. The treadmill takes her body and drags it backwards. However, she was listening to the TV that’s attached to the treadmill. That means she has ear pieces in her ears. And they must have been really stuck in there, because I swear they held her for a moment on the belt. It was like a mighty tug of war: the treadmill vs. the earphones. The treadmill won. The ear pieces were plucked brutally from her ears and her body got flung backwards and unceremoniously dumped on the floor.

This entire post should be read because there is a certain amount of schadenfreude provided by this particular fall.

During medical school, I once witnessed a particularly dramatic treadmill bust with my own eyes.
I was in my senior year doing a cardiology rotation at the VA hospital. As part of this rotation I was to help with the treadmill stress tests, which meant that I stood there and observed the cardiology residents perform treadmill stress tests. As anyone knows who has had a treadmill stress test, the whole idea is to ‘stress’ the cardiovascular system of the person being tested. This is done by increasing the speed of the treadmill and, if that’s not enough, by increasing the grade, making the patient run more uphill. As patients taking the test begin to tire, the doctors administering the test usually encourage them to go just a little longer to really stress their cardiovascular systems to bring out any problems that are only visible under a load.
One morning I showed up at the stress test lab as the residents were hooking the monitors up to a pretty good sized (big, not fat) elderly man who was decked out in a tee shirt, tennis shoes and shorts. I didn’t know any medical history on the folks being tested because they weren’t patients I had worked up, so I didn’t have a clue as to what was wrong with this guy, only that he was getting ready to get stress tested.
He got up on the treadmill and started walking. After a few minutes the resident started to crank up the velocity. The patient hung in there. A little more speed, a little faster walking. So far, no changes on the EKG. The resident hit the gas a bit harder; the guy keeps going. Finally the point was reached at which the patient was starting to labor to keep up, the point at which his cardiovascular system was beginning to be stressed and the time during which the residents could begin gleaning the most valuable information from the test.
As the treadmill moved a little faster, the patient was really huffing and puffing and showing signs – at least to my untrained eyes – that he was at the end of his tether.
“Come on, Mr. So and So,” said the resident. “Just a little longer; we’re almost there.”
Suddenly, Mr. So and So says (and these are his exact words), “Boys, I’m about played out.” And with that warning he lets go of the handrails and quits running.
He doesn’t go through the 5 stages mentioned above. The treadmill catapults him out the back in dramatic fashion and wedges him underneath an H-frame exam table halfway across the room.
It takes the residents a beat to figure out what’s just happened before they drop everything and begin to extricate him from beneath the table where he is pretzeled rear end first with his head over his knees. Since none of the responsibility for this fiasco accrued to me, and since there wasn’t room for yet another under the table, I remained in my detached observer position.
They got the old guy out, dusted him off and checked him over. He was none the worse for wear from the experience, but I doubt he ever forgot his treadmill adventure. I doubt that the residents did either. Nor did I. The entire affair imbued me with the realization that treadmills are not exactly benign.
As I’ve said before, virtually all of the benefit that comes from aerobic exercise comes from the increase in strength such exercise builds. If that is the case – and it is – then one needs ask the question: is aerobic exercise the best way to increase strength? The answer is, of course, No. Resistance training is the best way to build strength. What is the best kind of resistance training? In my opinion that would be a Slow Burn kind of workout.


  1. Just as I keep saying to all those people who strain their knees & hamstrings at the gym….exercise is dangerous!!! & keeps you fit for what? exercise?? please most of my gym going friends can’t walk from one end of the airport to the other carrying a suitcase. Me I have no problems doing this or the various other everyday tasks they whinge about but then I don’t & never have gone to a gym. My house & garden oh & shopping give me plenty of exercise!!
    Hi Helen–
    I would rather have too little exercise than too much.

  2. I’ve been doing slow burn for almost a year-luckily Fred Hahn has a studio here in NYC – and it really does work. I was skeptical about giving up aerobics, but eventually I did, and it’s true, you really don’t need it. I just went skiing a couple of weeks ago, unfortunately, my first and only ski day this year, and without having done a bit of aerobics for many many months, I can say my legs never felt stronger on the slopes. I also test myself out on the treadmill once in awhile, and I find I can run the same distance I was running before, with ease. It actually feels easier. It’s really nice to free up all that time I used to waste on running, swimming, etc. not to mention just getting to the gym and back.
    Hi mrfreddy–
    I had the exact same experience.

