Friday, January 29, 2010

on shoeless joe

some of you may be old enough, or have seen the movie, "Field of Dreams", to remember the name "shoeless" joe. i'm old enough to know the name but not the reason he got this name. however, for almost 20 yrs, the idea that mankind should not be wearing fancy expensive hi-tech shoes for running has been bandied about, based on anthropological conjecture. actually, a study in canada about 20 yrs ago tested the idea of going barefoot for 1 hr/day for subjects who had plantar fasciitis, otherwise known as heel pain. the results showed that indeed the foot "shrunk" in length, presumably due to the small muscles of the arch learning to do their job again. did this resolve the fasciitis? first, i don't recall; second, it was a one month study - if the cause of it was removed, e.g. running, then it will resolve some. only long term relief counts; third, that was not the intent so it didn't matter.

now, i could add personal anecdote - as a martial artist who bounced around barefoot 4 hrs/day x 7/wk, and never had fasciitis until i got older and stopped training and stood around in good athletic shoes with a podiatrist-made orthotic that provided relief during those years when i was also a runner - but i won't. bottom line: the answer to the question - should mankind, or you, run barefoot instead of with fancy shoes?  - is yet to be answered. however, this article points to a study that found that some of the same forces women experience in the knee and foot while wearing high heels are also felt wearing running shoes; in fact, even more in running shoes!

the lead author does not suggest running barefoot - asphalt is not the surface we evolved to move on without protective covering. however, there are shoes - really, foot-gloves - that could protect the plantar surface of the foot that many trainers at my gym, STEPS Inc, wear just for working out. but that's different than running. my answer is - protect your feet, wear shoes; get properly fitted shoes, and then ask the professionals fitter about a cheaper pair if you don't need cadillac support. why the cheaper? for one thing, less support may enhance foot and ankle neuromuscular development. for another, that canadian study suggested it 20 yrs ago, and this one here - http://www.msnbc.msn.com/id/34824451/ns/health-fitness/ - reinforces the idea that maybe just maybe you're spending too much money to be cool rather that to protect your body against wear and tear.  just a thought....

Tuesday, January 26, 2010

normal wt obesity

it sounds paradoxical but those in the exercise/fitness field know it's there: people whose wt and whose BMI are normal, or even low, but are obese...by body fat standards. we've all heard about muscled athletes whose BMIs are high because their wt is hi relative to their height. so we should not be surprised to hear that there are many who fit the contrary formula of low wt/hi body fat. there are two basic formulae to alter this ratio: lose body fat or gain muscle mass. for men, either is relatively easy, even as we age. for women, it's much harder to do the latter and much slower to see the former. best advice i could give is: start young, get control of your wt now, and don't put it off any longer. too late for many, maybe most, but never too late to start. read on:

http://online.wsj.com/article_email/SB20001424052748704762904575025313433081780-lMyQjAyMTAwMDIwNjEyNDYyWj.html

Friday, January 22, 2010

on stretching

this article from way back in november - http://well.blogs.nytimes.com/2009/11/25/phys-ed-how-necessary-is-stretching/ - addresses the upside and potential downside of doing flexibility training, esp in excess. having studied stretching for the past decade when the science of stretching really took hold in the field, it was a comfort to see the author - who invariably does a good job presenting in common language the scientific principles behind many fitness and exercise matters - once again present a difficult concept in simple terms.

basically, as other studies have shown even better than this one, runners with less flexibility tend to be faster, more economical ones. it also discusses the fact that people who need to stretch are those whose lack of flexibility contributes to pain and dysfunction; if you have no pain or dysfunction, you may not need to stretch. my only caveat here is: if you live long enough - say, past 30 but definitely past 40 - you will need to do some stretching in order to avoid pain and dysfunction. as we age, tissues stiffen. in some joint areas, that may actually be a good thing; in others, it may portend a bad thing. but stretching is not the only way to increase range of motion; moving body parts thru large ranges of a joint's movement capacity will also do so. hence, the Olympic powerlifters at the 1984 Olympics in L.A. were the second most flexible athletes after the gymnasts of course.

so stretch, do yoga, pilates, or dance; lift wts or other large body movement exercises/activities; then ask yourself - have I moved my joints thru a large range of motion today so that they don't get stuck in the short ranges we tend to live in - like, while typing blogs? go ahead, stand up, move around...and stop reading this blog, for now.

