No, I’m not on a rant. But I sure could be. What’s funny about a chronic disease that impairs health and renders people more sensitive to deadly co-morbid factors associated with COVID-19? Nothing. Nothing is funny at all.
I write about obesity a great deal, have been caring for those with emotional and behavioral components related to the disease, speaking and teaching about it since the early 1970s, and won’t stop. When it comes to promoting health…
What’s all the fuss about “core”? Too many articles in the lay literature address core as if somehow it’s a brand new thing in fitness. Yet, those articles fail to appreciate the full measure of what core exercise is all about. In fact, they tend to further the image of core by emphasizing the abdominals, praising stars and models for their core work based on how they look with bare midriffs.
This is not to say the trainers for these media stars, or even the stars themselves, or the authors who write about them don’t know a core from an ab. But it is disturbing to me and my colleagues that the two phrases often get juxtaposed as if you can’t have one without the other.
THE REALITY IS A STRONG, CUT ANTERIOR ABDOMINAL WALL DOES NOT MEAN YOU HAVE A STRONG CORE, BUT A STRONG CORE DOES MEAN YOU HAVE A VIABLE AND STRONG ANTERIOR ABDOMINAL WALL.
Let me explain.
First of all, the core is the complex of muscles of the spine, pelvis and lower extremities that contribute to the stability and safety of the spine itself. I have addressed this on my website, here, here, here, here and especially here as it relates to athletic injuries. Thus core muscles act on the spine, directly or indirectly, to enable forces from the lower extremities and/or upper extremities to yield movement patterns from walking to kicking, throwing to shaking hands.
WHEREAS ANY MOVEMENT OF ANY PART OF THE BODY REQUIRES SOME STABILITY IN SOME AREAS IN ORDER TO BE FLUID AND CORRECT OR ON TARGET, THE CORE IS THE CENTRAL REGULATOR, DISSIPATOR AND CAPACITOR FOR ALL HUMAN MOVEMENT.
Without going into excessive scientific detail and rationalization, for the sake of simplicity for all to understand, the core partially consists of the anterior abdominal wall which is made up of the rectus abdominis (RA, or 6- or 8-pack) on the front and the external (EO) and internal obliques (IO) on the sides. The EO has fibers that run from the lateral lower rib cage toward the midline downward; the IO start more toward the lower back (attaching to the thoracolumbar fascia and anterolateral pelvis) and run upward toward the midline attaching on the lower anterior ribcage. If you can imagine it, the EO fibers run diagonally away from the midline and therefore pull the trunk toward the opposite side of the body; the IO pull the trunk toward the pelvis on the same side. Together they bend the spine laterally toward the side they’re on.
If the RA and both sides of the EO/IO complex contract at the same time, the chest moves toward the pelvis or, if the chest is held steady, the pelvis moves toward the chest (as in a reverse crunch). If the RA and the EO on the right and IO on the left contract, the torso rotates toward the left, as in a twisting crunch or throwing motion.
But the anterior abdominal wall, which is what people associate with a strong core, isn’t the whole picture, visually or functionally.
The posterior core consists of the quadratus lumborum (a low back muscle that bends the spine to either side), erector spinae (the thick, multi-muscle group of the lumbar spine which extends the spine backwards), and the gluteals, especially the big muscle, the gluteus maximus, your butt muscle.
But the core goes even deeper and further afield. For example, any muscles that attach to the pelvis, to which the spine is attached, are technically core muscles. In that they help to control the position of the pelvis relative to leg movements, they help to control the spine.
Thus, we should include the hamstrings on the back of the thigh and the quadriceps on the front; the adductors on the inner thigh and the abductors on the outer thigh such as the TFL (tensor fascia lata), sartorius and, above all, the gluteus medius and its baby brother, gluteus minimus. All these are what some have called the ‘global’ muscles of the core in addition to the abs and low back/gluteals above.
However, where there’s an outer or global core, there must be an inner or local core. These are the muscles that make up the ‘inner tube’ or ‘cylinder’ that support the spine. The front of the inner tube is made up of the transversus abdominis (TrA or TvA). The posterior wall is made by the psoas, which combines with the iliacus to form the iliopsoas. This under-acknowledged and under-appreciated muscle is worthy of more attention by spine docs and fitness professionals despite or maybe because of the lack of use it suffers in modern society.
Like any cylinder, there’s a top and a bottom. The top of the inner core is the diaphragm – yes, you read that right: the dome-shaped muscle that we always associate with breath and breathing. Again, out of respect for your time, I won’t delve too deeply into the role of the diaphragm but suffice it to say that, prior to any major body effort, that little breath-hold you take – the Valsalva maneuver – requires a functioning diaphragm to inhale and hold the air.
And the bottom is what we call the pelvic floor, the complex of small muscles in the bowl of the pelvis that help control urination, defecation and stabilization of the pelvic organs. You mostly know it when it’s not working right, such as with incontinence, but it’s a critical set of muscles most of us never have to think about when it comes to activity let alone spinal stabilization. According to some, though it may be a little too scientific for this discussion, its valuable role comes into play when stiffening the spine against heavy exertions.
To conclude Part 1, the core is the center of the body with branches upward, downward, and side to side that help stabilize the spine so that forces can be transmitted along the kinetic chain. These muscles link with each other in and around the pelvic-lumbar spine regions to direct our legs and feet, shoulders and hands in the directions and in the manners which we expect. They align our head and neck to enable us to see our world. They require a new way of thinking when it comes to training in the gym or on the field of play or work. Their integration is more important, unless there’s a known or notable weakness or dysfunction, than the strength or look of any one or more of them.
In Part 2, in a subsequent post, I will address the fundamental principles of authentic core training and will point out how to judge truly core exercises from tone-and-fit ones.
Originally printed on stepsfitness.com. Reprinted with permission.
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”.
As a longtime yoga instructor, I know that holding our breath is not recommended for seniors. Yet, I often see clients restrict their breathing, while straining to hear me. When we limit oxygen intake, the heart produces distressing symptoms.
Mary, who has impaired hearing, is one example. Frequently she experienced the kind of chest pains that once sent her to the ER for a “nothing wrong” diagnosis. During fitness class one day, her chest pains were back.
If you have arthritis but want to improve your current strength levels, there are smart strategies to get you there. In this article, we’ll discuss them and provide some basic steps to follow. With a solid foundation in place, you’ll be feeling stronger in no time.
The best bet is to start working with a personal trainer who’s trained clients with arthritis. That way you get to work with a professional who knows the appropriate training style and protocol to use.
Someone who knows to avoid exercises that put more stress on your joints. And instead provide exercises to improve your range of motion, flexibility, and of course, overall strength — all in a comfortable and safe way.
Then after several months of one-on-one training, you’ll have the knowledge and skills to confidently work out on your own, or continue training with the professional, if that’s what you prefer.
Pick a time of the day where your pain level is at its lowest. Exercising while in pain, stiff, or feeling inflamed will make the exercise uncomfortable, and that’s exactly what we don’t want.
Always warm up your body before an exercise. With arthritis, it’s better to have a longer warm-up time, so plan on setting aside 10 minutes or so. After this, your joints will feel lubricated and will make the exercises more enjoyable.
If you decide to workout at home, rather than with a personal trainer or physical therapist, then you’ll need to purchase some dumbbells or resistance bands if you don’t already have them.
Dumbbells and bands are more ideal than a barbell because they’re easier and safer to use. Safer in the sense that you could have an imbalance in joint strength and that would make it more difficult to use a barbell. Whereas, with dumbbells or bands, you can work your left or right sides individually and gradually increase your strength over time.
If it’s been many months or years since you exercised, then ease back into it gently and slowly. Pushing yourself too hard too soon will only overload and burden your muscles, which can increase joint pain.
This means starting with low weights as we just mentioned. It’s better to do more repetitions than to start off using heavy weights and only doing a few reps. Also, try to do a little bit every day. Even if that means going for a walk, doing some light stretching, or a few bicep curls. Being active every day will help decrease arthritis-related pain.
Furthermore, when you do work with a professional trainer or physical therapist they’ll teach you good form. And this is not only fundamental to effective exercise, but also for injury prevention.
Hydration keeps your body healthy, and it helps to lubricate the joints. As you know, this is essential for minimizing pain from arthritis. Plus, the more you exercise and sweat, the bigger the need for hydration becomes.
As the owner of Results Performance Training in Williamsburg, Virginia, Detric Smith helps people achieve their fitness goals through customized training and action-based coaching. Over the last two decades, Detric’s made it his mission to study the habits, strategies, and techniques of personal trainers and coaches who are successful and, most importantly, happy. Also, during this time he’s authored a book, mentored trainers through multiple organizations, and his own business. Finally, Detric’s written for well-respected fitness websites, magazines, and journals. Find out more about Detric at: resultsperformancetraining.com and www.detricsmith.com
References:
Muscle loss is a significant quality-of-life issue for patients with diabetes.
Diabetes is extremely common in the older adult population, affecting more than one-quarter of Americans aged 65 and older.(1) It’s increasingly recognized that individuals with type 2 diabetes—who comprise the vast majority of all diabetes cases—are vulnerable to sarcopenia—excessive age-related muscle loss. Although muscle loss can begin in persons with diabetes even at younger ages, it’s of particular concern among older adults.
“People with diabetes are living longer now, which is incredibly exciting,” says Rita Kalyani, MD, MHS, an associate professor of medicine in the division of endocrinology, diabetes, and metabolism at Johns Hopkins School of Medicine. But “it’s important to recognize [the potential for accelerated muscle loss] because it can significantly impact quality of life for people with diabetes and also mortality.”
Muscle loss is natural with advancing age. It is routine for individuals to lose 3% to 8% of their muscle mass per decade beginning at age 30, and the rate of decline is even higher after the about age 60.2 Muscle strength declines even more rapidly—at a rate of 3% to 4% per year in men and 2.5% to 3% per year in women by the age of 75.3
While some muscle loss is typical, sarcopenia refers to a condition of accelerated muscle loss. Earlier definitions of sarcopenia focused exclusively on loss of muscle mass as the key determinant of the condition, but more recent definitions have recognized that muscle strength and function are equally important for predicting adverse outcomes.(4-6) Thus, newer definitions for sarcopenia have included low walking speed and grip strength alongside low muscle mass.(5) Sarcopenia is associated with an increased risk of falls, functional decline, frailty, and mortality.(7)
The link between diabetes and sarcopenia is well established. In a study of 810 Korean adults, 15.7% of participants with diabetes were found to have sarcopenia, compared with just 6.9% of participants without diabetes.(8) A later study led by the same author, also in Korea, produced similar findings: in a sample of 414 adults aged 65 or older, participants with type 2 diabetes had significantly lower muscle mass (defined as appendicular mass/height) than did those without diabetes.(9) A link between low muscle mass and diabetes has been found in several other populations as well.(5,10)
Multiple studies have also linked diabetes to reduced muscle strength. In a cross-sectional investigation of 1,391 adults aged 60 to 70 years from the Hertfordshire (UK) cohort study, men newly diagnosed with diabetes had significantly lower grip strength than did those without diabetes.11 The effect sizes were smaller in women, but the trend was the same for both genders. Similarly, among 1,840 participants aged 70 to 79 years in the Health, Aging, and Body Composition study, subjects with type 2 diabetes showed a greater loss of both muscle mass and a greater loss of leg strength and leg muscle quality (though not arm strength/quality) over three years, compared with those without diabetes.(12) These declines were attenuated after adjustment for demographics, body composition, physical activity, and other factors, but the association remained significant.
The association between sarcopenia and diabetes has led some researchers to argue that sarcopenia is probably one of the underlying mechanisms that explains the reduced functional ability and mobility that is often seen in older patients with type 2 diabetes.(13)
While diabetes accelerates the process of muscle loss, the mechanisms aren’t yet thoroughly understood. “There are probably multiple underlying pathways linking the observational findings that we see between type 2 diabetes and accelerated loss of muscle,” Kalyani says.
The presence of insulin resistance, which is the key feature of type 2 diabetes, appears to be a major pathway. “Insulin resistance is associated with decreased protein synthesis in the muscle,” Kalyani says. One of the key roles of insulin is to drive nutrients (ie, glucose) from the blood into skeletal muscle tissue and stimulate protein synthesis. In type 2 diabetes, however, insulin signaling is impaired; insulin is not able to effectively drive glucose into the muscle tissue, and the muscle cannot synthesize new protein rapidly enough to keep pace with natural muscle degradation.(13)
Insulin resistance is linked not only to decreased protein synthesis but also to mitochondrial dysfunction. Individuals with diabetes frequently have decreased mitochondrial function, which again appears to contribute to the impairment of muscle function (possibly in part because these mitochondrial alterations may increase insulin resistance).(5)
Diabetes can also promote sarcopenia via peripheral neuropathy. Approximately 30% to 50% of diabetes mellitus patients experience peripheral neuropathy, and the condition has been shown to be an independent risk factor for sarcopenia in individuals with diabetes.(14) “Nerves are needed to help the muscles contract properly,” says John Morley, MD, a professor of medicine in the division of geriatric medicine at the Saint Louis University School of Medicine. “My leg muscles are almost certainly contracting as I sit here. If I’ve got some degree of neuropathy, I won’t get the same amount of contraction.”
Still other factors also may play a role in causing muscle loss in the context of diabetes. People with diabetes frequently have higher than normal levels of inflammatory cytokines, including tumor necrosis factor and interleukin.(6) Such cytokines have been shown to have negative impacts on both muscle mass and strength in older adults.(15) In addition, “people with diabetes are also more likely to have hypothyroidism, and people with hypothyroidism get a myopathy of the legs as well,” Morley says. “So you should always be thinking, if you see a diabetic who’s lost a lot of muscle, ‘Could this be due to something else, like low thyroid’?”
Thus, a wide variety of factors likely contribute to the connection between diabetes and sarcopenia. Some data suggest that these varying mechanisms come into play even in individuals who are comparatively young or who are comparatively early in the disease process. Kalyani and her colleagues examined a group of 984 participants from the Baltimore Longitudinal Study of Aging and found that loss of muscle function as a result of hyperglycemia was seen in some patients who were only in their 40s. Interestingly, peripheral neuropathy appeared to be a contributing factor. Also of note in this investigation is the fact that hyperglycemia affected muscle strength and quality even for patients with blood glucose levels in the prediabetes range.(16)
Until recently, scholarly attention on the connection between diabetes and sarcopenia has focused on diabetes as a cause of sarcopenia. “Clinically the direction that we think about most is accelerated muscle loss being a complication of diabetes—that people who have diabetes develop accelerated muscle loss over time,” Kalyani says. “But it’s possible that the reverse direction is also true.”
Kalyani herself explored this hypothesis in a recent study of 1,855 US adults (baseline mean age of 58.9 years). She and her colleagues found that men—though not women—who had a higher percentage of total or leg lean body mass had a lower risk of developing diabetes over the seven-year average follow-up period, even after adjusting for race.(17) The findings are in line with a previous study of young and middle-aged Korean adults (median age of 39 years at baseline) showing that individuals in the lowest quartile of relative muscle mass had a two-fold higher risk of developing diabetes than did those in the highest quartile over an average of nearly three years of follow up.(18)
According to Kalyani, the findings make sense. “Skeletal muscle is the main site of glucose uptake in the body after we eat,” accounting for about 80% of glucose clearance in a healthy individual. “So if we don’t have enough skeletal muscle, then the glucose is not taken up by the body, and it stays in the blood. As a result, your glucose levels are higher, and over time that could lead to the development of diabetes,” Kalyani says.
A recent review on the bidirectional relationship between diabetes and sarcopenia supports Kalyani’s hypothesis, arguing that loss of skeletal muscle mass and function is both a cause and a consequence of diabetes. As for how muscle loss can cause diabetes, the review supports Kalyani’s assertion that muscle loss results in a diminished target for insulin, altering glucose regulation. But the review also notes another mechanism by which muscle loss can lead to diabetes—namely, it can contribute to a decreased metabolic rate and a decrease in physical activity, which can cause inter- and intramuscular adipose tissue accumulation, in turn leading to insulin resistance.(19)
One of the difficulties associated with type 2 diabetes is that the disease doesn’t necessarily produce obvious symptoms in the early stages, meaning that some patients may not be diagnosed until after they have already developed cardiovascular problems.
However, the recognition that loss of muscle strength predicts risk of diabetes has led to new possibilities for diagnosing type 2 diabetes in its earlier stages. A recent study led by researchers at Oakland University in Rochester, Michigan, used data from more than 5,000 participants in the National Health and Nutrition Examination Surveys to identify specific cut points of handgrip strength that take into account age, sex, and body weight and that indicate the presence of type 2 diabetes in adults that appear otherwise healthy.(20) According to the authors, these cut points can be a useful screening tool for identifying diabetes at earlier stages and getting patients into treatment sooner.
The growing body of research on the connection between diabetes and sarcopenia has raised an important question: Does lowering blood glucose help preserve muscle mass?
According to Morley, there’s little research on that question, but diabetes medications that control blood glucose levels likely do have a role to play in treating (and preventing) muscle loss among older adults with diabetes. “If you’re using something like metformin or the gliptins, those improve insulin resistance. Improving insulin resistance will allow you to get more nutrients into your muscle tissue.”
The question of whether lowering blood glucose helps prevent sarcopenia is relevant because most clinical practice guidelines for older adults with diabetes recommend less aggressive glucose control as people get older. “The older adult population is heterogenous—there are some people who have long life expectancy, some have greater life expectancy, some are at greater risk for polypharmacy or hypoglycemia,” Kalyani says. “So in general glucose targets for older adults are not as strict as they are for younger adults.”
Unfortunately, Kalyani says, it’s possible that these relaxed targets may exacerbate muscle loss in vulnerable older adults. Key clinical trials on which clinical management guidelines for blood glucose have been based haven’t usually included older adults, so there’s no way to know at present. According to Kalyani, future research is needed to better understand the effects of glucose-lowering on muscle mass in older adults.
The Importance of ExerciseWhile diabetes medications may have a role to play in lowering blood glucose and in staving off muscle loss, Morley is adamant that no medication is as beneficial for treating sarcopenia as physical exercise. “The major treatment is resistance exercise,” Morley says. “You can argue that aerobic exercise is also useful, but if you’re going to do anything as a diabetic, you want to do resistance exercise to build your muscle bulk.” For older adults with sarcopenia, the key exercises he recommends are walking around the block four to five times, doing some weight lifting, and sitting in a chair and getting up ten times in a row as fast as possible.
Kalyani agrees on the importance of activity. “Physical exercise is always recommended,” in part to promote fat loss and maintain muscle mass, both of which can improve glucose levels. Those recommendations apply equally to both younger and older adults, she says. “As long as they can tolerate the exercise they are doing, we definitely recommend that, particularly muscle strengthening exercise and resistance activity.”
• Take seriously the fact that patients with type 2 diabetes are vulnerable to muscle loss. “Accelerated muscle loss is an underappreciated condition that occurs in people with type 2 diabetes. I don’t think it’s well recognized,” Kalyani says. One reason for the under-recognition, she says, is that most providers who treat diabetes aren’t geriatricians and thus aren’t as likely to be familiar with age-related muscle loss and how it can affect mobility. “It needs to be better recognized in clinical practice that this occurs at greater frequency in people with diabetes,” she says.
• Screen all individuals with diabetes for sarcopenia. Everyone aged 50 or older should also be screened, even if they don’t have diabetes, Morley says. “You can argue, ‘Well, I don’t really need to do that, I just need to get them out exercising, and they’ll do well,’ but people don’t do well if you don’t give them a diagnosis.”
As for a specific screening tool, Morley recommends SARC-F. This screen contains five questions that focus on a patients’ ability to lift and carry 10 pounds, their ease in walking across a room, their ease in rising from a chair, their ability to climb a flight of stairs, and the number of falls they have had in the last year. The questionnaire and scoring instructions are available at cgakit.com/sarc-f-questionnaire.
• Spend time making sure patients understand the importance of exercise. “Every clinician knows that diabetics should exercise and exercise is good for them,” Morley says. “Realistically, every diabetic should be in an exercise program. It should be covered by medical insurance, because that’s by far the best treatment for diabetes, period.” The problem, according to Morley, is that physicians often recommend exercise without driving home how thoroughly important it is. “[We need to] stress that this is more important than the drug.”
Get a Free Subscription to Today’s Geriatric MedicineThis article was featured in the November/December 2020 issue of Today’s Geriatric Medicine.
Today’s Geriatric Medicine is a bimonthly trade publication offering news and insights for professionals in elder care.
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This article was featured in the November/December 2020 issue of Today’s Geriatric Medicine (Vol. 13 No. 6 P. 14). Written by Jamie Santa Cruz, a health and medical writer in the greater Denver area. Reprinted with permission from Today’s Geriatric Medicine.
References
1. Centers for Disease Control and Prevention. National diabetes statistics report, 2020. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Published 2020.
2. Volpi E, Nazemi R, Fujita S. Muscle tissue changes with aging. Curr Opin Clin Nutr Metab Care. 2004;7(4):405-410.
3. Wilkinson DJ, Piasecki M, Atherton PJ. The age-related loss of skeletal muscle mass and function: measurement and physiology of muscle fibre atrophy and muscle fibre loss in humans. Ageing Res Rev. 2018;47:123-132.
4. Sobestiansky S, Michaelsson K, Cederholm T. Sarcopenia prevalence and associations with mortality and hospitalisation by various sarcopenia definitions in 85–89 year old community-dwelling men: a report from the ULSAM study. BMC Geriatr. 2019;19(1):318.
5. Morley JE, Malmstrom TK, Rodriguez-Mañas L, Sinclair AJ. Frailty, sarcopenia and diabetes. J Am Med Dir Assoc. 2014;15(12):853-859.
6. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis [published correction appears in Age Ageing. 2019;48(4):601]. Age Ageing. 2019;48(1):16-31.
7. Cruz-Jentoft AJ, Sayer AA. Sarcopenia [published correction appears in Lancet. 2019;393(10191):2590]. Lancet. 2019;393(10191):2636-2646.
8. Kim TN, Park MS, Yang SJ, et al. Prevalence and determinant factors of sarcopenia in patients with type 2 diabetes: the Korean Sarcopenic Obesity Study (KSOS) [published correction appears in Diabetes Care. 2010;33(10):2294]. Diabetes Care. 2010;33(7):1497-1499.
9. Kim KS, Park KS, Kim MJ, Kim SK, Cho YW, Park SW. Type 2 diabetes is associated with low muscle mass in older adults. Geriatr Gerontol Int. 2014;14(Suppl 1):115-121.
10. Leenders M, Verdijk LB, van der Hoeven L, et al. Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc. 2013;14(8):585-592.
11. Sayer AA, Dennison EM, Syddall HE, Gilbody HJ, Phillips DI, Cooper C. Type 2 diabetes, muscle strength, and impaired physical function: the tip of the iceberg? Diabetes Care. 2005;28(10):2541-2542.
12. Park SW, Goodpaster BH, Strotmeyer ES, et al. Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes Care. 2007;30(6):1507-1512.
13. Umegaki H. Sarcopenia and diabetes: hyperglycemia is a risk factor for age-associated muscle mass and functional reduction. J Diabetes Investig. 2015;6(6):623-624.
14. Yang Q, Zhang Y, Zeng Q, et al. Correlation between diabetic peripheral neuropathy and sarcopenia in patients with type 2 diabetes mellitus and diabetic foot disease: a cross-sectional study. Diabetes Metab Syndr Obes. 2020;13:377-386.
15. Jang HC. Sarcopenia, frailty, and diabetes in older adults. Diabetes Metab J. 2016;40(3):182-189.
16. Kalyani RR, Metter EJ, Egan J, Golden SH, Ferrucci L. Hyperglycemia predicts persistently lower muscle strength with aging. Diabetes Care. 2015;38(1):82-90.
17. Kalyani RR, Metter EJ, Xue QL, et al. The relationship of lean body mass with aging to the development of diabetes. J Endocr Soc. 2020;4(7):bvaa043.
18. Hong S, Chang Y, Jung HS, Yun KE, Shin H, Ryu S. Relative muscle mass and the risk of incident type 2 diabetes: a cohort study. PLoS One. 2017;12(11):e0188650.
19. Mesinovic J, Zengin A, De Courten B, Ebeling PR, Scott D. Sarcopenia and type 2 diabetes mellitus: a bidirectional relationship. Diabetes Metab Syndr Obes. 2019;12:1057-1072.
20. Brown EC, Buchan DS, Madi SA, Gordon BN, Drignei D. Grip strength cut points for diabetes risk among apparently healthy U.S. adults. Am J Prev Med. 2020;58(6):757-765.
Oftentimes, we may consider co-morbidities such as malnutrition, muscle wasting, reduced aerobic capacity, and motor disturbances when working with individuals with a history of Alcohol Use Disorder. However, there are other considerations that may be less obvious, but of equal importance when designing exercise programming for members of this special population.
My first published article as a medical fitness pro (30+ years ago) was “Muscles…our True BFF (Best Friend Forever) in Life.” Fast forward over 30 years later in a global health pandemic, this is even more critical. Alas, our muscles have not prospered as Netflix and liquor sales.
We all know that muscles exemplify “use it our lose it.“ Fascinating study August 2020:
“Exercise Induces Different Molecular Responses in Trained and Untrained Human Muscle”
Conclusion: “…several key regulatory genes and proteins involved in muscular adaptations to resistance exercise are influenced by previous training history. Although the relevance and mechanistic explanation for these findings need further investigation, they support the view of a molecular muscle memory in response to training.”
⇒ Our “muscle memory” speeds the process by which we regain our former muscular strength and size. This merits the word “awesome”.
What an evolutionary advantage to regain muscle mass, for both physical and mental health. Survival of the fittest in action.
Before the pandemic, studies showed 60% of US adults do not strength train. We are our own worst enemies.
During the COVID pandemic: Working from home, not getting up and going out to work — various factors have made us more sedentary. A study from eMarketer said TV viewing dramatically increased this year, ending a 9-year steady decrease in television viewership. Studies show there’s been a 32% reduction in physical activity this year, and not surprisingly, another poll says 53% of people struggle with mental health issues due to the pandemic.
Sitting truly is the new smoking.
I think gyms were closed more in 2020 than they were open. Many of us love the gym — a real adrenaline rush. Many people are dependant on the gym for exercise, whether it’s to see their trainer, attend a class, discipline, motivation. The fallout: this pandemic has been more of a sit down than a lock down!
If there is ONE thing, COVID has taught us: Adaptation, the ability to change to our environment, is truly paramount to survival.
Exercising and working our muscles is a vital part of preventative health, even more so now. Muscle wasting is a product of aging, too much tush time and many diseases, including COVID.
Pop exercise advice always mentions get 10k steps per day”. And yes, “strength train 2-3 times per week”. Sadly, the perception of strength training is that it must be with heavy barbells and machinery at the gym. No gym, no strength.
May I suggest we encourage muscle mindfulness? Working our muscles is not just for “exercise time”. We can encourage muscle work in many forms, multiple times per day. Just like we eat, use the washroom, have screen time… let’s help people anchor some muscle time to daily activities.
Example: cooking in the kitchen – hang on to the counter and give me 10 squats.
Muscles are a key factor in our metabolic equation. Increasing our muscle mass boosts our resting metabolic rate, burning more calories at rest, not just during exercise. Muscles help balance hormones such as leptin, insulin, estrogens, androgens and growth hormones. These are all imperative for appetite control, cravings, metabolism and body fat distribution and management. At the ripe old age of 30, we start to lose muscle mass (sarcopenia) unless we are mindful to nurture it. And yes, people over 90 can still build muscle mass.
Amongst the many functions of our muscles is utilizing the glucose in our blood, therefore reducing blood glucose levels, irrelevant of the presence of insulin.
Diabetes is an inflammatory disease. Type 2 diabetes causes the body to become less sensitive to insulin, and the insulin resistance leads to inflammation. A vicious cycle.
Diabetes is a gateway disease. It is a red flag for the potential to develop other diseases such as heart disease, cancers, kidney disease, eye issues. As I mentioned before, insulin resistance leads to greater levels of chronic inflammation, which greatly increases the risk of all of our plaguing chronic diseases.
Lowering chronic inflammation has been the focus of my medical fitness journey, research, coaching and published work. Getting people to move “chronic inflammation” into their daily vernacular, permanently affix it to the top of their health wish list has been my professional raison d’être.
My last article here on MFN was all about chronic inflammation, how it is at the root of all of our chronic illnesses, mental & physical: diabetes, many cancers, mental health challenges, heart disease, arthritis, prostate issues, Alzheimer’s, neurodegenerative disorders… and yes, COVID-19. One line here: Please don’t get caught up in pop anti-inflammatory diets causing people to eliminate vital food groups.
The inflammatory response of COVID-19: The severe reactions to the virus happen more in seniors, and those with diabetes or obesity, or other preexisting inflammatory issues. No coincidence. COVID provokes an exaggerated immune response, excessive inflammation and inflammatory products called cytokines – the infamous cytokine storm. Exercise is a crucial factor in controlling inflammation – moderate cardio (NOT long high-intensity cardio, which actually can increase chronic inflammation) and preserving muscle.
So just how important is it for us to encourage our clients to build muscle? Obviously, it is HUGE, and unfortunately, most people do not focus on muscle work. It is our job as MedFit pros, friends and family, to demonstrate how to creatively and seamlessly incorporate muscle mania into their daily lives — yoga, Pilates, resistance bands, dancing…
The COVID pandemic is going to have far-reaching complications for many years to come. Adaptation is key. Integrating muscle work throughout the day along with other activity bodes well for lowering our levels of inflammation — helping to pandemic proof our bodies. Don’t just depend on a vaccine, we could have a new normal for a while. Preventative health is more important now than ever. Our muscles are truly our BFF.
Shira Litwack has been in chronic care management and prevention for 30 years, specializing in lifestyle habits including holistic nutrition, medical fitness and oxidative stress reduction. She is frequently called upon by the media, has her own podcast bringing current research to the public. She has created and provided oxidative stress assessments, to help clients identify potential health risks. From these, she provides guidance to lower inflammation. Shira is now a product specialist with a major COVID-19 test kit supplier, working with epidemiologists educating people on COVID testing, and setting up and designing protocol for COVID testing clinics
Women love their high heels. They’re designed to symbolize feminine beauty by accentuating the butt and legs, and make us taller. But, there’s a trade-off — they hurt your feet, hips, lower back, and even your shoulders and neck!
The human body is designed to walk flat. High heels raise our heels and put our feet into a plantar flexion position where the weight is concentrated at the ball of your forefeet forcing your center of gravity to shift forward. To prevent you from falling, you have to lean back and this indirectly creates excessive curvature on your lower back (lordosis) resulting in stress being placed on the lumbar area. Over time your lower back muscles become overactive in order to maintain your balance when you wear heels. While your posture in heels looks great, it’s actually abnormal.
Photo: Erik Dalton
Apart from lower back pain, other side effects of wearing high heels include tight and stiff calves and soleus muscles, which run from below the knee to the heel. You may also increase your risk of spraining your ankle and having sore hips due to muscle imbalance.
Lie on your back with both knees bent, lift your hips and place the 1 or 2 tennis balls under your lower back or the area that’s sore – avoid placing the ball directly on your spine. Gently lower your body onto the ball and place sufficient pressure until you feel a tolerable level of pain.
Maintain this pressure for at least 1 minute, or until the pain lessens. Increase the pressure and repeat the process for another 2-3 minutes. Repeat on the other side of your lower back.
When your lower back muscles become overactive, your butt muscles weaken. This is referred to as lower cross syndrome. To strengthen your butt, lie down on your back with both knees bent, and raise your hips by pushing off from your heels. Contract your butt muscles by squeezing your cheeks together at the top. Hold for 2-3 seconds and return to the start position.
Maintain a neutral and braced spine throughout and perform 2-3 sets of 10-15 reps.
Excessive curvature of your lower back causes abdominal muscles to lengthen and weaken. Unfortunately, exercises like sit-ups and crunches can harm your spine and don’t strengthen your abs effectively. Doing the Dead Bug targets your abs and improves endurance and function, while keeping your spine safe.
To begin, lie flat on your back with your arms held out in front of you pointing to the ceiling. Bring your legs up and keep your knees bent at a 90-degree angle. Slowly lower your right arm and left leg at the same time, and keep going until your arm and leg are hovering just above the floor. Engage your abs and keep your back as flat as possible. Hold the position for 2-3 seconds and slowly return to the starting position. Repeat on the opposite side.
Stop if you feel pain at your lower back as this could mean your abs aren’t properly engaged and you’re using your lower back instead of your abdominals. Opt for an easier variation or skip this exercise and consult a qualified trainer.
Place your hands on a wall and stand with one foot behind. Keep your back leg straight and push your heel towards the ground to stretch the calves. After 30 seconds, bend your back knee slightly and try to keep your heel on the ground to target the soleus. Repeat with the other leg.
Stretching the hip flexor for people with lower back pain is important. To do this effectively, get into a lunge position, contract your butt and tilt your hips upwards by tucking in your tailbone – you should feel the muscles above your quads stretch. Cushion your knees with a towel or exercise mat. Hold this stretch for at least 30-60 seconds, then repeat on the other side.
Lower back pain is unfortunately inevitable if you wear high heels over a period of time. Try wearing a lower heel to minimize muscle compensation or only wear heels if it’s absolutely necessary. If your lower back is acting up, wear cushioned flat sole shoes to alleviate the pain, and don’t forget to practice the exercises above!
Reprinted with permission by Ke Wynn Lee. Pictures courtesy of Ke Wynn Lee.
Ke Wynn Lee, author and an international award-winning corrective exercise specialist, currently owns and operates a private Medical Fitness Center in Malaysia. Apart from coaching, he also conducts workshops and actively contributes articles related to corrective exercise, fitness & health to online media and local magazines.
References
People faced with the day in day out experience of ongoing muscle and joint pain often develop mental habits to help them cope that can actually make their condition worse.1 Emotions such as anger, depression and/or making comparisons to how things used to be before the physical problem began, distracts the brain temporarily to help override current sensations of pain. While these mental habits can provide fleeting relief, they also serve to prolong chronic pain conditions by changing brain chemistry and altering the mind and body’s response to pain.