Tuesday, December 4, 2012

Holiday Tips

Dear Friend,

My apologies for letting too much time pass since the last blog, but family commitments do come first.

The Holiday Season is upon us with the first feast done and the second and third on the way. Every year I face similar questions: "How can I ensure the number on the scale doesn't go up" or "how can I win the "Battle of the Bulge" before it defeats me?" My answer remains the same, prepare and stay real.

The Holiday Season is most certainly a tough time to lose or even maintain current weight, and your goal should not be deprivation as temptations loom everywhere.  Instead try to maintain your weight and your workout schedule AS MUCH AS POSSIBLE.  It is unrealistic to expect to work-out as much as one would during other times of the year. Holiday parties with friends and colleagues, traveling and shopping consumes the time usually dedicated to your normal work-out routine.  However, exercise activities can still be integrated in many different ways.  Avoiding the ever so coveted close parking spot at the mall, or using the stairs instead of the elevator, will burn a few extra calories which can definitely accumulate to a measurable difference on January 2.  Family activities such as walks after holiday dinners or the traditional football game in the backyard are fun and are an excellent alternative to popping bonbons while sinking into a sofa and watching TV. 

Of course this is the season to be jolly and I love chocolates and all the other goodies abundantly and ubiquitously available.  Just establish a Holiday Game Plan and stick to it!  Make sure you provide the healthy fall back option when invited to a pot luck party. Arriving at the buffet fill your plate on the first round with healthy and low calorie food choices such as veggies and fruits. The second round opt for some lean meat or fish dishes and go easy on the deserts by the 3rd round. Any good host/hostess ensures that your wine glass is full at all time, so make sure you leave a sip to discourage any refills until you are ready for more.  Add a glass of water after each alcoholic beverage to further reduce the party calories.

Another hot topic at the end of each year is the Personal Training question. Can I afford Personal Training?  Will I realize a true benefit?  How do I choose the right Trainer?  A Personal Trainer can be a great ally in the prevention and reversal of holiday expansion.  He or She will hold you accountable to an agreed-upon work-out schedule. Pricing for trainers varies greatly depending on the area in which you live, the qualifications and experience of your trainer as well as travel time and expense.  As a Personal Fitness Trainer, I strongly believe in the benefit of enhanced quality of life, that fitness training provides whether through a PFT or on one’s own efforts.  I have personally experienced the difference a good trainer can make in my own athletic endeavors.  I’ve also had the pleasure of influencing positive impacts of many of my clients’ health and wellness. 

For guidance on how to select a Personal Fitness Trainer, visit a blog I wrote in January of 2011 titled Happy New Year: How to choose a Fitness Trainer.

Have a wonderful Holiday Season and a healthy, wealthy and joyful 2013!


Wednesday, October 10, 2012

Childhood Obesity - Let's face the challenge

Dear Friends,

after taking a break I am coming back to you with a blog that addresses the fitness needs of an age group opposite to those I wrote about last time, our children and adolescents. Childhood obesity has according to the CDC (Center for Disease Control) tripled over the past 30 years, increasing from 7% in 1980 to 20% in 2008 among 6-11 year old kids and in the same time period increasing from 5% to 18% among the adolescents (age 12-19). One third of all children 6-19 were overweight. Healthy weight, over weight and obesity are defined in children and teenagers with the help of the BMI (Body Mass Index - relationship between body height and body weight) in addition age and sex are taken into mathematical consideration. Children among the 5th-85th percentile are considered "healthy weight", 85th-less than 95th percentile are considered "over weight", and those 95th percentile and higher are labeled "obese".

The effects of being over weight and obese have immediate and long term health consequences.

Early heath effects:
  • Increased risk of cardio-vascular disease (due to hypertension and hyperlipidemia).
  • Increase in pre-diabetic conditions
  • Extra weight is also hard on joints and bones creating early onsets of osteo-arthritis.
  • Being out of shape and furthermore leads in many to being ostracized and suffer from poor self-esteem.
Overweight adolescents have a 70% chance of becoming overweight or obese adults. This chance increases to 80% if one or more of the parent/s is/are overweight or obese.