Thursday, January 21, 2010

Salted...

occasionally i go to the movie with a buddy of mine who loves popcorn - but not the kind i would share. he likes buttered popcorn. so do i but i hate the mess, the unnecessary and useless calories, and the idea that he's slowly adding to his girth, his heart condition, and his blood pressure. why make matters worse on something already overpriced and easily replaced on a long list of enjoyable but unhealthy foods?

but salt is the topic today and worth noting for a couple reasons. one, we all have full control of the shaker, but not once we buy pre-prepared foods or restaurant food. so we would have to be diligent and insistent if we are really watching our salt intake. two, our nation's obesity and related health care problems can be exacerbated by maintaining high salt intake...or significantly reduced by lowering it. and, three, we don't need it. as this article reports, lowering sodium in our diets is good for our personal health as well as the nation's health. what it does not report is that increasing salt in our diet is good for the food industry, health care industry, national debt, political discord, and declining american power.

now, about that salt shaker.....http://www.healthcanal.com/blood,-heart-and-circulation/5132.html

Monday, January 18, 2010

ski safely

dear blog-readers:

it's full blown winter now, esp in the high country. that means ski season is up and running. it also means for those who don't live up there that that annual visit portends great risk, esp as the years pass and the body rusts.

here's an article that reviews the myths of ski injuries. some will shock you; some you may already know; and some will relieve your anxieties. all, however, point to the same three elements of ski safety that have always existed: proper equipment, proper training, and proper conditioning. and the latter is my brief topic today.

how to condition against ski injuries is a three-sided coin, if there were such a thing. first, endurance - most non-altitude livers will feel tired those first several days up high, esp with trying to get in as many runs as possible before you run out of time for your vacation. so build endurance - cardiovascular and muscular. the cardio is easy - but don't expect it to acclimate you to altitude. even superbly fit runners will experience the low oxygen of hi altitude, and some may even get so sick as to have to retreat to lower levels for a couple days. but muscle endurance is more about reps and time - like isometric wall sits - than how heavy a squat you can do. so do reps....

second is hamstring function, not just strength. why hams? because they protect the knee against ACL injuries. here's where squats, lunges, dead lifts, one leg squats, and what i call "norwegians" - kneel with feet firmly braced under the bed, dumbbell rack, or someone's hands; with the body in perfect alignment, tip forward SLOWLY from the knees til you feel the hams catch; come back up before you cramp...or tear a muscle. add reps, not distance of tilt. this is one of the few exercises studied that has proven itself valuable in reducing athletic ACL tears, and maybe even hamstring tears.

finally proprioception - what some call joint position sense. here's where balance drills - not on a ball but on the ground, or balance boards, foam rollers, or Bosu's - can make a difference. they teach the body to stabilize the lower extremity joints. it's best if you can do these with movements, like squats and lunges, but even semi-static will help...in theory. there are many ways to include these into a regimen but for now, gradually progress from two to one leg on any drills where you're standing- even biceps curls or lateral raises.

so read the article and have fun, safe fun, this ski season:
http://www.healthcanal.com/surgery-and-rehabilitation/5044.html

Friday, January 15, 2010

Get your Butt going

this just in from Exercise ETC's FitBits, a monthly on line newsletter full of exercise facts. it's an article discussing gluteal exercises, esp those of the gluteus medius, the one on the outside of the hip, the one considered most dysfunctional in folks who develop or incur certain knee problems - ACLs, patellofemoral pain syndrome, etc. so here's my comments: the study is sound, and results are what one might expect: standing on one leg, or doing a one leg squat, gets it more than two legged exercises. what's interesting is the fact that standing on a foam pad - Airex pad - does not significantly alter the muscle actions around the joint. now, that may or may not be the case. what i know of EMGs is that they do not give direct feedback as to how hard a contraction is and that they can tell you when a contraction occurs. depending on the way the data is filtered, it may actually have notable differences in the medius's function but was not part of the study's intent; only the gross percentage difference of activation signals. so, it is still possible that the foam pad may enhance activation of the medius...but even if not, are there other benefits of doing exercise on the pad? answer is from another ACSM journal article late last year: proprioceptive training works at the ankle, maybe at the knee, but not so much at the hip. bummer- as most trainers are still touting the value of these exercises all the way to the lumbar spine. bottom line: maybe it do, maybe it don't, but just because it's a more challenging exercise does not mean it's a more valuable one. a good trainer should be able to justify - with data/facts - why he's doing the exercise. maybe you can get results from doing exercise, but it may not be any specific exercise that does it, so don't risk falling just because a trainer thinks it actually works to be off balance:

Fire Up Those Glutes

Over the past few years, industry leaders have emphasized preparatory activation of the gluteal muscles to enhance both injury prevention and training effects. Awareness was heightened as a result of research which determined poor gluteal recruitment subsequent to lower extremity injury, and from the teachings of the late Vladimir Janda who suggested the gluteus maximus is reciprocally inhibited by a tight psoas as is found in the anterior pelvic posture distortion. Although this is not revolutionary information, it has yet to be integrated into the fitness culture on a broad scale as pieces of the puzzle are still coming together. For example, researchers have yet to determine the most effective movements and loading characteristics through which to optimize glute muscle recruitment. The most recent study looked at the effectiveness of closed-chain exercise in recruiting gluteus medius (GM)

Researchers from the Mayo Clinic measured EMG in the GM in five closed-chain weight-bearing exercises to determine which is most effective. The GM is both an abductor and adductor of the hip, giving it a primary role in stabilization when standing on one leg. Recent evidence links poor GM function to ACL injuries, IT Band syndromes, and patellofemoral pain, the most common form of chronic knee pain in adults.

Twenty healthy young men and women with no history of lower extremity injury participated in the study. Researcher collected EMG readings from the GM during 5 activities: bilateral standing, single leg standing on a stable base and on an Airex pad, and a single leg squat both on stable footing and on the Airex pad.

As expected there was greater GM activity when the individual moved from a bilateral to single leg stance. However, the EMG recordings for both squatting and standing on the stable and unstable surfaces were similar. Although the authors reported a trend towards greater activation on the Airex pad it may not be appropriate to speculate that an unstable surface is any better than a properly loaded single leg squat to improve hip stability. Regardless, this is the first study to report the GM EMG during dynamic functional movement patterns.

Previous studies have determined isometric closed-chain activities to be more effective in activating GM when compared to open-chain exercises (i.e. side lying leg lifts, or standing hip abduction). Based on this information, fitness professionals should include more single leg exercises if they wish to improve hip stability.

Krause, D.A., et al (2009) Electromyographic Analysis of the Gluteus Medius in Five Weight-Bearing Exercises. Journal of Strength & Conditioning Research. 23(9): 2689-2694.

Wednesday, January 13, 2010

praise the lard, pass the butter

the bad news: 68% of americans are overwt or obese. the good news: the numbers are holding steady enough that some think we've topped out. the bad news: while maybe fewer will get fatter, it's likely the fat people will simply get fattier - and that means more risk of disease and disability. some suggest that obesity, like tobacco use, has a limit, lower and upper. over the past 40 yrs, fewer people still smoke. one reason, of course, is that the generations who started before it became taboo have nearly passed on - maybe due to smoking, maybe just due to aging. however, some stats show that people are smoking in greater numbers, esp among the young. so, at the bottom, it can only go up. likewise with obesity, except nothing's really changed- - people still eat poorly and our lives are becoming more sedentary in general. therefore, while the numbers of overwt/obese may have plateaued, the risk that others will join the multitude remains; and the likelihood that those who are there will run into the same problems that those who have tried for eons to not get there will only increase in weight. what's the solution: hate to say it but, eat less, move more. everything else is window dressing....

see: http://www.nytimes.com/2010/01/14/health/14obese.html?ref=health

Tuesday, January 12, 2010

BMR and you

BMR - basal metabolic rate - is one of those numbers we love to know....right? you say no; why not? don't you know that if you know this number, you know how much to eat, or not to eat, to manage your weight? don't you know that, if you know this number, you'll know why you're not losing, or why you're gaining, weight? and don't you know that, if you do the math, you'll automatically and remarkably if not magically be able to lose those last 5 lbs just by following the yellow brick road?

