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The Role of Exercise in the Treatment of Diabetes

/21 June 2019/ All MFN blog/

Diabetes Word Cloud Concept

According to the American College of Sports Medicine’s flagship journal, Medicine and Science in Sports and Exercise (1), there are more than 21 million Americans with Type 2 Diabetes as of 2010 with an estimated 7 million undiagnosed. If these numbers don’t mean much, let’s give it some perspective: in 1958 there were only 1.5 million. (Granted, the US population has increased, but only from about 180 million to 310 million, not 15-fold as in the numbers of T2D.) Furthermore, due to the now-defined pre-diabetes – or sub-clinical diabetes where the precursors to diabetes are lurking if lifestyle does not change dramatically – it is estimated that 80 million Americans are at risk. Thus, some public health officials are predicting that 21-33% of Americans will have diabetes by the year 2050. The healthcare burden this portends will bankrupt the nation. To make matters worse, the preponderance of both pre-diabetes and T2D is increasing in children and adolescents as sedentary behavior, poor diet and obesity abounds.

While prevention is optimal and much is being done in the way of public health messaging, one of the best means by which to regulate blood sugar in either healthy, pre-diabetes or T2D patients is through physical exercise. Recall above where we discussed how muscles use the sugar in the blood for fuel. The more muscles you have and the more regularly they work at some critical level of effort, the easier it is to control blood sugar. In fact, one’s levels of physical activity (PA) may be a better predictor of risk for diabetes than one’s BMI (body mass index, a ratio of height to weight.)

For the sake of discussion, we should break down physical activity into three main types – activities of daily living (ADL), aerobic exercise (AE) and resistance (or strength) exercise (RE). The MSSE article reviewed the data on all these for their impact on blood sugar, insulin control and T2D risk. Not unremarkably, the evidence strongly suggests that the more active you are, the lower your post-meal and long-term blood sugar is, the better your muscles are able to use the sugar in the blood (glucose tolerance or insulin sensitivity), the lower or lesser your insulin response is to food intake, and the lower your risk for diabetes is. What is remarkable, however, is how little physical activity is required in order to affect many of these changes and benefits.

As far as ADLs is concerned, the general prescription is to ambulate (walk, run, bike, etc) for 30-60 minutes a day or close to 10,000 steps/day, or almost 4 miles/day. This does not mean you have to take walks that last that long; it means you should move around more often throughout the day and sit less often. In fact, some studies show that simply standing up for 2 minute bouts of walking every 20 minutes of sitting lowered post-meal blood sugar and insulin response to eating. (2) While walking is effective, new studies (3) demonstrate that high intensity interval training (HIIT), or sprinting, may be an even better regulator of blood sugar. Comparing training programs in two groups of sedentary women, one doing intervals of moderate intensity, the other at high intensity, the authors found that the HIIT group had slightly greater fat oxidation in the muscles, a roundabout indicator of improved glucose control. HIIT might also be more time efficient.

Between the two studies referenced here, and many more that have looked at HIIT programs compared to traditional long, slower/lower intensity programs, the general belief is that the more muscles that are contracting and the harder they contract, the better the short-term and long-term blood sugar control. The only caveat here is that large muscle groups or bigger body movements are necessary to see these effects; single joint/small muscle contractions will not elicit the disease-modifying effects one might be seeking. For these reasons, RT has been getting more looks when it comes to modifying risk factors for T2D. In fact, the preponderance of evidence shows that RT, at sufficiently high enough intensities to build muscle mass, improves blood sugar control both by using sugar to fuel contractions and by improving the insulin sensitivity of those muscles even after the workouts.

Overall, physical activity has been shown to be an effective, efficient and low-risk/low side-effects treatment and preventive for T2D. A single bout of exercise is sufficient to regulate blood sugar for the next 16-24 hours.

As such, it is recommended that exercise be partaken nearly every day for at least 30 minutes; if obesity is a factor in a patient’s disease, then 60-90 minutes of accumulated physical activity is strongly suggested. Furthermore, a combination exercise prescription of cardiovascular and RT exercise – either same or alternating days – is deemed optimal.

To conclude, physical activity of all sorts has been found to enhance blood sugar uptake by muscles during the session and for several hours thereafter. Thus, it is one of the best, least invasive means by which to prevent, regulate and, for early stage T2D, even reverse diabetes and its downstream effects on the heart, kidneys, nerves (especially of the lower extremities), and eyes. Besides its collateral benefits on the cardiovascular system, it may help reduce weight though it is essential in maintaining weight loss. And PA clearly improves quality of life, not just through its physical benefits but its effects on the brain and psyche, reducing the risk of depression which may be a factor in both the sequence of events leading to weight gain, the challenges of both weight loss and disease management, and the reduction in one’s ability to enjoy various aspects of life due to immobility, neuropathy, visual impairment, and dialysis.

For more information about diabetes, exercise, pharmaceutical management and research, please visit the American Diabetes Association site at diabetes.org

Dr. Irv Rubenstein graduated Vanderbilt-Peabody in 1988 with a PhD in exercise science, having already co-founded STEPS Fitness, Inc. two years earlier — Tennessee’s first personal fitness training center. One of his goals was to foster the evolution of the then-fledgling field of personal training into a viable and mature profession, and has done so over the past 3 decades, teaching trainers across through country. As a writer and speaker, Dr. Irv has earned a national reputation as one who can answer the hard questions about exercise and fitness – not just the “how” but the “why”. 

