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healthy middle aged man workout at the beach

The Aging Athlete

If you’re reading this you are likely interested in beginning or improving in a recreational activity or sport. You might want to train for stadium football, a rec team, fun runs, obstacle courses or something as major as a triathlon. While you may be anxious to jump right into a training program there are a few things you should consider such as your current activity level, current physical condition (i.e. chronic conditions, aches, past surgeries, injuries), and knowledge of physical fitness programming.

Who is the Aging Athlete?

The aging athlete can be anyone who needs to rethink their recovery strategy as it relates to the rigors of the desired/continued activity due to the aging process. Likely this is any athlete or recreational athlete in their 30’s, 40’s and beyond. The National Strength and Conditioning Association (NSCA) states, that while the cardiovascular endurance and muscular strength of older competitors or athletes are truly exceptional, even the most highly trained athletes experience some decline in performance after the age 30. As such participating in recreational sports or activities fully depends on your health and preparation and the sport or activity you are pursuing.

Before you begin you should consult with your primary health care provider (PHCP). If you’ve been cleared but inactive for any period of time complete a physical activity readiness questionnaire (PAR-Q) to ensure nothing has changed. Additionally, if you have a chronic condition, chances are your PHCP has already discussed exercise with you, and most likely gave you some general guidelines. A chronic condition defined by the Center for Disease Control and Prevention (CDC) is a condition that lasts one year or more and requires ongoing medical attention or limits activities of daily living or both. This does not preclude you from participating in recreational sport or activity necessarily, but it is a factor to be taken into consideration. You may be asking yourself, is this something I can do? Is this something I can do on my own? Do I need a trainer? How do I know what trainer I should go to?

Is this something you can do on your own?

The answer is yes, with this caveat. Unless you have a background in exercise, likely there will come a point when you will need someone to reach out to for advice. If that happens reach out to a professional with the appropriate qualifications. Frequently, I have heard gym members echo comments questioning the validity or worth of paying someone to do something they can do on their own. They often do not realize or recognize that hiring a professional who is educated and experienced in strength and conditioning is more than just programming exercise, it’s also injury prevention. Activities, movements, or lack of recovery may not have caused injury in the past, but as we age the dynamic changes, and to remain healthy and injury free, we must change. Commonly people just work around injuries, avoid certain exercises, or reduce intensity and accept that’s just part of aging, so they press forward. However, if they would have consulted with a fitness professional they may have found a better more comprehensive solution.

Working around past injuries is a useful and worthy approach, if done correctly. However, the truth is that most of those injuries are a result of their habits. Perhaps they have been predominantly inactive, spending much of the day sitting. Perhaps they were training hard without any or little variation in intensity, without any or little variation of joint movement, and without any or little variation in program design. These all add up to repetitive stress injuries. Common repetitive stress injuries often appear as bursitis, arthritis, tendonitis, and lower back pain/injuries.

That is not to say you cannot do this on your own nor that you need a trainer or will always need a trainer. It is to communicate the point that we do not inherently know how to exercise properly. Many in their youth have participated in sports, and the programs they were taught may be missing some crucial elements to keep them healthy and pain free. These elements are missing sometimes because years ago we did not have the information we have today. Sometimes it’s because we only remember some of what we were taught, and other times it’s because we have aged, or our physical needs have changed and require a change in programming.

If you’ve never exercised before, it’s recommended you either take a few classes (not a fitness class such as spin, but an instructional class offered at a gym, YMCA, or college) or hire a trainer for a short period of time. Perhaps you are on the fence on taking a class or seeing a trainer. If that is the case, ask yourself these questions:

Are you developing aches and pains that are lasting for longer periods of time?
Do you know what a plane of motion is, and how to exercise your joints in each plane of motion?
How often do you change your program? Do you have a chronic condition?
Are you developing lower back, knee, or hip pain?

The answers to these questions can give you a good sense of whether you may benefit from seeking professional assistance or instruction.

