It is well recognized that the population of individuals over the age of 65 in the United States is expanding. With age, comes natural and expected physiologic deficits in the musculoskeletal system that affect the pursuit of exercise and fitness.
Believe it or not, eating a good sports diet can be simple. Yet too many athletes have created a complex and confusing eating program with good and bad foods, lots of rules, and plenty of guilt. Let’s get back to the basics and enjoy performance-enhancing fueling with these simple ABC’s for winning nutrition.
Athletes get injured. It’s part of the deal. Be it a torn ACL, Achilles tendonitis, or a pulled muscle, the questions arise: What can I eat to recover faster? Would more vitamins be helpful? What about collagen supplements? At this year’s virtual Food and Nutrition Conference and Expo (FNCE) of the Academy of Nutrition and Dietetics (AND, the nation’s largest group of nutrition professionals), several presentations offered updates on nutrition for injuries.
Risk factors for heart disease – elevated LDL cholesterol, hypertension, elevated triglycerides, inflammation, and blood glucose – are all exacerbated by excess body fat, and overweight/obesity itself is considered a risk factor.1-3
Is it beneficial to be a little overweight?
However, there has been controversy about a potential “obesity paradox” in heart disease: the idea that some amount of excess weight either does not pose any risk or is even protective. Unfortunately, the studies that suggest there may be a protective effect of body fat are often the ones that get more news coverage; but this does a disservice to an already overweight and nutritionally misguided public, allowing them to believe that excess body fat won’t harm their health.
Is there really an obesity paradox? Or is it just that BMI is not a good measure of body fat?
Many of these studies have used body mass index (BMI), however BMI, which only takes into account height and weight, is not an accurate indicator of body fatness. BMI does not distinguish between fat mass and lean mass, nor does it take into account fat distribution (visceral fat vs. subcutaneous fat). Many people whose weights are within the “normal” BMI range are still carrying excess fat.
There has been no evidence providing a convincing explanation of how excess fat could possibly provide a cardiovascular advantage. Plus, there are numerous medical conditions may cause unintentional weight loss, including depression, anxiety, autoimmune diseases, cancers, and digestive disorders. In the elderly especially, a low BMI may be an indicator of muscle loss and frailty rather than an indicator of a healthy low level of body fat. In short, people who are thinner are not necessarily healthier.
Relationship between body fat and heart disease: using better measures than BMI
A new study is helping to clear this issue up,4 in a cohort of almost 300,000 people in the UK (age 40-69) who were followed for an average of 5 years. Their first analysis puts the optimal range of BMI for heart disease prevention at 22-23 kg/m2. It was a “J-shaped” association, meaning risk rose both above and below the 22-23 range. But the researchers went further. They used multiple measures of body fatness to get a more accurate picture: waist circumference, waist-to-hip ratio, waist-to-height ratio, and percent body fat.
Ultimately, what the researchers found was that using BMI produces different results than the other indicators. BMI was the only one that showed an increase in risk at the low end (<18.5 kg/m2). When they excluded smokers and participants with pre-existing diseases, the increase in risk associated with low BMI almost disappeared. The more accurate measures of body fatness – body fat percentage, waist circumference, waist-to-hip-ratio, and waist-to-height ratio – showed a clear trend: more body fat, greater risk.4
More body fat, greater cardiovascular risk
The researchers concluded that the obesity paradox observation mainly occurs due to confounding effects of disease and other factors on BMI, and that the “public misconception of a potential ‘protective’ effect of fat on CVD risk should be challenged.”4
As discussed above, a low BMI is often an indicator of disease, rather than an indicator of a healthy weight resulting from healthful eating. The standard American diet (SAD) is fattening. If someone is eating the SAD and is not overweight, there is likely something wrong.
Lose weight permanently on a Nutritarian diet
The dramatic weight loss-promoting effect of the Nutritarian diet contributes to cardiovascular protection. A 2015 study published in the American Journal of Lifestyle Medicine analyzed and reported weight loss results provided by 75 obese patients who had switched to a Nutritiarian diet. The average weight loss was 55 pounds, and very importantly, they kept the weight off. None of these respondents had gained back the lost weight after three years.5
Reprinted with permission from Dr. Fuhrman.