References

1. Roberts et al, Modification of Insulin Sensitivity and Glycemic Control by Activity and Exercise. MSSE, Vol. 2013: 45(10):1868-1877
2. Dunstan et al., Breaking up prolonged sitting reduces glucose and insulin responses. Diabetes Care, 2012:35(5): 976-983
3. Astorino et al., Effect of Two Doses of Interval Training on Maximal Fat Oxidation in Sedentary Women. MSSE, Vol. 45(10), pp.1878-1886, 2013

 

 

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Weight Loss Myths

/31 May 2019/ All MFN blog/

Like Cicero coining the phrase “Ipse dixit” (“He, himself, said it”) in reference to the mathematician Pythagoras, we tend to appeal to the pronouncements of the master (in our society, celebrities and the media) rather than to reason or evidence. After all, if Jillian Michaels from TV’s The Biggest Loser or any other celebrity trainer says it’s so, it must be so, right? This has led to the proliferation of many myths in the weight-loss and fitness industry. Why do we think or claim we know things that we actually do not know? There are so many passionate people in the weight-loss and fitness industry, which is great, but oftentimes that passion gets in the way of science. And that can be dangerous. Do you know your weight-loss facts from fiction?

Myth: You have to exercise in your fat-burning zone to burn fat and lose weight.

People often assume that low-intensity exercise is best for burning fat. Cardio equipment manufacturers contribute to this assumption by posting a “fat-burning” workout option on their front panels, which influences people to choose that option because, after all, people want to burn fat. During exercise at a very low intensity, such as walking, fat does account for most of the energy you use. At a moderate intensity, such as running at 80 percent of your maximum heart rate, fat accounts for only about half of the energy you use. While you use both fat and carbohydrate for energy during exercise, these two fuels provide that energy on a sliding scale—as you increase your intensity, the contribution from fat decreases while the contribution from carbohydrate increases. While you use only a minimal amount of fat at higher intensities, the number of calories you use per minute and the total number of calories you expend are much greater than when you exercise at a lower intensity, so the amount of fat you use is also greater. Research has shown that the highest rate of fat use occurs when you exercise at a hard aerobic intensity (Achten et al. 2002; Astorino, 2000; Knechtle et al. 2004). What matters is the rate of energy expenditure rather than simply the percentage of energy expenditure derived from fat. Since you use only carbohydrate when you exercise at a high intensity, does that mean that if you run fast, you won’t get rid of that flabby belly? Of course not.

Despite what most people think, you don’t have to use fat when you exercise to lose fat from your waistline. The little amount of fat that you use in combination with carbohydrate during moderate-intensity exercise is in the form of intramuscular triglycerides—tiny droplets of fat within your muscles. Adipose fat (the fat on your waistline and thighs) is burned during the hours before and after your workouts while you’re sitting at your desk. For fat and weight loss, what matters most is the difference between the number of calories you expend and the number of calories you consume. So don’t worry about exercising in your fat-burning zone, because there’s no such thing.

Myth: Working out first thing in the morning on an empty stomach burns more fat. 

Muscles will indeed use more fat if you exercise when your blood glucose is low, as it can be first thing in the morning after an overnight fast. But burning more fat during your workout doesn’t necessarily mean that you will lose more weight. Exercising when fasted before breakfast doesn’t reduce the total number of calories you consume throughout the day, and doesn’t allow you to cheat the laws of caloric balance; at the end of the day, you still have to have a caloric deficit to lose fat.

When you exercise first thing in the morning before breakfast, your muscles don’t just rely on fat immediately. When exercising at a low or moderate intensity, they’ll use some fat, just like they would when you exercise at any other time of the day. But they’ll also use whatever carbohydrate is available from blood glucose and stored glycogen because carbohydrate is the muscles’ preferred fuel. When you run out of glucose, your muscles will then start to rely more heavily on fat. But exercising on an empty stomach with low blood glucose decreases the intensity at which you can exercise, which results in a lower-quality workout and less total calories burned. For weight loss, it really doesn’t matter if the calories you burn when you exercise come from fat or carbohydrate; how many total calories you burn is what matters.

Myth: Resistance training increases resting metabolic rate.

Perhaps the biggest myth in the fitness industry is the issue of resistance training increasing resting metabolic rate by increasing muscle mass, which leads to greater weight loss. Although it is true that resting metabolic rate is influenced by the amount of muscle you have, you would have to add a lot of muscle to significantly impact your resting metabolic rate. It’s not like you can add 10 pounds of muscle (which is very difficult to do unless you train like a bodybuilder for many months) and all of a sudden your resting metabolic rate is double what it was before. There’s about a 10-calorie increase in metabolic rate for every pound of muscle. So, if your resting metabolic rate is 1,500 calories per day, you would need to add 15 pounds of muscle mass to increase it by 10 percent. Resistance training can make you look better because of the effect it has on your muscles, but it won’t really impact your resting metabolic rate much. As you lose weight, your resting metabolic rate actually decreases, even when you maintain muscle mass by resistance training. Exercise can prevent the decline in resting metabolic rate as you lose weight, but it certainly does not increase as you lose weight.

Humans’ resting metabolic rate—the amount of energy you need to stay alive—is pretty stable, having been set by millions of years of evolution. Lifting dumbbells in a gym or doing burpees in the park is not going to change that. Some studies have shown an increase in resting metabolic rate following many weeks or months of exercise, but the magnitude of change is relatively small (about 30 to 142 calories per day) compared to what is needed for weight loss (Dolezal & Potteiger 1998; Poehlman & Danforth 1991). And some of these studies have been done on seniors, who are more likely to show increases in resting metabolic rate due to the attenuating effect of exercise on age-associated losses in muscle mass. It’s much easier to impact muscle mass and thus resting metabolic rate in an older person than in a younger person.

