Tuesday, August 8, 2017

Nutrition Crazyness

Nutrition has been making headlines for the past few decades. And those headlines can make it difficult to eat healthily. In the 1970s, eggs were vilified because they were high in cholesterol. Research had shown that high levels of LDL cholesterol in blood were linked with an increased risk of heart disease and stroke, and we knew eggs were packed with cholesterol. But it turns out that most of the cholesterol in our bodies is made by our liver and doesn’t come directly from our diets. You can’t fit that kind of nuance into a headline.

The stereotypical problem with news covering nutrition, said David Klurfeld, a nutritional scientist with the USDA, is that studies not designed to answer specific questions are portrayed as though they do.

Observational studies touting the health benefits of coffee have been in the news recently. Researchers followed coffee drinkers and non-coffee drinkers and monitored when and how they died.

Observational studies like these are useful for identifying interesting trends, but they do not demonstrate cause and effect. To test whether coffee prevents a certain disease, the researchers would need to conduct a randomized controlled trial. In this type of experiment, volunteers (preferably hundreds of them or more) are randomly assigned to one of two groups. In this case, one that drinks coffee and one that abstains.

Only when multiple observational studies, randomized controlled trials and experiments in animal models or individual cells all point to the same answer do responsible scientists begin to draw conclusions about nutrition. The results of all of these studies taken together can help inform us about how to improve our diets.

Unfortunately, news can’t wait until a consensus is reached. So here are a few strategies you can use to identify which headlines you should pay attention to. First, make sure the study was conducted in actual living humans. Then, determine whether the study was observational or based on a randomized controlled trial.

Whether the news is reporting on an observational study or a randomized controlled trial, Dawson and Ludwig recommend applying the “sniff test.” Ask yourself whether the claims make sense with what you know of your own experiences and human evolution.

There are lots of dietary trends that don’t pass the sniff test. Consider the fat phobia that erupted about the same time eggs made the bad food list. Ludwig called the low-fat craze a “nutritional disaster” because it caused many Americans to give up things we now know to be exceedingly healthy, like avocados, nuts and full-fat yogurt, while reaching for sugar-packed alternatives. Claims that cutting any given food from our diets will cure us sound too good to be true because they are.

Most importantly, “don’t change your diet based on one study,” Klurfeld advised, especially if that study has a small effect or contradicts a whole lot of other studies.

So next time you hear that chocolate will help you lose weight, cocktails protect you from heart disease, bingeing on sugary fruit juices cleanses your liver, ancient grains like wheat are toxic, or an extra two cups of joe a day will make you immortal, ask questions. How strong is the evidence? Are there multiple studies saying the same thing? And does it pass your common-sense sniff test?

What we do know about nutrition comes from repeated studies with a variety of methodologies in large populations and with mechanisms tested in animal models that show the same thing: Eating lots of fresh fruits and vegetables is good for you. Eating a low-fiber, high-calorie diet packed with sugar and fat is bad for you. But that’s not new or news, so those studies aren’t going to make headlines.

Amid the headline mania, if you want some surefire dietary advice to hold onto, Klurfeld predicts “moderation and variety are the two nutrition rules that are never going to change.”

Full Article

New Treatment Guidelines for Chronic Low Back Pain

While some people with lower-back pain may doubt whether movement is the answer, new treatment guidelines from the American College of Physicians (ACP) recommend nondrug therapies as the first line of treatment to relieve acute and chronic lower-back pain.

For people with acute back pain, the new treatment guidelines recommend heat, acupuncture, massage, or spinal manipulation. Initial recommendations for chronic back pain include exercise, tai chi, yoga, progressive relaxation, and mindfulness-based stress reduction.

The report advocates that drug therapies should not be considered until after other nonpharmacological methods have been tried. The guidelines are available in the Annals of Internal Medicine (2017; doi:10.7326/M16-2367) and are public.

Saturday, July 1, 2017

Muscle Biopsies, Movement, and Anti-Aging

New science shows that it's not just how much muscle you have that's important--it's what's inside it that matters most. Metabolically active muscle--the kind that's devoid of harmful fat and teeming with mitochondria, the metabolism-boosting powerhouses within cells--has a profound influence on everything from your weight to your energy levels to your risks of diabetes and heart disease. Even your chances of surviving a hospital stay or beating cancer are affected by the health of your muscle.

