Exercise and Cholesterol Subfractions: What You Should Know

Written by Johnny Nguyen


Most of us know that LDL cholesterol is the “bad” kind and that HDL is the good kind, but this conventional focus on only these cholesterol categories is incomplete and can often be misleading (1).

Cholesterol molecules are carried by different lipoproteins. The American Diabetes Association and the American College of Cardiology endorse assessment of these lipoproteins for superior prediction of cardiovascular disease. For example, apo-B (apolipoprotein-B), a primary lipoprotein in LDL cholesterol, is a much stronger predictor of cardiovascular risk than LDL level or total cholesterols (2).

ApoA-1 (apolipoprotein A-1), on the other hand, is a major lipoprotein in the good cholesterol HDL. It’s the beneficial “roto-rooter” for your arteries. ApoA-1 promotes efflux of fat and cholesterol out of the arterial walls and to the liver for excretion — a sort of “fat remover.”*

So looking solely at LDL or HDL doesn’t tell the entire story; it’s important to have a blood test that breaks down the subfractions of these cholesterols. And among the important things you want to know is the ratio of apoB/apoA-1.

Why is it important to know the ratios of these subfractions? Because a major study published in Lancet shows that apoB/apoA-1 ratio is the strongest among ALL modifiable predictors for myocardial infarction, or heart attacks (3).

Another reason to know: your LDL doesn’t reflect the actual ratios of these subfractions. In other words, you can have seemingly great LDL cholesterols but your apoB/apoA-1 can be darn bad, and you’re one step away from a fatal heart attack. Or, you can have higher “bad” LDL but great apoB/apoA-1 ratios and be healthy (4).

You can decrease total apoB level and lower the ratio of apoB/apoA-1, yet not change your LDL number. That’s why LDL alone doesn’t tell the story. You should get a more thorough assay to know more about your heart health. (See below for some resources.)

And, you guessed it, these positive changes can be accomplished (along with nutrition) through exercise:

  • An inverse association exists between exercise and apoB/apoA-1 ratio (Simonsson M, 2007). More exercise = improved ratio.
  • Exercise also lowers total amount of harmful apoB (O’Donovan G, 2005). Exercise lowers this subfraction independent of others.
  • Higher levels of beneficial apoA-1 is associated with endurance exercise (Olchawa B, 2004).
  • ApoB/apoA-1 ratio is seen to improve significantly with fitness improvement in one year (Holme I, 2007). In sedentary men who started exercising and become fit, their subfraction ratio improves within one year.


There are many important markers of health to measure and know, but the point of this article is to encourage you to care more about numbers beyond the conventional HDL and LDL. Here are some resources, if you’re interested in a thorough analysis of your cholesterols and other cardiometabolic factors. These services can give you vital data that may be useful to your own doctor, as well as to your trainer who ought to know how to structure or modify an exercise program as a result:

www.wellnessfx.com   and/or   www.bhlinc.com

* When there’s damage to arterial walls (and we inevitably experience this damage at varying degrees through food choices, stress and disease), white blood cells move in for healing. White blood cells can become “fat-overload” and transform into foam cells, die, and contribute to artheroma (arterial plaque). So removing or minimizing low density cholesterols such as apo-B is one factor to lowering cardiovascular risk. There are other factors, of course, but this post focuses on cholesterol subfractions.


1.  Genest J Jr, McNamara JR, Ordovas JM, Jenner JL, Silberman SR, Anderson KM, Wilson PW, Salem DN, Schaefer EJ. Lipoprotein cholesterol, apolipoprotein A-I and B and lipoprotein (a) abnormalities in men with premature coronary artery disease. J Am Coll Cardiol. 1992; 19: 792–802.

2.  Brunzell JD, Davidson M, Furberg CD, Goldberg RB, Howard BV, Stein JH, Witztum JL. Lipoprotein management in patients with cardiometabolic risk: consensus conference report from the American Diabetes Association and the American College of Cardiology Foundation. J Am Coll Cardiol. 2008; 51: 1512–1524.

3.  Yusuf S., et al. The Effect of potentially modifiable risk factors associated with myocardial infraction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937-952.

