Most people, especially doctors, tend to not appreciate how powerful exercise is. However, I believe it needs to be viewed like a drug--you have to be very careful with the dose. If the dose is not high enough, it will not work.

One of the keys in using exercise is to make certain minimum thresholds are met. It is my experience that most people are not exercising enough.

Many thousands of people have told me they thought they were exercising enough when they were actually seriously under-dosed. Typically, Americans don’t appreciate or understand optimum exercise. This may be because many have not previously competed in an aerobic sport, which allows you to understand the feelings of "training" and how hard you have to push yourself to obtain aerobic and insulin benefits.

There are three important variables with exercise:

• Length of time
• Frequency
• Intensity

Assuming people can exercise, I encourage my patients to gradually increase the amount of time they are exercising to one hour per day.

Initially the frequency is daily. This is a treatment dose until they normalize their weight or insulin levels. Once normalized, they will only need exercise three to four times per week.

The intensity is a bit tricky. I was one of the first to own a heart rate monitor many years ago, so I am more than familiar with them. I have never really found them too useful though. My general recommendation is far simpler and less expensive.

Exercise hard enough so that it is very difficult to talk to someone next to you. When you are exercising that hard your cardiovascular system is under such a significant stress that the mere act of talking makes you unable to provide your body with enough oxygen because of the diversion of airflow.

If you cannot carry on a conversation at all, then you have gone too far and need to decrease the intensity slightly. However, most people don’t exercise at the appropriate intensity and as a result aren’t able to obtain the benefits.

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