Exercising during and post menopause

Today's blog is trying to offer some insights into the challenges women are faced with during perimenopause and post menopause and how exercise can help overcome some of it's challenges.

Menopause is defined as the natural absence of a menstrual period and fertility for at least 12 months. The time from the onset of first symptoms to full menopause is called perimenopause. The time after that last period is called post menopause. Menopause can happen as early as the 30's and as late as the 50's. The median age for U.S. women to reach menopause is 51. Menopause can have a variety of causes. The first and natural cause is the reduced production of the reproduction hormones estrogen and progesterone, which are produced by the ovaries. Once the ovaries shutting down hormone and egg production a woman has reached the state of infertility. Other causes of menopause can be surgical through a full hysterectomy (ovaries and uterus are being removed) or by treatment for certain cancers through radiation and chemo therapy.

The symptoms of Peri-menopause and Menopause can include but are not limited to:

• Irregular periods
• Vaginal dryness
• Hot flashes
• Night sweats
• Sleep problems
• Mood changes
• Weight gain and slowed metabolism
• Thinning hair and dry skin
• Loss of breast fullness

The hormonal changes that occur during the peri-menopausal phase and after menopause can increase the risk for developing other health problems. Research shows that with the drop of estrogen levels women tend to eat more and be less physically active. Lower estrogen levels also lead to a reduction of a woman's metabolic rate. As hormone levels drop the risk for Cardio Vascular Disease, Osteoporosis, urinary incontinence, and weight gain (Hypertension, Diabetes Type2) go up.

Exercising helps to minimize stress and enhance mental outlook, helps to reduce anxiety and depression and increase an overall feeling of well-being. Exercises do help maintain and improve bone and muscle mass and thereby lessening the chances for osteoporosis and weight gains. Keeping the body fat low especially in the midsection during these difficult years shrinks the risk for diabetes type 2, cardio-vascular disease and certain types of cancer. Exercises designed to help strengthen the muscles of the pelvic floor can improve or eliminate urinary incontinence.

Any exercise program should include strength and resistance training, low impact weight-bearing exercises such as walking or jogging, and exercises that address balance to help prevent falls, as well as exercises to increase flexibility and mobility. Thirty minutes of moderate aerobic activities on at least five days per week have proven to have a positive impact on cardio-vascular and respiratory fitness as well as metabolic issues arising from lower estrogen levels. Aerobic exercise increase HDL (good cholesterol) and decrease LDL (bad cholesterol) and Triglycerides. Strength and resistance training helps maintain muscle mass and counter balance the reduction of metabolism after menopause. Weight-bearing exercises help to maintain/improve bone density lessening the risk of fractures at hips, wrists and lower back.

Those of you who are going through this period or are already post menopausal, and have developed osteoporosis, might have to reduce the impact and work load of certain exercises. Shortening levers especially when working around the hip (clam shells instead of long leg hip abduction) can reduce the risk of exercise induced fractures. Those that have already developed cardio-vascular disease and/or hypertension need to monitor blood pressure and heart rate during and after work-outs. If you are diabetic please check blood glucose levels prior to starting your work-out in order to prevent hypoglycemic emergencies.

Conclusion:
Regular exercising is the single most powerful lifestyle choice that not only has a positive effect on the symptoms of peri-menopause/menopause, but can beyond that significantly reduce the occurrence of secondary health problems.

I hope today's write up has given you a better understanding of the importance of exercising during and after menopause. As always, your comments and questions are strongly encouraged.

