Friday, August 12, 2016

Walking: Spiced Up

Have you noticed your physician paying greater attention to your exercise habits? Healthcare leaders are calling on physicians and their industry to routinely prescribe exercise, in general--and walking, in particular. For example, the Journal of the American Medical Association (Berra, Ripee & Manson 2015) recommends that clinicians do the following to integrate physical activity counseling into their practices:
  • Make physical activity a vital sign at each clinic visit
  • Ask if the patient exercises regularly or engages in physical activity
  • Associate physical activity with reduced risk of heart disease, stroke, diabetes, and many cancers
  • Write a prescription for an agreed-upon daily physical activity
  • Encourage use of a pedometer and advise recordkeeping
I'm excited about the continued recognition of exercise as a vital part of health. Increasing your exercise frequency can be as simple as walking more. Here are some ideas for how to adapt high-intensity interval training (HIIT) to walking. Which will be your favorite?

High-Intensity Aerobic Interval Walking: Complete up to 10 high-intensity walking intervals lasting 4 minutes each, interspersed with 2-minute relief intervals (walking at a lower intensity). About 1 hour duration

Sprint Interval Walking: Complete 4-6 sprint-walking intervals lasting 30seconds each, interspersed with 4.5 minutes of light walking at a self-selected pace. 20-30 minutes duration

Step-Wise Interval Walking: Start with a relatively easy walking workload for the first 5 minutes, then increase intensity by 15% for 4 minutes and continue to increase intensity every 4 minutes. This program can be halted at a particular intensity or after a specific duration; follow with a cool down walk. 20-60 minute duration

Near-Maximal Interval Walking:
Perform a 5-minute walk at near-maximal intensity, followed by a 5-minute recovery walk; repeat. 20-60 minute duration

Supramaximal Interval Walking: Complete 7-10 sprint-walking intervals lasting 90 seconds, interspersed with 30 seconds of walking at a self-selected slower pace. 20-30 minute duration

Happy Walking!

Sunday, July 31, 2016

Weight Management

I'm excited to announce that I'm working on a new specialty certification from ACE (American Council on Exercise), "Weight Management." I am about 25% through the learning material and the content of the material is a bit of a surprise to me.

It doesn't approach weight loss from a nutrition or exercise prescription, but rather, a more empathetic understanding of people's needs. I've been learning about the prevalence of weight bias. Even among health and fitness professionals, many assume normal weight individuals are "fit", and overweight individuals are "unhealthy." Research shows that one's lifestyle, exercise and nutritional habits, are far more indicative of overall health and longevity than a number on a scale. The certification material stresses the importance of creating a "weight neutral" environment. In a weight neutral environment, goals are set based on controllable factors, such as exercise frequency and nutritional intake. "Exercise and good nutrition are things you can do, weight is something that happens."

The educational materials also stress the importance of acknowledging unmodifiable genetic and previous lifestyle factors, and focusing on maximizing the health of whatever body we may have. I'll keep you updated on the later material in the certification, but for now, focus on the process of maximizing your health and how every day that you continue to make a commitment to your health is a goal achieved!

New research evaluates how many of us live a healthy lifestyle

Despite the billions of dollars spent on gym memberships, diet programs, and low-fat food options, American't don't seem to be getting any healthier. In fact, a recent paper published by the Mayo Clinic (Loprinzi et al. 2016) reports that fewer than 3% of American adults are living a healthy lifestyle.

THE STUDY
The researchers in this study defined living a healthy lifestyle as meeting four parameters: being sufficiently active (150 mins of moderate-to-vigorous physical activity each week), eating a healthy diet (based on a 24-hour recall), being a nonsmoker (serum cotinine level) and having a recommended body-fat percentage (5%-20% for men, and 8%-30% for women). Researchers then examined the association between having different combinations of these characteristics and several biomarkers for cardiovascular disease. The results from the study came from a survey of 4,745 adults.