As the years go by and we spend more time sitting and less time moving, our muscle loses its zing. Mitochondria slowly decline in number and vigor, while fat starts to seep in. Health and vitality start to decline, leading to weight gain, exhaustion from everyday activities, and greater likelihood of lifestyle disease.

It turns out that the wealth of our mitochondria and the leanness of our muscle is bound to how much we move. When muscles need energy, they call on the mitochondria to turn glucose and fat into ATP, cellular energy. If we stay away from the gym too long, the body notices that it doesn't need as many mitochondria, and their numbers start to dwindle. Over time, this decreases our energy and capacity to burn fat.



Full Article

Monday, June 5, 2017

What is the best way to measure and monitor intensity during exercise?

Maximum heart rate is the maximum attainable heart rate for a person usually reached during all-out maximal exercise. Percent of maximum heart rate is often used as a marker of intensity and has even been used to prescribe exercise intensity. However, making a prescription based on heart rate alone, while precise, is not always very accurate.

The most accurate way of prescribing exercise intensity is ventilatory threshold. However, measuring ventilator threshold is difficult, time consuming, and requires a fully equipped exercise physiology laboratory. Ventilatory threshold is measured using collected exhaled air as you exercise at higher and higher intensities. By analyzing breathing rate and exhaled air, the two ventilatory thresholds, VT1 and VT2, can be measured. The ventilatory thresholds correspond to how your body is creating energy and how the heart and lungs are working. Training below VT1 (Zone 1) can be sustained for long periods of time, but usually doesn’t lead to much improvement in cardiovascular fitness. Training between VT1 and VT2 (Zone 2) cannot be sustained for very long, but leads to greater improvements in cardiovascular fitness. Training above VT2 (Zone 3) can only be sustained for very short periods of time and is most effective in maximizing work capacity. Heart rate matched to the laboratory measured ventilatory threshold is a very accurate way of prescribing cardiovascular intensity.

However, since we don’t all have access to an exercise physiology lab, heart rate prediction formulas have been used to prescribe exercise intensities by estimating maximum heart rate. The traditional maximum heart-rate estimation is 220 minus age. For example, somebody who is 25 years old would have an estimated maximum heart rate of 195 beats per minute. Recently, a more accurate formula for women has been suggested, 206 minus 88 percent of age. A 25 year old woman would then have an estimated maximum heart rate of 198 beats per minute. While these calculations are usually easy to compute and provide an easy marker from which you can determine exercise intensity, they should be questioned due to inaccuracies. The estimation may be 10 or 20 beats per minute more or less than your actual maximum heart rate. Basing exercise intensity on an inaccurate estimation of maximum heart rate can mean straying from your training prescription and training in a different heart rate zone than intended.

A better and more accurate way to monitor intensity during exercise is by using the Talk Test. Research has shown that one’s ability to talk correlates with VT1 and VT2. The point at which talking first becomes slightly difficult was at the same intensity as VT1. The point at which talking becomes impossible or very difficult was at the same intensity as VT2, according to the ACE-sponsored research study. Using the talk test, while not as specific as a number on a heart rate monitor, is a much more accurate way of prescribing exercise intensity. This talk test is best used when cardiovascular training is highly specific and competitive, for example an endurance athlete training for a triathlon.

Another way to monitor exercise intensity is by the Rating of Perceived Exertion (RPE), or Borg scale. Using the Borg scale, with values from 0 to 20, can help you monitor your cardiovascular intensity. A rating of 7 corresponds to very, very light training intensity. A rating of 12 corresponds to moderate intensity. A rating of 17 corresponds to very hard intensity. A rating of 20 corresponds to maximum all-out intensity. Notice how, as your fitness increases, your exertion level at a previously difficult intensity starts to decrease. For example, running a 10 minute/mile pace used to be a level 16 exertion level for you. Two months after exercising regularly, you notice that the same 10 minute/mile pace is only an exertion level 12. RPE is a useful way of monitoring progress and keeping intensity appropriate. It is best used when cardiovascular training is more generalized and less specific. A person most likely to benefit from using the Borg RPE scale is following a general weight loss program.

