What Exactly is Exercise?
What is Exercise?
It’s obvious isn’t it?
Seems like a dumb question right?
Understanding Osteoarthritis
Osteoarthritis (OA), the most common form of arthritis, affects some 27 million adults per year and is on the rise. The Centers for Disease Control and Prevention (CDC) estimates that in 2005, self-reported arthritis or other chronic joint symptoms affected approximately 21.4 million Americans aged 65 years and older. This estimate is expected to reach 41.1 million by 2030. Osteoarthritis makes simple movements and activities of daily life painful and difficult to perform.
Osteoarthritis typically occurs in the hands, knees, spine and hips affecting a multitude of joints. Those affected with OA will typically complain of symptoms of stiffness, low-grade inflammation and pain. This stiffness and pain are most prevalent in the morning which improves with activity and as the day progresses.
Pathology
The cause of OA involves a combination of mechanical, cellular and biochemical changes. The processes involves changes in the composition and mechanical properties of the articular cartilage. Cartilage is comprised of water, collagen and proteoglycans, In healthy cartilage, there is continual remodeling that occurs as chrondocytes (cartilaginous cells) replace macromolecules that are lost through degradation. In Osteoarthritis, this process is disrupted leading to degenerative changes and abnormal repair response. 2
Contributing Factors
Despite increasing awareness of the negative effects of obesity on health and OA in particular, the prevalence of individuals who are overweight or obese is increasing. Data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2000 show that 64.5% of the US population is overweight, including 30.5% classified as obese. Carrying extra weight places biomechanically places increased stress and force on the weight bearing joints. Other common risk factors include joint injury, mechanical stress, history of immobilization and trauma.
Medical Management
Arthritis treatment first begins with education. Treatment for osteoarthritis can help relieve pain and stiffness, however the condition can progress. Physicians will tend to focus to help those afflicted with OA by helping patients manage their pain. There are several ways to do this. The first commonly used approach is pharmacologic intervention. Traditional non-steroidal anti-inflammatory drugs(NSAIDs) have been shown to be effective for OA pain, and are perceived as second-line drugs for the treatment of mild to moderate OA.
Physical therapy is very effective in helping those suffering with OA. Where the focus is on helping the patient by improving their muscle flexibility, joint mobility and strengthening the weaker hip musculature. Resulting in improved mobility, function, decrease pain and improved quality of life.
Training Recommendations
Because arthritis is a “process,” the most effective training is education and prevention. From a cardiovascular perspective, a cardiovascular program should be tailored to the client. A recumbent or stationary bike is a great starting point to reduce the load to the hips and knee which can be progressed to the elliptical machine. Stretch the tight (postural) hip flexors and quadriceps seen in figure one will reduce the load to the knee joint. Yoga can also be an effective intervention which will improve flexibility, balance, strength and body awareness. Strength training should focus on targeting the weaker phasic muscles; glute maximus, glute medius/minimus as seen in figure two. These muscles are necessary for everyday movements such as arising from a chair, climbing stairs, and negotiating uneven surfaces.
Figure 2. (right) Posterior muscles of the hip complex
Strengthening the core begins with simple exercises such as bridging with the ball (figure three), targeting glute maximus, hamstrings, and the lower back musculature. This can be progressed to having the client hold longer or to perform a single leg bridge. Functional strengthening exercises such as reverse lunges holding a medicine ball that can be progress to either holding overhead or adding trunk rotation will do two things. four and figure five). The use of aqua therapy can also be effective which eliminates gravity resulting in a client’s ability to strengthen their lower body in a relaxed environment.
Figure 5. (right) Diagonal lunge with trunk rotation with medicine ball
Summary
Arthritis continues to affect many individuals for various reasons. One thing is certain, knowledge, prevention and early screening is fundamental. Understanding the pathological process and medical approach is the first step in helping your clients with OA. Refreshing yourself on anatomy, biomechanics and understanding proper exercise prescription is fundamental. Any exercise program should be individualized resulting in improved function.
Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, C-IASTM, NASM CPT. Chris is the President of Pinnacle Training & Consulting Systems, LLC. A consulting and education company that is committed to creating and providing evidenced based educational material in the form of home study courses, dynamic live seminars, mini-books, DVD’s on the areas of; human movement, fitness and rehabilitation with unique practical application. Chris has 20 years clinical experience having worked with primarily orthopedic patients, spinal injuries, post-surgical conditions, traumatic and sport specific injuries and 20 years as a personal trainer. For more information, please visit www.pinnacle-tcs.com.
REFERENCES
- David M Lee et al. Rheumatoid Arthritis. The lancet. Vol. 358. September 2001. pp: 1240-1242.