The Key is Individualized Programming

Assuming your destination is recreational sports and activities or even occupational activities the program should be appropriately progressed in intensity, duration, and specificity to get you to your desired destination.  Repetitive stress injuries occur because one set of tissues in the body/muscle/joint continue to be challenged in the same way at the same spot over, and over again. By taking your occupation, past activities or recreational sports into account your program can be structured to bring the proper balance of strength, and flexibility to the areas that may be neglected or strained. Below is a list of general guidelines if you’re choosing to do this on your own:

General

  • It is recommended you undergo a health screening by your PHCP prior to beginning
  • Cardiovascular and resistance training are both recommended, intensity in both depend on your medical clearance, training status, and sport of choice
  • Perform exercise through a full pain free range of motion, and do not exercise if the joint is in pain or inflamed3
  • Listen to your body, and when in doubt seek guidance from a qualified fitness professional

Resistance, Cardio and Sport Specific Exercise

  • Warm-up for 5-10 minutes with low-moderate aerobic activity and calisthenics, and perform static stretching after the warm-up and at the end of the workout2
  • For cardiovascular/endurance perform 20-60 minutes of large-muscle aerobic activity most days at an intensity of 60%-90% of age-predicted heart rate1
  • If you have been sedentary or are just beginning, resistance train no more than twice a week, allowing 48-72 hours to recover, as you progress you can workout daily with different muscles groups at different intensities each day2
  • Focus on mastering basic resistance exercises then implement exercises that are more sport specific, as well as balance, free weights, multi-directional, multi-joint, and power/agility exercises2
  • Begin doing 8-12 repetitions of a weight that is equal to 50% of your maximum weight and gradually increase to up to 80% of your maximum weight, weight should be lifted and lowered in a controlled manner, and at a slower speed in the beginning (2 seconds for the lifting phase, and 2 seconds for the lowering phase), for 1-3 sets2
  • Take 1-3 minutes of rest between sets3
  • Avoid holding your breath during exercise2
  • Once you’ve advanced to power/speed training, perform 1-3 sets per exercise at 40-60% of your maximum weight and 6-10 repetitions at a high (but controlled) speed2
  • Train each joint in multiple directions (ie. planes of motion). For example, the hip can perform flexion, abduction, adduction, or circumduction.

What Should I look for in a Trainer?

If you elect to see a trainer there’s a few things you want to look for. You want a trainer with verifiable experience, an accredited certification/college degree, and liability insurance. The fitness industry is largely unregulated and there is some debate among which certifications are the best. A good place to start is the MedFit Network as trainers have to meet professional criteria in order to be listed. Additionally, it is important that their experience and background suits them to your specific needs. If you have a chronic condition, dealing with pain or have past injuries these are areas you want to be confident they can serve. As you are either engaged in athletic activity or want to engage in athletic activity it is important that the trainer have a solid foundation of periodization, and athletic performance. Quack science and self-professed gurus have no place here. The trainer’s practices should be founded in the principles set forth by the American College of Sports Medicine (ACSM), and the National Strength and Conditioning Association (NSCA). Most trainers offer a free assessment, which gives them an opportunity to learn about you, and you to learn about them. Be sure to meet with several trainers and ask for client references. This is a reasonable request and a quality trainer will not take offense. Lastly, if something feels off, seek a second opinion.

When undertaking rigorous activity and sport, there are other services you may want to consider, or discuss with your PHCP such as massage therapy, nutritional counseling, or chiropractic care depending on your needs. Remember one size does not fit all and by keeping your health in balance now you will be able to continue to enjoy the activities and sports you love for years to come.


Jeremy Kring, holds a Master’s degree in Exercise Science from the California University of Pennsylvania, and a Bachelor’s degree from Duquesne University. He is a college instructor where he teaches the science of exercise and personal training. He is a certified and practicing personal/fitness trainer, and got his start in the field of fitness training in the United States Marine Corps in 1998. You can visit his website at jumping-jacs.com

References

  1. Jacobs, P. L. (2018). NSCAs essentials of training special populations. Champaign, IL: Human Kinetics.
  2. Haff, G., & Triplett, N. T. (2016). NSCAs essentials of strength training and conditioning. Champaign, IL: Human Kinetics.
  3. Brown, L. E. (2017). Strength training se/National Strength and Conditioning Association. Champaign, IL: Human Kinetics.
spinning-HIIT

HIIT Diabetes Before Diabetes Hits You

What is HIIT and Its Benefits for Those with Type 2 Diabetes?