THE RESULTS
Although many people accomplished multiple lifestyle goals--16% had three healthy characteristics and 37% had two--fewer than 3% met all four. Moreover, 11.1% met none of the criteria. Overall, the survey revealed the following:

71.5% did not smoke.
37.9% consumed a healthy diet.
9.6% had a normal body-fat percentage.
46.5% were sufficiently active.
2.7% had all four characteristics.
11.1% had none of the characteristics.THE BOTTOM LINE
This study does an excellent job of providing four concrete steps anyone can take to achieve a healthier lifestyle: Become a nonsmoker, be sufficiently active, eat a healthy diet, and achieve a recommended body-fat percentage. Of course, as the research reveals, none of these steps are easy to take. However, even small improvements matter, and any effort toward these lifestyle goals--even if it's below the defined threshold--can have a life-changing, or even life-saving, impact.

How many of these lifestyle goals are you currently accomplishing? What changes can you make to increase that number?

Tuesday, June 21, 2016

Exercise and Rheumatoid Arthritis

I wanted to share my personal success story with exercise and rheumatoid arthritis. It has now been 13 years since my diagnosis and exercise has played a very significant role in my disease management.

As the daughter of two avid runners, I grew up running, running, running. In high school, I competed in cross-country, track, and orienteering. I continued to run in college, but chose not to compete in Boston U's athletics initially. I intended to start sophomore year after becoming accustomed to college life.
During the winter of my freshman year, I noticed I was having some difficulty with small tasks, like flipping on lightswitches, typing on a keyboard, and walking around in bare feet. I didn't think much of it, until one January Sunday morning when I stepped out of bed and literally couldn't walk. I felt this ridiculous pain in all the joints of my feet, so standing and walking were incredibly painful. Confused and in tears, I got myself to the ER of Mass General Hospital, where they did a multitude of tests and sent me home without a diagnosis, but in slightly less pain. Days later, I followed up at the Student Health Center, where I received results indicating rheumatoid arthritis, and was instructed to go to a rheumatologist.
My visit to the rheumatologist was depressing. I was 18 years old, surrounded by old patients in the waiting room as well as old people magazines. This wasn't me! The rheumatologist confirmed the rheumatoid arthritis diagnosis and prescribed me Celebrex to take as needed.

Rheumatoid Arthritis is an autoimmune disease in which the immune system attacks the joint linings causing painful swelling. Over long periods of time, the inflammation associated with RA can cause bone erosion and joint deformity. My arthritis manifests itself in my wrists, knuckles, elbows, shoulders, and the joints of my feet. Different areas are affected at different times.

I returned to Boston and continued with school. I had to start running less and took up swimming and limited weightlifting. The weightlifting was tricky, because my fingers were frequently very swollen. I was happy to be learning more and more about fitness, so I could make the appropriate modifications to avoid damaging the inflamed joints further. I started to notice that exercise helped decrease my inflammation and pain.
4 years after my diagnosis, the pain and swelling started to return. I had become wrapped up in my senior year of college, had been exercising less, and had gained 20 lbs. Research has since shown that body fat increases inflammation. My rheumatologist then recommended prednisone and methotrexate, very strong medications that required regular liver blood tests. The medication only helped for a few months before my symptoms returned, and my rheumatologist wanted to add more medications to my treatment plan.
I thought back to when I had managed to keep pain at bay in the past and made a conscious effort to get ample sleep, increase my exercise frequency, and improve my eating habits. I didn't fill my next prescription of prednisone or methotrexate. After about a month of modifying my lifestyle, I noticed a remarkable decrease in my joint pain and inflammation, despite not taking any medication. I later told my rheumatologist, who was supportive, as long as I was managing my joint pain.
Since then, for the past 9 years, I've managed to stay medication free. My current doctor insists that it is because of my active lifestyle, and I agree. Working as a trainer allows me to keep a moderate activity level all day long, so that my joints don't get a chance to stiffen up. My exercise program decreases the inflammation in my joints on a daily basis.

Although I have been active since a young age, it has at times been frustrating and a real struggle. There are still some days when certain joints will be in so much pain that I'm reluctant to get out of bed. However, I know that once I start moving, the pain will decrease; and once I exercise, it will be almost gone. It's doubtful whether I'll ever be fully "pain free," but exercise helps me have a better outcome than anyone I know with RA. The genetics we're dealt don't have to determine our future. We're all working with the body we've got and trying to make the best of it.
Have you had a similar "success story" with exercise and a health condition? Please share your story with me or contact me if you'd like to improve your health.