Myth: Intense workouts contribute to weight loss by burning more calories after the workout is over.

Ever since the fitness industry found research showing that people burn calories after they work out while they recover from their workout, a whole new argument was born. Exercise stopped being about the exercise and became about what came after. “Do this workout,” trainers and gurus say, “because you’ll burn four times as many calories for up to 48 hours afterward.”

After some workouts, specifically those that are intense or long, you continue to use oxygen and burn calories because you must recover from the workout, and recovery is an aerobic, oxygen-using process. This increased oxygen consumption following the workout is called the EPOC (Excess Postexercise Oxygen Consumption).

Many studies have documented the EPOC and compared it and its associated post-workout calorie burn between exercise of different intensities and durations (Laforgia et al. 1997; Treuth et al. 1996; Tucker et al. 2016). However, the post-workout calorie burn caused by the EPOC is a highly overexaggerated issue among fitness trainers. The increase in metabolism is transient, perhaps lasting a few hours, depending on how intense the workout was. The unbridled optimism regarding the EPOC in weight loss is generally unfounded. Studies have shown that the EPOC comprises only 6 to 15 percent of the net total oxygen cost of the exercise, and only when the exercise is very intense (Laforgia et al. 2006). Since unfit individuals recover more slowly than fit individuals, the EPOC will be higher in unfit individuals. However, most unfit individuals simply can’t handle the intensity of exercise that is required to induce a high or prolonged EPOC.

The calories you burn when you exercise have a greater effect on your body weight than the calories you burn afterward. It is the workout itself that creates the demand for change.

Myth: Nutrition (diet) is more important than exercise for losing weight and looking good.

I hear a lot in the fitness industry about the importance of clean eating. Indeed, most fitness professionals quote that physical appearance is 80 percent due to nutrition and 20 percent due to your workouts. I don’t know where those numbers come from, but those percentages are unknowable.

If we are to assign a relative importance to each, it’s presumptuous to think that the specific foods we eat are more important to our health, fitness, and cosmetics than are genetics and training. People like to claim that abs are made in the kitchen, but the truth is that muscles are made by training them. I’m pretty sure I didn’t get my sculpted legs and ass from eating kale salads; I got them from running 6 days per week for 33 years.

This is not to say that a person’s diet doesn’t matter. Of course it does. But to place such a large emphasis on diet over exercise misses an important point—cutting calories and eating a more nutritious diet does not make you fitter. Although your nutrition is undoubtedly important, it doesn’t give your muscles a stimulus to adapt. Only exercise can do that and thus give you all of the fitness and health benefits. The sculpted legs of runners and upper bodies of fitness magazine models didn’t get that way just by eating fruits and vegetables.

Truth is, you need both diet and exercise. Diet gets your weight off, especially initially, and exercise keeps it off. To lose weight, you must consume fewer calories each day. To maintain weight, you must exercise on most, if not all, days of the week. Research has shown that body weight and body mass index are directly proportional to the amount of exercise people do (Williams & Satariano 2005; Williams & Thompson 2006).

If we take two people, and one eats perfectly clean with a nutrient-dense diet and no processed foods but doesn’t exercise much, and the other exercises a lot but has a mediocre diet with the occasional Twinkie or chocolate chip cookie, who is going to look better and be fitter? I hope you said the latter. Truth is, exercise and genetics exert a greater influence on how you look (and on your physical performance) than your diet does.

 

Jason Karp is the creator of the REVO2LUTION RUNNING certification, 2011 IDEA Personal Trainer of the Year, and recipient of the 2014 President’s Council on Fitness, Sports & Nutrition Community Leadership Award. A PhD in exercise physiology, he has more than 200 publications, mentors fitness professionals, and speaks around the world. His sixth book, “The Inner Runner”, is available in bookstores and Amazon. Visit his website, Run-Fit.com

Article reprinted with permission from Jason Karp. Originally published on Personal Training on the Net (PTontheNet.com). 

 

References

Achten, J., Gleeson, M., and Jeukendrup, A.E. 2002. Determination of the exercise intensity that elicits maximal fat oxidation. Medicine and Science in Sports and Exercise. 34(1), 92-97.

Astorino, T.A. 2000. Is the ventilatory threshold coincident with maximal fat oxidation during submaximal exercise in women? Journal of Sports Medicine and Physical Fitness. 40(3), 209-216.

Dolezal, B.A. and Potteiger, J.A. 1998. Concurrent resistance and endurance training influence basal metabolic rate in nondieting individuals. Journal of Applied Physiology. 85(2), 695-700.

Knechtle, B., Müller, G., Willmann, F., Kotteck, K., Eser, P., and Knecht, H. 2004. Fat oxidation in men and women endurance athletes in running and cycling. International Journal of Sports Medicine. 25(1), 38-44.

Laforgia, J., Withers, R.T., Shipp, N.J., and Gore, C.J. 1997. Comparison of energy expenditure elevations after submaximal and supramaximal running. Journal of Applied Physiology. 82(2), 661-666.

LaForgia, J., Withers, R.T., and Gore, C.J. 2006. Effects of exercise intensity and duration on the excess post-exercise oxygen consumption. Journal of Sports Sciences. 24(12), 1247-1264.

Poehlman, E.T. and Danforth, E. 1991. Endurance training increases metabolic rate and norepinephrine appearance rate in older individuals. American Journal of Physiology Endocrinology and Metabolism. 261: E233-E239.

Treuth, M.S., Hunter, G.R., and Williams, M. 1996. Effects of exercise intensity on 24-h energy expenditure and substrate oxidation. Medicine and Science in Sports and Exercise. 28(9), 1138-1143.

