Thursday, December 22, 2011

running against the age

first of all, let me say that this will be the last posting of a blog on this site. not because it's an ineffective or inefficient site on which to blog. no, it's because i have finally gotten my new site up - www.stepsfitness.com - with its own blog-ability. so if you really want to follow my rants, please check me out there.

so, as i wrap up the year and this blog site, let me just say it's been a doozy in many ways. first of all, i'm proud to say i had some great opportunities this past fall to contribute to the profession. in late september i presented on the topic of wt management/wt loss in las vegas at a new organization's first meeting, lifestyle intervention. the topic was titled 'the weighting game (see, vegas? get it?): why it's so hard to beat the house (the house in this case is our bodies.) much to the chagrin of those who were there representing wt loss companies, and much to the glee of those who actually do medically supervised research or wt loss programs, i was honest and detailed on why wt loss is so damned hard to accomplish. dieting is essential and exercise is hardly enough to do it alone, but at the end of a long period of time, very few keep the wt off. hormones, habits, and circumstances seem to intervene on behalf of wt gain. helps to pick the right gene pool.

also, i was nominated but did not win the "personal trainer to watch" from IDEA/ACE in october. while a self-nominating process, it was still good to be recognized for my 25 years of contributions, and the others listed were equally qualified for theirs so no hard feelings on my part. glad there are some serious professionals out there representing the field.

additionally, i have been working on a task force with the NSCA for a new certification that's being rolled out. what an opportunity to make a difference in the field, with some very enlightened and enthusiastic fellow professionals!!!

but not all has been roses and glory. for one thing, i had to endure a 10 day layoff due to an out-of-the-blue retinal detachment. still can't see perfect but at least not blind. i also have had to endure a very difficult personal event that will take more time to recover from but at least i can work out, eat, and write again. finally, biz is tough here but at least i have a job i love with people i love and fellow professionals i admire. can it be better than that?

yes, but then, no - i have like all of us gotten another birthday under my belt. and just as this article reveals, there are effects we cannot alter other than by slowing down the descent. not to sound gloomy and all but aging does have its effects, and most are not favorable to physical prowess. BUT - as the article attests - lifting wts and stretching really do help to keep one's athleticism viable. so while i'm not going to dispute or support this article, let it be known that the gym can be your friend - in fact, is your friend, for life, and possibly longevity.

hope to see you on my website blog.
happy holidays, and happy new year.
irv

Saturday, October 29, 2011

MRI's and athletic injuries

who am i to question a medical provider's advice and guidance?

i'll tell you who i am: a concerned citizen and health care patron. i use my docs and their skills and i pay my own insurance and deductibles, so i know the costs i incur. and if, as a reasonably intelligent and informed adjunct health care provider, i see the issues on my bills, i know there are way more out there who don't see them. and that leads to rising health care costs.

this news piece talks about the highly sensitive technology of non-invasive scanning - magnetic resonance imaging, or MRI. this allows, without radioactivity, for looking inside the body and seeing soft tissue, not just bone. hence, muscles, ligaments, tendons, organs - all are easy to see before going in to repair damage. at one time, these were so expensive, docs referred to the few hospitals that had them and only in cases where uncertainty about a diagnosis - and i'm going to keep this to orthopedic/sports med concerns - existed. in the old days, docs asked questions, palpated, manipulated and if need be, x-rayed to diagnose. today, they are quick to get an MRI, too. for one thing, many groups own their own unit. if you got it, use it, is the mantra. often times they are used instead of the traditional methods, whereupon things get 'seen' that may or may not be related to the problem at hand. several studies show that, while sensitive, MRI's are not that specific. that means, it shows a lot but not necessarily that what you see is what the problem is. in this piece, it talks about all the bad shoulders in pro pitchers who actually do NOT have pain or problems. hence, just because it's visible does not mean it needs repair. this has been found in spinal disks, too: about 33% of us without back pain have damaged disks. that means that not all back pain is caused by disk damage even if the disk is bad. it takes a good doc or therapist to ascertain the difference and the subsequent value of further treatment options.

when i went to get my hyaluronidase shots last summer for an obviously arthritic knee, my doc pulled out his cool new ultrasound machine. he could show me the joint and found exactly where to inject. as he did so, he noted that this is where he'd have injected anyway. by the third treatment, i had gotten a bill. that less than a minute ultrasound cost over $600!!! i was stunned and brought this to his attention. he subsequently stopped using it on me saving me, my insurer, and the health care system the next $2000. but how many other patients caught this; how many objected to its use; how many more dollars did this doc make doing a procedure he never had to use before to do the procedure he was tasked with?

now, i don't fault him; he's a friend and a conscientious doctor. but his group's business manager saw a cash cow here and suggested he use this new toy. and of course, as this becomes 'standard of care' the insurance industry is bound to reimburse, to the tune of 20-35% of charges, and lawsuits will evolve as some docs resist its use.

perhaps its the nature of the system - each group trying to make dollars while each group's nemesis trying to keep dollars. whatever it is, please be aware of the game, esp if you can do so before you get nailed for the procedure. ask if, indeed, an MRI is going to actually help with the diagnosis or the subsequent procedure. save your money....and mine.

Thursday, October 27, 2011

why it's so hard to lose weight

much has been written about dieting, exercising, or combining the two for effective weight loss. many a book, and many an author, have pretended to know the answer for the vast majority of those carrying excess weight. while some of these sources have gained wt in the process - made tons of moolah - few have offered the magic bullet that keeps people on task for the duration...of their entire lives. that's because nearly anything that reduces calories in or increases calories out will cause some wt loss. how much depends on many factors not the least of which is genetics. but ultimately, how much and for how long depends on how consistent, regular, and diligent one is with the program that helped you lose it in the first place. that said, here's another piece of the puzzle that is just now starting to enter the mainstream of discourse by pros and by the lay public.

a month ago, i presented a 90 minute lecture to a cadre of wt loss professionals from all around the country. the event was the Lifestyle Intervention conference, in las vegas, at the lovely Four Seasons Hotel. and while it sounds glamorous, due to circumstances, not the least of which is that i earn my living training clients one on one, i did a quick turn-around trip - got in wednesday nite, lectured at 330, got on a plane home and in at 2 a.m. so i saw nothing other than my room, the lobby, the restaurant, and the gym - yes, i made sure to get in a workout after i arrived that nite; it always helps me sleep better in strange places. the rest of the time, in the plane out and in my room, i was prepping for my talk: The Weighting Game: Why it's So Hard to Beat the "House". the house, of course, is our body, our physiology. and anyone who's ever tried to lose substantial amounts of wt understands from whence i come.

my challenge, in speaking to diet, exercise, and treatment-center professionals was to convey just how difficult - based on science and data - it is to lose substantial amounts of wt. now, you should understand by now that 'substantial' is the key word. it's easy to lose 3, 4, maybe even 10 lbs if you are carrying lots of excess fat. but that is not, in the minds of the overwt/obese, substantial. losing 10% of your body wt, tho, would be for some an ecstatic accomplishment...despite the odds stacked clearly against you maintaining it off. doing so was not difficult; there's tons of support for the almost miserable stats of long-term wt loss: many studies show that after 1-2 yrs, avg wt loss among participants in diet-based studies is about 3 kg, or 6.6 lbs. of course, most have lost more early on only to regain it back. and longer term studies show that by 5 yrs out, they've gained back their original losses PLUS added more wt. also, studies show that those who complied with the programs - be they wt watchers, zone, atkins, or whatnot - lose the most and keep it off the longest despite gaining some of it back from those first few months. but, medically speaking, substantial wt loss is different than clinically-useful wt loss; and while the latter may not achieve statistical significance, the long term stats rarely do. nonetheless, 3 kg is medically useful wt loss, esp if kept off.

where my talk deviated from the basic diet/exercise loop was in the discussion of hormones. this article hits it on the head. but, while it confirms my speech, it does have a major flaw that needs to be addressed here. that is, all the subjects were put on a very low calorie diet (VLCD) of 500-550 cals/day for the first 10 wks. they lost an average of 14% of their body wt. and subsequently added wt over the ensuing year.

for anyone who's been in this field long enough, or anyone who's dieted their whole lives, this is a DUH! conclusion. i refer to a 'duh' conclusion as one that we all know just by reading the results; of course, the way the study is designed, it almost never comes out saying anything other than what you'd expect. it's kind of like that famous 'golden goose' (a political title for wasted money by the fed gov) award for a study that showed cow manure in a dairy farm is slippery. DUH!

why this study lacks utility is that hormonal drivers to eat more are exacerbated by the extremes of the diet itself. these subjects were frickin' starved for 2.5 months! hell yes, they wanted to eat, and eat a lot. furthermore, as i learned in my prepping for the talk, not only does leptin decrease which stimulates appetite when you lose wt by dieting; your body's sensitivity to it - much like it's sensitivity to insulin when you've become type 2 diabetic - is diminished with obesity. that means that, as it goes down and stimulates greater appetites,and wt increases such that leptin increases to suppress appetite, the brain can't sense it. yes, you read right: the brain, on which the leptin acts, is less able to sense rises in leptin that tell you to stop eating as you regain wt. hence, you keep eating. and gaining.

can you guess what works to keep leptin resistance at bay? if you guessed the same thing that keeps insulin resistance at bay - EXERCISE - you are a genius. because those who lose wt with a substantial exercise program also see leptin drop, that drop that decrease is sensed at higher levels by the brain to minimize appetite surges. or, in easier to understand terms - which by the way was a real challenge in presenting to this audience - exercise-induced wt loss does not get as sabotaged by hormones as diet-induced wt loss. you can more readily resist appetite surges and more readily control or maintain wt loss. the why's have yet to be elucidated. but that exercise is absolutely so much more effective and essential in maintaining wt loss is indubitable.

so, diet - but not to extremes - to lose wt; diet plus exercise to lose a little more wt; but continue or increase your exercise to keep the wt off even if you stop being overly diligent with your dieting. it's the only way. and, it's the healthiest way.