By focusing on exercise intensity as a personal measure that is different for different individuals, rather than a number to attain, you can set better exercise intensity prescriptions. As you become better trained, the intensities at which VT1 and VT2 are reached will increase. This means that performing the same intensity that used to be difficult is becoming easier and easier, meaning an increase in cardiovascular fitness!

Saturday, May 13, 2017

Finding Your Why

Last weekend, I attended The Fitness Summit, in Kansas City, Missouri. Presentation topics included Nutrition, Training the Hybrid Athlete, Wellness, Uncommon Mobility Methods, and Gym Design. At first, it seemed like every presentation had a different angle: offer many choices, don't offer choices; recommend pre-packaged foods, encourage food journaling. Overwhelmingly, however, every presenter stressed the importance of "Finding Your Why."

Finding your why is important in all aspects of life. Many people focus on what they have to do. The endless tasks continue to mount up, and we may wonder why we're never getting ahead. Life gets a lot simpler when we stop to ask ourselves why we do things.

For the purpose of this email, think about why your health and fitness goals are important to you. Whether your goals are specific or general, what is it that motivates you to exercise and keep a healthy diet? By focusing on the underlying reason behind our motivations, preforming the tasks, be they exercise or healthy eating, can all start to feel much easier.

My why(s):
  • regular exercise decreases the pain I feel from rheumatoid arthritis
  • I come from a very active family and it's important to me to maintain the family value of running and exercise
  • exercise keeps me emotionally stable
What are your Why(s)?

Adults will Walk For Money, Charity

A recent study showed that financial or charitable-giving incentives motivated adults to move more. In a 16 week study, 94 adults aged 65 and older were given pedometers and challenged to increase their daily steps by 50%. Participants were assigned to one of four groups.

Control: received weekly feedback on progress
Financial: received a $20 reward
Social-Goals: received $20 donation to charity
Combined: received $20 that they could choose to cheep, donate to charity, or split between themselves and the charity

All three incentive groups met the step goal on more days than the control group. The financial group took more than double the steps taken by the control group, and the social-goals group eked out a few hundred steps more per day than the financial group. The combined group walked less than the other two incentive groups but still more than the control group.

That said, a 4-week postintervention follow-up found no difference in steps among the four groups, with all three incentive groups dropping back to the same level as the controls.

How do you feel about these results? It seems that incentive schemes can increase adults levels of walking, but only temporarily. What would be a more long term plan for success in increasing activity.

The study appeared in the American Journal of Preventive Medicine (2017; http://dx.doi.org/10.1016/j.amepre.2016.11.011).

Monday, March 27, 2017

Office Stretching Program

Recently, the scientific community has identified a new disease called the “Sitting Disease.” The average American spends 55% of waking time (7.7hrs) sitting. Sitting for long periods of time has been linked with increasing the risk of heart disease, diabetes, and even death. Other research found that women who sat more than six hours per day were 94% more likely to die than those who sat less than three hours per day. In men, the longer sitters were 48% more likely to die.

In addition to this, the “desk posture” we adopt leads to certain musculoskeletal adaptations. By sitting and using our arms in front of us (at a keyboard), we tend to develop tightness in the chest. This leads to weaker muscles in the upper back. Over time, this can cause a forward shoulders hunched posture. In the hips, sitting leads to tight hips flexors and weak glutes. The weakened glutes force the hamstrings and low back to become overactive to compensate for the inactivity of the glutes. Over time, these musculoskeletal changes can lead to low back pain, upper back pain, etc.

Can exercise counteract prolonged sitting?
Research has come to two different conclusions when it comes to whether or not exercise can counteract prolonged sitting. One conclusion is that no amount of exercise can counteract prolonged sitting. The other conclusion is that exercise can improve health outcomes, even with prolonged sitting. I tend to agree with the 2nd conclusion. Expecting exercise to “counteract” another habit is unrealistic. Everything we do is cumulative, and thus, while we cannot counteract prolonged sitting, we can improve health outcomes by exercising before or after prolonged sitting at work.

In addition to exercising before or after work, taking some time for more activity in the office can also be a very effective way to combat the effects of prolonged sitting. Activity trackers nowadays have reminders that will remind you to get up and move at certain time intervals. I would also recommend adopting an office stretching habit 1-2 times per day. Stretching will increase performance in physical activities, decrease your risk of injuries, help joints move through their full range of motion, and enable muscles to work most effectively. Print out and try to implement this office stretching handout. I’m here to help if you have difficulty understanding any of the stretches.