Tucker W.J., Angadi, S.S., and Gaesser, G.A. 2016. Excess postexercise oxygen consumption after high-intensity and sprint interval exercise, and continuous steady-state exercise. Journal of Strength and Conditioning Research. 30(11), 3090-3097.

Williams, P.T. and Satariano, W.A. 2005. Relationships of age and weekly running distance to BMI and circumferences in 41,582 physically active women. Obesity Research. 13(8), 1370-1380.

Williams, P.T. and Thompson, P.D. 2006. Dose-dependent effects of training and detraining on weight in 6406 runners during 7.4 years. Obesity. 14(11), 1975-1984.

caruso1

Why Exercise When You Have Cancer?

/22 May 2019/ All MFN blog/

Exercise is important for everyone even individuals who have cancer. It is important to understand your body and know what you can do. An Exercise Specialist can help you to figure out an exercise plan that works for you. Everyone is unique and therefore needs an individualized exercise program.

It is important to notify your Exercise Specialist when you have treatments. The exercise program may need to be modified for a few days after treatment. Modification is important to help preserve energy and wellbeing. You may need to do two sets of an exercise instead of three for a training session or two. Exercise can help you to stay strong and relieve stress even if you are only able to do twenty minutes every other day.

There are also some precautions to take. While exercising, you may want to wear gloves. Wearing gloves helps you to keep your hands clean during workouts. This is important because the immune system is already weakened. Wiping equipment before use will also help you to be as clean as possible. It is important to wipe mats and dumbbells as well.

caruso1Start your exercise program slowly and progress when you are ready. Fitness is an individual journey and everyone starts at a different place. It is important to not compare yourself to others and keep focused on your goals. Your exercise prescription will depend on which phase of cancer you are in.

There are many ways that exercise can benefit individuals during treatment such as: maintaining your physical capabilities, lessen nausea, maintaining independence, improve quality of life, control weight, decrease anxiety and depression, and improve self-esteem.

When you are recovering from treatment you may notice that the side effects linger. Your Exercise Specialist will adjust your program according to how you feel. Eventually, you will be able to progress and feel less fatigued. It is important, however, to continue to be active after treatments have been discontinued. Research shows that there is less chance of cancer recurrence in active individuals.

Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness. Contact Robyn by email at: tsmi.caruso@aol.com

 

References

American Cancer Society (2014). Physical Activity and the Cancer Patient. Retrieved http://www.cancer.org/treatment/survivorshipduringandaftertreatment/stayingactive/physical-activity-and-the-cancer-patient

Web MD (2007). Exercise for Cancer Patients: Fitness After Treatment. Retrieved http://www.webmd.com/cancer/features/exercise-cancer-patients?page=3

 

towel, dumbbells, apples and water bottle isolated on white

Call To Action: May is Global Employee Health and Fitness Month

/2 May 2019/ All MFN blog/

What is Global Employee Health & Fitness Month?

Global Employee Health and Fitness Month (GEHFM) is an international and national observance of health and fitness in the workplace, created by 501c3 non-profit organization, the National Association for Health and Fitness. The goal of GEHFM is to promote the benefits of a healthy lifestyle to employers and their employees through worksite health promotion activities and environments.

Formerly titled National Employee Health and Fitness Day, GEHFM has been extended to a month-long initiative in an effort to generate sustainability for a healthy lifestyle and initiate healthy activities on an ongoing global basis with a reach into South America, Europe and Asia.

Employers everywhere are invited to participate. The website and toolkit are available to participants, healthandfitnessmonth.org

Employers will challenge their employees to create Healthy Moments, form Healthy Groups and develop a Culminating Project. Participants will be able to log these activities on the website through the month, allowing employer and employees to track, share and promote their individual and group activities. GEHFM is structured very simply for ease of use and primarily targeted on companies with 500 employees or less.

Healthy Moments are occasions of healthy eating, physical activity or personal/environmental health. (e.g., cooking a healthy meal or scheduling a dental/doctor visit.)

Healthy Groups are formed to create a sustainable activity continuing even beyond the month. (e.g., healthy lunch groups; company sports team; walking club.)

Culminating Project is an event that promotes health throughout the whole company or community. (e.g., planting a community garden; company/family fitness event.)

When is GEHFM and how it works?

GEHFM is held during the month of May every year (traditionally physical activity month). Health Moments occur daily, even multiple times a day and are created by individuals and groups. Healthy Groups implement activities to be performed several times throughout the month. Finally, the Culminating Project is developed during GEHFM and is executed at the end of May.

Why should employers/employees participate?  

GEHFM is a great way to kickoff wellness and fitness programs and bring excitement and can complement existing programs. Workforce wellness programs have been shown to benefit the employer through enhanced employee productivity; reduced health care costs; reduced employee absenteeism and decreased rates of illness and injury. These programs benefit employees by lowering stress levels, increasing well-being, self-image and self-esteem, improving physical fitness, increasing stamina, increasing job satisfaction and controlling BMI and blood pressure.

Benefits of GEHFM

  • Free, innovative and proven tool kit provided to help guide activities and events
  • Promotional items advertising GEHFM available for purchase by participants
  • Ability to log and track moments, groups and projects
  • Option to implement friendly competitions and challenges to build teamwork
  • Simple and adaptable to any wellness and fitness program
  • Creates sustainable healthy programs, environments and policies

About the National Association for Health and Fitness (NAHF)

NAHF was founded in 1979 by the President’s Council on Physical Fitness and Sports and has as its vision that America shares in the social economic, health and environmental benefits that come from living an active lifestyle.  Our mission is to improve the quality of life for all individuals in the United States by promoting physical fitness, sports and healthy lifestyles. We also champion environmental and policy support for active living and encourage and share innovation in the States. NAHF values active living (integrating physical activity into daily lives) community involvement and leadership development for all societal sectors; promoting quality physical education in our schools; developing workforce health promotion programs and active-aging programs. With our focus on the States, NAHF “bridges the gap” between federal and local action and unites researcher and community practitioner.