4.  Holme I., et al., ApoB but not LDL-cholesterol is reduced by exercise training in overweight healthy men. Results from 1-year randomized Oslo Diet and Exercise Study. J Intern Med. 2007;262(2):235-243.


Are You Overtraining?

written by Holli McCormick

Yes, it is possible to overtrain your body.  In my book – overtraining can be just as serious if not more serious than not working out.  Just like everything, there is wisdom in balance and moderation.  The following article – What Does Overtraining Mean? – shares with you some typical signs of overtraining…and mentions that most of overtraining occurs from extensive exercise.  However, I would add that being a weekend warrior, or progressing your workout intensities/amounts before your body is ready can also be damaging and dangerous for your body.

If you are in doubt of how to proceed safely with your workout plans, please do not hesitate to contact us here at Elementus for your complimentary consultation with one of our highly-trained personal coaches.

Article: What Does Overtraining Mean?

Fitness Trends: How to be safe

written by Holli McCormick

One topic we discuss here at Elementus often is the newest – or not so new – fitness trends we see making a surge in the world.  As personal trainers with over 10+ years in a relatively “young”  industry, we have seen lots of trends come and go over the years.  From the shake weights to the whole body vibration machines, from TRX to Zumba Toning, from U-Jam to Paddle board Yoga – as a participant it is fun to get involved in these new trends to spice up your workouts.

They may look shinny and new and promise BIG results…the bottom line is they might not be the best or safest form of exercise for every individual.  Look to answer these questions with any new class or workout you are considering:

  • What is the science behind the tool or class style? What is this class or tool promising to do for me?  Is it realistic?
  • What do the studies say?  Is there enough data out there to support their claims?
  • What do other people I know in the industry (personal trainers, group fitness instructors, coaches, athletes) say about this tool/class?
  • Is it safe for me?

While many forms of exercises may be beneficial ~  a personal, individualized approach is always the safest route to take to reach your goals.  This doesn’t mean that the high intensity boot camp is not right for you, it might just mean that there is another form of exercise that will better match your current fitness level as well as help you achieve success in maintaining an exercise program in the long run.   If you don’t know your level of fitness and the safety with any given exercise or tool, please do not hesitate to contact us or search for a personal trainer in your area to help you evaluate this.

With that being said, today’s fitness tip comes from ACE (American Council on Exercise) and Jessica  Matthews – an Exercise Physiologist and media spokesperson for ACE.   Jessica evaluates 3 of the hottest trends right now – plyometrics, kettlebells and HIIT training – and gives you pointers on how to make this a possible fit for you.

NOTE: We are excited to announce we are in the process of developing several more flexible workout options that will be using a variety of techniques to spice up your your workouts and get you moving.  The great news is all these options will be supervised by trained coaches to ensure safety and answer your questions.  Like us on Facebook to keep up to date with the development of this exercise program!

What are some common mistakes people make with popular fitness trends and how can I avoid them?



Scar Tissue: When a Solution Becomes a Problem by Ruth Werner

This interesting article comes to us from the magazine “Massage & Body Work” (July/Aug 2012 publication).  The article gives a slightly technical look at what scar tissue is, what it is meant to do, how it differs from collagen…and when a good and vital aspect of our body design turns into a problem.  Our own Daniel Villeda – new to our staff – specializes in the massage and is knowledgeable in this field if you would like to contact him with questions.

Dr. Daniel Villeda


Please click the link to read the full article:  Scar Tissue: When a Solution Becomes a Problem

Why a hike in the woods might be a healthier option


Here is an interesting article from Alex Hutchinson, a health and fitness blogger for Runner’s World, that talks about the mental and physical benefits of exercising out in nature. If you are always stuck on a treadmill or stationary bike, you might want to grab your hiking shoes and find a great a trail to explore for your next workout. Some of the benefits of exercising in nature includes improved cognition, enhanced immune function, reduced stress hormones and lower blood pressure. Read on below…


In Japan, they call it shinrin-yoku – literally, “forest bathing.” Here, we might just call it a walk in the park. Either way, people around the world have an intuitive sense of the restorative power of natural environments. The question is: Why?