Saturday, October 22, 2011

set point theory - not for weight but for activity

i'm sorry it's been so long since i've posted a blog. besides being busy at work and moving out of one house and into another, i also got slammed by a retinal detachment two weeks ago that required emergency repair. fortunately, despite being forced to lie on my right side for 10 days under threat of a failed surgery and potential blindness, i survived this sentence and now can type sitting upright.

there is lots to be written but it does not have to be done today. i did read a lot and found some very interesting fitness-related material i could share, but that'd be ex post facto now, so let's move on to today.

in the above link, the hypothesis is that we have an 'activitystat' much like a thermostat that keeps our bodies at a set level - of activity, in this case. studies have shown that kids in varying amounts of school-based p.e. are not stimulated to be more active as a result of their school behavior. that is, if you are in p.e. class x-hrs/wk, you are not apt to be more active outside of school than kids who are not given similar opportunities to be moving around. in fact, they find that most kids move about the same numbers of hours/wk regardless of how many hours of p.e. they have in school. as such, the hypothesis is we have a set point of hours of activity and, if we move a lot today, tomorrow we'll move less; and if we don't move in school, we'll be more inclined to move after school.

i don't buy it. and there is other literature that supports this counter-belief. i say belief because (1) i've not done nor read much research in this arena and (2) i think our activitystats are all screwed up by our environments. and my proof? ME! audacious, yes, but let me explain.

my life is pretty active. i train clients moving about the gym anywhere's from 5-13 sessions/day, or 5-12 hrs. (the days i do 13 i also have some half hr sessions.) when i get home, i don't sit around more or less depending on my sessions that day. in fact, as i've written before, i often get on the exercise bike or ski machine later in the evening before bedtime in order to get some activity that i'd call exercise. now, sure, i'm an exercise professional for whom it's a lifestyle. but if set point theory was right, i'd be more apt to chill on long days and more apt to exercise longer on short ones. again, a study of one is insufficient to argue one way or the other but i have more to tell you that may be more scientifically valid.

while laid low, i had no appetite. despite shopping with my girlfriend - cherrie - and staying at her house under her watchful eyes for those 10 days, i could not find any foods or junky foods that appealed to my tastes. not unusual here; illness and injury often disrupt normal taste for food. but i proceeded to lose 5# lying still allllll day long. most would gain wt. i lost - mostly muscle mass. this past monday, when the doc released me to resume work, even tho i didn't actually go work, i went to the office, i came home hungry. and the next day, even tho i only worked 50%, as per orders, i came home and ate big. in 4 days, i've nearly regained the wt i lost, tho surely not in the form of muscle since i've been restricted til next wk from any lifting - a..n...y! and i've been a good boy about it.

so what happened? why didn't i gain? and how is it i've regained? it's really quite simple.

as a lean, muscular person who's been this way my entire pre-adult and adult life, my body is 'set' to such a degree that it eats what it expends and vice versa. when i trained in martial arts 3-5 hrs/d, and did construction work, and a few miles of running, i ate like a horse. when i gave up the construction work and scaled the tae kwon do to teaching, i ate less. when i could not exercise as hard due to bad joints and had even stopped teaching, i ate even less. and when i was laid up and not able to do any activity, i hardly ate at all. the hormonal stimuli that otherwise told me to eat had scaled itself down to where it was telling me i hardly had to eat any more.

now this differs from the homeostatic mechanisms of most, esp the obese and sedentary. most folks, sentenced to supine-ness, would have eaten as normal and gained weight, mostly fat. we know, interestingly, that leptin, a brain hormone that's linked to appetite via fat stores and intake, is less effective in the obese than in normal wt people. in other words, they have leptin insensitivity. interestingly, when they diet and lose wt, leptin continues to stimulate appetite to a greater degree than when they exercise to lose wt. in both cases, leptin decreases but with exercise, due to the increased sensitivity to it, it actually requires less in order to be more effective at modulating appetite according to the new wt.

the message here is, as a lean, active person, i'm regulated toward leanness, even when inactive. it's a pretty tight setting under which i operate. the overwt/obese may not have such tight settings - we don't know which comes first tho genomics is looking hard at this - and so are apt to eat even when not burning calories, or even after eating. and i suspect the same is true for activity: lean, active people are active, more than their overwt/obese peers, even if they've been encouraged or forced to be active by outside or internal mechanisms, and it has little to do with how active they had been earlier. in other words, without assigning guilt - as it could be genetics for some - those who are carrying too much wt have set their thermostats to lower settings such that they may indeed reduce later activity if they had some earlier. but it may be that our culture and environment simply does not mandate enough activity to re-set their activitystats because, in days of yore, before electricity and other modern conveniences, if they didn't move, they didn't eat. it's the lifestyle, not the genetics, that determines movability!

Saturday, September 10, 2011

athletes are the most gullible people.....

athletes will try anything it seems. follow the link above and learn about the next crazy thing on their ever-lasting pursuit for greatness. hard work aside, that magic bullet just seems to be at the end of that rainbow, like the pot of gold....

anyway, cryotherapy at 166 degrees BELOW zero sounds absolutely crazy. but someone's pitching it to some athletes who seem willing to buy into anything.

now, there are some supplements and steroids and drugs that work...but all will have some detrimental if not dangerous side effects that do not seem to deter jocks. i've given this some thought over the years - is it ok for jocks in pursuit of big bucks and fame to put their bodies at risk by taking substances that are potentially dangerous? can society blame them?

back when i first opened my gym, STEPS, in late 1989, a phenomenal athlete at u of georgia = herschel walker - was all the rage. a specimen beyond belief, and a great athlete, too, and all natural. the story has it that he never lifted weights til college - but he did a 1000 push ups (not all at once) with his siblings on his back (not all at the same time.) when his coach found out about this, he didn't bother making walker lift like the rest of the team. now, i don't know if this is true or legend, but it speaks to the possibility that there are athletes born, and athletes made, and those who work hard and put in the energy and focus will take 'made' only so far; being born to be an athlete is not a ticket to success but it is the first big step towards it.

anyway, over the years we read about jocks, pros and college athletes, who did substances that are illegal or just delusional. society faults these kids - and they are kids, now that i'm almost 60 - for abusing their bodies this way in pursuit of fame, money, and sex - yes, that comes with it, so don't discount the driving power of all the hot chicks you could ever ask for. but these are public images that don't speak to the same driving forces that impel some to become great researchers, doctors, lawyers, or investment bankers and such. whatever their drugs - even if not exogenous, such as speed or alcohol - that they use to get to where they get, there are untold numerous stories of failed marriages, dislocated families, etc that result from these same drives. sure they wield power and fame and money but have they really touched anyone in a way as to have a positive impact? or did they leave burnt fields behind them in their wake as they slashed and burned anything to get to the top of their field? well, who am i to say, but that drug - the one that drives us, men and women alike, to succeed is probably nothing worse than the ones the kids take to go to the next level of success along the athlete's ladder.

i know that when i trained heavy in tae kwon do - 7 d/wk, 3-5 hrs/d - i was leaving a set of bad joints in my future and disrupted families as i single-mindedly went about justifying everything i was doing to become a better tkd-ist. not being an athlete by birth, i had to work hard just to be decent. others could get by on less effort and therefore succeed but i wanted to succeed at a higher level. today, with one new hip and a new knee in my near future i don't regret a thing. but i do feel bad about having put my first family on hold as i dawdled in grad school so as to be able to train hard. and while it's not all my fault, it is 100% my responsibility for how i handled my pursuit of success. had there been some good cheap - i was poor during that phase - drugs that would have helped me along my desired path, maybe i would have taken them.

but, even before herschel walker, i believed you should go naturally.

still do....

Monday, September 5, 2011

sports med, voodoo, and you

i love reading about sports medicine - from lay to professional literature i find this stuff amazingly interesting. why? because today's news is tomorrow's old news.

when i was in graduate school, i did a project - and independent study - where i reviewed many articles on hips and knees and summarized each in abstract form so that i could learn way more than my department profs could teach me. needless to say, i forgot nearly everything but some i remember because it keeps cropping up again and again.

for example, when jerry rice of the 49ers tore his acl years ago, in september, it was expected that he would not be back for the rest of the season. surprisingly he played again in early december, caught a touchdown pass, landed on his surgical knee, and ended his career. why? because the very procedure - patella bone - patella tendon - patella bone, or b-t-b - that sped his recovery left his patella a little weaker so that when he landed on his knee, it fractured. and that's a bad injury. nonetheless, orthopods started doing that procedure and prevented their patients from going out into contact situations a bit later than rice's couple months plus.

at the time it was believed that this procedure would not interfere with the hamstrings' ability to control the knee after a graft. furthermore, what with infectious diseases like AIDS, it was a great technique that used the patient's own tissue to reconstruct the acl. furthermore, tho the quads would be weakened by this technique, they would recover quickly, as rice's did, with the p.t. techniques that were available at that time. so, here was a great new procedure...until too many issues came up. you see, the more these are done, the more data is collected. unlike drugs, you can't provide placebo surgeries on otherwise healthy people to test the short and long term effects of a surgical technique. also, it's not til folks go and test these procedures in real life, not the clinic or lab, that you find out if they work better than previous or other procedures. so, when improved hamstring techniques - the ones i read about in college - came along, and the improved p.t. that had evolved since my college days that would reinstate proper hams function (proprioceptive strategies that were hardly in use in the mid 80s)the b-t-b procedure fell out of favor.