Standing a little more each day tones muscles, improves posture, increases blood flow, ramps up metabolism, and burns extra calories.

Tuesday, March 14, 2017

Take more steps to ward off sickness

Good news for regular exercisers: The more active you are, the less likely you are to get sick. At least that's according to data compiled by Jawbone, a manufacturer of wearable tracking devices.

The company wanted to determine a person's likelihood of becoming sick, so it compiled a variety of self-reported data from the Jawbone UP app. Based on that information, data analysts developed a sickness likelihood score. Here's what they learned:
  • People are more likely to fall ill during winter months
  • Individuals with higher BMIs tend to become sick more often
  • Men aged 25-45 who take an average of 14000 steps daily are four times less likely to become sick than those taking fewer than 4000 steps daily
  • When sick, most people see a decrease in steps of 5%-12% and an increase in sleep time of 5%-7%
Have you noticed a similar effect from exercise yourself? Regular exercise boosts immunity, so that may be the contributing factor to why fewer active people are getting sick.

Please let me know if you'd like help making regular exercise a part of your life!

Some kind words

One of my clients just sent me a very kind write up of her personal training experience:

I am a 62 year old female. I just completed 4 months of personal training with Viktoria and Fit Athletic Club/Carmel Mountain Ranch.
I have tried so many, many times to get fit-- joined clubs, had personal trainers, done it all, but this is the first time I have ever stayed committed to the process. I have seen in four short months, my body fat mass drop, my balance improve considerably, and I am definitely stronger and overall I feel good.

Viktoria is very knowledgeable, made it "fun", listened to my concerns (I have chronic back pain) and at the same time pushes me forward. I definitely believe by starting out with her as a trainer and getting understanding of the equipment and type of exercises I should be doing has made all the difference in my being able to stay committed.

Viktoria is a very good rep for your gym/company and a very valuable member of your team.

Wednesday, March 1, 2017

Combating Prediabetes in Healthy Weight Adults

Recent research from the University of Florida reports that one-third of normal-weight adults over age 45 have prediabetes, a high-risk state for developing type 2 diabetes. The researchers compared data from 1988-1994 with data gathered in 2012. The results showed that the prevalence of prediabetes among healthy-weight adults aged 20 and older increased from 10.2% to 18.5%. Among people aged 45 and older, the prevalence of prediabetes increased from 22% to 33.1%. The report raises concerns about current practices used to detect the disease.
Current recommendations for prediabetes screening focus nearly exclusively on adults who are overweight or obese. These guidelines make it less likely that individuals with healthy BMI will be screened, despite the increasing prevalence of prediabetes among this group.

Fortunately, there may be a solution. Another study, this one from Duke Health, examined the effect of different exercise intensities on glucose homeostasis. Good news: it doesn't have to be "go big or go home" for people to benefit.
The 6 month intervention study separated 150 adults with prediabetes aged 45 to 75 into the groups below. I've indicated their improvements in glucose tolerance with the---->
  1. low amount/moderate intensity (walking 7.5mi/week)---->5% improvement
  2. low amount/moderate intensity (walking 7.5mi/week) plus caloric restriction and reduction in fat intake---->9% improvement
  3. high amount/moderate intensity (walking 11.5mi/week)---->7% improvement
  4. high amount/vigorous intensity (jogging 11.5mi/week)---->2% improvement
Results showed that the diet-plus-exercise group led the pack with the greatest glucose tolerance improvement. This emphasizes the importance of combining a healthy diet and exercise. The exercise intensity did not have to be very vigorous, as seen in groups 1, 2, and 3. This indicates that the time duration of the exercise may also be an important factor to consider; the same volume of exercise performed at a higher intensity will take less time.

Bottom line: Exercise and healthy diet is important to everyone regardless of weight in order to decrease risk of prediabetes.

Healthy Weight Adults at Risk for Prediabetes

Regular Moderate Exercise Best for Glucose Control

Wednesday, February 15, 2017

Protein: When and How Much

Protein is always a hot topic. Carbs and fat have both been on the chopping block in our diets at different times. Protein, however, has been connected to everything from weight loss to muscle gains. Perhaps there is something to this. Researchers have been investigating protein's role in aging and satiety across the lifespan. They have found that we're eating too much protein at the wrong times and not enough at the right times. We need more high-quality protein at breakfast and less protein at dinner.