Health consequences later in live include:
  • Increased risks for type 2 diabetes
  • Increased risk for heart attacks and strokes
  • Greater rate of osteoarthritis
  • Increased risk for many forms of cancer
How can I as a parent prevent my child from growing overweight or obese or help him/her when already overweight?

In the vast majority of cases childhood obesity  is a result of caloric imbalance. Too many calories are being consumed while too little calories are being used for physical activities. In plain English; most children spend too much time in front of TV and computer screens while consuming high caloric foods of very little or no nutritional value. Educating your youngster on healthy dietary choices, limiting his/her screen time and encouraging physical activity by being a role model and activity partner goes a long way in the prevention and treatment of childhood obesity. When addressing the need for more physical activity please realize that sending your child outdoors is not enough to encourage physical activity. You going to the pool, playground or neighborhood park together and engaging your child goes a lot further. Another mistake parents make when choosing a physical activity for their kids is to integrate them into their own routines i.e. jogging. When deciding on a specific activity for your child please take his/her age and physical developmental stage into consideration. Jogging might be a good choice for a 16 year old adolescent (if it isn't painful due to the extra weight), but is certainly utterly boring for a 5 or 6 six year old kid. In addition, young children up to age 12 are metabolically "High Speed Stop and Go Engines". Next time you have a chance observe little kids on a playground. They most likely go in short spurts to full exhaustion, recover and go full blast again. Chose playful forms of activities in younger years and continue on with more organized forms of exercising as your child grows up to be a teenager.

To give yourself and your child a better chance to be successful in dealing with her/his weight issues make sure your whole family is on board and ready to support each other in living a healthier live.

Helpful websites:




As always, your questions, comments and suggestions are appreciated.

In good health,


Thursday, July 26, 2012

Fitness Training for Seniors: From Frail 2 Fit

This month I would like to write about fitness for the aging population.  More than half of our clients at BACK IN FORM are 60 years of age or older. We truly cherish this group and love working with them. We offer a program called “Frail-2-Fit” that suits every Senior no matter what stage of life or what level of physical ability he or she is in. Today's blog will explain how aging affects us physically, and how exercise and fitness training can help slow down the process of aging.

It is a well-known fact that there are individuals who live abusive lifestyles and exercise very little if at all, but live to celebrate their 107th birthdays, think Winston Churchill or George Burns.  Understand that this is the exception and not the norm.  For most of us, exercise is the key to maintaining a high quality of life and preventing the physical decline that often ends in assistant living or nursing care at a very high price. (See also my previous blog: "Your greatest financial asset is you")

According to statistics the US population over the age of 65 will reach 70 million by 2030, with the group of those 85 and older growing faster than any other segment. Unless Seniors adopt healthy living standards that include physical activities and balanced nutrition, the US could experience unprecedented growth in health care cost. 

The physical effects of aging and the counter effects of fitness training

is reflected by the level of cardio-respiratory fitness (CRF) which is being measured and expressed through the VO2max (maximal Oxygen uptake). CRF declines at a much greater rate after age 45 in both men and women depending on exercise habits, Body Mass Index and smoking. Those leaner, trained and non-smoking experienced in many different studies far lower declines in CRF than their untrained, overweight and smoking counterparts.However even those who smoked or were overweight were protected from early death if they exercised/walked at least 30 minutes per day, reinforcing the importance of exercise.


loss, outside of a stroke or accident, is the leading cause of immobility and loss of independence. We tend to lose about 3%-5% per decade starting in our 40's and that loss increases often by 1%-2% per year after age 50. However, the good news is that hypertrophy and improved neuro-muscular adaptation can be achieved at any age. That means strength can be regained and maintained after loss, by increasing muscle mass and fine tuning the communication between the Brain/Spinal Cord and the muscle. Strength increases of up to 200% in lower extremities and well above 100% in upper extremities have been found in many case studies with weight and resistance training.

decreases with age because of reduced movement and the natural reduction in soft tissue elasticity due to the inability of cells in the aging body to retain water in an sufficient manner. There is no clear science as to how much stretching should be described. However regular stretching can help preserve functional range of motion and joint health preventing increased wear and tear (Osteoarthritis).

depends on several physical abilities that all decline with age, such as strength, mobility, neuron-transmission speed, eye sight, proprioceptive information flow, depreciation of vestibular system etc. Many of these physical abilities can be corrected and/or their regression slowed through adequate fitness training. For example: A loss of strength and decreased mobility and flexibility commonly effects posture negatively increasing the challenge to maintain the body's center of gravity over the base of support. Exercises geared to correct postural deficiencies can reduce the negative impact on balance.Another example: Reducing physical activities such as golfing, tennis or dancing reduced the stimulus for the proprioceptors, starting up a fitness program and reintegrating some of the activities done earlier in life will awaken those receptors and can reverse the negative effect on balance.