for your understanding as to why i feel so confident in this assessment, i have had many opportunities to observe one of nashville's best orthopedic surgeons do the b-t-b procedure a few years back. based on my daughter's observations last summer, he's not doing as many of them; he's doing more hamstring reconfigurations.)

my point is, this article addresses these issues and how it is that procedures and techniques hit the mainstream only to fail under scrutiny over a longer time frame than most of us injured athletes are willing to wait on. does this make these voodoo, or experimental? well, if it's your joint, it's experimental til it becomes voodoo. but don't fault the doc - he's simply following his muse. and if he didn't, we would not know for sure, in the future, whether or not we missed an opportunity to perform a different, better procedure. unfortunately, you may have been the guinea pig. fortunately, rarely is sports orthopedics a life-death issue. however, other sport med treatments are potentially dangerous, not just expensive or painful, so beware a doc's advice just because he has this new certification or machine. also, i know from experience with a very trusted and competent sports med doc who gave me hyaluronidase (sp?) injections for my arthritic knee that costs are added in when you don't know about them. so, he used a new ultrasound machine he'd just gotten to better see where to put the needle. upon doing so, he said it showed him exactly where he'd have put it anyway. when i got the bill, and saw it cost an extra $500 plus, i confronted him on it. he quickly stopped using it, explaining that the main office told him to use this - and obviously for making extra money on an otherwise relatively inexpensive treatment - like double!!!

so, before you volunteer to be a lab rat, be sure to ask the doc if there are other more proven methods; and how one stacks up against the other in cost, convenience (how many times do you need to see the doc- because each visit costs a lot of money), and consequences, incl pain, time off, etc. then make an informed decision, not based on jerry rice's enormously aggressive work ethic and his unreasonable hours in the gym that allowed an elite athlete already biologically unique to rapidly heal and perform.

Sunday, August 28, 2011

on gary taubes, author of "why we get fat"

normally i take a more conservative stance on dieting for wt loss. that is, while i know it's important to lose wt for the two-thirds of americans who are overwt or obese, i am sensitive to the wt loss mantra that pervades our society and has been over-used in the minds of some afflicted with body image issues and eating disorders. confusing? well, it is for me too. that is, i am sensitive to the needs and issues of those with ED (eating disorders) but i'm also sensitive to the needs and issues of those with excess wt....and pissed off, if you've read some of my previous blogs. pissed off because excess wt is in many cases avoidable or at least manageable and when i see the millions of unconcerned parents of little kids, and other adults or near adults, who seem not to be taking any actions to avoid wt gain, i know the drain on our medical systems and dollars that seem so selfishly being left open. that said, i keep reading.....

when a formerly obese but currently lean client - a surgeon - came in to consult about his exercise program, he informed me of gary taubes, author of "why we get fat" which was s sequel to "good calories, bad calories". both are catchy titles and both pitch the low carb diet. however, different from other books of this type, he goes thru the world history, literally, of how excess fat consumption may NOT be the source of excess fat DEPOSITION let alone metabolic consequences of obesity. historically speaking, there is a substantial body of accepted evidence from all kinds of trials and meta-analyses that demonstrates that hi insulin resultant from hi carb diets is the source of both obesity and heart disease/diabetes/metabolic syndrome...and maybe many cancers. his review of literature is comprehensive tho he does avoid alternative explanations for some of the supportive studies he uses when debunking the diet- or exercise-only methods of wt loss. more on that later. additionally, his review of biochemistry that anyone can almost make sense of - i write this pen in cheek because, while he does soften it up and masticate it for the common reader, never delude yourself to think you can understand the complexities of our hormonal and metabolic systems by his or anyone else's descriptions - is also compelling. let me summarize and synopsize this for you: simple carbs - anything refined, starchy, white - elevate insulin which causes all kinds of bad things in your body if you persistently run high in your blood stream. his diet advice, however, is more sane sounding than one might otherwise expect from this warning.

now, to his exercise critique, something about which i do know and am sensitive.

taubes contends that studies show exercise is not an effective way to lose wt. he uses two types of studies: clinical, where control groups and supervision/guidance are offered, and epidemiological, where you survey people in large numbers. of the first, often times wt loss, on AVERAGE, does not occur from either cardio or strength training. taken on the face of it, this would make it appear that exercise is only useful for health, not wt loss; and while this is clearly true, don't discount its ability to help with the latter. in fact, many lose wt by exercising for the following reasons: calorie use while exercising, calorie use to restore homeostasis (post exercise oxygen consumption, or what is referred to in the fitness lit as EPOC, exercise post oxygen consumption which to me puts the cart before the horse but never mind....), and body composition changes, esp from resistance training. now, can you lose as much as you might wish via exercise, and is it easy? NO, but it's not ineffective. and it does confer great health benefits even beyond those that are medical - such as increased vigor, function, and emotional stability. taubes acknowledges as much but does not equate these benefits to the ones he touts when he reviews the studies that support his preferred diet, low carbs. so, in one study where subjects lost almost 10# after 6 mos, which is not that impressive really, one could find exercise routines that do the same. but he argues that exercise actually stimulates eating, and he's wrong here, from two angles. first, exercise actually increases leptin sensitivity such that the hormonal signaling that shuts off appetite if fat cells are satisfied does not need the enormity of output necessary to effect eating restraint. much as with increased insulin sensitivity, another benefit of exercise, if the body is better adapted to using hormones, the decreased hormone output not only conserves organic function (think pancreas when you think of insulin) but it also reduces negative effects of too much hormonal output overall (think hyperinsulinemia). furthermore, tho the exercise is hard to induce and maintain in many subjects, it does not stimulate so much as modulate hunger; minimally, it's another hour of the day you DON'T EAT. in fact, studies have shown that athletes, in hard training, lose wt often because they UNDEREAT. granted, the overwt/obese may compensate, and taubes does point that out, but with new studies recommending shorter bursts of higher intensities, i would think this type of compensatory eating - and even compensatory sedentariness, which taubes does not address - would be diminished, too.

now, as for large pop studies, self-reported exercise (over estimated) and diet (underestimated), esp if recalled over large tracts of time - like how many days/wk did you exercise at X% over the past year? - are inherently of nominal value. they may show why some succeed in accomplishing a study's goal - whether of wt loss or blood cholesterol reduction - but do not allow us to categorically state why some fail. we'd have to accuse them of lying, to the researchers and to themselves. no one wants to do that, right? taubes does not really address it when he accuses studies of exercise or low fat diets of failing.

that all said, let me pat him on the back for writing what i believe has not been writ large enough by authors promoting any sort of diet of the sort he promotes: he goes thru the various negatives of the higher protein/fat diets and explains them in ways that make the reader not pause but consider with some forethought the reality of taking on this kind of LIFESTYLE change. i emphasize lifestyle seriously because this is NOT a two week diet - if you have diabetes or have been overwt/obese for a long period of time, it may take months if not years to reverse your metabolism...and still some may not succeed to the degree to which they or their doc may like. and finally he presents the medico-legal problem inherent in his recommendation to docs: it's still outside the mainstream of government-supported recommendations so docs may be reluctant to put folks on this kind of diet. my advice: give patients the book, highlight certain features, and let the patient decide; then refer to a dietitian for specifics. and taubes i think could live with this, too.

so, my recommendation to readers who are interested in wt loss either from a personal or professional perspective: read this book, why we get fat, esp the last two chapters. if you want more of the history and science behind it, read the first 172 pages and/or read his other book, "good calories, bad calories", and decide for yourself.

my one caveat, and my daughter personifies this, is that vegetarians or vegans, or people like myself who don't eat red meat/pork, will have a harder time adapting to this kind of meal plan. hi pro/hi fat diets need to be creatively prepared to avoid mundanity; if you only know so many ways to prepare fish and chicken, good luck. otherwise, learn to cook better or learn to eat meat.

Friday, August 19, 2011

on core exercises - what works, what doesn't, and whether you should at all

there are some things in the fitness world that are accepted entirely on faith. to argue against them is to walk right into the path of someone's whole way of seeing the world. flexibility - whether it helps performance (not necessarily, and may hurt it), reduces risk of injury (maybe increases it), or helps you be stronger (maybe, maybe not) - is one of these on faith principles that has achieved near-idyllic status. only the studies over the past 15 yrs has altered its stature yet to hear all the new found love of pilates and yoga that is touted in the media and among fitness people, you'd think it's the answer to everything. (disclaimer: i stretch, a lot, and always have, esp when i did martial arts 7 d/wk. but stretching is useful for some sports, tae kwon do being one of them; but at the same time, overstretching, which is what i did, likely contributed to my bad knee and hips, and maybe even interfered with my ability to actually be more effective as a fighter. looked great in forms, tho:))

another is the paramount role the core has come to play in fitness circles. the classic 6-pack, those cuts in the anterior abdominal wall that signify leanness and well toned abdominal (not stomach) muscles, has come to suggest that an individual, esp an athlete is somehow more effective, efficient, powerful, capable, and less prone to injuries, esp of the back. but the thinking here may be, and i believe as this article suggests is, way off base. for one thing, the 6 pk is just one set of the musculature of the core which we now understand to be all the muscles around the waist plus the hips, and even the upper thighs. furthermore, despite all the talk about having a strong core, few have distinctively identified any one or even battery of tests that measure it.

in this article, there are references to stuart mcgill, of canada, whose work in this arena is profoundly influential. he argues against sit ups and crunches as valid tests of or exercises for good core strength or function. he even suggests that these may be more dangerous than helpful, but he does suggest a safer way to do them - by placing one hand palm down in the small of your back and only raising up just enough to feel the abs contract. but for core, he recommends planks, front and side ones.

mentioned too is an article in this month's NSCA journal of strength and conditioning by schoenfeld which reads really well. he suggests, in opposition to mcgill, that the crunch may be perfectly safe and may have value for some athletes and body "builders" - those seeking, if lean enough, to have a toned midsection. his review of the literature is well taken. and his guidance at the end of the article is suitable for all levels of fitness participants.

however, as i've written before, all these are isolational exercises: they work one section or one side of the core without reference to how the core works. let's review this functionality.

the core transmits power/force from the lower body to the upper body. studies show tennis serves and baseball throws come primarily from the navel down - anywhere from 55-60% of the power comes from the legs and hips. the waist is a conduit to the upper body. if not strong, and functional, it will dissipate force coming from below. now, how does this force come up?

first, you rotate from the feet, twist thru the legs, and then into the hips. before the spine actually rotates, usually the rear leg hip externally rotates to turn the trunk toward the target be it the opponent or batter or what not. in this manner the spine is put into a twisted position - javelin throwers show this quite well - and then, like a spring, untwists to propel the upper trunk and shoulders into action. thus, the core is really a twister, not a squarer. that is, it does not operate in one plane; it operates in all three, as twisting is a multiplanar movement. so, training it in twist is really more appropos. and what exercise does that? the torso rotation with tube or cable resistance. done properly, whether statically to develop core stability, or on an unstable surface such as on a stability ball or less-than-optimal stance, or in a firm and solid stance or position, such as sitting on a bench, straddling or normally (why? because polo players straddle a horse; race car drivers sit in chairs; and so do you....), the torso rotation exercise most approximates the way the spine has works. let's imagine.....

if you stand with feet shoulder or hips width apart, knees soft, and hands directly out in front of the sternum, you have effectively created a spoke (hands) and wheel (spine/core) system. now, if you have some force - manual from a partner or tubing or cable - that tries to twist your arms over to one side, and you resist, you are isometrically rotating to the opposite side. for example, if a partner pushes the hands to your right, you rotate to the left using your right gluteals, left inner thigh/hip rotators, left erector spinae, left latissimus dorsi, right external oblique and left internal oblique - all the same muscles that actually turn you to the left to throw a ball or punch or serve. in other words, it makes your core work like your core works - in synchrony with all the muscles of the hips, thighs, and midsection. wow!!!

the problem is how to test core strength. and i believe ohio state is testing with a self-designed mechanism at least function if not strength. so maybe someone will come up with a way to standardize the tests for core strength. in the meantime, i use a tubing pull - where i pull the tube while the client faces the mirror and watch for when the core starts to give out. not truly accurate - more qualitative than quantitative - but it allows me to see if someone needs to be trained more to one side than the other. it also allows me to test the muscles of the hips and low back because the client can often identify where the weakness lies.

to conclude, this article is provocative because it touches the sensitivities of many in the fitness world. but read it closely and think about it. and think about what i've said here. i believe you'll find what i've found - sit ups and crunches are just for fun and tone but not function or strength of the core.

on barefoot running

barefoot running, and barefoot shoes, are the newest things in fitness and in fitness gear. i've commented and written before on this topic and more studies keep popping up about it. most are positive - so far as actual running barefoot is concerned; some are negative so far as injury rates while running barefoot are concerned. but some are neutral - discussing the science behind barefoot running while also discussing the spate of injuries that have been reported by those attempting to run barefoot. this then leaves the researcher -not scientific ones, but potential buyers and users of barefoot technology shoes - in a quandary: should i or shouldn't i?

here is an article in the american council on exercise's on line mag for professionals. it does not shed a pleasant light on the subject but i want to point out a few problems with it.

first, recreational runners were subjects, meaning they were less likely to be "soft" or skilled runners, ones most likely to benefit from these shoes for performance sake. two, they were young females. in other words, we don't know if men - generally heavier but also stronger - would be better 'landers' while running in these kinds of shoes. three, the researchers told the subjects to run no more than 20 mins three times a week for the two weeks prior to testing. and four, they were tested after running 20 meters on ground reaction forces.
why these may be problematic i'll discuss below.

first, recreational runners come in all types, but many if not most are heel runners. two weeks is not enough time for a heel runner to adapt her style. second, being female runners, as i said above , they are not likely to be strong enough in the lower extremity to absorb impact via mid foot landings quite so well as a male might be. the fact that we know nothing about their body weight, body composition, or other measures or indicators of fitness suggests that these subjects may not have be representative of more elite, male runners trying out barefoot shoes. third, to make the adjustment to these kinds of shoes, one should probably not go right out and start running, perhaps at all but definitely not for 20 mins. that we do not know about their fitness levels, it's feasible that 20 mins was half of their capacity, in which case they would definitely not be fit runners, tho they would be fit individuals. furthermore, most sales and fitness pros would suggest starting a run/walk program with substantially less run time total than would otherwise be done in the early weeks of adaptation. so, 3 x 20 mins x 2 wks is not enough time to adapt or learn to adapt. finally, the technique of testing is a good one for most running biomechanics studies. but we don't know anything about trials - numbers, cues, etc - and actual forces - vertical, horizontal or shear. so while it's an interesting set of data, i would not bet my shoes on this study.

nonetheless, take from the study my comments - slow and easy introductory period - and the advice of others - learn to land on the forefoot - and then maybe you will be one of the lucky many who've learned that running barefoot is now possible in these funny looking but very comfortable shoes.

Sunday, August 14, 2011

coconut water and other concoctions

the latest, today, because who knows what it will be tomorrow, is coconut water. yes, this natural product from the islands and tropics is capable of damn near anything you athletes would want, from hydration to energy to curing all kinds of aches and pains. but as this article, and many others i've researched, shows, it does not hydrate better than sports drinks. however, if you follow the link to the pubmed article, you will note that the one - i emphasize, ONE - article says it's better tolerated than sports drinks. now, there are three things i want to bring to your attention.

first, the study was done in singapore. not that good research isn't done there, but being a land of milk and coconut, and the abstract does not tell us anything about this, it was possibly funded by the coconut industry itself. in fact, google coconut and you'll see bunches of 'research' all of which is funded by the coconut industry. possibly biased, you think?

second, we don't know, from this abstract, to what extent the study was done in the format we in the west would do it. that is, how much and at what rate were the drinks administered? what sports drink was it - gatorade, a well ressearched product, or some local/national brand? and there are many other questions one could, and should ask.

finally, the results show that coconut with added sodium - that's extra salt, for those who forgot chemistry 101 - works as well as the sports drink at hydration but was better tolerated. that's the question mark, but leave that aside. it works as well as artificially flavored and colored water with sugar and sodium added. more natural? no...because the coconut was also modified, with salt. and who knows what else. it was a coconut drink, not pure coconut. in other words, read the labels, and question the marketing. as you would for a computer, a car, or anything someone's hawking that somehow miraculously without notice from the Nobel Prize distributors have ever noticed, think twice. it may not be bad for you but it also may not be good for you. and if it's only as good, or marginally as good, consider cost, at the checkout and to your body. for the one thing we don't have evidence on is the accumulated cost of consuming products about which we know little other than what the sellers tell us.

Friday, August 5, 2011

HAES it going?

it's intentional: HAES = health at every size, a program to help overwt women come to grips with the lifestyle patterns that have contributed to their heaviness, but NOT by enforcing wt loss. rather, it encourages finding - no, creating -new patterns of thinking, feeling, responding, and acting to stimuli - both external as well as internal - that previously was counter-productive to their well-being. that is, food, eating, and dietary habits, as well as activity habits, which contributed to excessive weight gain are redirected with a loving message that participants can reconfigure into new habits and patterns that lend themselves to improved mental and medical health....even if participants never lose the weight they'd like to lose.

http://today.msnbc.msn.com/id/43591507/ns/today-today_health/t/end-dieting-new-movement-focuses-health-any-size/from/toolbar#

this concept came from the research of Steven Blair when he was at the Cooper Clinic in TX years ago; his writings and lectures on 'fit and fat' changed the way exercise and nutrition professionals started to approach the problem of overweight/obesity: small changes in lifestyle choices reaped large, very large benefits in health, even if the wt never got to the 'healthy' range.

as a trainer, i've been hit up since early in my career for the answer to wt loss. having provided the party lines - dietary and exercise - even as they've changed over time, i've come up with a simple dietary dictum: eat whatever you want, but take ONE THIRD off the plate even before you taste it, and put it in a to-go or tupperware container. i've also come to grips with the exercise rx of so many minutes a day times so many days per wk: do 15 minutes daily, where daily is nearly every day of the week. as for strength training and all that malarkey about building muscle mass to boost metabolic rate, well, old folks and women don't build so easily and really won't build enough to substantially reduce total calories; and the exercises themeselves won't do it, either. so, the exercise advice is more directed toward health, mental, cv, and musculoskeletal, than toward wt loss. why? because you really can't exercise it off. a combination of eating less and moving more may, that is, MAY help some lose wt, but will always, read: ALWAYS, improve wellbeing.

some get frustrated with these guidelines, but i prefer honesty to false and impermanent promises. it's really easy for trainers to brag on successful wt loss with their clients. but let's look down the long corridor to see where these clients end up years later. some will have kept it off; most will have regained it; and many if not most will have gained beyond where they had started from. what's really more important, other than how they feel about themselves, which is a far cry from anything i can offer, what is important and what i can influence is their well-being, their physical fitness, and to some degree their health, even in the long run.

so when i get a client who intransigently struggles in vain to lose wt - and won't because of lifestyle choices that suggest lack of discipline, laziness, or whatever other excuses all of us make to not do what we know needs to be done to accomplish whatever our goals may be, i fall back on my basic mantra of small changes for large results: if they will exercise twice a week with me, and modulate their diets as a function of our relationship, then i'm helping them....until such time as they are ready to help themselves.

why?

because ultimately, that's all the power anyone has to help another: loving support. from there, it's their choice how to use the knowledge, power, strength, endurance, functional capacity, etc. like HAES.......

Wednesday, August 3, 2011

on food and self-regulating industry

this op-ed in the Times - http://opinionator.blogs.nytimes.com/2011/08/02/when-big-food-makes-its-own-rules/?ref=opinion - highlights perhaps one of the strangest elements of american politics that has long gone unencumbered by both parties: the revolving door and closed feedback loop of those who should be regulated by those who were once or will someday soon be working for the very industries that are to be regulated. that is, the classic fox guarding the hen house model of government oversight.

this article takes our government to task over its weak rules and mild constraints against the food, primarily the fast food and kids' oriented food, industry and how they are allowed to both be represented at the table as well as be in control of the writing of the very rules that are supposed to provide guidance to their production and marketing. what if the oil industry were allowed to establish the rules for exploration, environmental management, and supply and demand of our nation's fossil fuel reserves? you think there'd be more holes in the ground any and every where with little regard for the environment during and after they were tapped? you think prices would be higher and their drilling fees lower? you think your cars would be getting any fuel efficiency? heck no. they'd be padding their wallets....oh, wait a minute; they are padding their wallets, and have very little regard and take very little responsibility to the larger issues faced by our people, our nation, and the global environment. fat chance they'd be so kind if there were teeth and guts behind the regs and the regulators themselves. but many if not most of them have worked for or will someday hope to work for the very industry they presumably regulate. furthermore, so long as our politicians are dependent on the largesse of such industrial giants, they will be sure to write the weakest of laws and finance the minimalist of regulators as to ensure the continued profits of these corporations.

the downside of this is highlighted in the food industry. what with crappy and unhealthy foods being produced and sold cheaper than healthy foods esp to kids and the underprivileged, our country is awash in obesity-related disease and lifestyle accommodations. while any one industry is not totally at fault for these circumstances, the depth and width of which are actually, not figuratively, killing people by the millions, without some government regulation, the food industry is getting off pretty light. when you can redefine obviously-unhealthy foods - damn near anything processed - as healthy, and the gov and regs look away, we are destined to stumble down the highway of heart disease, diabetes, and cancers for all.

but what to do about it? therein lies the conundrum. for if we really believe people are in their rights to choose how to live and eat, then putting out there for them foods that feel and taste good even if they offer nothing nutritionally is fulfilling a basic human right. and who'd deny an individual such a right, right?

but if we believe that each individual is entitled to this right, but then must take responsibility for the consequences of that right, then a public health policy is impossible to sustain; and a private-based health initiative should more precisely 'punish' those who have taken advantage of that right at the expense of those of us who have tried to live healthfully. it just does not seem fair to either let folks suffer and die needlessly so others can profit; nor does it seem fair to make those of us who watch what and how much we eat pay for the sins of gluttony and uncontrolled eating and sedentariness. but alas we do.

it's not easy but i do know this: the industry in this case should know the mission - public welfare- and be supported in supporting this mission, or financially penalized for seeking profits over well-being. i know - idealist if not socialist thinking. but isn't that better than just giving up?

Sunday, July 24, 2011

on fast food, national health, and taxes

for over 20 yrs, i've been struggling with my bleeding heart side and my self-responsibility side when it comes to wellness and fitness. knowing what i know and how difficult it is for some, for whatever multitude of reasons, to better manage their own health, i still find myself disgusted by those who allow themselves to retreat so far from a state of wellness by engaging in behaviors that are clearly counter productive. when i see young people smoke cigarettes - when i heard my own 28 y/o son smoked - i get angry, dismayed, and disgusted. when i see grossly overweight parents buying junk food for their kids, let alone themselves, i get angry, dismayed, and disgusted. when i hear and read of people spending hours - even my own teenage girls do this - in front of a tv or computer - oops, i'm in front of one now! - i get angry, dismayed, and disgusted. too many behaviors that too many americans - i can't worry about other nationalities right now - engage in are self destructive; worse, they are community and nationally destructive. they increase everyone's cost basis, increase the general discomfort - ever sit next to an obese person on an airplane? believe me, they don't feel real comfortable, either - and increase the level of medical insecurity we all have to face when, should it ever be required, as in war or even natural disaster, we must act with vigor and speed. if you live on an island, feel free to consume junk food and watch tons of tv; if you live in the real world, even if you can afford your own insurance and services and a personal trainer, you should not feel so comfortable in your right as an individual.

but this ny times op ed piece puts my arguments in economic terms that may actually be feasible politically. not yet; too contentious out there. but someday, maybe: http://www.nytimes.com/2011/07/24/opinion/sunday/24bittman.html?pagewanted=1&_r=1&ref=opinion

whether it is appropriate or not for the government - esp the fed - to tax certain foods is not, philosophically, a hard issue to confront. in fact, the fed is already, and has for years been, telling us what and how to eat, specifically by subsidizing certain food types such as beef, dairy, wheat, soy, sugar, and corn. by keeping costs either high or low or even just buttressed against the swings of the markets, its tax policies have enabled food choices to reach us that do not justify government intervention because they actually hurt us. there are millions of arguments for or against certain policies and food products but some, such as those highlighted in this piece, make common as well as economic sense.

as for free choice - ok, fine, but not on my or our dime(s): if you receive any sort of state-funded welfare, esp for food, then you are limited to food, not junk; if you receive state-supported health care - even medicare - you should be whipped into shape, at least better shape, by being excoriated to get moving. even 10 minutes a day is better than nothing. if you are in line for bariatric surgery, you should be forced to engage in a one yr fitness regimen and lose X% of your weight first before being 'entitled' to a procedure that effectively costs the system over $50Gs. and if you can't do so because you're already so morbidly obese as to be unable to move at all, then - well, you don't want to hear my opinion on this, now do you?

Saturday, July 9, 2011

thoughts on Los Angeles sun

i'm in l.a. visiting colleges, brother, and friends, with my youngest daughter. we looked at 3.25 colleges - hard to count USC as a full look as she summarily discounted its prospects upon departing the parking garage. otherwise, the three small colleges got a good look-see and the pleasant sunny weather here is clearly a draw.

as i sit outside by the hotel pool, catching some early morning rays, escaping the cool of the building-induced shadows, i feel compelled to reflect on sunshine, its benefits and its dangers.

first, its benefits: tans (done safely, sure look healthy), warmth (done safely, or out of necessity as during the cold winter months, is comforting), light (esp for aging eyes, it helps you read better; but even for non-aging eyes, a welcome introduction to the day unless one's been partying far too hard and long), and finally, vitamin D, on which i've written before and will write again, i'm sure.

now, it's dangers: sunburn and potential severe burns, excessive exposure and increased skin cancer risk, and heat (too much of which can lead to heat related injuries).

for the most part, tho, sun is to be appreciated and respected, like almost anything else in life. feared - now that's taking caution a bit too far.

i do not intend to play statistician or medical historian. however, i cannot but help question the real risks we humans have determined when it comes to such things as cancer and neuro-degenerative diseases; even heart disease is questionable in the following light: we humans are living longer than our predecessors under much more coddled childhoods, making us weaker and, over time, more susceptible to diseases that may or may not be solely due to our exposures to various risks. let's start at birth.

many modern humans get inoculated against a variety of diseases that dramatically increase our prospects for survival. i just read that 10% of kids born in sudan die before the age of 5 - my guess is that that's closer to the historical norm of mankind in the wild, or even pre-20th century. furthermore many of us had exposure to health care beyond the dreams and fantasies of our forefathers whereby medicines and procedures further expanded our opportunities for survival success. finally, our mothers - many of whom died in childbirth pre-1850s - used to give birth to several children knowing full well some would die young, as would they themselves. as such, with more mothers successfully birthing more kids who will live, we have in effect 'weakened' the stock of humanity to where people who otherwise would not be alive are birthing others who otherwise would not have been able to survive. we have essentially produced a flood of humanity incapable of withstanding the rigors of nature without the crutch of modern medicine. hence, natural assaults upon our bodies - air, sun, water, pathogens of all sorts - now get blamed for making us sick or even killing us.

i'm a fan of america's founding fathers. to think that ben franklin and john adams, two who were sedentary by comparison to the george washingtons in the crowd, and who were portly by comparison to their peers, lived into their late 70s, early 80s, suggests that, by themselves, excess wt and sedentary lifestyles alone are not dangerous. rather, some are hardy despite the savage medical practices of their times and the various exigencies of lifestyle - both crossed the atlantic several times as well as traveled the rough 'roads' of the colonies through all kinds of weather conditions - no heat or air conditioning!!! - and thrived. granted, they were way more active than we of modernity, even in their feebleness and sedentariness. but cardiovascular fitness is relative and i'm sure they would not be categorized as fit by modern metrics; just fitter than our norms when you factor in the 67% who are obese and sedentary.

my guess is that those strong enough constitutionally to make it to adulthood and to procreate to the extent that some of their offspring survived to do likewise were constitutionally 'blessed' to pass on strong genes. these genes were either resistant to many of the diseases we currently consider rampant or epidemic or endemic; or the effects of sunshine, dirty water, and the many air- and water-borne pathogens simply were not as dangerous as they once were. somehow i don't buy the latter. i suspect, and maintain, that the human gene pool is weaker and getting weaker the more we expose it to such protective measures as modern medicine and some health nuts propose. of course, to allow nature to take its course is a crude and inhumane response to my thesis. in fact, i or my loved ones very likely would be non-survivors if not for modern medicine and lifestyles. nonetheless, let me state right here and now that we should not be throwing caution to the wind, esp when it comes to known risk factors like diet, activity, cleanliness, and sunshine, but we also should not be so paranoiac as to hide from the pleasures of nature nor modernity.

i suppose it all comes down to moderation. aristotle wins again.