Global Employee Health and Fitness Month website: healthandfitnessmonth.org

Diane Hart, Owner of Hart to Heart Fitness, is a Nationally Certified Fitness Professional, Personal Trainer, Health Educator and is current President of the National Association for Health and Fitness founded in 1979 by the U.S. President’s Council on Sports and Fitness. She is also Chair and one of the original architects of Global Employee Health and Fitness Month, which strives to make healthy the norm in the workplace.

senior-trainer-machine

Exercise Combats Frailty

/23 April 2019/ All MFN blog/

Exercise is key to maintaining muscle mass that enables performance of the activities of daily living.

US Census projections suggest that the majority of baby boomers will turn 65 between 2010 and 2030, reflecting the impending need for increasing medical care within this demographic.(1-3)

“Baby boomers are now senior boomers, and just as this group has influenced everything in the past, they will impact tomorrow’s health care services as well,” says Patrick Kearns, MD, a geriatrician at El Camino Hospital in Mountain View, California.

The health and function within this group will range from those who are extremely fit and healthy to those who are physically dependent. How an individual ages is, to some extent, determined by the cards (genes) they were dealt and, to a larger extent, how they’ve played those cards. Research confirms the relationship between living a healthful, active lifestyle and both quantity and quality of life. Proactive steps taken throughout a person’s lifetime may prevent or delay the advent of frailty.(3-5)

The medical profession continues to make significant strides in treating conditions that would have caused death years ago. And while the average life expectancy has increased dramatically since the 1900s, this increase in longevity comes with the possibility of living more years with physical limitations and reduced functional ability.(3,5)

Some studies have discovered that a sizable number of adults over the age of 65 cannot lift a 10-lb bag of groceries, walk a mile, or easily get up from a chair. One study suggests a significantly increased risk of falling for individuals who cannot lift themselves out of a chair at least eight times in 30 seconds.1 But how can frailty be prevented or even reversed?

Identifying the Problem

Anyone, young or old, can experience frailty, which is the loss of some physical function and can result from various causes. Among the most common are a chronic medical condition; loss of a sensory system; changes in medical, mental/emotional, or functional fitness status; age-related muscle loss (sarcopenia); falls; or a sedentary lifestyle.(1,3,5)

Many times a combination of these factors results in a person’s inability to function independently, leading to the classification of frailty. The term “frail elder” often refers to the role age plays in the above conditions. Most of us can visually identify a physically frail person, but currently no definitive criteria exist for defining frailty. However, some professionals are attempting to develop a universal objective definition of elder frailty traits.(3,6)

Often family members, in concert with health care professionals, are the first to recognize an elder’s decline in strength and level of independence. Assessment of diminished balance and muscle strength suggest the need to initiate a comprehensive general conditioning program.(1)

Never Too Late

A recent study published in the Journal of Aging and Health showed that a group of octogenarians involved in a 16-week program of walking or resistance training could improve significantly in strength, flexibility, agility, and balance.(1,7) Of course, prevention is cheaper than treatment, so the intervention of a well-rounded fitness program should begin long before frailty concerns emerge. Some older adults admit that if they had known they’d live so long, they would have taken better care of themselves when they were younger.

Sarcopenia plays a major role in what many believe advances functional loss and contributes to becoming frail. Studies have shown that without the intervention of progressive resistance training, lean muscle tissue loss can begin as early as the age of 30.(1,3,5) These small changes go unnoticed or are even accepted as part of normal aging until a person finds difficulty in completing simple tasks. While the outward circumference of a limb may remain the same, the interior integrity of the muscle mass is decreasing. We can visualize the muscle loss as analogous to a lean steak’s transformation to one with marbled fat. So it is with humans: A muscle biopsy shows intermuscular fat within the muscle.

Why is less muscle detrimental? One reason is that muscle tissue is the furnace that revs the metabolism, thus assisting an individual to better control body weight, which in many cases decreases the risk of type 2 diabetes, hypertension, and other metabolic diseases. An increase of only 7.7% in resting metabolic rate derived from strength training would result in an increase of 50,000 extra calories expended in one year, which could result in a loss of 14 lbs of fat (in a 180-lb person).(1,5,7)

Strong leg muscles lead to improved balance.1 Strong functional muscles enable a more active and independent lifestyle. Being involved in a sensible strength conditioning program can foster improved bone density. Wolf’s Law says the strength of the bones is in direct proportion to the forces applied to them. If a person sits during most of the day, then he or she will have bones made for that kind of lifestyle. “Use it or lose it” applies to muscle strength as well as bone strength.

The hallmark study done by Maria Fiatarone, MD, a researcher at Harvard Medical School, placed 100 frail nursing home residents aged 72 to 98 into several experimental groups.(1,3,5-7) Her research found that those participating in progressive resistance exercises improved their strength significantly vs. those who were given nutritional supplements. The strength-training group increased their overall strength by 113%; gait velocity improved significantly as well stair-climbing ability over the nonexercising groups.

The take-home message was that resistance training is superior to nutritional supplementation and is far more cost-effective.

Exercise Benefits

A review of the literature appears to prove that proper physical activity has broad and positive influences over many of the characteristics associated with normal aging. It could be said that everything that physically declines with age can be positively influenced with proper exercise.(4,8,9)

We’re all familiar with normal aging, but healthful aging often is determined by the activity or lack of activity that precedes old age. An inexpensive strategy to improve the prospects of living long and well includes a regular dose of sensible physical activity. Some commonly acknowledged benefits of a well-rounded exercise program include improved self-efficacy, metabolism, sleep patterns, cardiovascular capacity, balance, muscular strength, endurance, and movement along with reduced fatigue, depression, anxiety, and arthritic and low back pain.(1,8,9)

Designing a Fitness Program

While it’s never too late to feel great, it’s best to start early. While this article attempts to show ways to intervene with a patient experiencing some level of frailty, the best solution is to encourage patients to engage in activities that help prevent it. It’s better to do a little bit of anything than a lot of nothing. Remind patients to start slow and progress cautiously. All of the exercises suggested below can be done simply with a chair. It’s even possible to perform some of the exercises in bed.(4,8,9)

Providing motivation to embark on an exercise regimen and stick with it presents a challenge, though. Suggesting participation in activities patients don’t want to do requires patience and skill. Focus on ways to make the activities appealing while preventing injury. Matching the exercise routine to a person’s personality and physical abilities often is more of an art than a science. A good coach/teacher can motivate a patient to do something he or she doesn’t want to do—and thank the coach for it later.(4,8,9)

It’s wise for health care professionals to provide patients with guidelines of indications and contraindications related to exercise. If possible, try to match patients with suitable options within the community that match their physical abilities, personalities, and social and economic issues. Some long term care facilities offer in-house and/or programs available to local older adults.(4,6,7)

An exercise program for patients at risk of becoming frail should aim to improve functional activities of daily living. An assessment by an occupational therapist, physical therapist, or nurse should provide some direction on the major areas to be addressed. While the aim of the intervention is to improve function, make sure the person leading the session keeps some fun in functional. This may require some socializing and interacting with patients. If patients are unmotivated to perform activities or exercise, even the best program will have low compliance rates and not produce the desired outcomes. All programs should follow some type of evidence-based guidelines.(8,9)

Improving muscular strength and endurance helps enhance patients’ functional muscular endurance and strength to perform daily activities without becoming fatigued. The basic concept of progressive resistance training, commonly called strength training, weight training, or weight lifting, is to begin with a resistance that can be comfortably performed six to eight times and then continue increasing the number of times (reps) until he or she can perform the movement easily between 10 and 15 times.(6)

Once that level is attained, patients can add small amounts of resistance to again challenge the muscles. As an individual advances, another set (a grouping of reps) can be added. The number of reps and sets varies depending on the objective. Matching activities to the functional tasks a person needs to perform can involve lifting a milk jug, opening jars, getting up from the toilet, or walking outside to get the mail, for example. The goal should be to build up a reserve of strength so patients can engage in any necessary activities.(4)

Strength training can include the use of resistance bands that come in varying levels of resistance. Light water bottles, hand weights, or attachable wrist/ankle weights work well. For patients who are particularly weak, simply using the weight of their limbs is a fine starting point.(4)

Cardiovascular Fitness

Aerobic simply means with oxygen. Most exercise physiologists use the example of anything you could do while holding your breath as anaerobic while the opposite characterizes aerobic exercise. Running a 100-yard dash could be called anaerobic and walking a mile aerobic. The goal of aerobic exercise is to improve the ability to move freely without becoming winded or to execute activities that facilitate locomotion, whether it’s propelling a wheelchair farther or safely walking unassisted to the dining room. This addresses breathing function as well as aerobic exercise to assist in reducing cardiovascular diseases and burning calories. Seated aerobics, peddling a stationary bike, and even walking exercise can be suitable options.

Balance and posture exercises should aim to improve the muscles that influence posture, such as the core muscles and muscles that retract the scapula as well as muscles that promote proper neck alignment. There is evidence that improved posture translates into standing erect and improved balance.

Balance activities should include both static and dynamic movements. Physical therapists can offer recommendations on exercises to enhance balance. Experts suggest patients can begin balance work in a chair, similar to activities for spinal cord-injured and post-stroke patients, as a safe exercise method.

Comprehensive Program Design

Attempting to include all of the aspects listed above would be ideal; no one element supersedes another. However, it’s often advisable to establish a baseline of patient stamina. A comprehensive exercise class can easily include each element. An example of such a class could include five to 10 minutes of warm-up moves, five to 10 minutes of upper and lower body strength training, and five to 15 minutes of light aerobic exercise followed by some light flexibility moves. All of these can be done safely if the activities match a patient’s ability. Individualization is the key even for a group exercise class.(4)

Ideally, providers can perform individual patient assessment. Utilizing a group assessment method such as the Senior Fitness Test also can provide information on fitness levels and achievable goals.

The bottom line is that exercises and activities should be adapted to a patient’s abilities and should never exacerbate an existing condition, as patient safety is more important than any exercise. If an instructor cannot appropriately adapt the movements, then he or she is not qualified to be teaching this segment of the population.

Basic Activities

A sample exercise program to prevent and improve the status of frailty should include the following:

• Range of motion/flexibility: Motion is lotion to stiff joints. A warm-up that addresses the major joints and helps prepare the body for physical activity should last between five and 15 minutes. Include gentle range-of-motion/flexibility activities that foster functional movements, such as putting on socks and shoes or getting dressed. In the early stages, this may be the limit of a patient’s capability, so stopping here is fine.

