One- and two-minute exercise routines keep this Penn State doctor’s older patients strong

When Clarence Brockman’s doctor asked him in early 2020 to test a new, one-minute exercise program the doctor had developed, Brockman thought, why not? He’s in favor of “anything that keeps me moving.”

The doctor, Christopher Sciamanna, asked his patients to spend 30 seconds on each of two exercises: squats and push-ups. They were to do as many reps as possible in that time. As part of a study, Sciamanna would remind the patients by email at 6 a.m. and 6 p.m. every day, and they would report their progress.

Brockman started on April 14, 2020, with about 10 squats and six push-ups. Now, more than 500 days later — he hasn’t missed a day even though the study ended months ago — Brockman does a squat per second and 22 to 25 push-ups in the allotted time each morning after he brushes his teeth.

He is 96.

Sciamanna, an internal medicine physician at Penn State Health in Hershey, is now in the midst of a more ambitious study of the impact of two minutes of daily exercise on patients who struggle to walk three or more blocks, a group that’s at high risk for future disability. “Walking problems are the first problem,” he said. “It’s the first disability.”

Sciamanna, who has long encouraged patients to exercise, began thinking about this minimalist approach as he watched his parents decline. Both died in the last six months. “They never, ever did any exercise,” he said. His mother needed hundreds of thousands of dollars of caregiving help in her last years. He wondered what was the minimum amount of exercise she could have done to avoid disability.

“What is the minimum? That’s not what the field thinks about,” he said, referring to doctors such as himself who study exercise.

But that is how doctors often think about medicine, he said. They start patients on a low dose and increase it only if more is needed.

Because non-exercisers so often say they don’t have enough time to exercise, Sciamanna decided to start with just one minute and see how people reacted. “There’s no excuse for not doing a minute of exercise,” he said. He picked the two exercises because they work most of the body’s major muscle groups and don’t require special equipment.

Early in the pandemic, he invited all of his patients to join his new program, which is conducted primarily by email and doesn’t require in-person visits. “To my great surprise,” he said, “40% of them took it up. … We were just shocked at how many people did it and how many people kept doing it.” Three-quarters of those 60 and up who started the program exercised on half of the possible days over the 24-week study. Sciamanna made videos to show them how to do squats and push-ups properly. It’s possible that pandemic isolation and boredom made the program more appealing, he admits.

Although exercise is essential for healthy aging, it is not popular. Only 18% of people over 65 meet strength-training guidelines, which call for doing exercises that strengthen all the major muscle groups twice a week, Sciamanna said. Half say they do enough aerobic exercise, but only 10% to 15% meet guidelines when they wear devices that don’t exaggerate.

Sciamanna wants his patients to do the exercises as fast as they can. That builds power, the ability to use your strength fast. Power is what might keep you from falling if you trip on an uneven sidewalk. “Power is more important for function than absolute strength,” he said.

The speed makes the exercises feel like a sprint. “What I want them to do is race,” Sciamanna said.

During the study, the average number of push-ups participants could do rose from 13 to close to 20. They started at 12 squats and ended at 23. Their maximums plateaued after week 12, possibly because of the time limit.

For the new, three-month, all-virtual clinical trial, Sciamanna added stair steps and a rowing exercise that uses stretchy bands to strengthen more muscles.

So far, participants are doing their exercises on about 80% of days and Sciamanna can see their numbers rising. “We see people getting a lot better,” he said.

After Nov. 15, the patients will be evaluated. One measure seems too simple to be true: How long it takes participants to stand up from sitting five times. Sciamanna said that is “very predictive of future falls,” disability, and other health problems. The threshold for problems is 12.5 to 14.5 seconds. Their walking speed is also monitored, along with how many chair stands they can do in 30 seconds and how long they can stand on one foot.

Sciamanna hopes to get more funding to do a more complex evaluation of the impact of such exercise on walking capacity and a performance battery known to predict the risk of future disability. That requires in-person visits, which he hopes will soon be possible again.

Push-ups are the least popular exercise. Many people find them difficult, but Sciamanna allows multiple modifications that can prepare patients to do the real thing. He recommends starting with your hands on the fourth step on a staircase and moving down as you gain strength. You can also use a counter top or a wall or balance on your knees rather than your toes.

Feedback has been good, he said. “First off, they’re really surprised that they can get stronger,” he said. Also, “Wow, push-ups are hard.”

Does success make patients beg for more exercise? For the most part, no. “Most people want to do the bare minimum,” Sciamanna said.

John Russell, 90, of Hershey, said he was shamed by how easy Sciamanna, 54, made the exercises look in his videos. “Good God, I ought to be able to do something,” the retired hospital administrator thought. He hates push-ups and couldn’t do any when he started. Now he can do eight full push-ups followed by about 10 on his knees. He has added the rowing exercise and 30 seconds of biceps curls with eight-pound weights.

The impact of the exercise was noticeable, he said, when his wife was hospitalized in April. He thought he was better able to handle all the walking at the very large medical center.

He said he stuck with the exercise because he knew Sciamanna was checking on him. “It’s a challenge and some days you don’t want to do it and some days you know he’s going to be on your case if you don’t do it, so you do it,” he said.

Denise Kalp, 70, agreed that it helped to know that someone was watching her progress. The physically active Harrisburg woman, who worked in the state education department’s early intervention unit before retiring, has belonged to a weight training class since 2008. At first, she couldn’t do any push-ups. “It was pathetic, and that shocked me,” she said. She still can’t do a full push-up, but does her squats while holding six-pound weights. A minute wasn’t enough for her, so she added rowing and jumping. “I can’t help but wonder if there’s something else we should be doing,” she said.

Brockman, retired vice president for management and finance at Penn State Hershey Medical Center, is among the majority who think the one-minute program is just fine. “You don’t try to fix it if it’s working,” he said.

He can no longer do push-ups the way he learned in the service, but he does what he can. “I go as far as my shoulders and elbows will let me go,” he said.

He spends hours every day in the Masonic Village’s woodshop. He can still handle the lumber and he doesn’t need a cane or a walker. He doesn’t think he’s slowing down like some of his peers. Of the exercises, he said, “I don’t really know how I would be if I didn’t do them.”