So, you’ve heard the buzz in the media about HIIT, its impact on weight loss and cardiovascular benefits and are wondering, could HIIT be for me?  As a diabetic, someone with insulin resistance or one at high risk for either, you have likely heard the benefits of exercise, its impact on your blood sugar, and how your weight plays a role in all of it. However, you may be wondering is this safe? What should I do? How do I get started? What should I know?

There are four huge reasons to incorporate HIIT into your regimen (assuming you’re cleared by your physician).

  • It can improve insulin sensitivity (resistance)1
  • Improves cardiovascular health and reduces risk of cardiovascular disease (CVD)5
  • HIIT burns more calories per minute compared to Moderate Intensity Continuous Training (MICT) 6
  • Requires less time per session to receive the same or increased health benefits

What Exactly is HIIT?

HIIT stands for high intensity interval training. There are many HIIT program variations but what makes a program HIIT is that it has an element of high intensity exercise, and an element of low to moderate intensity exercise executed in revolving intervals.  An example is if someone used an exercise bike they might bike as fast as they can for 20-30 seconds, and immediately afterward slow down to a slow to moderate pace for 1-2 minutes. They might repeat these timed intervals for a period of 10-30 minutes. HIIT can take many different forms and incorporate various high intensity intervals, as well as various different types of exercises. Therefore, there may be some HIIT programs that are appropriately challenging and yielding a multitude of benefits and others that may be excessively intense or place too much stress on the joints. Here’s what you need to know: how to gauge your levels of intensity, HIIT program options, and what programs may be appropriate for you (with clearance from your physician), and things to be aware of.

Let’s Talk About Intensity

Intensity refers to the level of exertion of the heart. Vigorous/High intensity can be defined as activity that is at 6 or more METs (metabolic equivalents).8 However, this definition is not practical for the everyday participant. A more practical way of identifying the level of intensity that you’re working at is illustrated below:

  1. Light – This exercise creates a barely noticeable change in breathing, involving the beginning of an increased depth of each breath.
  2. Moderate – Activity that requires increased breathing but you can still carry on a conversation.
  3. Vigorous – Activity that is demanding to the point that talking cannot be maintained during activity.
  4. High – This is near maximal effort, and can only be sustained briefly.8

HIIT Program

As mentioned HIIT programs come in many different layouts, shapes and sizes. In most studies they use walking or biking as the exercise and use various rest, or active recovery intervals (very/light intensity recovery exercise). For example, in one study they had one group of participants perform one min high intensity biking followed by one minute of rest, which repeated ten times. They had a second group that performed two minutes of high intensity biking followed by one minute of rest, which repeated five times.3 In another study they took a group and used a range of 15-60 seconds of high intensity exercise followed by one minute of active recovery.6 The training sessions conducted in these studies typically lasted approximately 20-30 minutes and yielded better results than the moderate intensity continuous training (MICT) protocols they were compared to.6 The MICT done in the study was biking at a steady pace at a moderate level of intensity for up to 45 minutes. This illustrates just how much more effective HIIT can be than traditional cardio.

However, to be clear HIIT training is not appropriate for everyone, and if any doubts remain be sure to contact your physician. The American Diabetes Association recommends a 12-point electrocardiogram be performed on those with type II diabetes prior to beginning a vigorous training program, and while HIIT is not a prolonged vigorous training regimen, you should consult with your physician as a precaution.7

What Programs are Appropriate for You?

While some critics of HIIT argue that the high intensity increases participant dropout rates, the truth is you won’t know if it’s enjoyable or even tolerable unless you give it a try. Additionally, you may not like one HIIT program, but may find you like another. In all cases, it is recommended that you start at either a moderate or light intensity gradually increasing to higher intensities over time.8

What should I be aware of when undergoing a HIIT program

Specific to type II diabetes, you should be aware of:

  • Any medical restrictions that apply to you, especially if you have additional chronic conditions in addition to diabetes
  • How your blood sugar is affected and how to apply this to proper medication dosages
  • Qualifications of the instructor carrying out the program
  • Allowing your instructor to be aware of your health status or condition(s)
  • Find out if there are any high orthopedic stress or ballistic movements, in the program you’re considering. If you’re just starting (i.e. you have not been conditioning for a minimum of month), movements you may want to avoid in the beginning are:
    • High knees, jumping lunges, jumping squats, running/sprinting, and any movement that pounds on your joints

Consideration Regardless of Exercise Type

There are times when you should not exercise on a given day such as:

  • If you have a fever (over 101F)
  • If you have a new illness that has not been treated
  • If ambient temperature and humidity are excessive
  • If exercise causes pain8
  • If you have infection/mucus in the lungs

There may also be times when you should stop exercising and/or ask for guidance such as:

  • If you feel chest discomfort
  • If you unexpectedly have an irregular heart rhythm
  • If you feel dizziness or lightheadedness during exercise, or you have dizziness or lightheadedness that does not resolve after you stop exercising
  • If you experience leg cramps that persist after stopping exercise
  • If your vision is blurry8

In Closing

HIIT has proven to be an effective training protocol that can yield heightened health benefits in less time than traditional moderate intensity continuous training (MICT). For those with type II diabetes, insulin resistance, or are at increased risk of either, HIIT can help you increase insulin sensitivity, reduce cardiovascular risk, and be an effective part of a weight loss program. Like any exercise program it comes with a measure of risk and is not suitable for everyone. Participate within the parameters set by your physician, and be sure to listen to your body.


Jeremy Kring holds a Master’s degree in Exercise Science from the California University of Pennsylvania, and a Bachelor’s degree from Duquesne University. He is a college instructor where he teaches the science of exercise and personal training. He is a certified and practicing personal/fitness trainer, and got his start in the field of fitness training in the United States Marine Corps in 1998. You can visit his website at jumping-jacs.com

References

  1. Madsen, S. M., Thorup, A. C., Overgaard, K., & Jeppesen, P. B. (2015). High Intensity Interval Training Improves Glycaemic Control and Pancreatic β Cell Function of Type 2 Diabetes Patients. PLoS ONE, 10(8), e0133286. http://doi.org/10.1371/journal.pone.0133286
  2. Marcinko, K., Sikkema, S. R., Samaan, M. C., Kemp, B. E., Fullerton, M. D., & Steinberg, G. R. (2015). High intensity interval training improves liver and adipose tissue insulin sensitivity. Molecular Metabolism, 4(12), 903–915. http://doi.org/10.1016/j.molmet.2015.09.006
  3. Smith-Ryan, A. E., Trexler, E. T., Wingfield, H., & Blue, M. N. M. (2016). Effects of high-intensity interval training on cardiometabolic risk factors in overweight/obese women. Journal of Sports Sciences, 34(21), 2038–2046. http://doi.org/10.1080/02640414.2016.1149609
  4. Shepherd, S. O., Wilson, O. J., Taylor, A. S., Thøgersen-Ntoumani, C., Adlan, A. M., Wagenmakers, A. J. M., & Shaw, C. S. (2015). Low-Volume High-Intensity Interval Training in a Gym Setting Improves Cardio-Metabolic and Psychological Health. PLoS ONE, 10(9), e0139056. http://doi.org/10.1371/journal.pone.0139056
  5. Phillips, B. E., Kelly, B. M., Lilja, M., Ponce-González, J. G., Brogan, R. J., Morris, D. L., … Timmons, J. A. (2017). A Practical and Time-Efficient High-Intensity Interval Training Program Modifies Cardio-Metabolic Risk Factors in Adults with Risk Factors for Type II Diabetes. Frontiers in Endocrinology, 8, 229. http://doi.org/10.3389/fendo.2017.00229
  6. Jung, M. E., Bourne, J. E., Beauchamp, M. R., Robinson, E., & Little, J. P. (2015). High-Intensity Interval Training as an Efficacious Alternative to Moderate-Intensity Continuous Training for Adults with Prediabetes. Journal of Diabetes Research, 2015, 191595. http://doi.org/10.1155/2015/191595
  7. Francois, M. E., & Little, J. P. (2015). Effectiveness and Safety of High-Intensity Interval Training in Patients With Type 2 Diabetes. Diabetes Spectrum : A Publication of the American Diabetes Association, 28(1), 39–44. http://doi.org/10.2337/diaspect.28.1.39
  8. Moore, G. E., Durstine, J.L., & Painter, P. (2016). ACSM’s exercise management for personals with chronic diseases and disabilities. Champaign, IL: Human Kinetics.

 

 

Electronic bathroom scale and glucometer with result of measurem

Going Beyond Diabetes Treatment: Exercise!

There are many treatments for Type II Diabetes (which will be referred to simply as diabetes in this article) but none come with the level of benefits seen by the implementation of a proper exercise program. This is a tall order but exercise is effective for the treatment of insulin resistance and diabetes in three areas. These areas are inflammation, the cell mitochondria (where the cell generates power), and hyperinsulinemia (high blood insulin).2 Treating these areas with exercise goes beyond the benefits of treating just diabetes. In turn, you will be helping prevent other health issues associated with diabetes such as heart disease, stroke, and circulation issues. The questions is how does exercise do this and what kind of exercise is necessary?1

To understand how exercise treats diabetes, it is important to understand that diabetes is the end result of insulin resistance. Insulin resistance can be illustrated in that: when we eat something with carbohydrates or sugar, our body breaks it down into blood sugar known as glucose. This glucose triggers a response from our pancreas to produce the hormone insulin. Insulin in turn shuttles the blood sugar into the cells to be used as energy. However, when someone becomes insulin resistant the cells do not respond to the insulin’s attempt to shuttle the blood sugar into the cell, so the pancreas produces more insulin to get the same job done. In essence, the cells are developing a tolerance to the insulin and in order to get the blood sugar absorbed the cells begin to require more and more insulin to do the same job. This leads to the blood retaining the blood sugar for prolonged periods of time as well as an elevated presence of insulin. When someone has prolonged high blood sugar, we call this hyperglycemia and the person is said to be diabetic. Having high blood sugar is dangerous due to the stress it places on cells. It can cause many problems up to and including death.

In the area of inflammation, it is known that not all inflammation is the same. Inflammation can be acute — meaning it is brought on for a short period of time — which happens with activities such as exercise or when tissue undergoes some sort of trauma. Inflammation can also be chronic, meaning it is persistent and recurrent.

Acute inflammation is necessary, and healthy, because it begins the healing and repair process by bringing in white blood cells, and ridding the tissue of damaged cells. Inflammation is required otherwise the body would be unable to heal.

Chronic inflammation can be found in many conditions, such as autoimmune diseases, prolonged injury/infection, obesity, diabetes and other chronic diseases. When inflammation remains present, even at a low level, it begins to damage the body’s cells. Science now knows that:2

  • Obesity creates a level of chronic inflammation.
  • Inflammation is the precursor to every chronic disease including heart disease, arthritis, and cancer.
  • Inflammation suppresses the insulin signaling pathway (how insulin and your cells communicate) which is believed to be related to a reduction of a heat shock protein, this protein however, can be increased through exercise.
    • Increases of the protein begin after the first session of exercise.3

You may remember from science class the power generator of the cell is the mitochondria. This is where the energy is created from fatty acids and glucose. It is now believed that when the mitochondria of the cell becomes dysfunctional, less fatty acids are taken in, elevating fat (lipids) in the blood, and increasing fat storage. It is also believed that the cell becomes dysfunctional as a result of insulin resistance. This relationship may then further feed into the increased body fat and increased inflammation. Further scientific studies in this area have determined that:

  • Proper exercise increases mitochondrial efficiency, proper exercise being summarized as:
    • No less than 150 minutes of moderate activity per week but ideally more than 250 (start light and increase intensity).
    • Incorporate a combination of resistance exercise (i.e. calisthenics and weights) and cardiovascular exercise.
    • Supervision by a registered clinical exercise physiologist if two or more chronic conditions are present is recommended.4
    • Exercising following an interval training protocol ranging from 70-90% of maximal heart rate may provide superior results if tolerable by participant.5
  • It is well known that aerobic training increases the number of mitochondria in muscle fibers in order to increase the delivery of oxygen to the muscle. More mitochondria means more energy that can be generated within the cell.

Hyperinsulinemia is best described as an elevated level of insulin relative to the amount of glucose (blood sugar) present in the blood. This may be the truest indicator of someone who is insulin resistant and about to become diabetic.6 In the beginning, it was illustrated how insulin resistance develops, and it being characterized as requiring more insulin to do the same job. This additional insulin is the definition of hyperinsulinemia. When someone has hyperinsulinemia it can be expected that in a matter of time, even higher levels of insulin will be required as the cell increases its tolerance to the insulin. Eventually the pancreas will not be able to produce the level of insulin required to lower blood sugar and the person will be said to have hyperglycemia, and will be classified as diabetic. When someone is experiencing hyperinsulinemia, they are already experiencing inflammation, and a weakening of the insulin signaling pathway (ways the cells communication for glucose uptake), and likely a dysfunction of the mitochondria, which in turn may magnify the issue further.

What is known is:

  • Exercise lowers glucose in the presence of insulin, and thus exercise will lower both glucose and insulin levels.
  • If you’re currently diabetic and taking insulin, the amount may likely need reduced prior to exercise.
  • Consistent proper exercise may lead to the need to have a physician re-evaluate dosage or usage of insulin and/or pills (i.e. metformin). Never discontinue use of a medicine without consulting with your physician.

Proper exercise not only goes beyond the treatment of diabetes to the treatment of the cause (insulin resistance), it helps prevent other health issues that stem from diabetes. Health issues such as cardiovascular disease, stroke, and issues with circulation dramatically decrease with exercise. Also, remember diabetes aside exercise reduces risk of nearly every chronic disease.1


Jeremy Kring holds a Master’s degree in Exercise Science from the California University of Pennsylvania, and a Bachelor’s degree from Duquesne University. He is a college instructor where he teaches the science of exercise and personal training. He is a certified and practicing personal/fitness trainer, and got his start in the field of fitness training in the United States Marine Corps in 1998. You can visit his website at jumping-jacs.com

References

  1. Booth, F. W., Roberts, C. K., & Laye, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology, 2(2), 1143–1211. http://doi.org/10.1002/cphy.c110025
  2. Ye, J. (2013). Mechanisms of insulin resistance in obesity. Frontiers of Medicine, 7(1), 14–24. http://doi.org/10.1007/s11684-013-0262-6
  3. Matos, M. A. de, Ottone, V. de O., Duarte, T. C., Sampaio, P. F. da M., Costa, K. B., Fonseca, C. A., … Amorim, F. T. (2014). Exercise reduces cellular stress related to skeletal muscle insulin resistance. Cell Stress & Chaperones, 19(2), 263–270. http://doi.org/10.1007/s12192-013-0453-8
  4. Moore, G. E., Durstine, J.L., & Painter, P. (2016). ACSM’s exercise management for personals with chronic diseases and disabilities. Champaign, IL: Human Kinetics.
  5. Roberts, C. K., Hevener, A. L., & Barnard, R. J. (2013). Metabolic Syndrome and Insulin Resistance: Underlying Causes and Modification by Exercise Training. Comprehensive Physiology, 3(1), 1–58. http://doi.org/10.1002/cphy.c110062
  6. Paniagua, J. A. (2016). Nutrition, insulin resistance and dysfunctional adipose tissue determine the different components of metabolic syndrome. World Journal of Diabetes, 7(19), 483–514. http://doi.org/10.4239/wjd.v7.i19.483