A sante,

Hartmut

Sources:
http://www.webmd.com/women/guide/women-over-50-fitness-tips
http://www.webmd.com/menopause/guide/menopause-weight-gain-and-exercise-tips
http://www.osteopathic.org/osteopathic-health/about-your-health/health-conditions-library/womens-health/Pages/postmenopausal-exercise.aspx
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296386/
http://www.mayoclinic.org/healthy-living/womens-health/in-depth/fitness-tips-for-menopause/art-20044602
http://www.mainlinehealth.org/oth/Page.asp?PageID=OTH006116
http://www.acsm.org/access-public-information/articles/2012/01/12/exercise-recommendations-for-menopause-aged-women
https://www.womenshealth.gov/menopause/
http://www.mayoclinic.org/diseases-conditions/menopause/basics/definition/con-20019726
https://www.womenshealth.gov/menopause/menopause-basics/index.html
http://www.mayoclinic.org/diseases-conditions/menopause/basics/symptoms/con-20019726

FITNESS 50-PLUS: Rest and Recovery

Dear Friend,

Unfortunately, identifying the right balance of hard work and recovery is the most difficult part of serious fitness training. So it comes to no surprise that most of my clients are much more focused on the exercises I teach to help them reach their goals of rehabilitation, balance, weight management, health improvement, greater overall fitness etc. Paying attention to proper rest and recovery often is being neglected. I guess if one pays for training rest seems a waste. As a trainer and therapist it is my job to ensure that a client/patient is not sabotaging his/her own efforts of improvement and remind them that adequate rest and recovery are an essential part of any work out program and no less important than the exercise itself. Lack of rest in between exercises within a training session and too little or poor recovery on off days will compromise the success of training whether the goals pertain to rehabilitation, health maintenance, fitness or athletic performance and regardless of age. Rest and recovery will however increasingly gain greater relevance and importance as we age. Some of you might have watched the Winter Olympics in Sochi. Norway's Ole Einar Bjoerndalen (age 40) became the most decorated Winter Olympian of all times. He almost missed the team as he had dropped far down in World rankings in 2012 and only after changing his training and emphasizing rest and recovery did he become successful again. In today’s blog I want to help you better understand the role of rest and recovery and leave you with some tips on how you can maximize your rest and recovery periods to ensure training success.

The role of rest in between sets and different exercises within a training session

Rest in between sets and exercises depend on the intensity of a given exercise (number of reps and work load) the overall demand on the body and the goals of your training . If trying to improve muscular strength endurance/fatigue resistance you trainer will most likely chose light to moderate work loads, high number of repetitions and short (30 seconds or incomplete recovery) rest periods in between sets. If maximum strength is to be improved high to maximum work loads, low number of repetitions, and long rest periods (complete or nearly complete recovery) in between sets are the common choice. Improving aerobic cardio-vascular capacities requires you to train at or near the aerobe-anaerobe threshold for extended periods of time, while improvements of anaerobe capacities require a short high intensity stimulus like a sprint. Rest periods have to be far longer. And yes there are newer methods that have gained great popularity such as High Intensity Training (HIT) or High Intensity Interval Training (HIIT) mostly due to their high caloric expenditure and impact on VO2 that allow for very little or no rest in between exercises. These types of work-outs are typically shorter in total time (15-30 min) and require full recovery on off days to be successful.


Recovery in between training sessions - Super Compensation

Training success relies on the principle of “Super Compensation” which means that training is supposed to stimulate a response that improves the body’s readiness for the next training session and its demands. In order to accomplish “Super Compensation” the work-out has to provide a progressive overload challenging strength, balance, and/or aerobic/anaerobic capabilities etc. In order to ensure optimal results after each session, exercises, work loads, numbers of repetitions and rest in between sets and work outs have to be planned.

Super Compensation requires recovery. In order to improve performance, training has to be timed properly. The best time for the next training session is at the highest level of Super Compensation. Training prior to the climax of Super Compensation limits training results. Training prior to regeneration leads to overtraining and reduced performance. Waiting too long leads to maintenance without improvement. See graphs below for better understanding.