Scientists have advanced a wide range of theories about the specific physical and mental benefits nature can provide, ranging from clean air and lack of noise pollution to the apparent immune-boosting effects of a fine mist of “wood essential oils.” But the most powerful benefits, a new study suggests, may result from the way trees and birds and sunsets gently tug – but never grab – at our attention.

The study, which will appear in a forthcoming issue of the Journal of Affective Disorders, found that volunteers suffering from depression who took a 50-minute walk in a woodland park improved their cognition, as measured by the ability to remember a random string of digits and repeat them in reverse order, compared to those who took a walk through city streets. An earlier study found similar results in subjects who weren’t depressed.

The explanation, according to lead author Marc Berman, a research fellow at the Rotman Research Institute at Baycrest in Toronto, lies in the distinction between two types of attention: “voluntary,” in which we consciously focus on something; and “involuntary,” in which something grabs our attention.

The ability to direct voluntary attention is crucial in daily life (and for cognitive tasks like remembering random digits), but it’s easily fatigued. Dr. Berman and his colleagues believe that going for a walk in the park gives voluntary attention a break, since your mind has a chance to wander aimlessly and be engaged – involuntarily but gently – by your surroundings.

“In a lot of natural areas, you’re away from loud noises and distractions,” Dr. Berman explains. “It tends to be less crowded so you don’t have to worry about bumping into people, and it also has interesting stimulation to look at, which captures your attention automatically.”

In contrast, honking horns and traffic lights and crowded sidewalks – and pretty much every other ingredient of modern life in a big city – constantly force you to exert your voluntary attention to react or block them out, leaving you more cognitively depleted.

All this makes it sound as if the benefits of nature are mostly in your head. It’s true that simply looking out a window at nature or, to a slightly lesser extent, looking at pictures of nature scenes can produce some of the same effects. But the physical environment itself may also play a role, Dr. Berman notes.

One obvious candidate is air quality: A single exposure to polluted air can trigger lung and heart problems, and chronic exposure has been linked to cognitive decline. Even downtown parks and riverside bike paths are likely to have significantly better air quality than busy city streets, and trees offer an additional protective effect. The level of vehicle emissions just 200 metres away from a road is already four times lower than it is on the sidewalk next to the road.

A more unusual suggestion, proposed by researchers at Japan’s Nippon Medical School, is that trees emit a fine mist of health-giving “wood essential oils.” In a series of shinrin-yoku studies, the researchers have reported that walking for two hours in a forest enhances immune function (as measured by levels of “natural killer cells”), reduces levels of stress hormones and lowers blood pressure, compared to similar walks in downtown Tokyo.

(Before you rush out to buy a case of wood essential oils, it’s worth noting that this research was funded in part by Japan’s Forestry and Forest Products Research Institute.)

Still, the fact that pictures of nature can produce cognitive benefits suggests that at least part of the effect is mediated by what we see. One simple hypothesis is colour: Nature scenes tend to feature more green than urban scenes. A more subtle possibility is that natural landscapes have more fractal patterns – a mathematical classification that describes the complex shapes of phenomena like coastlines, mountain ranges and broccoli florets – compared to the simple straight lines that characterize man-made environments.

“Maybe looking at these fractal patterns captures attention automatically, which leads to this more restorative process,” Dr. Berman says.

Teasing out the key variables will take time – and ultimately, it seems unlikely that there’s a single magical quality or essential oil that fully explains the call of the semi-wild. For now, it’s enough to know that the benefits of exposure to nature are real and measurable. And in an increasingly distracting and distracted world, they’re more important than ever.


How to get the best from nature

Suck it up

While many people enjoy a walk in the park, pleasure isn’t required to get cognitive benefits. Marc Berman’s volunteers were less likely to enjoy their nature walks in winter than summer, but both groups aced the post-walk cognitive tests.

Think outside the park

Nature isn’t the only option: A trip to the museum might offer the same attention-restoring experience. Conversely, scaling Mount Kilimanjaro or trudging through a snake-infested swamp is unlikely to boost your mental health.

Find the sweet spot

You want to be stimulated enough to avoid boredom, but have enough freedom for your mind to wander. “For example, I don’t think walking in the park and talking on the cellphone would be restorative,” Dr. Berman says.

– Alex Hutchinson