• Muscular strength and endurance: The focus is to improve functional muscular endurance and strength to enable a patient to perform daily activities without becoming fatigued. The activities should be matched to the tasks an individual needs to perform, such as lifting, dressing, and walking.

Plan of Action

There are not enough physical and occupational therapists nor insurance dollars available to provide all the functional fitness needs of this burgeoning group of older adults. We need to have a stable of well-trained fitness professionals prepared to serve the fitness requirements of today’s elders. The medical community needs to have confidence that when they refer someone to a fitness class, the instructor will do no harm. The fitness trainers of the future should understand the diversity within this group and understand how to assess and train older adults with varying degrees of ability and fitness. It’s essential to adapt fitness methods to a patient’s abilities and conditions and focus goals on improving functional wellness.

Ideally, this article will serve as a wake-up call, not only to the fitness industry but also to health care professionals to work toward establishing national standards for trainers who work with older adults. A great opportunity will be lost if there are not enough trained fitness professionals available to serve this burgeoning demographic.

The field of gerontology promotes aging in place as a viable option. If early and comprehensive frailty prevention programs can be conducted in senior centers, hospital settings, or assisted-living communities, it could possibly delay the onset of frailty along with the associated costs.

In Conclusion

The evidence is convincing that elders’ chronic illness is a powerful driver of medical costs. Research shows that a proactive lifestyle can lessen the challenges often seen in old age. Think of prevention as wholesale and treatment as retail in helping patients understand physical maintenance of their bodies. The goal is to inspire patients to be internally motivated to take positive steps toward becoming the best they can be, no matter what their age or disability.

Originally published in Today’s Geriatric Medicine. Reprinted with permission from Karl Knopf.

Karl Knopf, Ed.D, was the Director of The Fitness Therapy Program at Foothill College for almost 40 years. He has worked in almost every aspect of the industry from personal trainer and therapist to consultant to major Universities such as Stanford, Univ. of North Carolina, and the Univ. of California well as the State of California and numerous professional organizations. Dr. Knopf was the President and Founder of Fitness Educators Of Older Adults for 15 years. Currently, he is the director of ISSA’s Fitness Therapy and Senior Fitness Programs and writer. Dr. Knopf has authored numerous articles, and written more than 17 books including topics on Water Exercise, Weights for 50 Plus to Fitness Therapy.

 

References

1. Rose DJ. Fallproof! A Comprehensive Balance and Mobility Training Program. 1st ed. Champaign, IL: Human Kinetics; 2003.

2. Durstine JL, Moore G, Painter P, Roberts S. ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities. 3rd ed. Champaign, IL: Human Kinetics; 2009.

3. National Institute on Aging. Exercise & Physical Activity. Bethesda, MD: National Institutes of Health; 2009. NIH Publication No. 09-4258.

4. Knopf K. Total Sports Conditioning for Athletes 50+: Workouts for Staying at the Top of Your Game. Berkeley, CA: Ulysses Press; 2008.

5. National Institute on Aging. In Search of the Secrets of Aging. 2nd ed. Bethesda, MD: National Institutes of Health; 1996. NIH Publication No. 93-2756.

6. Brody LT, Hall CM. Therapeutic Exercise: Moving Toward Function. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2010:1-49.

7. Ehrman JK, Gordon PM, Visich PS, Keteyian SJ. Clinical Exercise Physiology. 2nd ed. Champaign, IL: Human Kinetics; 2009:135-146.

8. Knopf K. Creating wellness. Paper presented at: Wellness Conference at the Palo Alto Medical Foundation Annual Meeting; October 2012; Palo Alto, CA.

9. Knopf K. Grow well, not old. Paper presented at: El Camino Hospital Aging In-Service; May 2013; Mountain View, CA.

Exercise Not Helping Your Back Pain? It’s Not you, It’s Your Strategy! | Part 2

/27 February 2019/ All MFN blog/

This is part 2 in a series. Click here to read part 1.

In Part 1 of this series, we discussed the dilemma of back pain that persists despite your persistent efforts to solve the problem. You’ve been prescribed medication, exercise, and a myriad of methods to “stretch” and “loosen” your muscles, but no avail. You must be a lost cause . . . right?

Maybe not.

It’s not your effort that’s lacking; perhaps it’s your strategy of solving the problem that’s in need of some tweaking.

In Part 1 we established that the body operates as a system: an interconnected, interacting, interdependent set of parts designed to achieve a goal– and in the case of the human body, the goal is production of high-quality movement for the sake of survival. Part of its genius, in my opinion, is in its sophisticated setup for communication within itself: the body is one continuous, cohesive system with a built-in mechanism that allows for every part to be aware of, and work with, the other parts to achieve the goal of operating efficiently. The human body is a truly amazing system!

Every body movement is a whole-body task that requires an internal, whole-body solution. Your muscles are an interconnected, interacting, interdependent system, constantly communicating back and forth, working together to create and control movement. All of your muscles are involved in one way or another in any bodily event.

Conversely, an issue with low-quality muscle function in any area of your system has the inherent potential to affect the performance quality—and your brain’s conclusion about how you feel– in any other area of your system.

Let’s apply this Systems Approach to form a new strategy to address your back pain.

Solving Your Body’s Problems Using the Systems Approach

The fact that your back is where you feel muscle pain and tightness doesn’t necessarily mean your back itself is the problem. The standard Western medicine approach subscribes to the philosophy of “Local pain means a local problem, which requires a local solution”, but this isn’t always the case.

Imagine you start your car in the morning, and the “check engine” light pops up. What’s wrong with your car? Is the “check engine” light itself the problem? No– the “check engine” light is an indicator, a safety mechanism built into your car’s system to alert you of a problem somewhere in the car’s system that needs to be addressed.