  3. Dr Eades you couldn’t be more right about this whole thing. As a Diabetic I have spent over an hour every day on cross trainers etc for 2 years now without much progress (except to feel sore and exhausted all the time)at all in things I need to progress on, particularly insulin resistance. In desperation after reading your Slow Burn article I emailed Fred Haan and he directed me to a Strength training centre in London who do a programme very similar to his. I am amazed at how much stronger I feel (backaches have stopped) in just 5 weeks x 2 sessions, and I have seen a definite improvement in the insulin resistance. Definitely seems to be the way to go and sooooo much less boring! I actually enjoy it.
    Hi Glenice–
    It’s all a matter of increasing strength.  Even flexibility and endurance are a matter of strength.  Amazing!
    Thanks for writing.

  4. Oh, lordy, I’m pretty sure my lunch will digest much better after all that giggling!
    I love to read your blog while I eat lunch (except the “safe in your tidy whities” story!) and this had me giggling like crazy. Which makes people look at me strangely, since I work in a doctors’ office! Thanks for the entertainment!
    Hi Char–
    I’m always glad to provide the lunchtime entertainment. Glad you enjoyed it.


  5. Dr Mike,
    My brother has atrial fibrillation. EVERY time he takes a stress test, he warns the techs, that his heart, when stressed, goes bonkers. They don’t listen. He repeats, they yawn. Then, the tests proceeds and they end up calling 911.
    Hi Richard–
    How many times have I heard versions of that same story.  Medical people just don’t seem to believe patients when it comes to describing their own idiosyncrasies. 
    Thanks for the YouTube link.  It’s pretty funny. Shows what can happen if you geek around on a treadmill.


  6. Dr. Mike,
    I have been enjoying your blog for several months now. I enjoy bicycling, and the idea of doing a century, and other long-distance rides is something I have considered. I have done as many as 38 miles on a ride, but I am wondering if there is really any fitness benefit to be gained from these real long rides, or if they could be potentially detrimental to my health. (I’m 51 years old.) I know a 60-something-year-old college professor who does centuries rather routinely, and to be honest, she doesn’t look particularly healthy. I know that Dr. Stephen Phinney is a long distance cyclist, and seems to be quite healthy . Moderate mileage and intervals along with low-carbing has been great for me. I wonder if longer rides would be productive or potentially harmful. Any thoughts?
    Hi Charles–
    I would say it’s pretty much an individual thing.  In my experience, most people don’t do well with long endurance exercise.  That doesn’t mean they can’t do it, just that it’s not the best thing for their health.  Most are beset by a host of such problems as chronic sore throats, never ending colds, fatigue and other symptoms of an impaired immune response, which are all a part of the overtraining syndrome.
    If you are wanting to do the century just to see if you can do it or to prove something to yourself or others, that’s one thing.  But if you’re looking to simply stay healthy, I would recommend that you continue what you’re doing.

  7. Slow burn makes sense to me. I want to get more information on it and then I might incorporate it into the swimming workouts I coach. It would seem that this principle would explain some of the benefit of yoga which is based on long slow sustained movements using the body as resistance. Of course, yoga requires MUCH more time.
    Hi Marilyn–
    That’s the beauty of Slow Burn: a lot of exercise quality squeezed into very little quantity.

  8. Nice post Mike. Did I tell you that I amazed my cardiologist at my last stress test? (I did it mainly for fun – there’s nothing wrong with me.)
    I did so well on the test he couldn’t get my HR up to 180 with the treadmill at full pitch. He said I did better than ALL of his athlete patients – runners included – of ALL age groups.
    I was all asmile!
    Hey Fred–
    Thanks for the report.  Just another example of how Slow Burn increases endurance, which is the part so many people have so much difficulty in believing.

