Rhonda: So this kind of reminds me of some of the vigorous intermittent lifestyle physical activity studies, VILPA, as you have called it, that you've been a part of. So are those studies also considered exercise snacks or...?

Dr. Gibala: No. So you're right. VILPA is vigorous intermittent lifestyle physical activity, and very much led by my colleague, Professor Emmanuel Stamatakis out of the University of Sydney. So I've been fortunate to be part of a really an international group that is looking at VILPA in various ways.

But to be clear, we're talking not-structured exercise. So you could think of VILPA in some ways as the non-exercise equivalent of an exercise snack. And so we're talking activities of daily living that you would be doing anyway. And so I'll give you a very specific example. So to get to the recording studio today, I left my hotel.

I had to get here, right? Somehow I had to get here. I took a ride-sharing service for most of it. But leaving my hotel room, I had a choice of taking the stairs or taking the elevator. I could have taken the stairs there or to get to my ride-share service, to walk a block, I could have walked at a leisurely pace or I could have picked up the pace, right?

And said, I'm gonna engage in a vigorous manner here. Arrive at the location, again, it's another minute to get from the ride share service to the front door. I could do that in a vigorous pace or at a pedestrian pace. Or I could carry my backpack, right? And engage in that. And so the question there with VILPA is in these activities of daily living that are already part of our lives, if you embed vigorous effort in those, another classic example would be, you take a five-hour flight and get off the plane, you have the choice, the escalator's there or you have the stairs.

Many people are taking the escalator, but you got some heavy backpacks, you could vigorously climb up the stairs for 30 seconds to a minute, that would be a dose of VILPA right there. And so again, you gotta move from one level to the other, that's not planned and structured exercise, that's just activities of daily living.

And the question that's being asked in that research is, if people choose to do that in a vigorous manner, is that meaningful? And there's some evidence for that, including a large study that was published in December that was, it mined the UK Biobank data. And so what that allowed the investigators to do was look at over 25,000 individuals who engaged in VILPA-like efforts, they wore accelerometers to try and capture this, and they were followed over almost seven years and the outcomes included all-cause mortality, cardiovascular disease mortality, cancer mortality.

And that work showed or revealed that people who engaged in even three to four minutes total a day of VILPA-like activity had substantial reductions in all-cause mortality risk, we're talking 25, 30%. So that would suggest that even brief, non-exercise, vigorous, intermittent physical activity can move the needle in terms of health outcomes.

And of course, we would suspect that maybe it has to do with some of these cardiovascular or metabolic changes that we know are associated with health. So that's not cause and effect evidence, it's observational evidence over time, but it was very robustly done the way the work was conducted and it's quite compelling, I think.

Rhonda: I agree because after you shared those studies with me, I read them and I think even on the higher end, so you mentioned kind of the conservative, three to four minutes a day, when they were getting up to like more like nine, I mean, you're talking, it was like 50% reduction in cardiovascular mortality, 40% reduction in cancer-related mortality.

I mean, that's really incredible that these people are just doing this, choosing to do these short bursts of vigorous intensity exercise and then having substantial benefits on longevity and health span, basically.

Dr. Gibala: The other, if I can add, the other key thing from that study, I think, is that all of these people were self-identified non-exercisers. And so the point is, even people who self-identify as non-exercisers seemingly are still engaging in vigorous activity through the day. Now, part of that might be their physical capacity is quite low and so what it takes to get them into a vigorous intensity range is not very much. And actually, as part of that study, it was repeated in individuals who also identified as exercisers and the same phenomenon were apparent.

So even in exercisers, engaging in VILPA-like activity was still protective. So again, lots of work to follow up on, what actually counts as a VILPA bout, will people do this? But you can imagine, again, getting back to this idea of prompts, building in VILPA-like activities in a smartwatch or an app on a phone and encouraging you to accumulate three or four or five or 10 minutes of VILPA a day. But three or four minutes of VILPA is about 30 minutes of vigorous activity a week and large reductions in risk.

Rhonda: And that is very doable. That is very, I mean, to say you can't do 30 minutes a week is, I mean, you're really just saying, I don't want to be healthy. And the other, it's interesting, I don't wanna go on too much of a tangent here, but you wonder how much also of these VILPA studies and these even exercise snacks has to do with just not being sedentary also, because that's like an independent risk factor for, I mean, independent of exercise, right?

So like I sit at my, I don't consider myself a sedentary person because I engage in physical activity almost every day, pretty much. So I'm doing something, I'm either doing my Peloton, HIIT workout, I'm doing resistance training, but I also sit at my desk for a good five hours. I'm sitting there, sitting, and that is when I am sedentary.

So I'm actually trying now to incorporate VILPA stuff, I guess, in, I guess it's more structured. So it would be more of an exercise snack in that case, but I'm doing the burpees or the high knees or something where, I mean, believe me, like one minute of that, I'm like, this is the longest minute of my life. I mean, it's like hard. So-

Dr. Gibala: I can empathize in that I'm very similar. I'm a committed exerciser. Pretty much I do something every day, but as a university professor, you sit at a computer a lot. And so trying to build them into my day as well. But yeah, I think the key there is, you're right, there may be a double benefit, if you will.

All of us should be meeting physical activity guidelines, of course, add these in, sprinkle them in, but there may be a double benefit to a VILPA-like approach or an exercise snack approach in that it simultaneously breaks up prolonged periods of sedentary behavior. Because I'm sure like you, I don't like to see that evidence and read those studies that suggest, even if you're a committed exerciser, prolonged sedentary is increasing your risk. Right. We like to think of exercise as this panacea, and it's not, it's not a vaccine against ill health outcomes, and reducing sedentary behavior is really important as well, as is proper sleep.