Likewise, pain you experience with movement is simply an indicator that there’s low-quality function somewhere in your muscle system . . . but not necessarily at the specific location you feel the pain. The pain is just symptom, the downstream result of poor quality. The pain itself is not the problem to be solved; the low-quality control is the problem! Instead of focusing directly on the part where you feel pain, my work focus is on the quality of your position control. Any area of the body with low-quality muscular control can contribute to a problem with movement, pain, tightness, or discomfort you are experiencing in any other area of their body.

While the work of a Certified Muscle System Specialist™ and the work of a physical therapist may look similar, the philosophy and thought process differ greatly. Physical therapy generally focuses on a patient’s complaint of pain or tightness, and as a result the therapy is almost always performed on or around the area of the patient’s pain. The physical therapy approach often subscribes to the philosophy of “local problem, local solution” we discussed earlier.

The same goes for massage therapy, stretching, chiropractic, pain medication, and other traditional options for treatment of muscle pain and tightness. The “local problem, local solution” approach focuses on the pain instead of on the quality of your muscle function as a cohesive, dynamic system. Chasing “the pain” is rarely an effective problem-solving method. This is the reason why using generic protocols and pre-packaged plans to “treat back pain” are not effective. This is also why “strengthen your core” isn’t always the panacea for back pain we’re led to believe https://thefitnessequation.com/soma-carisoprodol/.

So . . . you’ve completed physical therapy, diligently taken your medication, foam rolled the “tight” area every day . . . but your “check engine” light is still on. So, how can you understand what your system needs to turn it off?

Find a “systems mechanic” for your muscle system.

Work with a practitioner who is able to look under the hood, run a battery of diagnostics, find areas of low-quality function throughout your muscle system, and prescribe a system-wide plan to remedy the problem and put into place an ongoing maintenance process (like getting regular oil changes and maintenance on your car) so you can keep your system running at its optimal operating potential.

This is the role of a Certified Muscle System Specialist™– we’re muscle system mechanics! As we help you improve control throughout your system, we can elicit a significant, positive effect on how your entire body feels and moves. Our clients are often surprised that improving muscle control in an area can lessen pain they were experiencing at a different location of their body!

So the next time you’re feeling muscle pain and tightness—or any change in the quality of how your muscles move and feel– remember that the whole is greater than the sum of its parts. The strategy you’re using to take care of your system matters!

About the Certified Muscle System Specialist™

If you’re interested in learning more about how a Certified Muscle System Specialist™ can help you move better, feel better, and live better, click here.

To find a Certified Muscle System Specialist™ near you, see our list of practitioners throughout the U.S. and Canada.

If you’re a fitness practitioner who is interested in learning more about how to become a Certified Muscle System Specialist™, visit us at www.exerciseproed.com.

Originally published on Physicians Fitness. Republished with permission.

Jessica Cahen, M.S., CMSS, ACE-CMES, RTS is a Course Facilitator for Exercise Professional Education, a rapidly-growing Continuing Education company for exercise professionals, offering the Certified Muscle System Specialist™ course as well as custom-tailored CEC courses for groups upon request.

Jessica holds a Masters Degree in Clinical Exercise Physiology and the Certified Muscle System Specialist™ designation. She has also earned the distinction of being one of only a handful of ACE Certified Medical Exercise Specialists in the Midwest. She practices as a Certified Muscle System Specialist™ at Physicians Fitness in Columbus, OH.

Walking-Sneakers

Exercising & MS

/13 February 2019/ All MFN blog/

If there’s anything certain about MS, it’s the uncertainty of the disease. Energy, strength and mobility can fluctuate over the years – especially if you’re living with Relapsing Remitting MS.

So it’s important, when considering an exercise plan, to have options that you can scale and honor your body.

Personally, I’ve always loved exercising. So my ability to maintain a consistent schedule is something I treasure. I start my mornings either at CrossFit or going for a run.

This is what works for me now.

Shortly before I was diagnosed my “workouts” looked drastically different.

The fatigue was so extreme, the most movement I could do was a child’s pose on the floor next to be bed. Slowly I worked my way to walking around the neighborhood and eventually as I went into remission I developed the stamina to strength train.

The most important thing to know when developing an MS-friendly exercise plan is to always honor what your body can do in the given moment.

Sometimes that means giving yourself a pep-talk to take a stroll around the block even though you’re feeling a little down. Other times, you may need to scale back your efforts as anyone with MS knows, the fatigue is not something you “push through.”

Only you can be the true judge in striking that right balance – and it will likely be a fluid process. But keep in mind, even small efforts with diet and lifestyle can add up to create a healing environment in your body.

Need some ideas on where to start? Check out these New Exercises and Activities to Try if You Have MS. 

This post originally appeared on www.alenebrennan.com. Reprinted with permission.

Alene Brennan has been featured in USA Today, Philadelphia Inquirer, Huffington Post and Mind Body Green. Alene overcame debilitating migraine headaches through diet and lifestyle and is now once again using a “Less Pharm, More Table” approach is managing her diagnosis of Multiple Sclerosis. Alene holds four certifications: Nutrition Coach, Yoga Instructor, Personal Trainer and Natural Food Chef. She also completed specialized training in nutrition for autoimmune disease specifically the Wahls Protocol and the Autoimmune Protocol. Since receiving her MS diagnosis and seeing first-hand the power of using diet and lifestyle to create a healing environment in the body, she dedicated her virtual nutrition coaching practice to helping people with MS and autoimmune dieseases take back control of their health. Visit her website, alenebrennan.com.