  9. So, Dr. Mike…are you saying that we don’t really need aerobic conditioning for fitness? That resistance training will give us all the physical fitness we need? I admit, I have Slow Burn book and even tried it for a few weeks. It’s such a shift in another one of those commonly-accepted-as-truths–we need at least 3x a week aerobic exercise–that I felt as if I wasn’t getting enough exercise. I dropped SB and started back to more traditional 2x/full body workouts and 3-4x/wk cardio sessions. And for my effort? Heh. Not much! I think I’ll try SB again.
    Oh and by the way, my husband is participating in a study right now from Univ of Colo Health Sciences Center examining the effects of 3 months of supervised aerobic exercise on Type 2 diabetes. Maybe he should drop out and just do some resistance training?!
    Thanks for the great info.
    Hi Cheryl–
    You pegged it; that’s exactly what I’m saying.
    Keep me posted on your SB results when you get started back and on your husband’s efforts to reduce his diabetes with aerobic exercise.

  10. I tried SB several years ago and had a hard time getting the hang of it because I found it difficult to work from a book so I gave it up. At the time I wished that there was a tape that I could follow. A quick look at the SB site today reveals that you can now get tapes or DVD’s to use. I’m excited and will be ordering.
    Hubby was also a treadmill victim one time. He dropped something, forgot where he was, bent over to pick it up, and the rest was history. He’s a tall guy who is all legs and it was like a stork flying off.
    Hi Esther–
    Let me know about your SB experience.

  11. Treadmills are tools of the devil. A couple of years ago at my gym I saw a young girl take a vicious header on one very similar to the story above. However, she wasn’t as lucky–she got a nasty gash on her forehead and knocked out several teeth. Now there’s big signs all over the gym about using the stop tether on the treadmills. I’ve tripped on elliptical trainers but at least you can stop them moving before serious damage is done.
    Treadmills: I avoid them like death.

  12. Marilyn wrote “It would seem that this principle would explain some of the benefit of yoga which is based on long slow sustained movements using the body as resistance.”
    Actually both yoga and Slow Burn are just forms of isometric contractions – with yoga using self resistance and SB using a weight to force the contraction. The thing is that you can get the same benefit by using isometric contractions by themselves or by using self-resistance on slow controlled motions under muscle tension.
    I have been using that method for the last 7 weeks and have really packed on muscle, without the added unnatural strain that weights put on your joints.

  13. So, I can get my old Bullworker out again and get cracking on the exercises. I knew I’d kept it for a good reason, not just to irritate my wife!!
    Go for it! 

  14. Okay, confession time: I am not really a swim coach, not exactly. I am a synchronized swimming coach and my specialty is figures, the set pieces that all the swimmers are required to perform. Doing figures properly requires immense concentration, strength flexibility and breath control. I came at it from having done years of yoga so I had some idea of how much power, balance and patience are needed to really achieve the apparent effortlessness that is the most striking sign of mastery.
    My hardest task with my swimmers is convincing them to do the figure SLOWLY enough. Momentum alone is not enough. In fact, relying on momentum ensures that a swimmer will be unable to understand EXACTLY which muscles are used(and when and how much) and therefor will not be able to get stronger.
    So Drs E, next time you are doing your workout throw in a bunch of rotations around all axis and hold your breath for up to three minutes at a time. And don’t forget to keep the beat. I really don’t believe there is a harder sport.
    Gee, Marilyn–
    You sure make synchronized swimming sound like a lot of fun.  I think I’ll pass, though.

  15. I was advised to perform aerobic activity to lower my blood pressure – do you think that Slow Burn would have a similar affect?
    Hi Dan–
    The medical literature shows that Slow Burn conditioning does lower blood pressure as fitness improves, and does so better than aerobic exercise.  But it increases blood pressure during the workouts themselves (as does aerobic exercise), so you should do it only with your doctors okay.

  16. I have always feared the treadmill after trying it only one time. I thought it was just because I was so clumsy. And it certainly never appealed to me. I’m glad I was so cautious.
    Dr. E., I have been diagnosed with Osteopenia. Will the SB help increase bones mass? I have just started low carb-high protein eating plan, lost 12 lbs and close to 100 to go. I also have bad knees. Can someone in my condition safely do SB?
    Hi Babs–
    Any kind of resistance training will increase bone mass.  Since Slow Burn – at least in my opinion – is the most effective kind of resistance training, it should increase bone mass even faster.

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