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?