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The Evolution of Truly Personalized Medicine: Epigenetics, Food, and Fitness

Most would not argue that there is ongoing transition in how our healthcare is being delivered. This article will examine some of these transitions as a result of breakthroughs in technology, as well as how genetic information, exercise, and diet will play an increasingly greater role.

When medical science was first getting its start, a more holistic philosophy was taken on how to treat illness and maintain health. Hippocrates is often deemed the father of modern medicine, and even today the allopathic physicians (M.D.s) take the Hippocratic Oath – to do no harm to their patients. Hippocrates knew, even in 400 B.C., that the best healer of the body is the body itself. For the most part, the best treatment is to create a strong body and get out of the way. Five guiding principles used in his philosophy for treatment include:

  1. Walking is man’s best medicine.
  2. Know what person the disease has, rather than what disease the person has.
  3. Let food be thy medicine.
  4. Everything in moderation.
  5. To do nothing is also a good remedy.

The second and fifth principles emphasize the power of knowing the individual and getting out of the way! The first and third principles show the power of exercise and food for healthy living. Even the genius, Thomas Edison, realized that a health maintenance organization (HMO) approach was the best method of healthcare both practically and financially. His quote, “The doctor of the future will give no medicine but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease,” is evidence that a holistic, preventative approach is what he advocated. He is also quoted, “…you can’t improve on nature.”

One size does not fit all

Personalized medicine is now on the forefront and it utilizes the genetic and epigenetic data of a person to guide medicines and treatment plans. Cancer drugs have probably harnessed this advantage to the greatest extent, thus far. Former President Jimmy Carter received Keytruda (pembrolizumab) for his brain cancer and it boosted his immune system and beat the cancer. While most of America (71%), still doesn’t even know about personalized medicine, those who were familiar with it did not know it would yield better results with fewer side effects. The different directions of personalized medicine are still being realized, but the field of pharmacogenetics is the first to really jump on the bandwagon of highly effective, precision-based treatment.

The reasons some drugs work for some people and not for others, or why side effects occur in some individuals and not others, is due to individual variability in metabolism. Why are some people lactose tolerant, or some can drink alcohol with no problem, and others have severe issues? It is usually because of enzyme differences, which are under the control of our genes. Interestingly, our enzyme genes can often be turned on or off by “inducible sequences” known as promoters or suppressors of operons, respectively. These “switches” can be repressed or induced depending on our environmental stimuli. Thus, we actually have some control over our gene expression, and this field is known as epigenetics.

Knowing what gene variants someone possess or not will guide the personalized medicine physician on which drug to use or not. By knowing allergic reactions in advance or which medicines may have side effects will help physicians to not make a bad situation worse. Unfortunately, the cost of personalized medicine drugs is much higher than alternative treatments. There is still a lot of exploration to be done on all the various applications of this technology, but the bottom line is that understanding individual variations and enabling the body to do what it is designed to do is a very good thing! Companies like Toolbox Genomics is one of many companies that use your genetic information to then tell you what foods and supplements to eat or avoid, and which exercises may help you the most, and ones that you may not respond to so well. The reason physicians do an intake on family history, or run various tests is to collect information that will guide their treatment. A genetic test on certain gene variants is simply taking this a step further.

How does exercise and diet apply to our epigenetics?

Did you know that exercise is highly beneficial to not only help with fighting cancer once it is already present, but also to never getting it? Physical exercise or movement in general will shift the epigenetics so that genes that suppress tumors are increased, and genes that cause cancer (oncogenes) are decreased. It does this by changing the amount of certain reactions called methylations. Things go wrong when there is too much or too few methylation reactions. Exercise has been shown to reduce or even reverse the epigenetic mutations that often result in tumorigenesis or tumor production. Exercise has also been shown to reduce genetic factors associated with aging like telomere length.

The fields of proteomics and metabolomics as well as pharmacogenomics, are all emerging because of the knowledge on how our genetics affects proteins, metabolism, and reactions to drugs, respectively. The field of nutrigenomics is rapidly expanding, and several companies are capitalizing on studying the relationship of how our genes affect how we process and utilize foods, as well as how food can affect our genes. Vitamins A and D, certain fatty acids, especially medium and short chain, some sterols (derived from cholesterol) and zinc have been shown to directly influence gene transcription. In direct effects include how diet affects gut bacteria, which in turn influences gene expression. Soon when nutritional recommendations are given, it will likely be “for this individual.”

The future of medicine will be taking our genetic information to a whole new level. Soon “smart” watches, clothes, hats, and other common devices will collect information that can benefit our health in many ways as the way healthcare is delivered continually evolves.

This article was featured in MedFit Professional Magazine. Subscribe to MedFit Professional Magazine to read more great content like this!


Dr. Mark P. Kelly has been involved with the health and fitness field for more than 30 years. He has been a research scientist for universities and many infomercial projects. He has spoken nationally and internationally on a wide variety of topics and currently speaks on the use of exercise for clinical purposes and exercise’s impact on the brain. Mark is a teacher in colleges and universities in Orange County, CA., where Principle-Centered Health- Corporate Wellness & Safety operates.

woman-plank-exercise

My 3 Favorite Core Exercises

Core Exercises are always in style, right? If I had a $100 for every time I have been asked what is the best core exercise to help me get rid of my belly fat I would be writing this blog from the beach in Punta Cana!

Seriously, core exercises have their place and are important to do. Consider a few of the main reasons why they are important:

  1. They can help stabilize your spine.
  2. They can prevent low back injury or discomfort.
  3. They can help improve sporting activity.
  4. They help improve posture.

As a result of the benefits listed above for doing core exercises, here are my three current (yes, they do change) favorite core exercises:

Bridges

Preparation

Exercise preparation

  1. Begin by lying flat on floor in supine position with knees bent, feet flat, toes pointing straight ahead and arms by sides.
  2. Activate core by drawing navel towards the spine and squeezing the glutes.

Movement

With core activated and glutes squeezed, lift hips off ground to form a straight line between knees and shoulders.

Hold and slowly return back to floor, touching floor momentarily then repeat.

If your client feels their hamstring cramping, check their pelvis for correct alignment. Pelvis should be neutral – asis and psis should be even or horizontal. If there is a misalignment correct it. If you aren’t sure then gently stretch the quads and try the exercise again.

Prone Iso Abs (i.e. Planks)

Preparation

  1. Kneel on the floor on all fours.
  2. Align your hands directly beneath your shoulders.
  3. Align your knees directly beneath your hips.

Movement

  1. Lift and extend one leg to the floor behind you.
  2. Place the ball of your foot on the floor as in a push-up position.
  3. Maintain neutral spinal alignment in this semi-supported position.
  4. If you feel comfortable enough, extend both legs into a full plank position.
  5. Make sure to keep your shoulder blades down and wide on your back during all phases of the exercise.

Mecaback Wedge Crunch

Set Up (standard) 

Feet on the floor, Arms crossed at chest 

Execution 

  1. Maintain a stable pelvis. Tailbone gently pointing down. 
  2. Brace your abdominals and lift straight up. Only lift your torso 2-3 inches from the floor, 
feeling the point at which the abdominals are working hardest, pause.
  3. Slowly lower.
  4. Repeat. 

Maurice D. Williams is the owner of Move Well Fitness in Bethesda, MD, and Assistant Professor of Health & Human Performance at Freed-Hardeman University.  He is a NASM Master Instructor and Master Trainer,  and is also certified with NASM as a Corrective Exercise Specialist, Performance Enhancement Specialist, Senior Fitness Specialist & Weight Loss Specialist, and as a Certified Strength and Conditioning Specialist by NSCA.

Senior-Weight-Training

Fitness: Programming Your Body to Become Strong & Resilient

In the early 90s I worked with a colleague who had a track background as a pole vaulter. Doug subsequently became a fitness professional and athletic coach. He had a philosophy about fitness that was characterized by a simple notion: “Weight training is the paycheck and cardio is the bonus”. I have thought about this issue continuously since I met Doug and as I have grown older, I believe he was right.

I am now training as hard – or harder – than I ever have before to ensure I enter my 70s with as little loss of lean muscle mass, and as much strength and power, as I can create. This article will highlight the importance of resistance training, give you some valuable ideas on how you might implement a program, and finally share ideas with you that can protect and preserve your body for the “long haul”.   

The Issue

Resistance training is characterized by working a muscle group to fatigue or failure under a prescribed “load”. This load can be an actual weight or body weight. Any “load-bearing” movement that includes multiple muscle groups is called a compound movement, such as a walking lunge with an overhead press with dumbbells, for example. Because we are sitting for the greatest portion of our days and not stressing our bones we are losing bone mass as well leading to osteopenia (the forerunner of osteoporosis) and then of course osteoporosis – serious bone density decline. The issue of frailty and imbalance is becoming more and more pronounced in our population and will only accelerate if we don’t change our sedentary behaviors.

Identifying the issues related to loss of muscle mass and bone mass is relatively simple and can be done through clinical testing. Women have the highest potential to start this chronic loss because they have different hormonal issues with aging – less testosterone and smaller bones for example – that creates an earlier onset of disease. Fractures and other related problems can happen in an instant if the loss is not addressed in a timely manner and medication can help along with changes in lifestyle and diet. However, the real solution lies in weight-bearing exercise where stresses are applied to the muscles and skeletal structure intentionally and safely. Men are not immune from developing these conditions – they just start later in life due to larger and heavier frames and greater weight.

Beginning a weight training program earlier in life is the best way to prevent the decline and decay of tissues and the easiest form of that training is in the form of weight training – free weights, machines, and other load-bearing exercises, such as bodyweight exercises. I will highlight my program for you as an example of types of exercises that help the most in preserving and protecting our muscles and bones from further loss or damage and injury.

Programming

The idea is to do a multiple set (8-12 repetitions/ 2-3 sets to start) program that targets all the major muscle groups: Back, chest, shoulders, arms, abdominals, and legs (calf, quad, hamstring) while “loading” the muscle and joint appropriately to stimulate fiber growth. Fiber growth occurs over time when a muscle is exposed to a load that forces a larger than normal contraction. One contraction is the shortening of the muscle (positive or concentric) and the other is the opposite force of lengthening the muscle (negative or eccentric). This movement is accomplished across a joint and creates the change we seek in terms of strength and size.

Each movement is done in a rhythmic and controlled manner that gives the muscle an opportunity to move through a “complete range of motion”. This constitutes “one rep” and applies the stimulus necessary for a muscle to be stimulated to grow following the session during what is called the “recovery phase”.  Each time we increase the load, we enable the muscle to grow and become stronger because the stimulus changes the nature of contractions making the movement more difficult but insuring that it becomes stronger in the process. 

We are not really sure about why this works the way it does but the theory is that by “tearing the muscle” microscopically we create a muscle that is stronger, more adaptable, and able to withstand greater loads going forward. This is referred to as “progressive resistance training” because it is designed as a controlled process with its defined purpose of increasing lean mass.

By programming more than one set we set up the muscle to have to deal with “variable loads” and have to adapt to these increased loads thereby making it able to withstand more of life’s rigors. The theory of doing 2-3 sets initially is that regardless of the weight used – light and smaller to heavier and larger – is that ALL muscles react in the same way to each stimulus – they grow in strength – but NOT necessarily in size. You don’t have to fear getting “muscle-bound” by lifting weights. That takes a concentrated and persistent effort, with a significant caloric intake to help repair the body, as all bodybuilders know. Most of us will never be in that category – and I am certainly not! 

Program Design: The Schedule

Designing a program that addresses the needs of the body as it ages is relatively simple and yet very challenging to implement. The reason is that you will experience some muscle soreness initially that you might find uncomfortable, but this is just the body’s way of recovering from the session (you should never experience pain as that is not normal – don’t believe in “the no pain, no gain” theory – that is just wrong!). 48-72 hours of recovery time is generally advised so that you can allow the muscle to heal itself. In between, you can then initiate a cardio program of swimming, cycling, walking or some other form of movement that allows you the opportunity to encourage this process to become more of a habit – and train your heart to support your effort (my favorite organ, other than the brain of course). 

I believe in a 3-5 day opening schedule of activity that encompasses some cardio and some weight training. Each session can be anywhere from 30 minutes to an hour depending upon your willingness to include a warm-up and cool-down phase, which I highly recommend. Cardio activities include an extended activity (continuous movement) over time and include a warm-up, training and then cool-down phase. You can include an abbreviated walk on the treadmill or outside and then engage your weight training program with a brief cool down to finish the session. 

Exercises & Muscle Groups

  1. Chest – (examples) chest press with dumbbells, barbell, wall pushups, modified floor pushups (knees on the floor) or wall pushups at an angle. 
  2. Back – (examples) seated row, pulldown – bar, low back extension, rubber tube chest extension, dumbbell reverse butterfly – standing with weights at chest level and extend backward.
  3. Arms – dumbbell curls, triceps extension with dumbbell, reverse pushup off bench.
  4. Legs – Wall slide, traditional standing squat, standing from seated position, leg press, calf extension (stairs), and standing lunges.
  5. Abdominal – crunches – lying on your back, knees bent – raise shoulders off the floor and repeat. Exhale on shortening and inhale on lengthening.
  6. Shoulders – shoulder press with dumbbells, front and side raise with dumbbells

I do 16 main exercises twice a week: Bench press (barbell), incline upright row (back), shoulder press, incline/decline press (chest), incline-lateral low row (back), seated triceps extension, arm curl, latissimus pull (back), pullover – chair (shoulder/back), seated leg press and calf extension, lateral raise (shoulder), low back extension, seated abdominal crunch with 65 pounds, hanging dips – upper body, and seated cable row.

Each of these exercises is performed in multiple sets with many repetitions and a variety of loads and at varying speeds to not only encourage growth of my muscles but also to help me maintain my speed and quickness as well. Each muscle group consists of type 1 and type 2 muscle fibers. Type 1 fibers are used for longer endurance activities while the type 2 fibers are for quick explosive movements such as sprinting and power activity (jumping out of the way of a car for instance). 

The reason I train my muscles against variable loads – climbing (the ladder) and descending – is to insure I give each fiber a chance to be engaged and give them the opportunity to become stronger. As I said earlier, I do my program twice a week – on Monday and Thursday – to ensure I recover sufficiently and allow the muscles time to repair themselves.

I am also cognizant of the reality that regardless of how hard – or well – I train, the odds are not in my favor for remaining this way due to the aging process. I am, however, “cutting the odds in my favor” by doing what I am to stay fast and strong.  I am convinced that weight training is the key to my future and that my potential for running fast will be able to be maintained through my continued commitment to remaining strong. It is as Doug said more than two decades ago – “weight training is the paycheck and cardio is the bonus” – but I am so glad I ran all these years as well! 

Nick’s Tips

  1. Do find the resolve to begin – and continue – a weight training program. Schedule at least three days a week for a concentrated effort at building and maintaining your lean muscle mass – and joint integrity. Remember, we start losing 2-5% of our lean muscle mass starting in our 20s – and bone mass as well – unless we do the work to prevent and slow the loss.
  2. Take time to build your cardio capacity through a commitment to your heart. I am able to do my weight training in just over an hour due to my overall cardiovascular fitness.
  3. Take your body seriously and examine how you feel about it. Getting mentally strong through accomplishing your goals is one very important way to stay on track and feel good about yourself. 
  4. Getting lean and being able to burn more calories every day requires only two things: Commitment and discipline founded on purposeful activity.
  5. Take your fitness needs very seriously and yet find ways to make them fun. “Every act we take is its own reward” – Earl Nightingale
  6. Finally, when you see how fast your body will change with weight training (within 30 days, you will see results) it will excite and encourage you to do more and finally realize the dream of a healthy, lean, strong, and fit body.

Nicholas Prukop is an ACE Certified Personal Trainer & a Health Coach and fitness professional with over 25 years of experience. His passion for health and fitness comes from his boyhood in Hawaii, where he grew up a swimmer on Maui. He found his calling in writing his first book “Healthy Aging & You: Your Journey to Becoming Happy, Healthy & Fit” and since then he has dedicated himself to empowering, inspiring and enabling people of all ages to reach for the best that is within them and become who they are meant to be – happy, healthy and fit – and be a part of a world where each person can contribute their own unique gifts to life.

fruits veggies colorful

5 Ways to Amp Up Your Nutrient Intake

Thanks to fad diets, everyone has their own idea of what constitutes a healthy diet – and has a mental list of which foods will never touch their lips again. We’ve all been there: Low-Carb, No-Carb, Paleo, South Beach, Atkins, Gluten-Free, Foods That Match Your Eye Color – you name it. But these diet trends simply cherry-pick a few nutritional facts, served up alongside lots of disinformation.

The simple truth is that a healthful, nutritionally favorable diet means consuming a variety of vegetables, fruits, legumes, nuts, seeds and herbs. Fun fact: each and every plant food has its own distinct nutritional profile. More importantly: there are over 100,000 biologically active chemicals found in plants, agents that offer anticancer, antimicrobial, antioxidant, analgesic, and wound healing effects.

So how do you get those active chemicals to up our chances of living a long and healthy life? Let’s break it down:

1. Eat “the rainbow,” using a variety of natural plant foods.

Ensure that you consume a wide range of phytonutrients, many of which are antioxidants that offer a range of health benefits, from helping you lose excess weight and preventing disease, to slowing brain degeneration. The red in tomatoes comes from lycopene, the orange in carrots and sweet potatoes from alpha- and beta-carotene, the blues and reds of berries from anthocyanins, and the green in spinach and kale from lutein and chlorophylls. A variety of colors means a variety of health-promoting nutrients. 

2. The next time you load up at the grocery store, be sure your cart has these Superfoods.

Greens, Beans, Onions, Mushrooms, Berries and Seeds, known collectively to Nutritarians as G-Bombs. The planet’s best foods should be a part of everyone’s diet every day. Why? According to Dr. Fuhrman, these six magical foods benefit the immune system, can make you slim and healthy, and keep you that way while protecting you from cancer. Here’s just a taste of the power they possess and a simple recipe to help you reap some of their amazing benefits:

  • Greens, cruciferous vegetables in particular provide unique phytochemicals (ITCs) with a variety of cancer-fighting effects. Greater consumption of these vegetables is linked to reduced risk of cancer and cardiovascular disease and a longer life.1-3
  • Beans and other legumes  are rich in fiber and resistant starch, which help keep blood glucose, blood pressure, and LDL cholesterol down, promote weight loss, promote colon health, and nourish the microbiome.4-7
  • Onions and garlic are linked to a reduction in the risk of several cancers, and their distinctive sulfur-containing phytochemicals have a number of actions that benefit the cardiovascular system.8-11
  • Mushroom phytochemicals are unique in their promotion of immune system function and their abiity to inhibit of estrogen production; mushroom consumption is associated with a reduced risk of breast cancer.12-15
  • Berry phytochemicals have anti-cancer and blood pressure-lowering effects, and are linked to a reduced risk of heart attack.  Blueberries in particular have also shown promise for improving brain health, in studies on memory and cognitive function.16-22
  • Seeds and nuts: Eating nuts regularly is associated with longevity, reduced risk of cardiovascular disease, and a healthy body weight. Different seeds have different nutritional benefits; flax and chia, for example, are rich in omega-3 ALA and lignans, anti-estrogenic phytochemicals linked to a reduction in breast and prostate cancer risk.23-27

3. Focus on the nutrient-density of your diet.

A standard weight loss “diet” is one that focuses on controlling portion size and cutting down on junk food. The absolute best diet is one that concentrates on the amount of nutrients that food can provide and their phytonutrient power to protect against cancer. Natural foods with a high nutrient-density contain a significant amount of vitamins, minerals and other healthful substances with respect to their calories. This way of eating, called a Nutritarian Diet, has surged in popularity just as interest in the health benefits of various ingredients – kale, turmeric, berries – has spiked. Superfoods describe not only G-Bombs, but many others, too. For the list of some of Dr. Fuhrman’s must-eat foods, download his infographic 10 Best and 10 Worst Foods. Or for a deeper dive into the foods that benefit health and longevity, read Dr. Fuhrman’s magazine to learn his choices for the planet’s 100 Best Foods.


4. 
Break the junk food habit.

Processed junk foods are incredibly harmful to our health. They lead to obesity and illness, and cause detrimental chemical changes in the brain, affecting our emotional well being and drive cravings for more junk food. Eating junk food is a learned habit. These foods need to be eliminated entirely from your diet.

Kick start your transformation by cleaning out your refrigerator and pantry so you won’t be tempted with unhealthy foods. Here’s some easy ways to start:

  1. Sauté with water or low-sodium vegetable broth instead of oil
  2. Switch from cow’s milk to unsweetened soy, hemp, or almond milk
  3. Switch from sugar-sweetened breakfast cereal to steel cut oats topped with flax or chia seeds and berries
  4. Add tofu into a veggie scramble instead of eggs
  5. Say no to cheese
  6. Finish your meals with fresh fruit rather than sugary desserts

5. Don’t snack on healthy foods, either.

Learn to eat only at mealtimes, and only when you are hungry. If you are hungry between meals, it means you didn’t eat enough during the meal, so adjust your portions accordingly. Refraining from snacking might be hard to do at first, but it will become second nature after a while.  It is especially important not to eat after dinner before bedtime.

Join Dr. Fuhrman for his free webinar, Eat to Beat Cancer (and COVID)

 


Article originally printed on DrFuhrman.com. Reprinted with permission from Dr. Fuhrman.

Joel Fuhrman, MD is a board-certified family physician specializing in nutritional medicine. He is President of the Nutritional Research Foundation and the author of 7 New York Times bestselling books, including his most recent book, “Eat to Live”. Visit his website, DrFuhrman.com.

 

References:

  1. Zhang X, Shu XO, Xiang YB, et al. Cruciferous vegetable consumption is associated with a reduced risk of total and cardiovascular disease mortality. Am J Clin Nutr 2011, 94:240-246
  2. Pollock RL. The effect of green leafy and cruciferous vegetable intake on the incidence of cardiovascular disease: A meta-analysis. JRSM Cardiovasc Dis 2016, 5:2048004016661435.
  3. Higdon J, Delage B, Williams D, Dashwood R. Cruciferous vegetables and human cancer risk: epidemiologic evidence and mechanistic basis. Pharmacol Res 2007, 55:224-236.
  4. Papanikolaou Y, Fulgoni VL, 3rd. Bean consumption is associated with greater nutrient intake, reduced systolic blood pressure, lower body weight, and a smaller waist circumference in adults: results from the National Health and Nutrition Examination Survey 1999-2002. J Am Coll Nutr 2008, 27:569-576.
  5. Jayalath VH, de Souza RJ, Sievenpiper JL, et al. Effect of dietary pulses on blood pressure: a systematic review and meta-analysis of controlled feeding trials. Am J Hypertens 2014, 27:56-64.
  6. Bazzano LA, Thompson AM, Tees MT, et al. Non-soy legume consumption lowers cholesterol levels: a meta-analysis of randomized controlled trials. Nutrition, metabolism, and cardiovascular diseases : NMCD 2011, 21:94-103.
  7. Sievenpiper JL, Kendall CW, Esfahani A, et al. Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomised controlled experimental trials in people with and without diabetes. Diab tologia 2009, 52:1479-1495.
  8. Rahman K, Lowe GM. Garlic and cardiovascular disease: a critical review. J Nutr 2006, 136:736S-740S.
  9. Powolny A, Singh S. Multitargeted prevention and therapy of cancer by diallyl trisulfide and related Allium vegetable-derived organosulfur compounds. Cancer Lett 2008, 269:305-314.
  10. Bradley JM, Organ CL, Lefer DJ. Garlic-Derived Organic Polysulfides and Myocardial Protection. J Nutr 2016, 146:403S-409S.
  11. Galeone C, Pelucchi C, Levi F, et al. Onion and garlic use and human cancer. Am J Clin Nutr 2006, 84:1027-1032.
  12. Borchers AT, Krishnamurthy A, Keen CL, et al. The Immunobiology of Mushrooms. Exp Biol Med 2008, 233:259-276.
  13. Jeong SC, Koyyalamudi SR, Pang G. Dietary intake of Agaricus bisporus white button mushroom accelerates salivary immunoglobulin A secretion in healthy volunteers. Nutrition 2012, 28:527-531.
  14. Li J, Zou L, Chen W, et al. Dietary mushroom intake may reduce the risk of breast cancer: evidence from a meta-analysis of observational studies. PLoS One 2014, 9:e93437.
  15. Chen S, Oh SR, Phung S, et al. Anti-aromatase activity of phytochemicals in white button mushrooms (Agaricus bisporus). Cancer Res 2006, 66:12026-12034.
  16. Krikorian R, Shidler MD, Nash TA, et al. Blueberry supplementation improves memory in older adults. Journal of agricultural and food chemistry 2010, 58:3996-4000.
  17. Bowtell JL, Aboo-Bakkar Z, Conway M, et al. Enhanced task related brain activation and resting perfusion in healthy older adults after chronic blueberry supplementation. Appl Physiol Nutr Metab 2017.
  18. Stoner GD, Wang LS, Casto BC. Laboratory and clinical studies of cancer chemoprevention by antioxidants in berries. Carcinogenesis 2008, 29:1665-1674.
  19. Cassidy A, Mukamal KJ, Liu L, et al. High anthocyanin intake is associated with a reduced risk of myocardial infarction in young and middle-aged women. Circulation 2013, 127:188-196.
  20. Cassidy A, O’Reilly EJ, Kay C, et al. Habitual intake of flavonoid subclasses and incident hypertension in adults. Am J Clin Nutr 2011, 93:338-347.
  21. Johnson SA, Figueroa A, Navaei N, et al. Daily blueberry consumption improves blood pressure and arterial stiffness in postmenopausal women with pre- and stage 1-hypertension: a randomized, double-blind, placebo-controlled clinical trial. J Acad Nutr Diet 2015, 115:369-377.
  22. Whyte AR, Schafer G, Williams CM. Cognitive effects following acute wild blueberry supplementation in 7- to 10-year-old children. Eur J Nutr 2016, 55:2151-2162.
  23. Mattes RD, Dreher ML. Nuts and healthy body weight maintenance mechanisms. Asia Pac J Clin Nutr 2010, 19:137-141.
  24. Grosso G, Yang J, Marventano S, et al. Nut consumption on all-cause, cardiovascular, and cancer mortality risk: a systematic review and meta-analysis of epidemiologic studies. Am J Clin Nutr 2015, 101:783-793.
  25. Kris-Etherton PM, Hu FB, Ros E, Sabate J. The role of tree nuts and peanuts in the prevention of coronary heart disease: multiple potential mechanisms. J Nutr 2008, 138:1746S-1751S.
  26. Buck K, Zaineddin AK, Vrieling A, et al. Meta-analyses of lignans and enterolignans in relation to breast cancer risk. Am J Clin Nutr 2010, 92:141-153.
  27. Thompson LU, Chen JM, Li T, et al. Dietary flaxseed alters tumor biological markers in postmenopausal breast cancer. Clin Cancer Res 2005, 11:3828-3835.
Food-question

What Makes a Diet “Good”​?

When Mark Bittman and I were working on How to Eat, we spent several full days just talking through every question either of us had ever raised, or received, about all things food. For those who know the book, you will recognize its pedigree in this free-flowing discussion, for the book itself reads like pulling your chair up to our coffee table and joining in the conversation. Of course, the book offers a disciplined structure, the brevity of good editing, and a logical flow its parental chat all lacked- but still, the apple fell in proximity to the tree.

Among the topics that consumed the most time was this: what one thing, above all else, makes a diet “good”?

We agreed on a one-word answer (with nothing but love for the famously apt seven from Michael Pollan), and I will share it momentarily. But first, let’s be careful about “good.” In our polarized world, with our cultural heritage of Manichaeism, “good” all too readily takes on moral overtones. Dietary guidance should not adorn the wag of an admonishing finger. Dietary guidance should not populate the bark of dogma, or be the scion of sanctimony. The “good” in question is of the “good is as good does” variety, not of the “good versus evil” variety. That distinction gets all too murky all too often in the opposing, self-righteous assertions that dominate the pop culture of this social media moment.

Diet good is as diet good does. What good is that?

First, diet tends to be good as a noun (as in “dietary pattern”), and far less good as a verb. When diet implies its gerund- “dieting”- there is little lasting good in the offing. I won’t belabor this, but a lot of truly “bad” ideas can work well for short-term weight loss, all but inevitably followed by weight regain with interest. There is so much wrong with “dieting” that the case could be made – indeed, I’ve made it – that “dieting” should die. We “di-et” alone, we live it- together. Together is better. Together would be good.

But what of that one-word answer? Our choice was: balance. No, not carbs; not saturated fat; not sugar; not sodium. Balance.

To be clear, this is not “balance” of the “all things in moderation” variety; that is a slippery slope toward all manner of dietary debacle. This is “balance” of the good causes require good effects variety, conjoined to a balanced view of what effects truly matter.

A dietary pattern is good if it represents the balanced array of nutrients from an assembly of wholesome foods, mostly plants, that serves our native adaptations. The critical balance is between dietary composition, and metabolic needs. Those vary, of course, by species; a balanced diet for wildebeest involves a lot of grass, while a balanced diet for lions may involve a lot of wildebeest. At its origins, food is about sustenance and survival, and those needs are bounded by the adaptations of a given kind of animal. Protest though we may, we humans are a kind of animal, with a particular suite of adaptations governing the fundamentals of our nutrition requirements.

There is a balance, as well, between health and pleasure. As many of you likely know, Mark, while famously knowledgeable about food systems, is perhaps best known as an expert cook and foodie. The pleasure factor of “good” food is an essential part of the requisite balance that reconciles concepts of how we “should” eat with how we prefer eating. There are bridges that can be built between loving food, and food that loves us back – and on the other side, a balance worth pursuing. Good food gives pleasure; so does good health. Other things being equal, healthy people have more fun. Take a moment, chew on that.

There is, too, a balance in perspective integral to any valid concept of “good” food. Can food be “good” if sourcing it is predicated on overt abuse and torment of our fellow creatures? Few if any decent people want gratuitous cruelty on their menu. Modern dietary patterns conceal a great deal of just that– to creatures that think and feel in all the ways the dogs and cats we call members of our families think and feel. That is an extreme expression of imbalance, a case of cognitive dissonance. The only way to account for behaviors that condone cruelty by people with consciences that renounce it – is a failure to acknowledge what should be common knowledge. Mass-producing animals on factory farms is an unbalanced assault on the sanctity of life.

We must, of course, be in balance with the rest of nature if we are to fill our plates and bellies but not empty the world of its great treasures: fish in the seas, birds in the air, the stunning breadth of biodiversity, pristine aquifers, open grasslands, teeming rainforests. Eating in balance with the competing requirements of a vital planet is not negotiable- for by any other means, we are eating not only our food, but our children’s food, too. When dinner as usual ruins the destiny of our own kind and all others, diet has gone “bad” by any valid connotation.

There is, in addition, the obvious: a “good” diet confers good health. This is intrinsically all about balance. For someone suffering from protein malnutrition, any concentrated source of protein would lead toward a better balance, and thus- be good. For those of us who routinely get far more protein than we need and far too little fiber, it is vegetables, fruits, legumes, and whole grains that tip balance toward the good. As a general rule, getting more of what we get in excess already, or less of what is deficient relative to the set points of adaptation, is movement toward imbalance, and thus bad for that (rather than a moral) reason. There is, for instance, nothing intrinsically pernicious about saturated fat or sodium- but more of these is “bad” when prevailing diets deliver them in excess.

Even sugar isn’t immanently “evil;” in its place, it might fuel the periodic requirements of fight or flight, or feed occasional and relatively innocuous delight. It is rendered decisively “bad,” however, by context, dose, and its contributions to hyperendemic obesity, insulin resistance, pre-diabetes, and their dire, downstream consequences, both chronic, and acute.

Kale and spinach are so good because modern diets deliver such a deficit of leafy greens. Even these, however, would lose their luster in a diet of only kale. Toward balance is good, toward imbalance is bad. This is universal.

We may concede that the willful engineering of addictive junk food, placing corporate profit ahead of public health, is an egregious imbalance in societal priorities. That is fundamentally bad.

Good and bad are…as good and bad do.

Accordingly, what’s good for the goose may not be what’s good for the gander, if the goose is starving as the gander succumbs to obesity, type 2 diabetes, and coronary artery disease. Balance is good for both goose and gander, but the means of redressing the existing imbalance will vary by circumstance.

Finally, “good” is at least partly in the palate of the beholder. Legitimate definitions of dietary good allow for variations in taste- often linked to upbringing, ethnicity, and experience. We don’t fuss over the fact that there is more than one good way to be physically active; we should accommodate the same, balanced perspective about eating.

So much of our discourse on diet is both unduly dogmatic and truly misguided. The prevailing inclination to adjudicate diet quality by invoking macronutrient thresholds- this much fat or that; that much carbohydrate or this- is nearly analogous to judging the merits of exercise by the color of your shoes. More on such macronutrient malarkey – among the great boondoggles of modern nutrition– next time. For now, suffice to say there is more than one way to eat badly- and modern society seems dedicated to exploring them all.

We are fortunate that where so much hangs in the balance- human health and pleasure, planetary health, the treatment of our fellow creatures, the sustainability of food production – “good” populates a confluence. We should not take this for granted; it might have been otherwise. If we were more like great cats- our dietary requirements would diverge from the imperatives of biodiversity and sustainability. We great apes can- if we honor the requisite balance- take good care of ourselves, and the rest of the planet, too.

That would be…good. Because while there are many variations on the basic theme of eating well, there is only one Earth.

Free Webinar with Dr. Katz

The truth about food – for the health of people and planet alike – hides in plain sight, like that infamous elephant in the room no one manages to see. Why is simple truth so hard to perceive? Why does it struggle to prevail?

Join Dr. Katz for this free webinar, The Truth about Food: Of Science, Sense, and Expert Consensus – And All that Conspires Against Them


Article reprinted with permission from Dr. David Katz.

Dr. David Katz is a board-certified specialist in Preventive Medicine/Public Health. He is the Founder and CEO of Diet ID, a company advancing an entirely new way to assess and personalize nutrition, and working to make “diet” the vital sign it deserves to be; and President of the True Health Initiative, a non-profit advancing diet and lifestyle as the best of medicine where science, sense, and global expert consensus meet.

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How You Can Be the Solution to the Sarcopenia Dilemma and Help Your Older Client’s Thrive

Gene, a 77-year-old retiree, has been in quarantine for the previous 10 months. He was not comfortable leaving his house to go to the gym and has declined invitations to do virtual (online) training. Hence, Gene has lost significant muscle mass, has been prescribed increased quantities of medications for Type II diabetes and high blood pressure. Additionally, his wife reports she has seen his muscle mass, bone density and health rapidly decline. He has lost his appetite and his quality of sleep has also suffered. Gene was prescribed an anti-depressant by his primary care physician to address associated lethargy and depression.   

Joel, an 85-year-old male, has left his house a total of five times in the previous 10 months. Through his wife’s encouragement, he continued his at-home workouts and even increased the frequency of his sessions from two to three times per week once the quarantine moved beyond four weeks. During this time, Joel has increased his lean muscle mass, improved his balance and his wife reports his legs are ‘rock solid and his energy has never been better.’ 

While Joel exemplifies the benefits of maintaining an active lifestyle and improving his muscle mass while in quarantine, he is in the minority. Unfortunately, there are millions of older adults just like Gene who are experiencing the deleterious impacts of quarantine and the sedentary lifestyle on their physical as well as emotional health. This is such a vital and overlooked aspect of health because many older adults may never fully recover in the event they contract a life-threatening disease.

This sentiment is summed up succinctly by (English and Paddon-Jones 2021):

“Thus, with advancing age, it becomes increasingly likely that even a brief, clinically mandated period of bed rest could initiate a serious decline in muscle strength and functional capacity, i.e., a “tipping point” from which some may not fully recover.”

This article will discuss how the Medical Fitness Professional (MFP) who focuses on educating and empowering their older clients can positively impact those experiencing sarcopenia-related health issues. Also included will be a brief discussion about the barriers to exercise suggestions the MFP can implement to address these issues. Finally, MFP’s will be empowered to utilize an education-first strategy while positioning themselves to attract more individuals that will seek out their expertise. 

The Impact of Sarcopenia-Related Multisystem Deconditioning

Sarcopenia, or age-associated loss of muscle density and strength, is a major health problem even when not in a period of quarantine. The loss of muscle mass is associated with all-cause mortality including cardiovascular disease, diabetes, cognitive decline, depression and an increased risk of falls (Kirwan et. al. 2020). The average adult over 30 years of age experiences a 3-8% loss of muscle mass per decade (English and Paddon-Jones 2010). This means that a sedentary individual could literally experience between 9-24% loss of muscle strength and function by the time they reach 60 years of age. Furthermore, 71% of older American males and 42% of older American females present with moderate levels of sarcopenia.

Unfortunately, this problem is exacerbated by periods of forced inactivity, for example, while bedridden. Young adults can experience a 5-6% decrease in muscle strength per week when bedridden (English and Paddon-Jones 2010). Because older adults begin with less lean muscle tissue than their younger counterparts, they are extremely susceptible to multisystem deconditioning and the subsequent health issues associated with the loss of muscle, strength and endurance. 

Sarcopenia is extremely concerning in vulnerable populations (example: older adults) as well as those with comorbidities (example: those with cancer). Muscle atrophy, weakness and pain (myalgia) is even greater after a significant illness and corresponding bedrest. It’s been reported that .5-6% losses in muscle mass per day can occur increasing risk of deteriorating health (Casey et. al. 2021). A 1.7% loss of muscle mass occurs in as little as 2 days and 5.5% after only 7 days of bed rest (Kirwan et. al. 2021). Additionally, 50% of patients experience ongoing myalgia and associated weakness which can last months after recovering from COVID-19 (Casey et. al. 2021). Additionally, the loss of smell, taste and appetite after illness leads to further losses in muscle mass as well as nutritional deficiencies potentially leading to further deterioration of one’s health. 

The Sarcopenia Solution

While its etiology is multifactorial, decreased physical activity and poor nutrition are the two primary aspects contributing to the progressive loss of muscle mass in both the sedentary populations and those with chronic health issues (Kirwan et. al. 2020). Kirwan et. al. recommends that resistance exercise “…be considered of prime importance in attempting to halt and even reverse the progression sarcopenia.” Additionally, Web MD suggests that “The primary treatment for sarcopenia is exercise, specifically resistance training or strength training (downloaded from WebMD 2021). 

While the strength and conditioning industry has long recognized and advocated the benefits of resistance training, getting individuals to comply with the recommended daily activity levels has been a challenge. The challenges to older adults remaining physically active have only been complicated by quarantine. Several organizations including the World Health Organization (WHO) have provided suggestions for getting the recommended 150-300 minutes of vigorous-intensity physical activity per week. To achieve this number while in quarantine, WHO Europe suggests taking short, active breaks, indoor walking and following an online exercise program. 

Since quarantine has forced the closure of many commercial facilities and due to the fact that many older adults are reluctant to leave their house, online or virtual exercise programs have become increasingly popular. Online platforms including but not limited to Zoom, Google and Facebook make it easy to create small group meetings which provide a powerful tool for educating, providing guided exercise programming and increasing socialization, all of which are vital in combatting sarcopenia and isolation-related depression that occurs with prolonged quarantine.  

While historically it has been a barrier to exercising at home, novel equipment such as resistance bands make training at home both practical and functional. Resistance bands provide a low-cost option as compared to free weights (Kirwan et. al. 2021). While Sanchez-Sanchez et. al. (2019) found resistance bands did not provide as much benefit for older adults experiencing sarcopenia as compared to moderate to vigorous exercise, anecdotal finds report contrary findings. Progressive overload utilizing varying tensions of resistant bands and novel anchoring positions has been clinically shown to increase muscle mass, improve joint health and foster confidence in older adults when incorporated into an overall resistance training program (Osar and Linkul 2021). 

In addressing sarcopenia, the importance of nutrition cannot be overstated. High-quality protein (25-30 grams with each meal) to increase muscle mass is part of the lifestyle program recommended by English and Paddon-Jones (2010). Additionally, the consumption of nutrient-dense, calorie-sparse foods like roots, leaves, fruits and seeds can have a positive hormonal effect (Mattioli et. al. 2020) thereby improving mood and quality sleep, both of which are necessary to the overall health and vitality in older adults. 

Solutions to the 3 Greatest Barriers to Resistance Training

Finally, while the benefits of resistance training for addressing sarcopenia are obvious, it would be remiss to leave this article without including a brief discussion covering a few of the barriers to older adults participating in physical activity. One of the greatest barriers for many adults participating in a physical activity program is the reluctance to be proactive about their health care. In part, this is because older adults haven’t been properly educated about the vital importance and their responsibility in self-care. Additionally, even when properly educated, older individuals are rarely given specific instructions and/or directions to achieving success. 

Solution: In addition to the in-session education, the MFP looking to maintain their current clients and wanting to attract more individuals, should dedicate several hours per week to educating their community. Invite current and past clients to participate in a no-cost, regularly scheduled webinar, podcast or virtual training on a relevant health topic. Encourage them to invite their friends, family and colleagues. It is important that these events be education-based rather than focused on selling one’s services. Include at least one simple, actionable health nugget – a bodyweight exercise, mindset habit or healthy shake recipe, for example – that the participants can easily incorporate into their current lifestyle. 

Another important barrier for older adults is the reluctance to seek out a fitness professional because the fitness industry has largely catered their offerings to younger, healthier individuals. This has discouraged countless numbers of individuals from exercising and made it increasingly challenging for the MFP to differentiate their services from the general personal trainer that is often ill-equipped in training the older adult. 

Solution: The number one method for differentiating oneself and to enroll older adults is to highlight current client’s success. Highlighting a current client’s success eliminates the temptation to spend needless time discussing why one’s education is superior to someone else’s. For example, the MFP should highlight clients who can successfully garden or play with their grandchildren or hike because of the resistance training program they’ve been performing. Older individuals need to see, and will, in turn, be empowered by, seeing others just like them achieving success with physical activity programs. Seeing one their own age successfully accomplish things they would like to be participating in will help foster a natural curiosity. This curiosity can ultimately lead to a conversation where the MFP discusses how a tailored program can also help them accomplish their health and fitness goals. 

Additionally, Fitness Professionals like Jackie Bachmeier (Evolution Fitness and Wellness) and Robert Linkul (Training the Older Adult), both of whom cater to training the older adult population, deliver the specific equipment (including resistance bands, hooks and self-myofascial release tools) they want their clients to utilize during their programs. This removes an additional obstacle while adding huge value to the client. 

The third major barrier to online training are technology-associated challenges. While many have legitimate technology challenges, the resourceful and proactive MFP can help remove that obstacle and ease older adults’ in their online transition. 

Solution: Both Robert and Jackie have dedicated specific time to helping technology-challenged clients understand and develop the confidence in using social media and related platforms. While it may seem a hassle in the beginning, when they recognize the relative ease and benefits of online training, many older clients will enjoy the process and in turn encourage their family, friends and colleagues to join in. For example, Jackie’s 83-year-old client Lillian commented that had she realized how easy technology was, she would have done virtual training earlier. She’s since referred her husband and several of her friends to Jackie’s programs. 

Conclusion

Sarcopenia is a rampant problem in older adults, complicating existing health issues and leaving this population particularly vulnerable to prolonged periods of inactivity. Exercise, particularly resistance training, and nutrition are two components that show strong evidence in improving muscle mass, improving health and reducing the risks of all-cause morbidity. By focusing older adults upon the factors within one’s control – i.e., physical activity, nutrition and mindset – the Medical Fitness Professional are well positioned to be the solution for both their current as well potential clients. By addressing the three major barriers to being physically active, the MFP can help their current clients regain their health and, in the process, differentiate themselves and attract more individuals that need, want and will pay for their expertise. By adopting these best-practices, the MFP can successfully position themselves as a major player in the solution to the sarcopenia dilemma.  


Dr. Evan Osar is a Chiropractic Physician, an adjunct faculty member with Rocky Mountain University of Health Sciences (Motor Control) and educator with the Integrative Movement Institute. He has authored “Corrective Exercise Solutions to Common Hip and Shoulder Dysfunctionand Amazon #1 Best Seller, “The Psoas Solution“. He developed the Integrative Movement System™, an evidence-based approach to improving clinical outcomes and helping patients perform at their highest level. Dr. Osar is currently in private practice in Chicago, IL and educates health and fitness professionals that specialize in posture, corrective exercise and medical fitness for the older adult population. 

 

References

Casey P, Ang Y, Sultan J. COVID-19-induced sarcopenia and physical deconditioning may require reassessment of surgical risk for patients with cancer. World J Surg Oncol. 2021 Jan 11;19(1):8. doi: 10.1186/s12957-020-02117-x. PMID: 33430881; PMCID: PMC7798369.

English, K. L., & Paddon-Jones, D. (2010). Protecting muscle mass and function in older adults during bed rest. Current opinion in clinical nutrition and metabolic care13(1), 34–39. https://doi.org/10.1097/MCO.0b013e328333aa66

Kirwan R, McCullough D, Butler T, Perez de Heredia F, Davies IG, Stewart C. Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss. Geroscience. 2020 Dec;42(6):1547-1578. doi: 10.1007/s11357-020-00272-3. Epub 2020 Oct 1. PMID: 33001410; PMCID: PMC7528158.

Mattioli, A. V., Sciomer, S., Cocchi, C., Maffei, S., & Gallina, S. (2020). Quarantine during COVID-19 outbreak: Changes in diet and physical activity increase the risk of cardiovascular disease. Nutrition, metabolism, and cardiovascular diseases : NMCD30(9), 1409–1417. https://doi.org/10.1016/j.numecd.2020.05.020

Osar, E. and Linkul, R. (2021). The Arthritis Training Solution 2.0. Training the Older Adult Live (Virtual). 

Sánchez-Sánchez, J. L., Mañas, A., García-García, F. J., Ara, I., Carnicero, J. A., Walter, S., & Rodríguez-Mañas, L. (2019). Sedentary behaviour, physical activity, and sarcopenia among older adults in the TSHA: isotemporal substitution model. Journal of cachexia, sarcopenia and muscle10(1), 188–198. https://doi.org/10.1002/jcsm.12369

Web MD. Sarcopenia with Aging. Downloaded 2/15/21 from https://www.webmd.com/healthy-aging/guide/sarcopenia-with-aging

World Health Organization. #healthy at home. Downloaded 2/15/21 from  https://www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome?gclid=EAIaIQobChMItpfrsInt7gIV7vLjBx1pAwf0EAAYAyAAEgKgTfD_BwE

World Health Organization (Europe). Stay Physically Active During Self Quarantine. Downloaded 2/15/21 from https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/publications-and-technical-guidance/noncommunicable-diseases/stay-physically-active-during-self-quarantine

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Why Women Need to Lift Weights

Traditionally speaking, when it comes to exercise, men have dominated the lifting weights world. This occurred mainly due to men being allowed to participate in sporting activities while women were not allowed to because it was not considered “lady like” and it was illegal. However, times have changed, as women are no longer looked at as being inferior to men; and it is safe, appropriate and very normal for them to exercise, particularly lift weights.

Here are a few reasons why women say they do not need to lift weights and my answer to their concern.

It Will Make Me Look Bulky

While this is a very legit concern, it is typically not true. In order for a woman (or man) to look “bulky”, they will have to do what is called a lot of “volume” in their workouts. Volume is the number of weight, repetitions, sets and exercises done in order to achieve mass or bulk.

If a woman follows the recommended numbers of days of weight lifting/week by ACSM (2-3 days/week, lifting weights for all the major muscles using 1-2 sets of 8-12 reps), they will not get bulky

Lifting Weights Does Not Help Me Burn Calories

Weight lifting has a high metabolic (ability to burn calories) rate. As a result, the more lean muscle a woman has, the less likely she is to gain weight and the easier it is to keep the weight off. Muscles are like the gas in our cars. The gas is used by the engine and keep the car moving.  Having muscle, by lifting weights, allows your body to keep moving and consistently fight off fat gains.

There is No Benefit For Me to Lift Weights

There are tons of benefits of women lifting weights! They include weight loss, improved mood and well-being, better posture and prevention of osteoporosis. These four are all major concerns for most women and lifting weights helps with all of them!

I Only Need to do Cardio to Be Healthy

While doing cardio activities (i.e. running, swimming, elliptical, spin class, etc.) is beneficial for the heart, it does not put the necessary stress on the bone and muscular system that our bodies crave. We were designed in a way that our muscles were meant to be moved beyond just walking and typing on a computer! While cardio is a great way to burn calories, oftentimes, it will burn away muscle because it is a catabolic activity. Lifting weights help to balance that out. 

Do I Really Need to Start Lifting Weights?

Yes, YOU do! I recommend that a woman looking to start lifting weights seek out professional help. A certified personal trainer is well qualified to provide safe and proper advice for her.

Also, I recommend home DVD workout programs such Power 90, Slim in 6 and Chalene Extreme that have all proven to help women strength train properly.

Weight training is important for everyone to do. It helps with posture, weight loss, prevention of osteoporosis and other metabolic diseases. It does not require a lot to do it, so why not incorporate two days/week for 30 minutes or less to lifting weights!


Maurice D. Williams is the owner of Move Well Fitness in Bethesda, MD, and Assistant Professor of Health & Human Performance at Freed-Hardeman University.  He is a NASM Master Instructor and Master Trainer,  and is also certified with NASM as a Corrective Exercise Specialist, Performance Enhancement Specialist, Senior Fitness Specialist & Weight Loss Specialist, and as a Certified Strength and Conditioning Specialist by NSCA.

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Core Exercise, Part 2: Training The Abs To Do Their Job

In a previous blog, Core Exercise, Part 1: Fad, Fashion or Fundamental?, I proposed that core exercise is not just about training the abs since the core is a more integrated, comprehensive functional unit that simply includes the abs as one element. In Part 2, I want to stress how the abs actually function – not based on EMGs or ultrasounds – in doing movements we train with in the gym that correspond to real life.

Motivated by an article in Women’s Health, “17 Back Exercises Every Woman Should Add to Her Workout ASAP“, I was pleasantly pleased to see exercises listed with a by-line that said “It’s not all about the abs, you guys”. The thrust of the article and exercises was that the back is important, too. I’d add that the back is MOST important and that anything you do to strengthen the back, especially with some of the unilateral exercises described, is even BETTER for the abs than crunches.

While some of the exercises were simply simple adaptations of traditional exercises, such as the overhand and underhand bent over row, or were clearly aimed at the anterior core – the abs – they highlight the message I often bring to my sessions with clients.

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AS A PERSONAL FITNESS TRAINER, IT’S MY GOAL TO PROVIDE SAFE AND EFFECTIVE EXERCISES THAT ENHANCE A PERSON’S HEALTH, WELLNESS, AND FUNCTION.

With this mission statement, first and foremost in my mind when I approach a training session with whomever at whatever stage of health or fitness they are in, my goal is to train them to move and perform ADLs or recreational activities with less strain and stress to their bodies. Especially their spines!

Recognizing that many come in wishing to do something about their guts, I comply with some abs-specific exercises when they are ready for them. But first I aim to train the core as I defined it in the Part 1 blog.

Let’s, for now, leave out of consideration the person with a low back issue such as a ruptured disk or chronic low back pain (LBP). These kinds of issues require gentle step-by-step approaches akin to physical therapy-type exercises before venturing into real-life functional exercises just to get the core working. Which leads me to my framework for working the core, but really any muscle.

There are 5 layers to muscle function:

  1. activation
  2. endurance
  3. strength
  4. power
  5. speed

Activation is a neuromuscular bioelectrical event whereby an exercise causes muscles to engage – that is, to fire – so that they learn or re-learn how to do what they were supposed to do. Imagine a stroke victim unable to move a toe. It is the essence of core stabilization. If therapists can get the person’s focus on moving the toe, and the toe actually moves again, that means nerve signals went from the brain down the spine and into the legs all the way to the toe. When the muscle receives those signals, even though it’s been weakened by the stroke itself, it starts to twitch. When the twitch becomes large enough, it fires enough fibers to make the toe move… even a little.

When it comes to core exercise, first we want the muscles to get engaged, to fire, but not to generate movement – that is, to first do an isometric hold. So, for example, taking the bent over row as a case in point, by bending over, with both feet on the floor and one hand supported on a bench or chair, the other holding a weight, the core engages to prevent rotation toward the side that holds the weight. In other words, almost every muscle of the core is activated even as you focus on bringing the weight toward the ribs. Take the support arm away and now the core is super-activated as it now has to support the upper torso plus the weight(s). It’s not a back exercise anymore, it’s a total core exercise as even the abs engage to stiffen the spine against the pulls of gravity and of the lumbar erectors.

Endurance is the next phase of training. This doesn’t mean simply running for miles on end. It means that a muscle can be activated and engaged for longer periods of time than simply to make any particular movement. This entails multiple repetitions (reps) and sets and even exercises that target that muscle. This is initially done with lower resistances so that the exercise is learned properly and all moving parts and stabilizing parts are able to do their jobs properly.

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When it comes to core endurance, we often do high reps of crunches or bridges and call it a day. But the reality is our core works even while sitting, especially while standing and most importantly while moving. Thus an exercise that engages core muscles in functional positions or patterns of movement is more functional than one that isolates one section at the expense of others.

For example, taking the alternating bent over reverse fly (#14 of the article above), we see a long lever arm moving outward to the side as the trainee tries to stay parallel to the floor. Each subsequent movement by each arm applies a torque to the core that tries to bend and twist it. Doing multiple reps actually trains the core to stabilize for a long period of time, more so than if you do both arms at the same time. For one thing, the anti-rotation component doesn’t exist to the same degree in the bilateral move as it does in the unilateral. For another, assuming you can do the same number of reps with a particular weight whether bilateral or unilateral, the time under tension is longer for the alternating reverse fly; almost double if not more. (One could argue that you could even use a higher load as you have more rest between reps doing one arm at a time.)

Strength is the ability to apply force… or resist load. This entails lifting heavier weights in order to optimize one’s ability to apply a lot of force. Usually, this is measured as a function of %RM, or percentage of maximal repetition. That is, if you can curl 30# one time, that is your 1RM; if you can do it 10 times, it’s your 10RM. Thus, if you do 15# curls, you are training at 50% of your 1RM.

The other way to look at it is by how many reps you are able to do. If you can do more than 12, you are essentially training endurance as you are now working below 50% 1RM. It is recommended you lift at loads that actually fatigue you anywhere from 8 to 12 reps to get strong.

AT THE LOWER END OF REPS, YOU ARE GETTING STRONGER WHILE AT THE UPPER END YOU’RE CLOSING IN ON ENDURANCE.

Core Exercise, Part 2: Training the Abs to Do Their Job3

For the core, even though it’s just another muscle, the break point could endanger the spine so it’s usually not recommended to hit with high loads. That said, many exercises we do in the gym do actually involve the core at extremely high loads and never require isolating it. For example, a low-rep, high-load squat or power lift engages the core at extremely high load even though we tend to observe the legs or arm movements. But we could also do a standing cable row with a very heavy resistance which would fatigue the upper body in 8-12 reps but recognize that the core is also heavily challenged, making this an effective strength exercise for the core itself.

Power is the ability to produce lots of force quickly; it’s a function of speed but does not require actual speed. When the body tries to move quickly but the resistance prevents it, you’re engaging muscles, especially fast twitch, white fiber muscles, to produce speed, but the weight slows you down. Watch a powerlifter and you’ll note that he/she is hardly moving fast but is trying to do so with great effort. Now that’s power!

For core power, something as simple and basic as a squat and curl on the way up, assuming the resistance is greater than you could lift if you were simply standing or sitting down, would engage the core muscles rapidly in order to stiffen the spine. Likewise, a push-press, which is a shoulder overhead press performed off a partial squat, with speed, would constitute core power. The muscles that stabilize the lumbopelvic region would have to engage rapidly to propel the weights upward from the shoulder, then would have to contract isometrically very quickly to stabilize the spine against any backward bending resulting from the momentum of the weights from in front of the center line to on or behind it. If done with one arm, now you have to resist a lateral bending force on the core, too.

Finally, there’s speed, the ability to produce a high velocity movement. We know speed when we see it, in running, biking, etc. but in resistance training, we are often put off by it. The ability to move a light load very fast actually puts the joint in a dangerous position. Going back to the article, there are two exercises that should not be done fast: #4, the Good Morning, and #15, the Stability Ball Back Extension. I prefer to think of these as endurance exercises, maybe shifting into strength, but not power or speed.

Core-Exercise,-Part-2:-Training-the-Abs-to-Do-Their-Job3

But how could we do a core exercise to simulate speed? My preference is for the tubing torso rotation, especially with a controlled stopping point. As this video shows, with a modest resistance, you can move quickly. However, I would suggest stopping at 45 degrees past the mid-point as the resistance declines rapidly beyond that; thus there’s no counterforce applied by the tubing as the spine approaches the terminus of the tissues themselves. Nonetheless, you can see how, with slightly more resistance and with a controlled end point, core speed could be trained here.

Which brings me to the end.

In sum, core training is not muscle-specific. It involves, includes, entails and integrates many of the muscles we associate with the core. It takes into account the various elements of muscle training, from activation to high speeds, from endurance to power. Core training does not require, in fact, I’d say it actually is violated, by isolation exercises except where the person’s initial status requires it.

CORE TRAINING IS NOT A FAD, NOR IS IT A SEPARATE PART OF A WORKOUT SESSION. IT CAN BE PART AND PARCEL TO ANY IF NOT ALL EXERCISES SIMPLY BY DOING THINGS ON ONE LEG, WITH ONE ARM, WITH RESISTANCES COMING FROM VARIOUS DIRECTIONS (GRAVITY-DOWN, CABLE OR TUBE -HORIZONTALLY OR DIAGONALLY).

Core is neither a fad nor a fashion, it is fundamental, and now you know why and what-for to take your training to the next level.

Originally printed on stepsfitness.com. Reprinted with permission. Images courtesy of STEPS Fitness.


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”.