How Much Protein?
Nutritional recommendations have long recommended that 10-15% of our daily calories be from protein. However, recent research suggests that the minimum should be boosted to 25%, given the positive benefits of higher protein intake on satiety (fullness) and other physiologic functions. If you've been logging your food, you'll remember how I recommended the macronutrient percentage adjustment of 30% protein, 30% fat, and 40% carbohydrates.

Protein Intake and Timing
Most Western diets skew protein consumption toward the evening meal. Breakfast is typically carbohydrate-rich and protein-poor, while the evening meal is often much higher in protein and calories. Also of importance is that only 40% of Americans even eat breakfast. Thus, not only are many Americans consuming low-protein breakfasts, but the majority are not consuming any protein at all. There is increasing evidence of a causal link between breakfast skipping and obesity. Research shows that it is best to distribute protein intake throughout the day. This will promote muscle growth and repair, as well as satiety and reduced calorie intake throughout the day.

Boosting the Protein in 8 Basic Breakfasts
Bowl of cereal with milk: choose a high protein cereal
Egg and cheese on a roll: choose a (small) breakfast burrito with beans
Butter and jelly on toast: swap butter for peanut or almond butter
Yogurt: choose a higher protein Greek yogurt and sprinkle fruit and a high protein cereal on top
Oatmeal with water: swap water for milk and sprinkle on some chopped nuts
Smoothie with milk or yogurt: swap the milk or yogurt for kefir, a cultured probiotic
Homemade muffin: try baking a high protein muffin and spread some peanut butter on top
Banana: add a side of cottage cheese to feel full until lunchtime

Read the Full Articles:
Tapping the Power of Protein
High Protein Breakfast Ideas

Tuesday, January 31, 2017

The Real Reason you Should Warm Up

Too often, you may find yourself pinched for time, trying to squeeze a workout into a busy schedule, so you skip the warm-up figuring the main set of the workout is more important anyway.
Is a warm-up really necessary? What constitutes a "good" warm-up?

Enhanced Performance
A warm-up activity serves two major purposes—to enhance performance and prevent injury. Consequently, a warm-up is both physical and mental.
Relaxed, sitting in your chair and reading this column produces a relatively low 15- to 20-percent of blood flow to your skeletal muscles. Most of the small blood vessels (capillaries) within those muscles are closed. After 10 to 12 minutes of total body exercise, blood flow to the skeletal muscles increases to some 70 to 75 percent and the capillaries open.
Along with more blood flow comes an increase in muscle temperature. This is good because the hemoglobin in your blood releases oxygen more readily at a higher temperature. More blood going to the muscles, along with more oxygen available to the working muscles, means better performance.
An increase in temperature also contributes to faster muscle contraction and relaxation. Nerve transmission and muscle metabolism is increased, so the muscles work more efficiently.

Injury Prevention
Scientific studies on linking warming up with injury prevention are difficult to administer. Few athletes want to go through a muscle stress test to see what it takes to tear a muscle.
Old studies on animal subjects determined that injuring a muscle that has gone through a warm-up process required more force and more muscle length than a muscle with no warm-up. This study is in line with the anecdotal data that acute muscle tears occur more often when the muscles are cold or not warmed up.

Mental Preparation
Part of a warm-up process includes getting your head ready for the upcoming activity. Mentally preparing for the upcoming workout, or event, is thought to improve technique, skill and coordination.
This mental warm-up also prepares you for the discomfort of a tough workout or race. If the mind is ready to endure discomfort, the body can produce a better performance. If the mind is unwilling to endure discomfort, physical performance will certainly be limited.

How Much Should I Warm Up?
There is no hard evidence as to how much warm-up is needed before a workout or a race. Most recommendations are in the 10- to 20-minute range.
A general recommendation for warming up is that it should be specific to the activity you're about to perform. This is easy for running, swimming, or biking; simply start at a lower intensity and gradually increase intensity as you progress through the warm up period.
For more complex exercise, like strength training, a dynamic warm-up of gradually increasing intensity and complexity of exercises is best. You'll be taking your muscles through the range of motion to come in the workout as well as preventing injuries by stretching muscles that are usually too tight, and activating muscles that are usually underused.