Dr. Fuhrman is a board-certified family physician specializing in nutritional medicine. He is President of the Nutritional Research Foundation and the author of 6 NY Times bestselling books, including The End of Heart Disease. Visit him at DrFuhrman.com
- Coelho M, Oliveira T, Fernandes R. Biochemistry of adipose tissue: an endocrine organ. Arch Med Sci 2013, 9:191-200.
- Tchernof A, Despres JP. Pathophysiology of human visceral obesity: an update. Physiol Rev 2013, 93:359-404.
- Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017, 135:e146-e603.
- Iliodromiti S, Celis-Morales CA, Lyall DM, et al. The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296 535 adults of white European descent. Eur Heart J 2018:ehy057-ehy057.
- Fuhrman J, Singer M. Improved Cardiovascular Parameter With a Nutrient-Dense, Plant-Rich Diet-Style: A Patient Survey With Illustrative Cases. Am J Lifestyle Med 2015.
Meals and snacking patterns have changed over the past 40 years. You have undoubtedly noticed that many of us are eating fewer calories from meals and more calories from snacks. As a result, I get questions from both athletes and non-athletes alike about how to best fuel their bodies…
America is in bad shape. According to the Centers of Disease Control (CDC), 60% of adults are living with one chronic disease and 40% have two or more.(1) Astoundingly, 12% of adults are living with 5 or more chronic conditions(2) including cardiovascular disease, diabetes, obesity, coronary obstructive pulmonary disease and hypertension. A concept people need to understand is that these diseases can be prevented, managed and even reversed with lifestyle choices.
Today, the COVID-19 pandemic has shown a bright light on how our level of health can literally be a matter of life or death. A study of thousands of patients hospitalized with the novel coronavirus in the New York City area found that 94% had one chronic disease and 88% had two or more. The most common conditions included hypertension, obesity and diabetes.(3) In May of this year, the CDC reported that people with an underlying chronic illness had six times the risk of being hospitalized and twelve times the risk for dying.(4)
Boost Health & Immunity
Now is the right time to take small steps to improve health and build immune resilience with daily lifestyle choices. While there isn’t one diet, exercise regimen, or stress-relieving technique that is good for everyone, there are principles to follow that can boost health and vitality at any age.
There is a huge misconception that our genes determine our health destiny. This simply isn’t true. The study of epigenetics shows that we have the ability to change the expression of our genes by the way we think, feel, move and eat.(5) Each of our daily decisions and choices can increase or decrease inflammation in the body, moving us towards disease or back to health.
Acute & Chronic Inflammation
Our immune system uses the ancient, biological pathway of inflammation to protect us against injury and infections.(6) When you cut your finger, immune cells are sent to kill invading bacteria and begin the process of wound healing. This is acute inflammation that goes away in days or weeks when the body is healed.
One the other hand, chronic inflammation lasts a long time, from months to years.(2) It’s basically an abnormal immune response that causes damage to cells, tissues and organs. Oxidative stress plays a big role; it occurs when more free radicals are produced within cells than the body can neutralize.(2) As you can imagine, when more damage occurs than can be repaired, health problems crop up.
It is now widely accepted that chronic inflammation is at the root of most, if not all, chronic conditions like cardiovascular disease, diabetes, obesity, hypertension, cancer, arthritis and joint disease.(2)
The good news is that deliberate and healthier lifestyle choices can prevent, manage and even reverse chronic inflammatory disease, the most important cause of morbidity and mortality facing people today.(7) It’s empowering to know that if you have, or want to prevent a chronic disease, you can regain your health and vitality by choosing real whole foods, optimizing sleep, reducing stress, being social, and moving more.
You may be thinking, “How the heck can simple lifestyle decisions address the complexities of chronic conditions?” The body has an innate ability and intelligence to heal itself. You experience it each time you cut your hand; you wash the wound, put a bandage on and don’t have to think about it.
The research also supports it and I have lived it; by utilizing the power of lifestyle medicine I was able to restore my health from the ravages of chronic Lyme disease. You just need to provide the right environment for healing. This is not an easy task, but it can be done with time, effort and a plan.