- Hinton et al. Osteoarthritis: Diagnosis and Therapeutic Considerations. Journal of American Family Physician. 65(5) Pgs: 841-849. 2002.
- Weinblatt ME, Maier AL, Fraser PA, Coblyn JS. Long-term prospective study of methotrexate in rheumatoid arthritis: conclusion after 132 months of therapy. Journal of Rheumatology. 25: pp: 238–42. 1998.
- Kremer JM. Safety, efficacy, and mortality in a long-term cohort of patients withs rheumatoid arthritis taking methotrexate: follow-up after a mean of 13·3 years. Arthritis Rheumatology. 40: pp: 984–85. 1997.
- Tugwell P, Wells G, Strand V, et al. Clinical improvement as reflected in measures of function and health-related quality of life following treatment with leflunomide compared with methotrexate in patients with rheumatoid arthritis: sensitivity and relative efficiency to detect a treatment effect in a twelve-month, placebo-controlled trial. Arthritis Rheum. 43: pp: 506–14. 2000.
- Schneider, Rayfel. Et al. Rheumatology Disorders Clinics of North America. 28. pp: 503–530. 2002.
- Braun, Jurgen et al. Ankylosing Spondylitis. The Lancet. 369, 9570; Research Library. pp. 1379. 2007.
- Ding, T., Deighton, C. Management of Rheumatoid Arthritis. Journal of Medicine. Volume 38. Issue 4. 2009. pp: 172-1769.
- Calin, A. Ankylosing Spondylitis. Journal of Medicine. Volume 34. Number 10. pp: 396-399. 2006.
- Litman, D. Maximizing Success in Osteoarthritic Care: Benefits of a comprehensive Management Approach. Internet Journal of Rheumatology. Volume 5. Issue 2. pp: 1-2. 2008.
Fall Prevention: It’s Not Just Physical!
As a fitness professional or caregiver, what are you doing to help reduce the risk for falls? You may be reinforcing the importance of exercises that promote strength, balance, flexibility, and mobility, but are you aware that decreasing fall risk requires a multi-pronged approach? It’s time to reimagine what we know about reducing falls to better serve our clients of all ages and fitness levels.
Are you aware of these crucial fall risks and are you infusing these fall prevention best practices?
1. Proprioception
What is proprioception? Proprioception is the ability of your muscles and joints to determine where they are in space. The proprioceptive nerve endings in the body provide us with the information of where our hands, arms, and legs are in space without having to look at them. 1
Proprioception results from sensory receptors in your nervous system and body. Most of these receptors are located in your muscles, joints, and tendons, and when you move, the
receptors send detailed messages to your brain about your positions and actions. Your brain processes these messages and works with your vision, nervous system, and vestibular system to create your perception of where your body is and how you’re moving.2
As a fitness professional, it is important to address coordination and balance issues through various modalities when designing a movement session. For example, incorporating proprioception specific movements will not only reduce muscle deterioration, but also reduce risk of injuries from falls.
Have you tried these?
- Tai chi or Vinyasa Flow Yoga can boost proprioception in the legs
- Seated or Standing Core exercises to increase balance
- Pushing & Pulling (compresses & stretches nerve endings) to increase stability
- Self-hugging and releasing, squeezing playdough or touching fingers together for body awareness
- Stack objects like books and practice carrying them from one place to another
- Eyes Closed Prompted Movements: “Touch Left Elbow with Right Pointer Finger”
2. Brain Health
“In older people who had no signs of disease that would make them prone to falls, higher levels of activity in the front of the brain, called the prefrontal cortex, were associated with a higher risk of falls later in life.” 3 The prefrontal cortex, the area of the brain where goal setting and decision-making takes place, is just one part of the brain that has been linked to fall risk.
These exercises help to light up the prefrontal cortex and other parts of the brain responsible for improving reaction time, coordination and balance.
- Dual-Tasking
- Add questions or engage in conversation
- Listen to Music with or without words
- Tell stories and ask comprehension questions
- Play “Alphabet” or various memory games
- Number exercises and call out numbers
- ie. Right punch #1, Left punch #2, Right Kick #3, Left Kick #4
3. Hydration/Nutrition
In a 2015-2018 study by the CDC, “US adults drank an average of 44 ounces” of water, well below the recommended amount of fluid intake for a day. 4 As a fitness professional, being aware of the risk for dehydration is the first step to averting it. While dehydration can have serious mental and physical consequences, it is important to know that it is both preventable and treatable.
Many people, especially seniors, resist drinking a lot of water because they worry about falling if they have to take frequent trips to the bathroom. In fact, dehydration may even occur due to the fear of falling if they worry about getting up multiple times at night.. Whatever the
reason, having an ongoing conversation about hydration should be built into your daily programming.5 You have the ability to ease their fears about increasing hydration to reduce falls.
Are you asking these questions?
- How many glasses of water did you drink today? Are you also drinking electrolytes?
- Do you frequently feel thirsty throughout the day? When?
- What other foods are you eating that contain mostly water? Fruits? Vegetables?
- Are you keeping a water bottle or glass of water near you throughout the day?
- What concerns you about adding more water to your daily routine? Falls? Why?
- Can you add more fruits and vegetables to your diet so you stay hydrated longer?
4. Environmental
Perhaps one of the most important, and oftentimes overlooked, fall prevention best practice is analyzing one’s physical environment.6 Reminding clients about the hidden dangers and fall risks present in and around their home may significantly reduce fall risk and prevent life-threatening injuries. Creating an inventory of common environmental risks is a great start!
Are you constantly asking them about their environment and how to make it more safe?
- What kinds of routine activities do you perform every day?
- Do you walk to the bathroom at night or rush to answer a phone call?
- Are there obstacles on the ground within the home environment?
- Pets? Small tables? Plants? Boxes? Shoes?
- Is their adequate lighting throughout your home?
- Nightlights? Hallways? Stairways? Outdoors?
- Are the floors and/or floor coverings slippery or could snag?
- Slick Flooring? Throw rugs? Thresholds?
In summary, knowledge is power and consistency is key when it comes to fall prevention. While it is paramount to create safe and effective cardiovascular, strength, balance and flexibility programs, it is equally important to address factors such as proprioception, brain health, hydration and environment? The time is now to educate yourself to best help “fall proof” your clients!
Christine M. Conti, M.Ed, BA is and international fitness educator and presenter. She currently sits on the MedFit Education Advisory Board and has been nominated to be the 2020 MedFit Network Professional of the Year. She is the author of the MedFit Classroom Arthritis Fitness Specialist Course and is the CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation. Christine is also the co-host of Two Fit Crazies & A Microphone Podcast and the co-owner of TFC Podcast Production Co. She is also the best-selling author of SPLIT-SECOND COURAGE.
References
- “What is Proprioception?” Your Therapy Source. 22, August 2022. What is proprioception? – Your Therapy Source
- Brennan, Dan, MD. “What is Proprioception?” 27, November, 2021. Proprioception: What It Is, Disorder, Symptoms, and More (webmd.com)
- “Brain Activity May Predict Risk of Falls in Older People.” American Academy of Neurology. 7. December, 2016. 26. August, 2022. Brain Activity May Predict Risk of Falls in Older People (aan.com)
- “Get the Facts: Data and Research on Water Consumption.” Center For Disease Control. 7. June, 2022. Get the Facts: Data and Research on Water Consumption | Nutrition | CDC
- “Dehydration in Elderly People: Risks, Warming Signs, and Prevention Tips,” Great Senior Living. 7, June, 2021. Dehydration in Elderly People: Risks, Signs & Prevention (greatseniorliving.com)
- Buxton, William G., MD. “Fall Prevention & Balance Treatment.” Pacific Brain Health Center. 22 December, 2021. Fall Prevention & Balance Treatment | Pacific Brain Health Center
Turning Back the Clock on Aging
Consistent exercise and physical activity may be the closest thing we have to the “fountain of youth” in our society today. Dr. Michael Roizen, author of “The RealAge Workout”, cites studies on identical twins that show genetic inheritance influences only about 30% of the rate and way one ages – the rest is up to you!
Five Steps for Leveling Up Your Mindset
The perspective from which I want to discuss this topic today has to do with cultivating a mindset that actually allows you to reach your goals.
It’s easy to get fed up with your current situation – whether it be weight, a job, finances, a relationship or otherwise – and say to yourself “I’m done! Things are about to change!”
But then they don’t.
ADHD and (Adult) Athletes: Can diet help with management?
As a sports nutritionist, I commonly counsel athletes who have Attention Deficit Hyperactivity Disorder—generally referred to as ADHD (or ADD). ADHD is characterized by hyperactivity, impulsivity, and/or inattention. It affects 4-10% of all American children and an estimated 4.4% of adults (ages 18-44 years). ADHD usually peaks when kids are 7 or 8 years old. Some of the ADHD symptoms diminish with maturation but 65-85% of the kids with AHDH go on to become adults with ADHD.
Ideally, athletes with ADHD have gotten the help they need to learn how to manage their time and impulsiveness. Unfortunately, many youth athletes with ADHD just receive a lot of negative feedback because they have difficulty learning rules and strategies. This frustrates teammates and coaches. Older athletes with ADHD often use exercise to reduce their excess energy, calm their anxiety, and help them focus on the task at hand.
This article offers nutrition suggestions that might help coaches, friends, and parents, as well as athletes with ADHD, learn how to calm the annoying ADHD behaviors.
- To date, no clear scientific evidence indicates ADHD is caused by diet, and no specific dietary regime has been identified that resolves ADHD. High quality ADHD research is hard to do because the added attention given to research subjects with ADHD (as opposed to the special diet) can encourage positive behavior changes. But we do know that when & what a person eats plays a significant role in ADHD management and is an important complimentary treatment in combination with medication.
- ADHD treatment commonly includes medications such as Concerta, Ritalin & Adderall. These medications may enhance sports performance by improving concentration, creating a sense of euphoria, and decreasing pain. These meds are banned by the World Anti-Doping Agency (WADA) and the International Olympic Committee (IOC). Hence, athletes who hope to compete at a high level are discouraged from taking ADHD medications.
- To the detriment of ADHD athletes, their meds quickly blunt the appetite. Hence, they (like all athletes) should eat a good breakfast before taking the medication.
- The medication-induced lack of appetite can thwart the (teen) athlete who wants to gain weight and add muscle. Teens taking ADHD meds should be followed by their pediatricians, to be sure they stay on their expected growth path. If they fall behind, they could meet with a registered dietitian (RD) with knowledge of sports nutritionist (CSSD) to help them reach their weight goals.
- An easy way for “too thin” athletes to boost calories is to swap water for milk (except during exercise). The ADHD athlete who does not feel hungry might find it easier to drink a beverage with calories than eat solid food. Milk (or milk-based protein shake or fruit smoothie) provides fluid the athlete needs for hydration and simultaneously offers protein to help build muscles and stabilize blood glucose.
- A well-balanced diet is important for all athletes, including those with ADHD. Everyone’s brain and body need nutrients to function well. No amount of vitamin pills can compensate for a lousy diet. Minimizing excess sugar, food additives, and artificial food dyes is good for everyone.
- Eating on a regular schedule is very important. All too often, high school athletes with ADHD fall into the trap of eating too little at breakfast and lunch (due to meds), and then try to perform well during afterschool sports. An underfed brain gets restless, inattentive, and is less able to make good decisions. This can really undermine an athlete’s sports career
- Adults with ADHD can also fall into the same pattern of under-fueling by day, “forgetting” to eat lunch, then by late afternoon are hangry and in starvation mode. We all know what happens when any athlete gets too hungry – impulsiveness, sugar cravings, too many treats, and fewer quality calories. This is a bad cycle for anyone and everyone.
- All athletes should eat at least every four hours. The body needs fuel, even if the ADHD meds curb the desire to eat. ADHD athletes can set a timer: breakfast at 7:00, first lunch at 11:00, second lunch at 3:00 (renaming snack as second lunch leads to higher-quality food), dinner at 7.
- For high school athletes with ADHD, the second lunch can be split into fueling up pre-practice and refueling afterwards. This reduces the risk of arriving home starving and looking for (ultra-processed) foods that are crunchy, salty, and/or sweet.
- Athletes with ADHD are often picky eaters and tend to prefer unhealthy snacks. For guidance on how to manage picky eating, click here for adults and here for kids.
- Fiber-rich fruits, vegetables, and whole grains can be low on an ADHD athlete’s food list. Their low fiber diet can lead to constipation. Fiber also feeds the zillions of microbes in their digestive tract that produce chemicals that can positively impact brain function and behavior. Everyone with ADHD should eat more fiber-rich foods like beans (hummus, refried beans in a burrito), seeds (chia, pumpkin, sunflower, sesame), and whole grains (oatmeal, brown rice, popcorn). They offer not only fiber but also magnesium, known to calm nerves.
- With more research, we’ll learn if omega-3 fish oil supplements help manage the symptoms of ADHD. No harm in taking them. At least eat salmon, tuna, and oily fish as often as possible, preferably twice a week, if not more.
- Picky eaters who do not eat red meats, beans, or dark leafy greens can easily become iron deficient. Iron deficiency symptoms include interrupted sleep, fatigue, inattention, and poor learning and can aggravate ADHD. Iron deficiency is common among athletes, especially females, and needs to be corrected with iron supplements.
- While sugar has the reputation of “ramping kids up”, the research is not conclusive about whether sugar itself triggers hyperactivity. The current thinking is the excitement of a party ramps kids up, more so than the sugary frosted cake. Yes, some athletes are sugar-sensitive and know that sugar causes highs and crashes in their bodies. They should choose to limit their sugar intake and at least enjoy protein along with sweets, such as a glass of milk with the cookie, or eggs with a glazed donut. Moderation of sugar intake is likely more sustainable than elimination of all sugar-containing foods.
For more information about ADHD in kids, teens, and adults, please use these resources:
- Feeding the Child with ADHD—a podcast with Jill Castle RD
- Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) – a national resource center
Nancy Clark MS RD CSSD counsels both fitness exercisers and competitive athletes in the Boston-area (Newton; 617-795-1875). Her best-selling Sports Nutrition Guidebook is a popular resource, as is her online workshop. Visit NancyClarkRD.com for info.
12 Tips for Staying Healthy in a High Stress World
What do performing artists, professional athletes, politicians, and business executives have in common? They work long hours under the spotlight in constantly changing circumstances. They must adapt to stressful events and situations in short time frames while meeting the high expectations of themselves and others. They must perform and produce and look good doing it!
Disrupting All-or-Nothing Thinking
If you’ve ever found yourself ditching your healthy eating or exercise plan when it bumps up against a challenge that prevents you from doing it as intended – you’ve likely fell prey to “all-or-nothing” thinking.
Aging and Exercise
Time dictates so many aspects of our lives. When beginning this article, I thought to myself how much time controls my day from the seconds, minutes, and hours. And of course in relation to this piece of writing, it is the measure of our age. The aging process is unique to each of us. But ultimately, it does impact our life decisions, and that includes our exercise choices. So let’s take a look at the relationship between aging and exercise.
Naturally, activity level changes when we get older. As one of my long time clients put it, “Man, I don’t just roll out of bed anymore ready to go”. This isn’t to say that one is less motivated, rather, the energy expenditure levels are different. This is mainly due to the fact that, “A major fraction of total daily energy arises from resting metabolism, and it is thus important to note that resting metabolism decreases with aging, by about 10% from early adulthood to the age of retirement, and a further 10% subsequently.” (1) Adding to this, “One reason is the loss metabolically active muscle mass and parallel increase in metabolically inert depot fat. In later old age, there may also be some overall reduction in cellular metabolism.” (1) When muscle mass decreases, this can cause body fat to increase. Keeping the excess pounds off can get harder. As such, “Your body fat can increase by up to 30 percent, which leads to a loss of lean muscle tissue and can affect your sense of balance. This can make it difficult for you to perform exercise activities you once enjoyed.” (2)
We need to continue a strength training program in order to not let our bodies replace muscle with fat at the rate it would like to. Not to use a scare tactic but here you go: “Strength peaks around 25 year of age, plateaus through 35 or 40 years of age, and then shows an accelerating decline, with 25% loss of peak force by age of 65 years.” (1)
Exercise becomes so extremely important as we grow older. We tell ourselves that we used to be able to eat whatever we wanted and still look fabulous, but now the odds aren’t necessarily the same anymore. We have to take care of our bodies, and we can help prevent certain diseases with exercise. For example, “Your bone mass begins to decline once you enter your thirties, putting you at risk for conditions such as osteoporosis. If you are concerned about developing this condition, perform more weight-bearing exercises, such as running and tennis. Regular cardio activity will also help you control high blood pressure and high cholesterol, as well as ward off type 2 diabetes and some kinds of cancer.” (2)
As I always say, there is no can’t. That word is not allowed in my studio. There are modifications for so many exercises, and I will be by your side as we run, walk, or crawl to get it done. If we don’t use it, we lose is, right? Not every day is a peak performance day, but we do we can. As long as we are active, we are being productive to our bodies. Running a marathon might not be in the future, but what about making to your training session twice a week and keeping that commitment to your body? Goals should be realistic. Remember the glory days fondly, but know that you are keeping your mind and body in better condition and sticking around longer for your family and friends by maintaining an exercise program. Fitness is a way of life and the destination involves progress not perfection so just keep going one rep a time, one day at a time, and with every age of your life.
Originally printed on the Every BODY’s Fit Blog. Reprinted with permission.
Dr. Megan Johnson McCullough, owner of Every BODY’s Fit in Oceanside CA, is a NASM Master Trainer, AFAA group exercise instructor, and specializes in Fitness Nutrition, Weight Management, Senior Fitness, Corrective Exercise, and Drug and Alcohol Recovery. She’s also a Wellness Coach, holds an M.A. Physical Education & Health and a Ph.D in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.
References