Thursday, June 23, 2011

on stretching, time, and reward

in this piece in the Times, the issue of whether or not to stretch, and if so, how, is addressed, yet again: http://well.blogs.nytimes.com/2011/06/22/to-stretch-or-not-to-stretch/?ref=health

the quick and dirty is that studies have demonstrated that power and strength are lost after extended durations of static stretching; that newer studies have shown that stretches under 30 seconds do not impair strength or power; and that there are some sports and athletes where stretching is warranted, and others where it is not. but let me share some of the science behind this topic as i believe it is critical in helping you decide whether or not to stretch.

most studies that show stretching impairs performance have subjects do very long periods of stretches, sometimes multiple sets of 10-60 second stretches, or simply 15 minute - yes MINUTE - static holds, and then test those muscles that were stretched for strength or power output. clearly, the declines would be expected and now it was a matter of explaining what had happened within the muscles. generally, the 'creep' of tendon makes it hard for the contractile elements of muscles to shorten the tendon quickly or vigorously enough to produce sufficient pull on the respective bones such as to generate force or power. in other words, the compliance of the tendon, and muscle, has to be overcome before it can apply tension and create movement. long static stretches increase compliance - which is why people stretch IF you (1) need to be more flexible for your sport or daily activities, (2) lost flexibility due to chronic postures, movements (from doing the same activities such as jogging), or injury/disuse, or (3) it 'feels' good to be stretched out, as in yoga, pilates, or simply general comfort. (i am a stretch fiend myself, coming from being a very supple martial artist who in retrospect over stretched all the time. on injury, momentarily....)

but if you stretch to avoid injury or minimize risk thereof, perhaps you need to reconsider. studies do not show that it reduces the risk of injuries nor that it enhances recovery from certain injuries such as hamstring tears, for example. in fact, strength training yields more stretch-resistance and injury-resistance than does stretching per se. in my case, what with a hip replacement and an impending knee replacement on the same side, i suspect that hypermobility most likely factored into the etiology. by being too flexible and playing a high speed sport - kicking and punching - my joints may have been compromised in terms of stability, wearing out cartilage in areas of lesser thickness. a more recent study actually split runners into two groups - stretchers and non-stretchers. injuries were similar at the end of the study period, but the interesting part was why: those who never stretched but had been placed in the stretching group were more likely to be injured than those who never stretched and were in the no-stretching group. similarly, those who stretched and were in the no-stretch group got injured more than their fellow stretchers who were allowed to stretch. the conclusion: if you stretch and have no injuries, continue; if you don't stretch and have no injuries, continue. but maybe you should not start or stop stretching just because some research shows value or not.

going back to the static stretch duration issue. more recent studies tested the way real athletes might stretch, such as 10-15 seconds per body part, before activity. no adverse effects were found. furthermore, as another study smartly pointed out, most athletes don't go from the stretch to the performance line; that is, you don't stretch and immediately swing a golf club or try to dunk the ball or sprint a 100 yds. rather, you stretch, then warm up, then sit while the event/game is initiated, and by then all the benefits of stretching have dissipated. the warm up persists a bit longer. and no negative effects from the prior stretching are demonstrable.

furthermore, this kind of data supports the latest concept of stretching - dynamic stretching. this entails gradually increasing the range and intensity of the movements you will be making until you are fully up to speed and range. for a jogger, this means walk slowly, gradually add speed, then stride longer, and 4-10 minutes later, you start running/jogging your usual pace. this is functional and practical. and research supports it. (anecdote: as a new green belt still not on friendly terms with my korean instructor, i approached him about what to do if i needed to kick on the street. i'd been coming to class 60 mins early and stretching for over 45 of those minutes before ever throwing a kick. and i could kick higher than anyone in class, except the instructor. but wow, what if i needed it in a fighting situation? could i kick high enough? so next class, as i walked down from the changing area, into the workout area, he called me over to spar the senior black belt. i balked but not with any authority over my body; i was his student, his lackey. within the first two minutes of jumping around, kicking gradually higher, etc, i was able to kick as high as after 45 minutes of intense stretching. being thick skulled, i had to experience this kind of intro to kicking the next class, getting similar results. needless to say, the lesson learned was that stretching was unnecessary; just kick. and this was in 1973, way before there was any science to stretching.)

so, what are the lessons of this article?

well, another personal note: a 70 y/o male client of mine, lying supine, could not raise his straight leg over 50 degrees of flexion. he never had low back issues. and he was very athletic and active being a gentleman farmer and avid horseman, plus polo player even today. years ago, i consulted with a ballerina in the local ballet. she had bad back problems. and could stand with her leg touching the back of her head. plenty flexible, and pained.

in other words, it works for some people some of the time for some of their issues; for others it may be a massive waste of time; and there are no rules of thumb that apply to everyone of any age or activity level. that is, except for this one rule: warm up, somehow, before you do anything too vigorous.

Monday, June 20, 2011

the 10% rule of running

there's a standard exercise prescription in the cardio world, coming from the running community, that you should only increase your weekly mileage by 10%. this is stated so as to minimize risk of injury. it translates like so:

if you start running, or even walking, one mile a day, seven days/wk, a 10% increase could be done by either adding 0.10 miles to each walk or 0.70 miles to one of your walks. clearly, the former is less abrupt than the latter. however, numerically speaking, they are both 10% increases.

the article - http://www.nytimes.com/2011/06/21/health/nutrition/21best.html?ref=health - discusses the source of this rule and some studies that have taken it to task. but short of controlled studies, what else should we consider?

for one thing, real life people are not apt to simply increase a 1 mile walk by 0.1 miles. furthermore, if that walk takes 20 minutes, they would be unlikely to progress to a 22 minute walk the following week. finally, once a few progression weeks had occurred, few would be likely to make a similarly 10% progression by jogging and cutting back on mileage.

but those are how you should progress. in the early stages of a cardio program, i advise that you make small mileage progressions based on either distance or time. i prefer time. recognizing that the fitter you get the faster you move, you will also cover more distance per unit time those early weeks. granted these are the weeks you will most likely hurt yourself IF you make more than one progression at a time: that is, if you increase distance and/or time and/or speed jointly, you will run into problems later if not sooner.

so i advise people start with 15 mins walks nearly daily, for the first couple weeks. no progression other than behavior change. i advise 'nearly daily' so as to generate habit formation. by week three, they can add 2 mins to their walks- more than 10% but still way doable. in fact, most look at me like i'm crazy, claiming they can walk more than that. my response: then why haven't you been doing so? that puts things back into perspective and we move on from there.

now, once they achieve a 30 min walk, daily, i advise they increase speed...but cut back to 15 mins. even if they have no intention nor need to jog, slow walking is slow and calories are based on distance, not time. so the more distance covered the better. (btw, this is true for cardio benefits too, tho age and disability factor in.) once they get a faster pace going at 15 mins, i recommend weekly progressions similar to that of the first several weeks.

let's do some math here. the rule of 72 says it will take as many months to double for financial growth or payments at a specific percentage of the principle as that percentage divides into 72. i know this is putting it very rough and raw but here's a simple way to look at it. if something increases by 10%, then it will double- that is, the principle will double - in 7.2 periods of time. thus, if it's weekly mileage, and you increase by 10% per wk, in 7 wks you'll be walking, running, swimming, or biking twice as far as you did on week one. so, in two months or so, using my system of making virtually no progression those first two weeks, you'll double your walks to 30 mins. in fact, using my 2 min/wk increases, starting the third week, you'll now be at 17, 19, 21, 23, 25, 27, 29, then 31 mins 8 wks after that second week. thus, your progression will have been slower overall, and your habit will have been deeply ingrained with less risk of injury.

now, i know few can move this slowly, and most will quit much sooner than i, or they, would like. for many, they will claim a time issue despite the fact we all have 15, 17, etc minutes in our day to do some kind of movement. for others, it will be haste then burnout - a repetitive habit they've had with exercise for years. amazingly, it's so simple it almost breaks their will. they need a reason to fail and this model does not allow it. so they make one up.

10% or not, some folks simply don't want to make the kinds of lifestyle changes that will make them feel better, be healthier, and maybe even look better. why?

maybe science can't answer that.

Tuesday, June 14, 2011

on knees, shoulders and backs

i just returned from an exercise etc fitness conference in phoenix this past sunday (6/12). as a presenter for ex etc for over 15 yrs, i've had the opportunity to observe and even participate in the evolution of the profession of personal fitness training.

during the lecture on shoulders, i asked if anyone in the class was a thrower as i needed someone with coordination to demo my 'dynamic cam' technique using elastic tubing. only one person - out of 25 or so - admitted to being able to throw. i've had this happen before - trainers who were uncoordinated in the ways of sport movement. this alone concerns me as so many of our clientele - country club athletes, or even real athletes - play sports and need to learn how to exercise in ways that will enhance their activity of choice. if all a trainer knows is how to strengthen or stretch a muscle, but not the mechanisms of movements themselves, then training is half-assed, if you know what i mean. after all, what is functional training if not training that improves function and resists injury?

so, here's a few simple pointers on the major joints - knees, shoulders, and backs - and how you - trainer or worker-outer - can think about how you train those joints.

first, all joints have 4 major components: bones (which meet and may be joined - the scapula is not technically joined to the thoracic rib cage; it floats on it - to form a specifically-limited range of movements), ligaments (which hold most -but not the scapula- joints in place but do not move them), tendons (the attachments, usually close to the joint, of muscles that move them), and muscles, the only real source of movement of the joints.

now, muscles come in various sizes and strengths, but the rule there is the larger the muscle the stronger it is; and vice versa. the muscles closest to the joint itself tend to be the smallest; as such, they are the weakest and often are implicated in the injury patterns of many joints. learning how these muscles are supposed to work will help you train them, but here's my rule: if you use excessive loads early in training or rehabbing, the small muscles won't be able to do the work they're supposed to do, and the larger ones will compensate accordingly. therefore, the small muscles, the ones most integrated in stabilizing a joint, are undertrained at the expense of the larger ones, most likely doing movements TO the joint itself that are not good for it.

therefore, when training these important joints, remember to pre-train the smaller muscles around them by not over-burdening the systems. for the shoulder, do some cuff work; for the knees, do some basic conditioning for the hip abductors and vastus medialis with low resistance close chain exercises like leg press or squats; and for the spine, don't do crunches - start with simple core training exercises like bridges, abdominal contractions, and/or partial dead bugs. a couple weeks of these early in a novice's training, or even in the training of an athlete coming off the post-season, will prevent many of the types of injuries we trainers often contribute to, and may even allow steeper progressions once the early phase is over.

Wednesday, June 8, 2011

hi pro/hi fat/low carb diets and health

another study reported in the media - http://well.blogs.nytimes.com/2011/06/01/eating-fat-staying-lean/?ref=health --- shows there may be benefits to eating hi fat/hi protein diets compared to the hi carb diets that have been promoted for the past 35 yrs. and studies, mostly short time, bear this out: reduced wt, reduced fat, even better blood fat and blood sugar stats. the biggest problem lies in sustainability as the diets get pretty bland after a while without fruits, veggies, and grains. but, for those able to sustain them, they do work in many cases. obviously some people are not going to get the good blood values but many will see these improve as wt slips off.

the points i like to make to clients and students in classes (when i teach for Exercise ETC, as i'm going to be doing this weekend in phoenix) are these: first, all these diets help folks lose wt because they are providing fewer calories, with protein and fat being more satiating than hi carb diets ( hence you're hungry an hr after eating chinese food, right?); and two, hi carb diets are holdovers from the 70s because that's when the aerobics fad started and athletes in that arena eat enormous amounts of carbs to optimize performance and recovery. and this performance based dietary system prevailed until evidence started to appear that protein was useful for cardio athletes both during long events (as in cycling) and for recovery, tho it does not contribute much to actual performance, esp in terms of speed.

let me use me for an example, as i've done in a previous blog. when in my late 20s, early 30s, i was a very competitive and driven tae kwon do athlete. i trained 4+ hrs a day, some in the gym some at home, plus jogged a couple miles/day or did wind sprints after class, all after doing 8 hrs of construction work in all kinds of weather. being a vegetarian at home - i'd eat fish or chicken at restaurants or others' homes, but not red meat - i was constantly eating. once i grad school for exercise science, i did a project where i had to calculate my caloric intake for 3 day. now, mind you, i was all of 68" tall and 141-144#, with a skinfold measurement of 3.3% body fat. i was eating 3500-4000 cals/day. to give you an idea, i had two pb&j sandwiches on homemade whole wheat bread for lunch, in addition to a quart of yogurt and usually a piece of fruit. dinner was often rice and beans or rice and stir fried veggies, and often a full 12" skillet full of the topping over 2 cups of rice. breakfast was a large bowl of cereals - bran, wheat germ, raisins, oats, with OJ on it, not milk, to sweeten it up. a friend taught me about this and i'd still eat it if my gut could handle raisins and oats. but this did not include my snacks which were prolific. there were times i'd eat a whole baguette at lunch, with a couple yogurts. it was nothing for me to consume 1000 cals at a sitting. and i had to eat all day.

that's what hi carb diets do. in fact my diet was also 35% fat, some days 40#, so you may be wondering where i got my proteins. well, out of 3500 cals, to achieve the minimum protein calories that the ADA recommended at the time, and even today - 0.8 g/kg - weighing, as i did, 65 kg, i needed only 52 grams/day. of course, i was eating way more than that but had i done just that, it would have constituted only 200+ cals of the 3500/day, or about 6% of my intake. i can't recall the numbers but i was likely consuming at least 100 grams/d since the protein from peanut butter - about 3 tbsp, was over 20 g, and the bread - homemade and large slices - was likely 4 g/slice or 16 total; plus a quart of yogurt - another, say, 25 g; and then the grains and tofu and beans, etc - i'm sure amounted to 40-50 more per day. all this to say that if you eat enough calories short of just eating junk, you're going to get you protein needs met. but i could only do this because i worked out and worked so physically all day long. feed your face that way and sit at a desk all day and guess what? you'll be obese, diabetic, and sickly if not dead in a a decade.

so, to conclude, i guess what i want folks to appreciate is that the hi carb diets of yesteryear still apply for athletes and people who work out several hrs a day. for the rest of us, fewer calories are needed, and hi fat/hi pro diets meet that standard. of course, so does a well balanced diet of fewer calories, but clearly modern mankind has no interest in restriction. so these new diets and studies are designed to make dieting feasible. nonetheless, if they worked so well, we would not need more studies or books, would we? no, we don't need to diet more on special concoctions or foods. we need to simply eat less, and move more. or keep buying diet books.....

Tuesday, June 7, 2011

ooh ooh ooh ooh, staying alive.....

a norwegian study reports that a single measure of fitness - your aerobic capacity, as measured by ml/kg/min of O2 your body can use during hi intensity exercise (max VO2) - can provide you and your doc a measure of heart risk. they tested 5000 norwegians of all adult ages and determined that, if your maxVO2 goes down 5% relative to your age group, your risk profile goes up. this, of course, reflects on your overall risk for morbidity and even mortality due to cardiovascular decline. they also determined that maxVO2 declines, on avg, 5% per decade. but training slows this decline substantially, at least til age 60 or so.

the bummer to all these numbers is that norwegians are some of the fittest people on the face of the earth. thus, by their standards, many teenagers and twentysomethings are unfit and at risk in comparison to norwegians even in their thirties and forties. so, while the standard is high, it could mean it won't be used by other nations to guide health care or insurance considerations: too many will fall into the hi risk categories and this would lead to increased medications, procedures, and insurance premiums.

the good news, and there's always good news, is that for out of shape people willing and able to participate in hi intensity exercise even once a week, a 4 minute bout at 90% of your maximal ability is sufficient to provide some protection against aerobic decline. alternatively, a 15 minute bout of moderately intense exercise will also suffice for those who are out of shape.

maybe your doc can start prescribing this for you....or maybe you'll read this article and do it yourself:
http://www.healthcanal.com/blood-heart-circulation/17589-magic-number-for-heart-health.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+healthnewshc%2FOxfp+%28Health+News+from+HealthCanal.com%29


on a separate and personal note, just so you know, i have stage four OA of my right knee. it's been operated on twice over the past 25 yrs and simply won't get better but i'm not in horrible pain doing what i do best - fitness training. however, as i've written before, i did convert my desk to an upright so that i don't have to sit for long periods of time and try to get up; and i do take naproxen sodium and fish oil caps to mitigate the pain; and i do rub on voltaren cream/drops to get me going when i wake up; and i don't do things that blatantly hurt, unless you count sitting while typing, eating, or socializing. this past weekend i went to denver to the ACSM annual meeting - fitness geeks: GO - you will learn more than you could expect and even change the way you train your clients!!!! i stayed with friends in denver, visited an old tae kwon do buddy whom i had not seen in 29 yrs, and after the meetings on saturday, drove out to tabernash to see my oldest non-philadelphia buddy, whitney and his wife kathleen, for a day. on sunday we hiked gently around a lake near grand lake, which was at altitude (but that wasn't the issue) but never got too far bc of hard rushing snow melt streams. nonetheless, two things i want to share: one, i wore merrill barefoot shoes and not only my knee but my feet felt GREAT - the foot adapts to the surface, not the ankle, and so the shoe did not lever the tibia which torques the knee - hence, no knee problems. the second is, we got in the truck to get lunch in grand lake and getting out of the car killed me.

so, i called my sports med doc, jim johnson, and got my first cortisone shot as required to initiate hyaluronadase shots. within moments, as i walked out of the office, i noticed NO PAIN, despite the limp i've been using for years. so now i have to relearn walking. but i can also squat, step up, etc. not that i will, but i could. why? because i have to keep this leg strong. keeping quads strong is mandatory if you want to defer surgery on the knee, esp knee replacement. kaatsu, or blood flow restricted exercise, is what i've been doing but even that hurt a little the next day. we'll see - it did not hurt today after the shot and if good tomorrow, then i think i can defer the inevitable.

so there, i'm going to hit the bike, read, and do a sprint or two, then shower, and work tomorrow with joy and bounce in my step.

what are you doing to take care of yourself today?

Sunday, May 29, 2011

bikini bodies - few and far between

i've been real busy lately, so i have not taken time to blog. today my oldest daughter, lydia, graduated h.s. after many grueling years of late nights and drama. off to college next fall - bates, in maine - and independence, a phase i hope she finds every bit as enjoyable as the one i'm in now that she is leaving to find adulthood. not that i won't miss her; rather, i'm so proud of her and so respectful of the work she has done that her departure is a source of joy - because i know she can do what she sets out to do. a parent's fantasy....

but this blog is about what you set out to do - to be independent of society's imposition on your self concept. you see, bikinis are, by their design, esp nowadays, exposing, not just revealing, and they show way more than most women feel comfortable showing. and for those of us who are body watchers, they also show way more than we want to see. but they are really cover-ups that enable women to share in sun and fun, and to that extent should not be frightening - except for those involved heavily with dermatologists or dermatological issues. you see, very few women have 'perfect' bodies, with 'perfect' skin that does not wrinkle or sag, and that is disturbing to them, so much so that they even resist wearing any bathing suits - they wear loose fitting garb with shawls or cover-ups that look comfy but can't be swum in. i have seen this with lydia, who has a nice figure but excess fat. hence, she has spent the past 2-3 summers nearly refusing but definitely fearing to wear even a bathing suit let alone a bikini.

now, i am a body watcher. i am a critic of what the female, and male, body looks like. but i attest that my repulsion of some bodies results not from their appearance alone but from their lack of fitness. many a young female wear a bikini or even just a pair of tight pants with bare midriff, and don't look good despite youthful skin. like my daughter, they are out of shape with no obvious intent to alter it. what with a better diet and some exercise, they could proudly expose as much as they are comfortable exposing without exposing/revealing their inner fears. perfect - no; but happy with their bodies' abilities to do what they do to be healthy and fit; happy that they're treating their bodies with respect by feeding them healthy diets; and happy that, despite being less than perfect, they are not even striving toward it - they are enjoying themselves at the beach or by the poolside. it is how this article concludes and why i propose that women get out their bathing suits and maybe even their bikinis and show off what they've been doing to take care of themselves, rather than try to please the mass-media image of beauty or even their own self concepts.

but first, do take care of your bodies: http://www.nytimes.com/2011/05/26/fashion/the-bikini-as-a-badge-of-fitness.html?ref=health

Friday, May 20, 2011

the pain and pleasure of exercise

an interesting article in the Times debated, or better still explicated, the contention many athletic and competitive people make when they say they love exercising through the pain. it concludes that pain, as some describe it, is not really pain as our nervous system might describe it: http://www.nytimes.com/2011/05/17/health/nutrition/17best.html?_r=2&src=me&ref=health

having trained and competed in a sport - tae kwon do - inspired by causing pain in others (but unmistakeably causes pain in the athlete trying to cause it to the other - ask any boxer) i know a little about the pain and pleasure of training. to be honest, i never incurred serious pain - unless you want to include getting kicked in the groin, having serious tendon and bone injuries, etc as serious pain - but i do know that euphoria that takes place AFTER it's all over. man, it's great when class is over and you and your colleagues limp out of there like limp noodles all wet and droopy. what pleasure!

honestly, tho, all athletes know of someone who actually did compete in serious if not life threatening pain, and what kind of reward must have been offered to make it possible for them to continue?

i would argue on a third definition as from the two in the article above: the pleasure of communal experience.

much like laughter or the thrill of a last-second, game-winning goal, the joint sharing of that experience is often enough to drive athletes to work through the pain, and i do mean real pain. we see this in sport, we see it in the military (read "lone survivor" about the Navy SEALS team that fought its way to nearly-complete destruction in afghanistan), and we even see it in business. yes, in business, esp in fast-paced, hi-caliber team-decision making businesses, like marketing and advertising, where groups work together on projects often into the wee hours of the morning for days or weeks on end, suffering each others attitudes, ideas, idiosyncrasies, and personalities, if not eating behaviors and body odors, all for the common goal, the one they are all striving to accomplish in competition with inside or outside competitors. all enduring pain for the common pleasure of victory.

now, is this truly pain? this is like asking if people with depression are really depressed. mental pain, accompanied by physical discomfort, is pain, too. is it equal to the pain of extreme hunger - see http://www.healthcanal.com/mental-health-behavior/17301-Does-Eating-Give-You-Pleasure-Make-You-Anxious.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+healthnewshc%2FOxfp+%28Health+News+from+HealthCanal.com%29 - to get a new perspective on that. anorexics, for example, don't feel pleasure from food; they feel anxiety. and brain scans show it. is it equal to the pain of having your leg blown off by a mine? how many acts of bravery and grit in battle are noted because of the extremity of physical damage to the perpetrator, all to be overcome, or discounted, for the pleasure, if you can call it that, of standing alongside one's buddies and comrades during difficult times?

no, i would argue that pain is pain, and that sometimes, in certain circumstances, with certain people by your side, the pain you are willing to endure is not only real, it's even enjoyable in a certain kind of way. it's what makes us, as individuals and as a group of whatever sort, better.

Sunday, May 1, 2011

mind vs body, or mind & body...or mind BECAUSE of body? those are the questions. whether tis nobler to develop the brain whilst allowing the body to rot from the inside out; or to develop the body and let the brain evolve into a way station fro hedonistic and/or athletic purposes; or to enable the brain to develop to its maximum if not optimal potential by both engaging it and the body in which it grows - these are the issues that keep coming up in the literature of fitness/activity and mental well-being.

thus, this piece: http://well.blogs.nytimes.com/2011/04/27/does-exercise-really-boost-your-mood/?ref=health

a lot has been published lately probably in response to the increasing numbers of baby boomers and the general aging of the population that assert exercise's value in maintaining mental function. some even allude to the anti-depressant value of exercises - done regularly, mostly aerobically, and consistently. but general moods? well, this article brings up the idea that maybe exercise in the extreme is mood altering in ways we don't want it to be. of course, extrapolating from mice to men is questionable in this case as in others.

to be fair, the authors of the study, along with the author of this article, asserted other reasons for the mice's reactions to stressors (hiding in the corner), including better survival instincts. their reactions appeared to be those of enhanced anxiety attributed to neurogenesis in the hippocampus. (other studies showed that mice with less neurogenesis in that part of the brain did not get as anxious as those with normal or more.) furthermore, other studies show that neurogenesis from running differs from other forms of neurogenesis: it actually calms you down, reduces anxiety.

so, the take home message is, don't worry, or be anxious, about growing new nerves while you run. in fact, if you run, and presumably do other forms of aerobic exercise, you actually won't worry as much as others under the same stress loads. we've known this for years, and if you are an avid exerciser, you know how much more stress you can handle than when you didn't or can't exercise. it's just that scientists are trying to figure out why.

let them worry about it.....

i came across this blog article on nutrition and thought i'd share it with you. i posted it on my facebook page, too. (STEPS Personal Fitness Training) anyway, i thought it was a valuable piece of the puzzle as most athletes and non-athletes are stymied by the many mis- and myth-conceptions of carbs and protein consumption. simply put, there is this idea that if you train empty (of blood sugar or muscle glycogen) you will get more efficient at burning fats. and there is some truth to this. however, two facts mitigate against this concept of training, esp for athletes: first, that training itself makes your body more capable of using fats for fuel in order to spare glycogen for later in the run/race; and two, burning fats is a less efficient means of producing energy and is best done at LOW intensities. thus, if you are an athlete, you are already burning fats efficiently when you perform below, say, 70% max; and since you rarely compete at that low an intensity, and need to train at higher intensities in order to raise your lactate threshold and your neurological movement patterns, why spend too much time below 70% hungry. in fact, this type of training, except for ultramarathoners who probably do compete at below 70% max, is probably counterproductive.

now, for those trying to lose weight, esp body fat, training at this or lower intensity is appropriate both for its ability to be sustainable during exercise and repeatable on a near-daily basis. however, one would have to train for longer periods of time to get the same caloric value of the exercise session that could be achieved if done at higher intensities. since the latter is not an option for those who are out of shape and overwt, go slow, burn fats, but mainly burn calories. that's because the ONLY way to lose wt is by creating caloric deficits, and while dieting is more efficient, as i've written before, only with exercise added into the program is wt loss truly sustainable.

so, go fast, go slow - don't matter. just GO! http://www.active.com/nutrition/Articles/The-Truth-About-Carbs-Protein-and-Performance.htm?cmp=17-4-560&page=2

Tuesday, April 26, 2011

cardio intensity, calorie burning, and you

there is enough data and now enough publicity out there to make you think you should don your old cleats and hit the track hard to get in shape, burn calories, and reduce belly fat. yes, those daunted wind sprints, today called intervals, are back chasing the aging process and all its co-morbidities. however, like time itself, you can run but you can't quite hide; it will catch up to you. it all depends on how you want to live during that phase bw birth, maturity, and death. as a friend of mine, a long distance runner and hiker and skier, said shortly after his heart event (not an attack, per se): i'd rather bust than rust. hence he takes no meds, but has simply reduced his intensity while maintaining all the quality of his active lifestyle.

based on the results of an unpublished abstract posted in the ACSM's Med Sci Sports and Exercise on line journal, 45 mins of pretty hi intensity cycling resulted in over 35% EXTRA calories burned throughout the next 14 hrs. while the article in the Times - http://www.nytimes.com/2011/04/19/health/nutrition/19best.html?_r=2&ref=science - did not delve too deeply into other studies of this topic, there are many studies that have otherwise supported this position and it is becoming so commonplace in the fitness field literature that it's almost passe to say it: work harder, smarter, and shorter and get more and better results.

but what is "harder"?

if you walk, on average, 2 miles/hr, or 30 mins/mile, then going 2.5 mph would be a sprint. now, of course, this is the kind of pace you'd see in the elderly, the advanced arthritic, or the out of shape obese. (notice i prefaced obese with 'out of shape'? that's because not all overwt folks are deconditioned; furthermore, not all overwt folks are destined to cardiovascular disease; but nearly ALLLLL deconditioned folks will get cardiovascular disease at some level assuming they live long enough.) so take your average pace/mile, speed it up, in increments until you find that pace that will stress you but not cause you distress, and consider that your harder pace. you should be able to talk but with some breath-catching bw words or phrases.

now, the issue is, what's "smarter"?

same deal as harder, except that you should be aware of your limits, orthopedically and cardiovascularly. in other words, if it hurts, that's not smart; if it aches after or esp the next day, that's almost dumb. (mind you, nearly all athletes work dumb at different cycles of their training. but they already work hard, have specific goals, and are healthier, in some ways, than non-athletes. so this rule is for those who are simply novices or casual exercisers, those for whom no high aspirations in terms of performance are driving them. in other words, for those seeking improved HEALTH!!!! so, smarter interval training should consider your health needs first. once you find your limits there, go hard enough to push toward or up to the envelope, then stay there. if even just for a few seconds, this kind of training will condition the heart muscle, the leg muscles, the fat-burning enzymes, the sugar burning capabilities, and even the brain-developing abilities.

yes, if you train smarter and harder, you will get not just harder muscles, but smarter minds. it all works.........