Bone density,
decreases as we age. Significant decreases are more common in women than in men and more prevalent in post menopausal women. Moderate bone density losses are referred to as Osteopenia, the severe form is called Osteoporosis. US wide more than 40 million Americans (female and male) are affected by severe bone density loss. This disease causes roughly 1.5 million fractures in the US annually. Exercises such as lifting weights places stress on the bone as muscles contract causing the bone to thicken. Weight bearing exercises such as walking compressing bone structures in vertical direction which improves the nutritional situation inside the bone and helps repair bone density loss in lower extremities and spine. Please see also my previous blog: "Osteoporosis: maintain and recreate bone density"

Joint health,
is diminished in almost all older adults. Over time the cartilage that protects the bones inside the joints starts to degenerate and eventually bone starts to grind on bone. This degenerative condition is known as Osteoarthritis and affects nearly 27 million Americans. It leads to pain and joint stiffness and often results in joint replacement. Studies have shown improvements in joint function and joint pain in those who exercise regularly choosing low impact aerobics and light to moderate weight lifting. The Arthritis Foundation has created an exercise program called PACE (People with Arthritis Can Exercise) that offers tips and instructions for land and water based exercising with Osteoarthritis.

Cognitive functions,
can become impaired as we age. Studies have shown that adults ages 55 and older showed in MRI testing substantial declines in brain tissue density in areas associated with memory and thinking. Those who were actively involved in regular cardiovascular fitness training showed significantly lower losses. Another study showed that individuals 65 and older, who walked at least 3 days per week had a 35% lower incident rate of dementia than those who walked less or not at all. These results are very encouraging and should be taken into serious consideration when battling Alzheimer's Disease and other forms of dementia.

Mental Outlook
In the US about 14% of males and 18% of females over the age of 55 struggling with some form of depression or another. There is unfortunately very little research on exercising and depression in older adults. It is however safe to assume that it shows similar results as we see in younger adults with depression. Even if it's not a depression cure for Seniors aerobic exercises can at least help alleviate the negative impacts of depression and enhance the mental outlook.

It doesn't come as a surprise that exercise is a great tool to improve quality of life, stave off disease and the negative effects of aging as it has made it's way into almost every therapy protocol known to men. There is no age limit on when to start, and there is no success limit due to age as long as we take preexisting conditions that require changes to an exercise routine and the slower adaptation to training into consideration. I recommend you start by discussing your training plan with your physician and let a fitness professional guide you in the set-up of a program that takes your individual situation into account.

A Sante,

Andrew S. Jackson; Xuemei Sui; James R. H├ębert; Timothy S. Church; Steven N. Blair. ” Role of Lifestyle and Aging on the Longitudinal Change in Cardiorespiratory Fitness.”  Arch Intern Med. 2009;169(19):1781-1787

Sunday, June 17, 2012

IT Band Syndrome

Dear Friends,

today I want to address a very common and painful condition effecting the outside of thighs, hips and knees. The Iliotibial Band (IT Band) runs from the hip (ilia crest) along the outside of the thigh attaching to the tibia (shinbone) just below the knee. It stabilizes the knee and coordinates muscle activity while moving. This band can become irritated and inflamed causing pain at hip and knee.

IT Band Syndrome (ITBS) is common in long distance runners, cyclist and tennis players caused most often by
  • overuse/over training
  • increasing workload/distance to soon
  • returning from an injury before healed
  • training errors
  • poor biomechanics or anatomical problems

While the first three causes are pretty much self explanatory the last two might need elaboration. Training errors amongst runners can include running on the same side of the road or on the track in the same direction. By keeping same leg on the inside turn  you are causing excessive stress on the outside leg. Most roads are crowned, meaning the surface slopes to the outside edges causing a lateral pelvic tilt. Other biomechanic problems include super pronation, bow legs and significant leg length discrepancies.