Life After Dieting

A recent New York Times article looked at former contestants on Season 8 of "The Biggest Loser." Sadly, almost all of the contestants had regained the weight they'd lost on the show. The article concludes that after drastic weight loss, resting metabolism plummets to below average, and hunger and cravings increase. The article is also a testament to the faults in extreme weight loss through drastic measures.

The article doesn't mention how the follow up investigation was funded by the show's producers, nor does it compare the "Losers' " metabolisms to those of others who had lost equivalent amounts of weight, but at a much slower rate. For example, the show's winner, Danny Cahill lost 191 lbs in 7 months, and had regained 104 lbs in the 6 years since. That's an average weight loss of 7lbs/week for 7 months.

I don't recommend losing any more than 2lbs per week because that's the maximum amount of stored body fat one can lose in a week. Any weight lost beyond that is most often muscle or water. Losing muscle leads to even greater drops in metabolism. Strength training and muscle mass play a very important role in weight loss. As far as weight loss is concerned, "Exercising to build muscle (strength training) is like paying off a mortgage." The muscle mass you build is an investment in increasing your metabolism long term.

Research shows that losing weight at a rate of 1 to 2 lbs per week through a combination of diet, strength training, and cardio leads to greatest success in keeping the weight off long term. It's also important that lifestyle change is maintainable and not extreme. The "Biggest Loser" environment was extremely different from any of the participants' home environment's. They couldn't learn how to lose weight while also going to work and interacting with friends and family.

Friday, May 6, 2016

Diet or Exercise for Weight Loss

Diet and exercise go hand in hand for a healthy body.  However, researchers have recently gone so far as to determine when diet and exercise are most important in the weight loss process.  

The key to weight loss is to consume fewer calories than you burn.  That deficit needs to be between 500 and 1000 calories per day.  For most people, it is easier to decrease calories consumed than it is to increase calories burned to that great an extent.  This is why cutting calories through diet is often most effective for weight loss.  However, doing both, cutting calories through diet and exercise, can give you a weight loss advantage.  Exercise will help you burn more calories than diet alone.  This New York Times article illustrates the importance of diet in weight loss.

Studies also show that exercise was the most important component in weight maintenance after weight loss.  People who lost weight and were successful in keeping it off long-term were those who got regular physical activity.

If weight loss is one of your goals, make sure that a proper diet accompanies your physical activities and exercise.  Without diet, you will still reap the many other health benefits of exercise, improved body composition, increased longevity, decreased risk of diabetes, decreased incidence of high blood pressure, decreased depression, etc.  Weight loss, however, may be elusive. 


Thursday, April 14, 2016

Cardio (or) AND Strength

I recently found a great quote from Younger Next Year, written by Chris Crowley and Dr. Henry S. Lodge:  "Cardio may save your life, but resistance training makes it worth living."  This means cardio is keeping our vital organs healthy, for example, heart, lungs, circulatory system, etc.  Resistance training keeps our limbs, muscles, and joints healthy.  Although these are less vital for survival than our heart and lungs, the health of our muscles and joints is essential to having a good quality of life.

Cardiovascular and resistance exercise do share some benefits, but also differ in the merits they provide.  I've compiled 5 of the many benefits of cardio and strength training.  Keep these in mind as you follow your workout program to appreciate the many ways you're improving your health and fitness.

Benefits of Cardiovascular Exercise:

  • Improved hormonal profile: ease symptoms of depression and fatigue and release hormones that decrease appetite
  • Increased metabolism: can lead to weight loss
  • Improved heart health: decrease in blood pressure, decrease in bad (LDL and total cholesterol, increase in good (HDL) cholesterol
  • Improved recovery ability
  • Diabetes management: increased insulin sensitivity
Benefits of Resistance Training:

  • Increased bone density: decreases the risk of osteoporosis
  • Increased strength of connective tissue, muscles, and tendons: improved motor performance and decreased injury risk
  • Increased muscle mass:  decreases risk of sarcopenia, increased metabolism at rest because muscle maintenance requires greater caloric expenditure
  • Improved body mechanics: improved posture, balance, and coordination; reduces risk of falling
  • Improved appearance: greater muscle definition, increased tone
Make sure to incorporate both cardio and strength into your workout program!