In order to perform at your best and minimise the risk of hurting yourself, take time for an adequate warm-up. Below is my Dynamic Warm-Up, which is best to do before a strength training workout.
Dynamic Warm Up
Walking down and back 10 yds
Knee pull to chest
Walking lunges with rotation, then Backwards with an Overhead reach
Side Step
Cross-over side step
Side Lunge
Single leg reach In place
Prone Hip opener/chest opener

Monday, January 23, 2017

Mental Health and Exercise

Want to alleviate stress or cope with depression? Exercise may help. Increasingly, there is evidence from researchers that certain levels of physical activity can positively affect mental health. Let's take a look at what research has discovered about the connection between exercise and mental health.

Stress
A growing body of research over the last 10 years shows that physical activity and exercise also improve psychological well-being. Published data show that people with higher levels of fitness are capable of managing stress more effectively than those who are less fit. It appears that cardiovascular exercise is the method that most benefits stress reduction. The research indicates that moderate-intensity aerobic exercise, performed three times a week (sessions lasting over 20 minutes) for up to 12 weeks, has the most influence on stress management.

Depression
The antidepressant action is one of the most commonly accepted psychological benefits of exercise. Patients diagnosed with depression have credited exercise as being an important element in comprehensive treatment programs for depression. Cardiovascular and resistance exercise seem to be equally effective in producing antidepressive effects. It also appears that both a one-time exercise session and chronic exercise training programs have a positive effect on people with clinical depression. The effects of exercise on depression seem the same for men and women.

Anxiety
The results of over 30 published papers show a link between acute and chronic exercise and the reduction of anxiety. There appears to be much debate about whether low-intensity, moderate-intensity or high-intensity aerobic exercise is most beneficial. (If you’re not sure at what intensity you should exercise, consult with a personal trainer.) It appears that even short bursts of 5 minutes of cardiovascular exercise stimulate anti-anxiety effects. The research also indicates that people who train for periods of 10–15 weeks receive the greatest beneficial effects.

Get in a Better Mood
It appears that cardiovascular and resistance exercise can positively affect various mood states, including tension, fatigue, anger and vigor (a psychological variable defining vitality or energy) in normal and clinical populations. Plus, it has been shown that even a single session of 25–60 minutes of aerobic exercise (at low, moderate or high intensities) increases positive mood feelings while also decreasing negative mood feelings. Researchers need to further research resistance training to learn more about the connection between it and mood state.

Full Article and References

Tuesday, January 10, 2017

US News Ranks Top US Diets

US News evaluated 38 of the most popular diets and identified the best. Find which top-rated diet is best for your health and fitness goals.

Best Diets Overall:
1. DASH Diet: DASH (Dietary Approaches to Stop Hypertension), was originally developed to prevent and lower high blood pressure. This diet promotes the foods we've always been told to eat (fruits, veggies, whole grains, lean protein, and low-fat dairy), while shunning those we've grown to love, (calorie- and fat-laden sweets and red meat). This healthy eating pattern is key to deflating high blood pressure and may also promote weight loss. The DASH diet is also ranked #1 for Diabetes and Heart Healthy Diets.

2. Mediterranean Diet: It has generally been accepted that the folks in countries bordering the Mediterranean Sea live longer and suffer less than most Americans from cancer and cardiovascular ailments. The not-so-surprising secret is an active lifestyle, weight control, and a diet low in red meat, sugar, and saturated fat and high in produce, nuts, and other healthful foods. The diet claims to promote weight loss, then maintenance, and to promote heart and brain health, cancer prevention, and diabetes prevention and control.

3. MIND Diet: The MIND diet is a new hybrid of two balanced, heart-healthy diets (DASH and Mediterranean) that may lower your risk of mental decline. The emphasis is on eating from 10 brain-healthy food groups: green leafy vegetables, all other vegetables, huts, berries, beans, whole grains, fish, poultry, olive oil, and wine. MIND adherents avoid foods from the five unhealthy groups: red meats, butter and stick margarine, cheeses, pastries and sweets, and fried or fast food.

Check out the full results

Have you tried any of these dietary approaches? What has been your experience with them? I hope your new year has had a great start. Please contact me if you'd like any more information.