The cardinal symptom of ITBS is knee pain as the IT Band slides across the femoral condyle on the outside of the knee. Pain can extend along the thigh up to the hip. Pain typically is worse at heel strike while running and when ascending/descending on stairs, or getting up from seated position.

Treatment of this condition initially involves Rest, Ice, Compression and Elevation (RICE) in combination with Physical Therapy, stretches  and mobilization of IT Band. In addition Non Steroidal Anti Inflammatory drugs might be prescribed or in severe cases Cortisone Injections given.

Even though there are only insufficient randomized, controlled trials as to which particular exercises are most beneficial in reducing the IT Band Syndrome and prevent recurrence some studies amongst specific groups of patients (i.e. long distance runner) seem to indicate that stretching the IT Band, mobilization of the IT Band and single leg strengthening exercises have been successful in the secondary prevention of ITBS.

Here are some recommended exercises I'd like to share with you:
  1. Standing ITB stretch
  2. Advanced ITB stretch (Pigeon Pose)
  3. Foam Roller ITB mobilization
  4. Hip Hike on step
  5. Single Leg Squat
  6. Side Lying Hip Abduction
Since ITBS is most often caused by overuse cross training can be successful in reducing the risk of acquiring such injury.

I hope this little bit of information was helpful and will keep your IT Band in great shape.

A Sante,

About.com Sports Medicine
VHI's Evidence-Based Exercise Prescription Newsletter

Wednesday, April 11, 2012

Chest Pain: Indigestion or Angina?

In today's blog I would like to share a recent experience I  had with one of my clients, hoping that sharing this story with you and elaborating on it will help you recognize the symptoms of coronary artery disease and prevent heart attack and possible death for yourself and others.

I recently started working with a new client, a male in his 70's, with a history of an ischemic brain infarct/stroke. At the start of our work-outs he had pretty much fully recovered from the event other than some lingering short term memory problems. His physician recommended a regular work-out regimen to reduce his elevated cholesterol levels, improve his stamina and help with the prevention of future strokes.

Three weeks into our relationship my client complained during a work-out session about frequent problems with heart burn or indigestion causing pain behind his sternum. He was experiencing these episodes several times during the day, but they never lasted very long. Lately the same episodes plagued him during our work-outs. When asking him whether he felt any acidic reflux he declined. Alarmed by his prior stroke and his elevated cholesterol levels I urged him and his daughter to schedule a stress test to eliminate the possibility of Angina. His primary care physician prescribed Anti Reflux medication and ordered a stress test ECG (better be safe than sorry). The stress test unfortunately confirmed my concerns. My client was indeed experiencing Angina, a common symptom of coronary artery disease caused by a reduced blood flow to the heart muscle. Angina is fairly common and often described as pressure in the chest or someone standing on the chest, but often mistaken for other health problems just like in this case.

Cardiologists differentiate between three types of Angina that I would like to introduce, and discuss their symptoms and characteristics.
  • Stable Angina
  • Unstable Angina
  • Variant Angina (Prinzmetal's Angina)

The symptoms of all three types can vary and include:
  1. Chest pain or discomfort
  2. Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
  3. Nausea
  4. Fatigue
  5. Shortness of breath
  6. Anxiety
  7. Sweating
  8. Dizziness
Commonly the perception is that Angina only effects the left arm, left side of jaw or left shoulder. That is a myth I would like to debunk. Both sides of the body can exhibit symptoms.

Stable Angina is the most common form of Angina and typically occurs during periods of elevated physical and/or emotional stress (Exercise, stair climbing, mental stress etc.).
Other Characteristics:
Predictable (patient knows how to and what triggers an event)
Consistent (chest pain is at least similar each time)
Short term (passes usually within 5 minutes or less)
Responds well to rest and Angina medication
Can feel like indigestion
Can spread to arms, back or other areas of the body (see above)

Unstable Angina is considered a medical emergency.
Occurs even when resting
Change in the pattern of previously experienced Angina
Long term (often 20 minutes or more)
Might not respond to rest and medication
Could indicate Heart Attack

Variant Angina is a very rare form of Angina accounting for only 2 percent of all Angina cases. This form is caused by a temporary coronary artery spasm reducing blood flow to the heart muscle.
Occurs often during rest
Can be very severe
Might respond well to Angina medication

Your Cardiologist will order the right tests to diagnose your problem and develop a treatment plan that might include lifestyle changes, medications, medical procedures and surgery if needed.