my answer is no way! in a NSCA article on line - http://www.nsca-lift.org/Perform/articles/080603.pdf - the author promotes the value of calculating with medical equipment or estimating with the formulae included in the text your BMR. she gives reasons, very rational ones, as to why and how this number is useful. and to the extent you're working with motivated athletes, or health-challenged patients, this number is very useful. it allows the trainer the ability to more closely supervise caloric intake based on needs, be they athletic or simple existence. but for the majority of people, this number is insignificant if not a pain in the rear. here's why.

once you calculate your BMR, you know how many calories you need to lie in bed and stay the same weight. if you intend to do that, or are sick and can't do your usual activities, this may be useful. but you will lose muscle mass, or lean body mass - LBM. so, at the same weight, a week or two later, your LBM is down, your FM - fat mass - is up, and your weight is close to the same. of course, studies show a very hi protein diet will modulate these changes but that's not why you want to know this number. the reason you want it is so you can then add calories based on your daily activities: baseline eating, sitting at a desk, driving to work, and going to the bathroom, plus other ADL's, may add up to another 300 cals/day (more if you weigh a lot, or move a lot, less otherwise). then your fitness activities or any other physical activities - do you park far from the store or close? - have to be factored in, and adjusted for gender. let's just say it's another 400 cals/day. so now you add BMR + 300 + 400 = daily caloric needs. great - but now you have to accurately add up all the calories you currently eat and start adding all the calories you need to eat to meet this magic number. this is good for a 3-day food record but a daily version of this and, guess what? you'll be sitting too long to burn calories.

my simple advice: if you've been gaining weight, take each dish/plate/bowl of food you've been eating, and toss out a fourth or third; save it for another meal or trash it. it's likely you've started adding excess calories to your life in a variety of forms, some of which may be simply good, real food. so, be it a coke, a wine glass, or a salmon salad, if you're eating too much such that you're gaining weight, then cut down on what you eat and drink but have 2/3rd or 3/4ths so you are eating what you like. if you're still gaining, after a few weeks- it may take the body time to adjust - then cut again. most likely, you will start the long, slow weight loss that may not satisfy the upcoming wedding or reunion but will get you where you need to be to be healthy and fitter.

one caveat: if you are having trouble with this simple advice, see a professional - not an exercise or diet pro, but a mental health professional. you are eating more than you think and having too hard a time controlling impulses, and its for reasons other than those we exercise and most diet professionals are qualified to deal with. BMR may be part of the investigation process but won't be much help in the behavior change process.

diet and mental health

as we move further into our new year's resolutions, esp those centered around eating and exercising, here's one to consider. this is the first to show a link between healthy EATING, not simply components of a diet like vitamins or antioxidants, but real food, and mental health. women should rejoice as simply eating more fruits and veggies will reduce your risk of dementia...even if you let men bug you: http://www.healthcanal.com/mental-health-behavior/4916.html

Sunday, January 10, 2010

on Michael Pollan's “Food Rules: An Eater’s Manual” (Penguin).

pollan is synonymous with the current trend toward understanding, if not altering, our dietary behavior patterns. he has written and exposed the food industry for its abuses, not only of nature and beast but of consumers and eaters. however, here he discusses how to eat, simple rules to consider in making healthier food choices: http://well.blogs.nytimes.com/2010/01/08/michael-pollan-offers-64-ways-to-eat-food/

in reading this interview in the Times, i was struck by his openness to cultural and individual tastes in giving advice that's time-worn and suitable for any and all. one, in particular, is his rule that it's ok to eat junk food....so long as you PREPARE it. think about this: french fries, great food, cheap, easy to procure, and horribly bad to for you if a regular part of your diet. on occasion, go for it; too often, we'll see you in cardiac rehab. but, if you want more, go prepare it: peel potatoes, get a large pot of oil real hot, drop them in the pot a few minutes, and chow down. oh, yes, whatcha gonna do with all that oil? and the clean up won't be easy what with all those peelings, splattered grease, and greasy plates. but go ahead, have some a couple times a day, or week - feel free. the point is, this simple rule dilutes our food choices down to what we're willing to make. he did not impose the rule of grow it yourself - that's unwieldy. nor did he outright ban it. he just put the caveat that it's all yours if you make it yourself. what a simple concept.