Super Compensation

Perfect timing leads to improvement

Overtraining - negative training


Symptoms of Overtraining may include but are not limited to:

• Persistent muscle soreness
• Persistent fatigue
• Difficulty sleeping
• Elevated resting heart rate
• Reduced heart rate variability
• Increased susceptibility to infections
• Increased incidence of injuries
• Irritability
• Depression
• Mental breakdown

Periodization - variable training intensities and training goals short-, medium- and long term

"Periodization is an organized approach to training that involves progressive cycling of various aspects of a training program during a specific period of time. Periodization is most widely used in resistance program design to avoid over-training and to systematically alternate high loads of training with decreased loading phases to improve components of muscular fitness (e.g. strength, strength-speed, and strength-endurance). This system of training is typically divided up into three types of cycles: microcycle, mesocycle, and macrocycle." (Frankel, C.C., & Kravitz, L. (2000). Periodization. IDEA Personal Trainer, 11 (1), 15-16)

Additional ways to maximize rest and recovery on training days and in between

Whether it is between interval bouts, immediately after an interval session, or the day following strenuous exercise, there is compelling research evidence that active recovery is superior to passive recovery (Del Coso et al., 2010). Here are some ways you can speed up and improve your recovery process.

1. Post Exercise Nutrition Recovery has three goals, refueling glycogen storage by consuming complex carbohydrates (unprocessed, wholesome grains), offering protein for muscle repair and synthesis (first 45 minutes post exercise are key), and restoring fluid and electrolytes lost through sweat while exercising. Nutrition Recovery efforts should start within 45-60 minutes post exercise.
2. Stretch your muscles and/or  perform Self Myofascial Release by using a foam roller.
3. In addition an ice-cold full body plunge, contrast therapy by alternating hot and cold showers, and icing hard trained muscles right after working out can significantly reduce muscle soreness and inflammation and decrease the existing lactic acid build up, speeding up recovery.
4. Ensure a good nights rest with plenty of hours and quality of sleep.
5. Low intensity exercises such as walking or light weight lifting on the day following intensive work-outs will increase circulation and reduce lactic acid build up.
6. A massage to help with myofascial release, circulation and relaxation can further promote recovery in the days following intense work out sessions.

Conclusion

Despite the fact that recovery is an under-researched topic and therefore not as well understood as other areas of training, we do know that it takes a well thought out training plan and active recovery strategies to speed up and maximize the recovery process, and optimize training results and performance in athletic endeavors as well as in activities of daily living.

I sincerely hope I was able to shed some light on rest and recovery and help you improve your current strategies after finishing your work outs. Please feel free to respond with any comments and questions you might have.

In good health,
Hartmut



References:

Del Coso, J. et al. (2010). Restoration of blood pH between repeated bouts of high-intensity exercise: Effects of various active-recovery protocols. European Journal of Applied Physiology, 108, 523–532.

Frankel, C.C., & Kravitz, L. (2000). Periodization. IDEA Personal Trainer, 11 (1), 15-16

http://sportsmedicine.about.com/od/sampleworkouts/a/RestandRecovery.htm

http://www.ffnetwork.co.uk/fitnessfacts/recovery.php

https://www.acefitness.org/certifiednewsarticle/2757/training-recovery-the-most-important-component-of/

http://www.pponline.co.uk/encyc/recovery-training-increasing-your-speed-of-recovery-will-ensure-your-training-is-progressively-expanded-454

http://greatist.com/fitness/18-scientifically-proven-ways-speed-recovery

http://www.sportsdietitians.com.au/resources/upload/120628%20Recovery_SD%20version.pdf

http://sportsmedicine.about.com/od/sampleworkouts/a/After-Exercise.htm

Exercising with advanced chronic kidney disease (CKD)

Dear Friend,

recently one of my long term clients and dear friends started dialysis after years of chronic kidney disease (CKD) as it moved from stage 3 to 4 and finally reached stage 5 which called for aggressive treatment and dialysis.

Today's blog is trying to provide some insights into exercising with advanced chronic kidney disease and dialysis.

Did you know that one in seven adult Americans suffers from chronic kidney disease?

 http://www.physiciansweekly.com/ckd-incidence-prevalence/

The presence of CKD should be established through presence of kidney damage and level of kidney function measured by glomerular filtration rate (GFR). During stages 3 and 4 your kidneys are still able to remove some waste and excess fluids from your blood  and treatment is mostly focused on keeping your body nourished and treating other diseases contributing to the kidney disease. In addition your doctor will closely monitor kidney function to quickly intervene through medication and diet when necessary. