All MFN blog Archives - Page 5 of 142

The Importance of Isometrics for the Joint Replacement Client, Part 1

Pat Marques/13 February 2024/ All MFN blog/

Isometric exercises are the most highly under-utilized form of exercise in fitness in general, but they are especially important in a medical fitness context. In this two-part blog series we’re going to discuss what isometrics are, why they are so good (especially for joint replacement fitness), and how you can use them.

In Part 1, let’s define what we are talking about.

What are isometric exercises?

Isometric exercises utilize an isometric contraction of the muscle, which is a contraction in which the muscle is neither shortening nor lengthening as the muscle contracts. A concentric contraction is when the muscle belly is shortening as the muscle contracts (e.g., flexing the elbow as you raise the weight during a biceps curl). An eccentric contraction is when the muscle belly is lengthening as the muscle contracts (e.g., extending the elbow as you lower the weight during a biceps curl).

With isometrics we are contracting/flexing the muscle, but there is no movement (shortening or lengthening) of the muscle.

What are the types of isometric exercises?

There are many ways to do isometrics, but they all essentially fall into two broad categories:

Yielding isometrics

Yielding isometrics are when you are trying to resist a force, weight, or gravity. These are sometimes called “holding” isometrics. If you were a disruptive student in gym class as a kid, like me, you may fondly remember wall sits… a great example of a yielding isometric exercise.

With yielding isometrics, think deceleration. You are essentially fighting the eccentric (lengthening) contraction. Other examples include:

Holding the top position of a chin-up for the back and biceps
Holding the top position of a push-up for the chest and triceps

You do not have to be in the fully contracted position like the two examples above. Holding a mid-range position, like the wall sits example or holding a weight halfway through a rep range, would also be a yielding isometric.

Overcoming isometrics

Overcoming isometrics are when you are trying to produce force against an object that will not move. These are sometimes called “pushing” isometrics.

With overcoming isometrics, think acceleration. You are engaging the concentric (shortening) contraction, but the shortening of the muscle is blocked by the immovable object (i.e., bar, strap, etc.). Using a hip belt connected to a strap you are standing on would be an example for a squat pattern. Other examples include:

Pressing an unloaded barbell into the safety pins in rack (i.e., for bench press, squat, deadlift, etc.)
Using an ankle cuff on the wrist or ankle attached to a strap (NOT a resistance band) and setting up a direction of push or pull so the strap resists your contraction

Which type of isometric is best for joint replacement clients?

Both types of isometrics are very useful for regaining muscular force production capability. Some studies have shown that under equal force generation, a muscle will fatigue faster during a yielding isometric, possibly due to the more complex neural control strategies involved.^[1]

When choosing between the two types, consider the SAID Principle – Specific Adaptation to Imposed Demand. Does your joint replacement client most need to work on getting up out of a chair? If so, then overcoming isometrics will likely help them the most (more concentric contraction focused). Conversely, if they are having the most difficulty in descending stairs, yielding isometrics may be of more benefit (more eccentric contraction focused).

In Part 2, we’ll talk about the specific benefits of isometrics, especially for joint replacement clients, and ideas on how to use and program isometrics.

Continued Education for Fit Pros

Begin learning a neuro-centric approach to medical fitness and how to work with joint replacement clients with our Joint Replacement Fitness Specialist online course, available through the MedFit Classroom!

Pat Marques is a Z-Health Master Trainer and NSCA-CPT specializing in training the nervous system to improve performance and get out of pain. After retiring from the Active Duty Army, Pat pursued his education and certifications in exercise science, initially working with wounded, ill, and injured soldiers. During this time that Pat discovered the power of using a neurological approach to training to get out of pain and improve fitness and performance. He currently provides exercise therapy, movement reeducation, and strength and conditioning for all levels of clients at NeuroAthlete, from chronic pain sufferers to Olympic-level and professional athletes.

References:
[1] Schaefer, L & Bittmann, F. (2017). Are there two forms of isometric muscle action? Results of the experimental study support a distinction between a holding and a pushing isometric muscle function. BMC Sports Science, Medicine, and Rehabilitation, 9:11.

Cool Breathing: Why is breathing cool? It keeps us alive!

Dr. Audrey Pullman/6 February 2024/ All MFN blog/

There are several reasons why breathing is important. First, it’s the key to every human being’s survival to sustain life. Our breathing system supplies oxygen to vital organs of the body so they can function properly and keep us alive. Second, breathing is one means by which we get rid of waste products and toxins from the body.

Aquatic Pre-Hab for Joint Replacement

Dr. Rick McAvoy/30 January 2024/ All MFN blog/

By 2030, the demand for primary total hip arthroplasties is estimated to grow by 174% to 572,000. The demand for primary total knee arthroplasties is projected to grow by 673% to 3.48 million procedures.

Pre-surgical or prehabilitation (prehab) programs have been gaining increased popularity and show promising results in getting clients moving quicker after surgery. Prehab can be defined as an individualized physical conditioning program to improve strength, endurance, and range of motion prior to surgery.

I have found in my experience that by incorporating an aquatic program six or more weeks prior to surgery can have significant benefit post-operatively.

A multicenter study performed at New England Baptist Hospital, Beth Israel Deaconess Medical Center and Harvard Medical School found that knee- and hip-replacement surgery patients who had participated in prehab for just six weeks prior to surgeries reduced the need for inpatient rehabilitation by 73 percent. This study involved water-and land-based strength training, plus aerobic and flexibility exercises.

Why Use the Water to Help with Pre-hab?

Reduced Pain & Swelling

Clients awaiting joint replacement surgery are usually in a significant amount of pain. They may experience pain not only at the specific joint but also in corresponding joints that have compensated for improper biomechanics. Using the water’s unloading properties to reduce pain, as well as the hydrostatic pressure to help with swelling reduction, are tremendous benefits.

Restore Range of Motion (ROM)/Muscle Balance

I always tell my clients, “Motion is Lotion.” This means that the more you move correctly, the better you will feel. Gaining as much ROM prior to joint replacement is very important. I also share, “The doctor will be replacing your joint, not your ligaments, tendons or muscles. The more muscle balance we can get the better you will do post operatively.” I give the example of a worn out tire on a car. Over time the cars suspension adapts to that worn tire and pulls out of alignment. The replaced joint represents the new tire; now we have to realign the suspension so everything rides correctly.

In the water using flotation equipment on the lower extremities allows the client to gain much more ROM.

Buoyancy unloads the joint and assists the motion, but more importantly the client has control over the movement. If try to manually stretch a client, he/she is automatically guarded, no matter how much I remind them to “relax”. Moving freely in the water, the client is more likely to push their ROM than if I stretch him/her manually.

Improve Strength

Pain causes muscle inhibition and hence muscle weakening. Neuromuscular control needs to be restored prior to surgery in order to facilitate muscle recovery post-operatively. The stronger the muscles are, the faster the recovery. Strengthening exercises to help balance all muscle groups are much easier and comfortably performed in the water. Water provides an accommodating three-dimensional resistance which allows multiple muscle groups to be strengthened simultaneously.

Improve Proprioceptive Awareness & Normal Movement Patterns

Any functional movement depends on the coordination and fine tuning of the neuromuscular system. Joint degeneration affects the soft tissues that contain proprioceptors, which will cause significant reduction in the awareness of joint movement.

Proprioceptive exercises can be be started prior to surgery to stimulate the neuromuscular mechanisms and make them more responsive after surgery. The water provides a surrounding proprioceptive enriched environment to help restore neuromuscular function, including balance and proprioception.

Improve Gait

Degeneration of lower extremity joint will commonly result in a compensated gait pattern. This pattern is often continued, even after surgery, because of abnormal motor patterns. Use the water to correct gait patterns prior to surgery, which will assist with alignment, weight shift and proprioceptive input, and therefore facilitate a normal post-op gait pattern.

Client Education

Surgeons often do not tell the client what they will experience post operatively. Thus, another benefit of prehab is the opportunity to educate the client on the post-op process. Clients often compare themselves to other people who have had a similar surgery, which can lead to frustration. By educating the client and with the understanding that everyone progresses at a different rate.

In my experience, by utilizing the water for prehabilitation prior to a total joint replacement is one of the best ways to get clients moving and feeling better faster!

If you’re interested in sponsoring a Medically Based Aquatics (MBA) course at your facility, please contact Rick McAvoy at rick@rickmcavoyaquatics.com

Dr. Rick McAvoy has specialized in Aquatic Physical Therapy and Sports Performance for over 30 years and promotes aquatic fitness, rehab and training. He is the Owner of Rick McAvoy Aquatics, an Aquatic Fitness and Sports Performance Training and Consulting Company. Rick is also a published author and researcher in the field of Aquatic Therapy and Fitness as well as Sports Performance.

Coaching Hardiness of Heart: Buffers vs. Band-Aids

Pat VanGalen/26 January 2024/ All MFN blog/

Like a leaky roof, do we just patch the hole, and hope for the best? Or do we replace and restore it, and do the maintenance to optimize it, despite extreme weather conditions? In ski-speak, we joke about variable conditions, never predictable. In life, it’s the same thing. Are we prepped and ready for the curveballs and Murphy-strikes that WILL come our way? Do we have an ample buffer, a reserve capacity to pull from? Can we bounce back, repeatedly, take hits and remain solid? Hardy folks can and do! Think of a hardy person you know. What keeps them surviving, and thriving?

Today, it is well-accepted that cardiovascular disease (CVD), the leading cause of death in the U.S., is rooted in inflammation, insulin-resistance, oxidative stress (rusting), hormonal imbalances and exposure to toxins. We also know that a lousy diet, long-term micro-nutrient deficiencies, physical INactivity, chronic DIStress, and various toxins, raise cholesterol and blood pressure exacerbating an inflammatory response in our arterial endothelium. Remember that half of the people who experience heart attacks do NOT suffer from hypercholesterolemia. To quote Mark Hyman, M.D., Founder, Cleveland Clinic Center for Functional Medicine, “CVD is not about cholesterol; it is about inflammation in a cholesterol environment.”

So, when 45 year old 2-stent Charlie, husband, father of three, small business owner, with a passion for hunting and fishing comes to me, I need Whole-Charlie coaching. A Hardiness model fills the bill.

Hardiness Coaching is designed to fortify FIVE structural pillars: 1) Movement, 2) Diet, 3) Rest-Recovery-Regeneration, 4) Stress Resistance and, 5) Purpose-Relevance-Meaning. The Pillars are grounded in a foundation of DAILY habits, patterns and practices, not programs with a start and end date. They are interconnected, and the robustness of one supports the others; if one crumbles, the others bear the brunt. By repairing cracks and leaks within a given pillar, we boost overall resilience, durability, and robustness, not just the CV issue at heart (no pun intended). Hey, what’s good for the heart, is good for the brain is good for the gut is good for the immune system is…

Our clients come to us with the desire to move better, feel better and get back to living life, even surpassing it, despite their issues. Their current health does NOT define them, nor does their age. It’s our responsibility to meet them where they’re at, know where they have been [for decades], and get them where they want to go. Keeping their hopes and dreams alive is paramount.

As Hippocrates so eloquently stated, “Know the person who has the disease, not just the disease that has the person.”

So, when we hear ‘cardiac or cardiovascular’, think beyond the heart and vasculature for transport and waste removal. Think integration with the lymph and respiratory systems, and their role in running a well-oiled machine, one where the other six systems [gut microbiome, immune/inflammatory, energy production (mitochondria), waste disposal – detoxification, communication (neurotransmitters, hormones), structural (cells, tissues, organs) synergistically thrive. This is a Functional Medicine model. Check it out.

Clinical psychologists, physical therapists or medical doctors, we are not. But, we impact lives in a multitude of ways, some measured by hard data, and others, by those intangibles like confidence and joy. Yes, we work within the physical realm, but when we take the integrated pillar approach to coaching Hardiness, we sync and link the pillars, buttressing them to exponentially resist and adapt better to the stresses and strains of life. Buttresses, NOT band-aids!

Coaching MUST transfer to performing and feeling better, at home, in labor, care-giving, recreation and even competition. For example, with regards to the movement pillar, there are three realms: 1) physical activity, as in walking, stairs, labor and chores, 2) recreation, as in sport, dance, all-seasons GO on snow, ice, sand or water, and 3) TRAINING, exercising with purpose. ALL contribute to the robustness of our movement pillar. Training is only one piece of the movement pie, so yes to targeted training, AND to more movement in labor, hobbies and play.

When training any adult, there are 7S Buckets that may need to be restored and refilled. The 7th Bucket is Specificity and Specifics. Specificity refers to “we get what we train for; we keep what we do!” Specifics are those things unique to our client; in this case, those CV conditions that propelled the client in our direction in the first place. It may have been a primary care Doc, a referral from cardiac rehab or simply the client’s grit to BE better. Whatever, we are here to fortify all their pillars of hardiness.

Don’t get me wrong. We must know CVD pathologies, physiology, metrics and measurement, and network with relevant healthcare professionals. But more importantly, we must customize and personalize coaching to provide the springboard for Charlie to thrive, as a husband, father, business owner and outdoorsman, to optimize his health-span, and his zest for living life to his fullest.

So, from pacemakers, stents, meds and more, to risk factors, co-morbidities, MSK challenges and all else in store, we practitioners are here to reboot, rebuild, coach, train and restore.

Specialization for Fit Pros

Join Pat VanGalen in the online course, Cardiac REHAB Fitness Specialist. Learn the nuts and bolts of coaching hardiness within the cardiovascular system. Evidence-based facts, figures, updates AND case studies will tweak your coaching. Integrate, don’t isolate!

Patricia ‘Pat’ VanGalen, M.S. brings a unique blend of education, practical experience, common sense application, science and research to her lecturing, teaching, training and coaching. She launched her professional career 40+ years ago in physical education and coaching, then spent the next 10 years in corporate-industrial fitness, health promotion, cardiac rehab and injury risk reduction programming design, implementation and management. Visit her website, activeandagile.com

Sugar and Addiction Are Connected

Tambryn Crimson-Dahn/23 January 2024/ All MFN blog/

There has been a proven link between sugar and dopamine. Sugar consumption has been proven to produce dopamine in the body, causing feelings of happiness and euphoria. This explains why people with depression tend to eat more processed and sugary foods — because the sugar in those foods produces the dopamine that their body is lacking. Dopamine is the same chemical that is released in the body during the use of illicit drugs such as cocaine and heroin. For individuals addicted to illicit drugs, attempting sobriety often leads to extreme cravings of sugary substances due to the absence of the dopamine that is no longer being introduced into the body. For alcoholics, there is a similar issue because many alcoholic drinks contain sugar, which also produces high levels of dopamine. These cravings of sugar could obviously then trigger weight gain, self-esteem issues, and increase the risk of diabetes, as if the battle that comes along with giving up an addiction isn’t hard enough.

The Neural Response of Dopamine

Our brains produce dopamine in response to things our body thinks we need to survive, like sex, for example, as evolution has hardwired humans for procreation, causing the brain to deem sex a necessity for our species to survive. Once dopamine produces feelings of happiness and pleasure, we then obviously want to engage in the actions that produce those feelings again and again. Studies have shown that the consumption of sugar causes the same high rise in dopamine levels in the brain that hard drugs cause. Thus why addicts struggle with sobriety as their brain continues to crave the dopamine that was produced by their substance/s of choice. Substance use, as well as severe depression, can cause the brain to lose its ability to produce dopamine naturally, causing it to become even harder to give up sugar the longer one uses the substance or is clinically depressed.

Evolutionary Eating Habits

Throughout history, humans have needed to consume many calories to survive, which is no longer the case due to advancements in food technology and the way that food is produced now. Although we humans no longer need to consume high amounts of calories, evolution simply has not caught up yet, forcing us to have to rewire our brains consciously with the information we now know to be true about healthy eating choices. This evolutionary hardwiring in combination with long-term use of sugary food and drinks cause the body to develop a high sugar tolerance, which again, can lead to the aforementioned issues listed above.

Reducing Sugar Is A Process

When a client is struggling with addiction, they often express feelings of guilt and shame about craving sugary substances in excess. Often, they feel as if they’re switching addictions, which in and of itself makes one feel bad, but they also feel that they should be living a wholistically healthy lifestyle. Don’t get me wrong, this is a great long-term goal, however, one needs to start slowly, taking one step at a time to ensure long-term success.

“Baby steps. There’s no need to punish yourself for getting sober. This is supposed to be fun, not a chore, remember?” I’ll say with a chuckle. Starting an exercise regimen already puts physical stress on one’s body that they are unaccustomed to, which, even though it is fun, causes the body to need to adapt. That, in addition to having to abstain from the substance of one’s choice, is already enough for anybody to have to cope with. This is why people always have to be told not to beat themselves up over food cravings.

Reducing sugar intake is something that should be done gradually, over time. We’ll get there eventually, after we tackle all the other obstacles. As the adage goes, “You gotta learn to walk before you learn to run.”

Tambryn Crimson-Dahn is a certified personal trainer, fitness coach, nutritionist, and addiction recovery specialist with years of experience. After having worked in the gym industry, she now owns and operates her own company, Crimson Wholistic Fitness. She specializes in addiction recovery, depression, anxiety, and overall mental health and wellness, and enjoys psychology as continuing education.

References

Dopamine triggers sugar cravings and is used to cope with depression – Fitness Nutrition textbook, International Sports Sciences Association
https://wellnessretreatrecovery.com/sugar-and-dopamine-link-sweets-addiction/

Healthy-Lifestyle-Nutrition-Exercise-Medicine

The Power of Why: Motivation for Better Health

Trevor Wicken/15 January 2024/ All MFN blog, Conditions/

As a movement practitioner, I love it when my clients become my teachers. One conversation with someone going through the process of changing their life and fighting challenges may prompt, lead, or sometimes shove me into examining my practice, my approach, and my connection with the people I serve. Just recently Mary, one of my clients, wanted to meet with me to discuss her progress and our conversation inspired this article.

Best Exercises to Prevent Osteoporosis

Maurice D. Williams, MS/12 January 2024/ All MFN blog/

Osteoporosis is a disease that affects our bone system due to a decrease in bone mass, density and an increase in the space between the bones. As a result, one’s bones become brittle and suspect to breaking. There are two types of osteoporosis: type 1 and type 2. Type 1 is generally a result of the aging process and a decrease in hormones such as estrogen and progesterone. These hormones help regulate how fast bone is lost. Type 2 is a result of medications or other health issues that interfere with bone reformation. Thankfully, both types are treatable!

Most Common Areas Affected: Osteoporosis is generally found in the neck of the thigh and lower back. A lot occurs in these areas, so, a decrease in the strength of the bone there is not a good thing.

Nutrition: Since nutrition plays a factor in everything we do, it is important to mention it for those with osteoporosis. The three things to focus on the most are: an increase in calcium, and a stoppage of alcohol intake and smoking.

Exercises: Research shows that it takes about six months of consistent exercise at somewhat high intensities to produce enough bone mass change. With that being said, it is important to use proper exercises in a progressive fashion and make them specific to you. Exercises should focus on the following areas of the body as they stress the overall bone structure: core, hips, thighs, back and arms. Here are my top six exercises to start your 6-month program:

Planks: 1-3 sets of 8-20 reps

Supine Bridges: 1-3 sets of 8-20 reps
supinebridge

Prone Cobras: 1-3 sets of 8-20 reps
cobra

Squats: 1-3 sets, 8-20 reps
squats

Standing Tube Row: 1-3 sets, 8-20 reps
tuberow

Single leg balance: 1-3 sets, 8-20 reps
singlelegbalance

Conclusion

While osteoporosis can be a life threatening disease, it can be managed through exercise. Most people who include daily exercise are able to ward off further damage to their body and are able to do their normal daily activities of life. Performing the six exercises listed and then progressing to more challenging ones will keep a person with osteoporosis healthy!

Maurice D. Williams is a personal trainer and owner of Move Well Fitness in Bethesda, MD. With almost two deciades in the industry, he’s worked with a wide range of clients, including those with health challenges like diabetes, osteoporosis, multiple sclerosis, hypertension, coronary artery disease, lower back pain, pulmonary issues, and pregnancy. Maurice is also a fitness educator with Move Well Fit Academy and NASM.

Understanding and Conquering the Relative Insulin Resistance of Midlife – Beyond the Blood Tests

Carla DiGirolamo, MD, CF-L1, PN-1/3 January 2024/ All MFN blog/

One of the most common things my midlife clients struggle with is weight gain. “The things that worked before just don’t work anymore” is the mantra of so many during this phase of life. They visit their healthcare provider with concerns about “waking up in someone else’s body”. The doc runs some tests – thyroid levels, blood sugar studies, and insulin – and all the results come back in the normal range. “Great news!” says their doc. “There’s no problem. You’re just getting older”. End of story.

Many of you who have heard me on various podcasts know that I’m not a fan of the notion that hormone testing reflects the entirety of the Human experience as many “practitioners” would have you believe. The relative insulin resistance of midlife is a perfect example. One does not have to meet the criteria for “pre-diabetes” or metabolic syndrome for there to be real changes for which there are interventions. Isn’t the goal of medical care to prevent these things in the first place rather than just send you away until you actually become diabetic?

One does not need to meet the criteria for “pre-diabetes” or “metabolic syndrome” for there to be changes for which there are interventions. Isn’t the goal of medical care to prevent these things in the first place rather than just send you away until you actually become diabetic?

This is where understanding what’s happening inside your body during the various phases of hormonal life keeps you one step ahead of mainstream medicine. Today we will discuss the phenomenon of relative insulin resistance – the physiologic changes to energy utilization occurring in your body as a result of the normal hormonal changes of midlife – and how to mitigate the effects of these changes so that you can be your healthiest self.

Your Body on Carbs

In a nutshell, carbohydrate is consumed in the diet, digested and absorbed as glucose (among other simple carbohydrates), and utilized as fuel by the tissues in the body. Excess glucose that is not used is stored as glycogen in the liver and muscles, but also as fat. The hormone, “insulin”, is secreted by the pancreas in response to glucose entry into the bloodstream. Insulin drives glucose into the cells so that the cells can use the glucose as fuel to carry out their functions. The “efficiency” of insulin function is impacted by cycling estrogen and estrogen receptors on the surface of cells.

The two bodily systems that use the greatest amount of blood glucose are the brain and skeletal muscle – the voluntary muscles that move our bodies. During midlife, there is a decrease in cycling estrogen and estrogen receptor presence on the surface of skeletal muscle cells. As the ovarian hormonal cycles change and become irregular, there is less circulating estrogen. As a result, muscle mass, strength, and power decline along with the efficiency of the muscle’s ability to utilize blood glucose through insulin-mediated pathways.

A prominent player in cellular and insulin efficiency is an intracellular organelle called the mitochondria: the “batteries” that supply energy to cells. Below is an excerpt from my course Menopause Health and Fitness Specialist Course through MedFit Classroom that explains the science behind how skeletal muscle function is impacted by changes in estrogen and its receptors.

As we just mentioned, when blood glucose is not used as fuel, the excess is stored as fat. When the hormonal changes of midlife reduce the efficiency of glucose utilization by skeletal muscle, the result is a greater excess of unused glucose and increased storage of fat which results in changes in body composition.

Your End-Run Around Relative Insulin Resistance

There are three basic approaches to mitigating the impact of the hormonally-driven changes in how our bodies manage glucose. Resistance training (particularly weight training), nutrition, and neuroendocrine activation.

Resistance Training

If you want your muscles to use more glucose, then you need to increase the activity of those muscles. This looks different for different individuals. If you are sedentary, then starting with walking for 30 minutes 4-5 times per week is a great start! From there, add a weighted backpack, then maybe add some hills or even hiking trails. Simultaneously, engage a personal trainer for 6 weeks and become familiar with weight training. If you are an endurance athlete, make friends with the barbell. If you are a powerlifter, explore different ways to stimulate the muscles that add cardiovascular stimulation like combining running segments with heavy deadlifts. The point is, no matter what your fitness level or expertise, there are new and exciting ways to increase the functional capacity of your skeletal muscle.

Why does this work? The Human body is an amazing machine designed for survival. Mother Nature has programmed redundancies within our physiologic systems to promote longevity. We discussed the impact of our cycling reproductive hormones on how our muscles utilize blood glucose. Fortunately, other physiologic pathways facilitate glucose entry into the muscle cells that depend less on cycling hormones, most notably, the GLUT4 pathway. GLUT4 is a glucose transporter protein that works with muscle contraction to transport glucose into the cells. So when we stimulate muscle contraction through resistance training, this activates the GLUT4 pathway to facilitate the entry of glucose into the cells to be used as fuel, leaving less excess to be stored as fat.

GLUT4 is a glucose transporter protein that works with muscle contraction to transport glucose into the cells. So when we stimulate muscle contraction through resistance training, this activates the GLUT4 pathway to facilitate the entry of glucose into the cells to be used as fuel, leaving less excess to be stored as fat.

Nutrition

We have discussed how glucose enters the cells of our tissues through pathways involving insulin and GLUT4 and how unused, excess glucose is stored as fat. In this section, we will discuss the other important part of this equation, which is the load of glucose that enters the bloodstream by way of the foods we eat.

Glycemic Index – The glycemic index is a measure of how much a carbohydrate source will increase blood sugar over 2 hours from the time of consumption. There are low, medium, and high glycemic index foods with a great description in this resource from Healthline. A lower glycemic index reflects lower blood sugar following consumption and a higher index reflects greater increases in blood sugar. This is important because the glycemic index reflects the glucose “load” on the systems (such as insulin and GLUT4) that need to shuttle the glucose into the cells. When the glucose load is greater, the systems can become overloaded, leaving more excess to be stored as fat. When the load is less, insulin and GLUT4 can better “keep up” with transporting glucose into the cells for use as fuel leaving LESS excess to be stored as fat.

By focusing on carbohydrate sources with a lower glycemic index and minimizing those with a higher glycemic index, you can effectively decrease the glucose load that insulin and other glucose transport pathways see and thus more efficiently use carbohydrates as fuel and minimize the excess that is stored as fat.

Neuroendocrine Adaptation

Adaptation is the ability of the body to adjust or “make familiar” movements or tasks that we undertake. This is a coordinated effort by the muscles, joints, metabolic, and endocrine processes all driven by the master puppeteer we know as the Nervous System!

Because Mother Nature designed Humans for survival, our ability to adapt to physical stimuli and physical tasks is powerful! When we stimulate the muscles repetitively in the same way for an extended period of time, the body doesn’t need to work as hard to manage the load or task and effectively switches into “Auto-pilot”. This is great for elite athletes where the tasks that their sports require become second nature through adaptation.

However, from the standpoint of muscle physiology, they crave something more! This is why we train differently in the off-season: to keep the muscles guessing and thus contantly adapting to become fitter, faster and stronger so that we can crush it on game day! To learn more about this incredible phenomenon, check out Neuroendocrine Adaptation: Your End-Run Around the Menopause Transition.

Key Points for Combatting Midlife Relative Insulin Resistance

Get moving! The first step to using more glucose as fuel and storing less as fat is to move those muscles. For the sedentary, walking, backpacking, and hiking are great ways to start.
If you have never trained with weights, another great place to start is a group “boot camp” style fitness class. Find one at your local gym and sign up with a friend! My favorite group class for getting started with weights is Les Mills BodyPump.
Any level of athlete can benefit from a 4-6 week training program with a trainer or strength coach to gain some basic skills and techniques from basic to more advanced movements depending on your fitness level/familiarity.
Incorporate resistance/weight training at least 2-3x per week.
No equipment, no problem! Push-ups and their many variations are fantastic for anyone of any fitness level to add mass, strength, and power to the muscles of the upper body.
Take an inventory of your carbohydrate intake and using the resources in this LINK, identify carbohydrate sources and potential substitutions that can move the needle toward lower glycemic index choices.
Nutrient timing is a strategy where carbohydrate intake is timed within an hour before training and within an hour after when the muscles are “looking” to fuel movement during the workout and then looking to replenish glycogen stores in the liver following a training session.
Most importantly, be consistent, but be patient! It’s about progress, not perfection. Every little bit you can do has benefits.

Fit Pros: Offer menopausal and perimenopausal women an individualized approach to training, nutrition and wellness as a Menopause Health and Fitness Specialist.

Dr. Carla DiGirolamo is a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist who specializes in the care of reproductive age and mid-life women. Carla completed her residency training in Obstetrics and Gynecology at Brown University Medical School/Women and Infants’ Hospital and her Reproductive Endocrinology training at the Massachusetts General Hospital at Harvard Medical School.

Exercise and Prostate Cancer

Carol Michaels/22 December 2023/ All MFN blog/

The rising rate of prostate cancer necessitates developing better methods to prevent and treat prostate cancer. Prostate cancer is the third leading cause of cancer death among U.S. men, according to the American Cancer Society. The country’s 3.3 million prostate cancer survivors account for 21 percent of all cancer survivors.

There are many reasons why a cancer patient should stay as active as possible through cancer treatment and recovery. I will begin by pointing out a few studies that show how exercise can benefit cancer patients. These studies demonstrate how exercise can reduce certain side effects from treatment, increase energy, decrease stress, and improve quality of life.

There is evidence to support the use of exercise in prostate treatment. Exercise plays a role in the all-around improved physical and mental health and therefore should be considered in the treatment plan. We know that exercise can decrease recurrence for some cancers and the role it plays in weight control, which is correlated with some cancers. For prostate cancer specifically, data indicates that obesity increases the aggressiveness of prostate cancer, and thus mortality. Men receiving androgen deprivation therapy are at higher risk for depression. Exercise reduces depression.

Studies do have their limitations. Some use self-reported data about lifestyle and exercise. Moreover, there may be a low number of minority participants who may often have higher cancer rates. The following are a few of the published studies, which confirm that exercise should be included in the treatment plan for prostate cancer patients.

Studies have suggested that patients with high levels of physical activity had a lower rate of disease progression and also reduced mortality from prostate cancer. Ying Wang, PhD, a senior epidemiologist in the Epidemiology Research Program at the American Cancer Society in Atlanta, and colleagues analyzed data on 10,067 men diagnosed with non-metastatic prostate cancer between 1992 and 2011. Men with prostate cancer, which hasn’t spread may have longer survival the more they exercise. A study demonstrated that men who were the most physically active had a 34% lower risk of dying from prostate cancer when compared with men who were the least physically active. Men who either maintained or increased their exercise level also benefited. Prostate cancer patients who kept up a moderate to high level of physical activity also had better survival prognoses compared with their more sedentary counterparts. Those men who were more active before diagnosis were more likely to have lower-risk cancer tumors and a history of prostate screenings. They were also leaner, more likely to be nonsmokers and vitamin users and they ate more fish. Wang concludes, “Our results support evidence that prostate cancer survivors should adhere to physical activity guidelines, and suggest that physicians should consider promoting a physically active lifestyle to their prostate cancer patients.”

Androgen Deprivation Therapy leads to numerous side effects, which can be decreased through exercise. Side effects of ADT include loss of muscle, increase in fat mass and osteoporosis. Risk for diabetes and heart disease also increases. Brian Focht, reported at the November AICR convention, that functional ability increased dramatically as did quality of life for those that exercise, and side effects of ADT were reversed.

Exercise can decrease blood sugar levels, which lower insulin levels and also helps to lower inflammation. There does appear to be a positive association between insulin levels, inflammation and prostate cancer risk.

The evidence for physical activity in reducing anxiety and depression, while increasing general-well being is fairly substantial. Improving well-being can have a dramatic beneficial effect on sexual function. Consistent exercise will also help to lower insulin, blood sugar, and improve overall cardiovascular health, all of which have positive impact on erectile dysfunction and libido ().

In 2016, Rider and Wilson studied the connection between ejaculation and prostate cancer, which was published in European Urology. Men that reported higher ejaculatory frequency were less likely to be diagnosed with prostate cancer . This study showed a beneficial role of frequent ejaculation particularly for low-risk disease.

Some doctors have traditionally told patients to rest during this time but Favil Singh’s research confirms the importance of getting fit prior to surgery. Singh’s research published in the journal Integrative Cancer Therapies has shown that a regular dose of physical activity prior to surgery helps the recovery process. This reduces time in the hospital.

Singh stated “This is the first time we’ve been able to demonstrate the benefits of ‘pre-habilitation’ for prostate cancer patients. It is safe, side effect-free and can be done while undergoing chemo or radiotherapy. Just two sessions a week of resistance and exercise training for six weeks can make a difference to recovery.”

Often, there is a waiting period in between diagnosis and surgery. If fitness level can be improved before surgery the patient, then the patient goes into the surgery stronger and may have a better recovery.

The American Cancer Society and American College of Sports Medicine recommends at least 150 minutes of moderate physical activity or 75 minutes of vigorous exercise each week. This advice is a good goal for those who have been inactive. Unfortunately, in my view this is insufficient for a significant number of cancer patients. Having worked with cancer patients for over 20 years, I believe that this recommendation needs to be changed. It is impossible to include aerobic exercise, strength training, and other exercise methods in the current recommended time frame.

Carol J. Michaels is the founder and creator of Recovery Fitness® LLC, located in Short Hills, New Jersey. Her programs are designed to help cancer survivors in recovery through exercise programs. Carol, an award winning fitness and exercise specialist, has over 17 years of experience as a fitness professional and as a cancer exercise specialist. Visit her website, carolmichaelsfitness.com

References

Steven C. Moore PhD, et al, Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016; 176(6): 816-825.

Lynch B.M., Dunstan D.W., Vallance J.K., Owen N. Don’t take cancer sitting down: A new survivorship research agenda. Cancer. 2013, Jun 1; 119(11): 1928-35 Medicine

Kristina H. Karvinen, Kerry S. Courneya, Scott North and Peter Venner, Associations between Exercise and Quality of Life in Bladder Cancer Survivors: A Population-Based Study, Cancer Epidemiology and Biomarkers Prevention May 2007, 10.1158/1055-9965

Gopalakrishna et al, Lifestyle factors and health-related quality of life in bladder cancer survivors: a systematic review. Journal of Cancer Survivorship, 2016 (5): 874-82

Vallance, J., Spark, L., & Eakin, E.. Exercise behavior, motivation, and maintenance among cancer survivors. In Exercise, Energy Balance, and Cancer (2013) (pp. 215-231). Springer

Cannioto et al., The association of lifetime physical inactivity with bladder and renal cancer risk: A hospital-based case-control analysis, Cancer Epidemiology, Volume 49 August 2017

Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2012; 14(11): CD006145.

Booth FW, et al., Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012 Apr; 2(2): 1143-211.

Stephanie Cash et al, Recreational physical activity and risk of papillary thyroid cancer among women in the California Teachers Study. Cancer Epidemiology, Feb 2013,37(1): 46-53

Hwang, Yunji MS; Lee, Kyu Eun MD, PhD; Park, Young Joo MD, PhD; et al, Annual Average Changes in Adult Obesity as a Risk Factor for Papillary Thyroid Cancer: A Large-Scale Case-Control Study, Medicine, March 2016, Mar; 95(9): e2893

Cao Y, Ma J. Body mass index, prostate cancer-specific mortality, and biochemical recurrence: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2011; 4: 486-501.

Galvao, et al. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010 Jan 10; 28(2): 340-7.

Galvao, et al. Exercise can prevent and even reverse adverse effects of androgen suppression treatment in men with prostate cancer. Prostate Cancer Prostatic Dis. 2007; 10(4):340-6.

Winters-Stone KM, et al. Resistance training reduces disability in prostate cancer survivors on androgen deprivation therapy: evidence from a randomized controlled trial. Arch Phys Med Rehabil. 2015 Jan; 96(1): 7-14.

Giovannucci EL, Liu Y, Leitzmann MF, Stampfer MJ, Willett WC. A prospective study of physical activity and incident and fatal prostate cancer. Arch Intern Med. 2005; 165: 1005-1010.

Storer TW, Miciek R, Travison TG. Muscle function, physical performance and body composition changes in men with prostate cancer undergoing androgen deprivation therapy. Asian J Androl. 2012, Mar; 14(2): 204-21.

Focht, Brian C.; Lucas, Alexander R.; Grainger, Elizabeth; Simpson, Christina; Fairman, Ciaran M.; Thomas-Ahner, Jennifer; Clinton, Steven K., Effects of a Combined Exercise and Dietary Intervention on Mobility Performance in Prostate Cancer, Medicine & Science in Sports & Exercise. May 2016:48(5S): 515.

Rider J, Wilson K.et al. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow up, European Urology. December 2016, volume 70, issue 6

Singh F. et al. Feasibility of Presurgical Exercise in Men With Prostate Cancer Undergoing Prostatectomy, Integrative Cancer Therapies (2016). DOI: 10.1177/1534735416666373

Wang et al, Recreational Physical Activity in Relation to Prostate Cancer–specific Mortality Among Men with Nonmetastatic Prostate Cancer. European Urology July 2017 online bit.ly/2tXMK6Y