so, as you sit down to dinner tonite and watch the nfl playoffs, consider the foods you put out for you and your friends and family. no need to go overboard on any one set of rules, but read his book - even just his interview - and if nutrition matters for you and your health, consider just a few and change your menu.

your guests, and your body, will appreciate it.

Saturday, January 9, 2010

Aristotelian Wellbeing

well, blog-readers, you are now off the hook: the new year's eve resolutions have just gotten easier to comply with. a new book by a Dr. Love - real name, not pen name - reviews the science behind lifestyle change and finds that too many people are putting too much stock on doing too much too soon to get too rapid results....that never last. if it wasn't so common a theme, i would not be in the business of personal training, for much of our work is redirecting the energies of people who have tried in the past and had either short term effect or detrimental effects. of course, some trainers are in the business of promising such skyward results; able to produce them for now, a few years from now, we "real" trainers get the majority of short-term succeeders/long-term failures.

here's the link to the article: http://well.blogs.nytimes.com/2010/01/04/new-health-rule-quit-worrying-about-your-health/

but here's the gist of it: to be healthy, you only need to make a few changes to your activity and dietary regimens: 3-5 days of 15-30 mins of moderate intensity cardiovascular activity; 2 days of 15-20 minutes of resistance training, most of which can be done at home with a cheap set of elastic tubes with handles; 5-10 mins of stretching the important body parts (more parts if injured, and longer stretches); less simple carbs, less saturated fats, more fruits and veggies, and more lean proteins, including dairy; for special circumstances, a multivitamin may cover most needs but calcium and vitamin D supplementation will help most females, esp if you don't do impact activities, spend time in the sun on a regular basis without sunscreen (which also is one of those moderation guidelines), and are at higher risk for osteopenia/osteoporosis; and drink more water (without additives of any sort - there usually is not enough of anything good and too much of some things unnecessary to spend any extra money on), possibly, if of age, a glass of wine several times a week.

that's all it takes to live healthier. however, to live fit, or to live lean, the rules change; some more dramatic if not extreme measures are necessary and vary according to what one brings to the table. for example, to be fit, some folks need to add weight, even some fat; others need to lose weight, and should be mostly fat that is lost. to be athletic, sometimes extreme workout schedules are mandatory, along with some pretty extreme diets. but health and wellness differ from fit and lean enough that Love's book would be a comfort for the 275 million americans who don't aspire to greatness on the physical plane. and it might be the answer to the american health care crisis as well.

Thursday, January 7, 2010

PT's on the ropes

today's NYTimes ran an article about the value of some of what physical therapists do: http://www.nytimes.com/2010/01/07/health/nutrition/07best.html?ref=health.

gina kolata is a very astute and interesting writer but as all media writers do, they try to create a story even if it means biasing it. in this piece she suggests, with some support from a medical doc, that some of what PT does is "voodoo", yet some works, some does not. she concludes by saying that you should ask questions as to why things work, and take note of progress to see if it is indeed working. well here's my take:

PTs work within fairly defined parameters. they are given a script by a doc to do a certain modality for a specific problem based on their diagnosis. good PTs are capable, sometimes, esp after working with a patient, of making a better diagnosis than the docs, and usually communicate such matters back to the doc to ensure continuity of care. but they also have their own methods of treatment and some are based on shoddy research, much of it anecdotal or empirical but not on good research. the problem i see is that often things work and therefore get adopted as procedures. i know bc we trainers do likewise. in fact, sometimes things work despite what we do and then we tend to take, or even get, credit when it's not really worthy.

for example, many PTs are doing lots of proprioception work for all kinds of knee problems. much of this comes from studies looking at ankle problems or acl repairs, and there is much to support proprioception work for these issues. but as a recent analysis of proprioception therapy in the ACSM's MSSE showed, it's only good for these issue. in other words, it may not have merit for other knee problems, nor for hips or spines - at least not standing exercises for the latter two parts. so, is the PT people get that uses proprioception worth while or a waste of time? maybe it actually does exactly that - waste's time, time otherwise spent doing the same stuff that caused the problems in the first place, time necessary to allow healing to occur.

in theory, many protocols work. as the theory of enhanced vastus medialis activation by adding hip adduction to quad work has since been debunked - adduction does not boost vmo over vastus lateralis, but it does elevate both muscles' activation overall - so, too, will many other theories in PT. but that does not make them useless, so long as they are not harmful. after all, for years docs pushed NSAIDs on those who had aches and injuries yet they only helped some and injured others (gastric bleeds.)

we should not throw out the babies with the bath water. but do as kolata suggests: ask questions and keep evaluating progress. if it's not getting better, maybe, just maybe, it's not the PT that's wrong; it could be the doc's diagnosis was.

Wednesday, January 6, 2010

another day in fitness-land

it may be self-indulgent to share one's personal or professional endeavors and thoughts on a daily basis. that's what blogging is about. but sometimes you actually have much to say that would be beneficial for others to hear.

this past summer, TIME mag ran a piece that was very controversial, esp among fitness people. the writer found some exercise physiologist(s) willing to address the thesis that exercising may actually lead to excess caloric consumption, leading to weight gain or retention. this raised a firestorm in the field such that the ACSM sent out an email to its members suggesting we counter these claims by writing to local press. unfortunately, the ACSM's bullet points did not refute the thesis; it merely declared that exercise is essential to healthy weight loss/management and that exercise is healthy in many other ways. but it did not counter the idea of the article that diet is essential for weight loss. i, unfortunately for the profession, actually concur with the TIME article. here's why....

an article in, i believe, the ACSM's flagship journal, Med Sci Sports & Exercise, this very year found that long distance runners lose weight because they tend to not eat enough calories. by 'enough calories' what scientists mean is calories to match your basic and activity-based needs. for example, let's assume you need 1600 cals/day just to lay in bed and hold weight - this is your BMR, or basal metabolic rate. then, you need about 300/day to do normal activities - eat, toilet, sit at work, etc. now, if you are active, say you run an hour/day, you burn about 400-800 (you're a real athlete at these higher numbers) per day over and above the 1900 you otherwise needed; that's, for simplicity sake, 2500 cals/day. most athletes do eat enough but those who lose weight were found to actually not eat enough. whatever reasons one might conclude - fatigue, loss of appetite, attempt to lose weight and therefore watch calories (all listed in a nancy clark, r.d., article in the ACSM's FitSociety newsletter this winter) - if you don't eat enough to compensate for your needs, you will lose weight. duh!!

so what can we conclude: exercising weight off is hard to do, and invariably requires you not enough to replace the calories you burned off. hence, only dieting loses weight.

but, the hard truth is, only by exercising, along with watching excess calories, can you retain your lean muscle tissue, assist in elevating overall metabolic rate both after exercise (EPOC- exercise post oxygen consumption), and develop life-long healthy habits, can you lose and maintain weight. so, what i would suggest is that exercise be promoted for the benefits we all know about, and that it be used to bolster a healthy, reduced-calorie dietary regime one can sustain throughout life, not just for the big weekend up ahead.

Tuesday, January 5, 2010

intro to fitness nerdville

welcome to my blog-world. this is my first foray into blogging so please excuse my style - i don't like capitalizing because it slows down my typing.

as an exercise professional, a personal trainer with a ph.d. in ex science, i am always on the lookout for material that's valid and reliable to share with clients, friends, and fellow trainers. so here's my first: http://online.wsj.com/article_email/SB10001424052748704350304574638550059084962-lMyQjAxMTAwMDAwNTEwNDUyWj.html

this introduces the concept of more, as in more exercise. to the extent one is capable of doing more safely, this concept holds true. to the extent one is willing to do more, it holds value. to the extent you have not gotten enthused about being fit thru exercise, this is a bust. so, depending on who you are and where you are in your fitness endeavors, read with caution. til next time....