Changing your lifestyle habits can feel overwhelming. To help you embrace this challenge, think about this analogy, “How do you eat an elephant? One bite at a time!” Any healing journey begins with awareness, learning and exploration; then gradually taking action, one small step at a time.
Start today by exploring lifestyle behaviors that decrease inflammation and can put your health back on track so you can live with less pain, more energy, and greater vitality. A lifestyle prescription to restore health includes:
- Reducing stress with deep breathing.
- Getting good quality sleep by going to bed and rising at the same time.
- Eating a plant-based diet rich in a rainbow of vegetables.
- Hydrating with filtered water in the morning and during the day.
- Nurturing relationships and engaging with positive people.
- Moving well with good posture when performing daily activities and exercise.
Be proactive, make one hour a week to learn more by reading books, researching on PubMed.gov, listening to podcasts, attending lectures and webinars so you can find the strategies and practices that work best for you. As you begin to feel better, you will naturally be motivated to continue learning and making better lifestyle choices because healthy feels so good!
Learn more about restoring health with lifestyle practices!
Register now for Cate Reade’s webinar on this topic. This webinar will give a basic overview of the principles and practices of why and how lifestyle choices can help prevent, manage and reverse chronic conditions.
Cate Reade, MS, RD is a Registered Dietitian, Exercise Physiologist and Functional Medicine Practitioner candidate on a mission to improve functional mobility and health span utilizing the power of lifestyle medicine. She has been teaching, writing and prescribing healthy eating and exercise programs for over 25 years. Today, as CEO of Resistance Dynamics and inventor of the MoveMor™ Mobility Trainer, she develops exercise products and programs that target joint flexibility, strength and balance deficits to help older adults fall less and live more.
- https://www.cdc.gov/mmwr/Novel_Coronavirus_Reports.html June 19, 2020
Most athletes want to have strong muscles to be more powerful, help prevent injuries, add protection for contact sports such as rugby or (American) football, and yes, to look buff. They wonder: What can I eat for more muscle, strength and power? The standard belief is eat extra protein, but more fundamental than food is doing some form of resistance exercise. Lifting weights is far more powerful for building muscle than is eating extra protein (unless you have been eating a protein-deficient diet).
he atmosphere in which you eat—both psychologically and aesthetically—may be one of the most overlooked reasons for overeating and weight gain. Our research has revealed that both the internal and external environment while eating can be a powerful determinant of weight. Here’s why.
The Roles of a Medical Fitness Practitioner: Scope of practice, prevention and interprofessional collaboration
Physical activity is any bodily movement produced by voluntarily contracting skeletal muscle that results in energy expenditure above a basal level. Physical activity has been demonstrated to positively affect over 30 chronic conditions and is considered the best deterrent of chronic disease in primary and secondary prevention. The main goal of a Medical Fitness Practitioner (MFP) in the healthcare continuum is to prevent the onset of chronic disease and bridge the gap between clinical intervention and conventional fitness programs. This is achieved by developing exercise programs for those who have, or are at risk for chronic disease or dysfunction, have health conditions that may be mitigated or managed by exercise and activity, are newly diagnosed with disease and need exercise guidance, or have completed a medically supervised rehabilitation program and need to continue to progress. A fitness professional versed in medical fitness protocols, such as an MFP, can work with those who are at risk for chronic disease.
Scope of Practice
Scope of practice refers to boundaries set by knowledge, skills and abilities (KSAs), as well as education, experience and demonstrated competency, such as a program of study, or an exam to measure proficiency. A basic personal training certification suggests the holder can develop exercise programs for apparently heathy clients. Unfortunately, considering the overweight and obesity rate is near 70%, and 50%-60% of the adult U.S. population has at least one chronic disease, adhering to scope of practice becomes increasingly important, yet at the same time many fitness professionals may be providing services outside their scope of practice, and beyond their level of certification. By accepting a client, the trainer is proposing a safe workout will be developed and implemented, and the client will not be at risk of injury. If advice is given that is not within the trainer’s scope of practice, the trainer and the facility may be subjected to a lawsuit.