I hope this information won't cause unnecessary panic or worry, but rather help saving lives. If you or someone else you know, or train, does experience any unexplained chest pains or other aforementioned symptoms please see a health care provider for further testing. If chest pain lasts longer than a few minutes and does not respond to rest and Angina medication don't hesitate to call 911 as it might indicate a heart attack.

In good health,

Source: Mayo Clinic Staff @ MayoClinic.com

Sunday, March 18, 2012

Osteoporosis: maintain and recreate bone density

This blog is focusing on one of the most common health problems among my older female clients/patients, Osteoporosis.

Osteoporosis is the most common bone disease in women over 50 in the US. A loss of bone density occurs when the body doesn't form enough new bone or reabsorbs too much old bone or both. This is caused by a lack of calcium and phosphate, two minerals vital to bone formation. Other causes include:

  • chronic rheumatoid arthritis
  • corticosteroid use
  • Hyperparathyroidism
  • bed confinement
  • Vitamin D deficiency
  • alcohol abuse and more
Symptoms include bone pain, fractures without or little impact/trauma, stooped posture (hyper kyphosis) and significant loss in height (6 inches or more).

Bone density loss is commonly diagnosed by performing a bone density test. The dual energy x-ray absorptiometry scans are comparing the patients levels with those of a healthy young woman (T Score) and with those of the patient's peers (Z Score). Negative T-Scores indicate the loss of bone mass with values from -1.0 to -2.5 being diagnosed as Osteopenia (milder form) and values of -2.5 and lower being considered Osteoporosis.

A treatment plan is trying to stop further bone density loss, increase bone density and manage the associated pain. The patient is typically using calcium and vitamin D supplements and medications such as Fosamax, Actonel, Boniva, and Reclast that are designed to increase bone density. In addition patients with low bone densities need to be educated on the importance of impact exercising and be put on an appropriate exercise program

Why is weight bearing and loaded exercising important? Bone is considered a bradytrophic tissue, meaning it has very little or no direct blood supply. It absorbs nutrition like a sponge absorbs water. You squeeze the sponge for maximum absorption. Compressing the bone through weight bearing- and impact exercises accomplishes the same. Studies performed among women with Osteoporosis and Osteopenia showed significant better outcomes in those that were involved in exercise programs involving weight bearing exercises and loading stresses. It needs to be mentioned though that patients with severe Osteoporosis are at a very high risk for hip, wrist and vertebra fractures. High impact exercises have to be avoided at this stage. Exercising under the supervision of an experienced trainer or Physical Therapist is highly recommended.

Exercises I recommend to my patients include but are not limited to:

  • Lunges
  • Squats
  • Step-ups
  • Jumps (milder stages)
  • Hip Abduction (short lever in severe cases)
  • modified Push-Ups
  • Supine Posterior Pelvic Tilts
  • Supine Bridging etc.
I hope this blog is offering some insights into the problem of bone density loss and the importance of exercise to treat this disease. As always, please feel free to contact me with questions and comments. Please like BACK IN FORM on Facebook (www.facebook.com/backinform) and follow our tweet on Twitter.

A sante,

Sunday, March 4, 2012

Piriformis Syndrome or Sciatica?

Many of my clients come to me asking for help after having been diagnosed with Piriformis Syndrome (PS) aka "Pseudo Sciatica". PS is caused by either a tight piriformis muscle or a spasm of the same causing irritation to the underlying Sciatic nerve. The term "Pseudo Sciatica" already indicates that it is hard to differentiate between true Sciatica and PS, as both cause the same symptoms (pain, tingling, burning, "electrical shock" sensations, and/or numbness down the leg, often all the way to the foot). Some recent studies contribute a tight piriformis or a piriformis spasm to the fact that the muscle is overworked due to weakness in gluteus medius and maximus (buttock muscles). True Sciatica is most commonly caused by the compression of one or more of its component nerve roots due to disc herniation or spinal degeneration in the lower lumbar region.

How can you actually tell the difference? There are two simple diagnostic exercises that give you a very good idea whether you are dealing with Sciatica or PS. If from a sitting position the patient/client straightens his/her painful leg and experiences an increase in pain you very likely are dealing with true Sciatica. If your client/patient pulls up his/her knee (painful side) from sitting position towards the same-side shoulder an increase in pain is only likely in severe Sciatica cases. If the same maneuver is performed towards the opposite shoulder and causes an increase in pain you most likely are looking at a client/patient with PS.

Can Exercise Therapy reduce the symptoms of Piriformis Syndrome?

Unfortunately there are no real scientific studies available that address this particular question. Treatment for PS has traditionally included physical modalities like heat, ice and ultrasound, stretching, and a combination of local anesthetic, corticosteroid and botulinum toxin injections into the piriformis muscle, muscle sheath, or sciatic nerve sheath. Furthermore Physical Therapy included soft tissue mobilization, positional release, and joint manipulation, performed two to three days per week over a three months period.

Recent case studies suggest that exercises strengthening the gluteus maximus and medius and help with movement reeducation can reduce PS symptoms dramatically and in some cases lead to a full symptom resolution within a couple of months.

Exercises recommended in these case studies and have shown improvement in my own PS clients included:

  • Piriformis Stretches
  • Resisted Side Step Abduction
  • Supine Bridging
  • Resisted Clam Shells
  • Myofascial Release of Piriformis with Foam Roller
  • Clock Lunges
  • Clock Single Leg Hops
I hope I was able to shed a little light onto the problem of Piriformis Syndrome vs. Sciatica and my tips prove to be helpful to you or people you might train.

A Sante,

Monday, January 9, 2012

Low Back Pain during Pregnancy

Typically at the beginning of the year I write about New Year's Resolutions and how to keep them, how to chose the right club or trainer, or how to prepare foods that help you lose those extra Holiday pounds. This year I decided to go a different route. My education favors clearly the work with special populations and the rehabilitation of a variety of orthopedic, neurological and internal medicine conditions. So besides attacking main stream fitness issues I will dedicate a portion of my 2012 Blog to tips on rehab. My first blog is a tribute to all women who have gone or are currently going through the most incredible transformation: Pregnancy and the sometimes not so incredible side effects.

Low Back Pain is very common during pregnancy (50-70% of pregnant women) especially as changes in weight and center of gravity put added strain on your spine. As a Physio Therapist I want to know whether exercises can make a difference and if so which exercises to choose.

Weight gains during pregnancy (typically 25-35 lbs) have to be supported by mom's spine in addition the growing weight of the baby and uterus might place additional pressure on vessels and nerves in the pelvis and lumbar region. The growth of uterus and baby has also the effect that the body's center of gravity moves anterior drawing the lumbar spine often into hyper extension causing pressure and irritation to nerves exiting the spine in the lumbar region and pacing additional strain on muscles and tendons supporting body posture. Hormonal changes during pregnancy include an increase in relaxin, a hormone that relaxes muscles and tendons preparing the birth canal for the process of giving birth. This hormone unfortunately works also on muscles and tendons supporting mom's spine possibly leading to further exacerbation of already existing back pain. Last but not least, some pregnant women do experience muscle separation of the rectis abdominis (Straight abdominal muscle or six pack :-) along the center seam leading to a decrease in spinal postural stability.

Looking at research, there are four major studies out, that have evaluated this situation with different conclusions. Two of the studies did see increased value in adding lumbar stabilization exercises in order to treat low back pain in pregnant women, two studies found no significant difference between pregnant women who did engage in such exercises and those who did not. I concluded based on those four studies that pelvic lumbar stabilization exercises appear to be helpful certainly are not likely to cause additional pain and therefore to be recommended.

Simple low back stability exercises include, but are not limited to:
  • Posterior Pelvic Tilt
  • Hip Abduction
  • Bridging
  • Side Plank
  • Hip/Leg Extension from Quadruped Position
any of these exercises can be modified to accomodate mom's prior experience with core stability training and her level of fitness.

I hope this little bit of info is helpful to all becoming moms and helps make your pregnancy a little easier.
Best wishes,

Hartmut Broring - M.S. Physio Therapy
Founder and President
Back In Form, Inc.