An MFP who integrates medical fitness into practice has the KSAs, based on education, experience and demonstrated competency to conduct pre-participation interviews, perform fitness assessments and to design and implement health and fitness programs for disease management to avoid future injury and to improve activities of daily living. Unlike an MFP, unless otherwise educated, a fitness trainer who promotes medical fitness is not a licensed healthcare provider and does not possess the KSAs to diagnose an unknown condition, suggest supplements, design meal plans, physically touch a client or provide behavioral counseling.
In the United States, medical care tends to focus on treatment rather than prevention. Whereas treatment is given for a diagnosed disease or injury, the goal of prevention is to avoid, improve or slow down the progression of a probable or possible disease or injury. Prevention can be categorized as primary, secondary or tertiary. The goal of primary prevention is to foster a life of wellness and therefore avoid or reduce the chance of disease or dysfunction. Primary prevention includes immunizations, targeted types of exercise, balanced nutrition and wellness and education programs. Secondary prevention is managing a symptomatic disease in the hopes of slowing down or reversing the progression. Examples include treatment for hypertension, asthma and some cancer treatments. Tertiary prevention involves the management and treatment of symptomatic disease with the goal of slowing progression and severity, as well as reducing disease related complications. Tertiary prevention includes treatment for late stage cancer, coronary heart disease and some types of rehabilitation to include orthopedic, cardiac and pulmonary. Physical activity has been demonstrated to effectively treat over 30 chronic conditions, mostly in primary prevention but also in secondary and tertiary, making it the number one intervention against chronic disease.
Due to the growing incidence of obesity and chronic disease, leveraging the skills of various providers who can collaborate to deliver the best possible care, based on clinical needs, is necessary to manage the complex health care demands of a population with an increasing incidence of comorbidities. Due to a worldwide shortage of health workers, in 2010, the World Health Organization (WHO) recognized interprofessional collaboration as means to mitigate the global clinician shortage, strengthen health systems and improve outcomes. Interprofessional collaboration refers to health care teams, made up of trained professionals with various backgrounds, who work alongside patients and their families to provide high-quality care, based on the needs of the patient. Consequently, as medical providers begin to recognize the need to prescribe evidence-based exercise as an intervention in the management of chronic disease, MFPs, who are on the front line of health care, are trained and educated to be part of a clinical team that complements and leverages the strengths of each team member to improve population health. As health-science and technology advance, it is imperative for fitness professionals who work with clients who have one or more chronic disease to remain up-to-date on emerging fitness protocols. An MFP is required to participate in continuing education in areas including cardiopulmonary disease, metabolic disorders and orthopedic dysfunction.
Although the scope of practice of many allied healthcare fields overlap, the role of the MFP is to work with the client’s team of other healthcare providers, while staying within the scope of practice, based on KSAs. Regardless of the collaborative health team, the client’s physician is always the center, and as such should be provided regular updates as to the client’s progress.
An MFP is uniquely qualified to work with individuals within the healthcare continuum. Some KSAs associated with MFPs are:
- Knowledge of basic chronic disease pathophysiology
- The use and side effects of common medications taken by someone suffering from a chronic disease
- The knowledge to perform and analyze basic assessments related to movement and anthropometry
- The knowledge to design a safe and effective workout based on information received via assessment results, and the clinical recommendations from other healthcare providers
- FITT protocols, exercise progressions and regressions
- The implications of exercise and activity for individuals with chronic disease
- Contraindications of chronic disease, and signs and symptoms of distress related to chronic disease
- Knowledge of signs and symptoms that require expertise outside of the scope of practice for medical exercise
- The ability to recognize a medical emergency
- Current CPR and adult AED are required
This article was featured in the summer 2020 issue of MedFit Professional Magazine. Click to read the latest issue and get your free subscription.
Dan Mikeska has a doctorate degree in Health Science and a master’s degree in Human Movement, as well as certifications from NASM, ACE, the Cancer Exercise Training Institute and the Exercise Is Medicine credential from ACSM. He currently owns NOVA Medical Exercise and Medical Exercise Academy and is adjunct faculty for A.T. Still University’s Master of Kinesiology program. Dan’s mission is to improve population health and to increase the quality of life by connecting education, medicine and fitness.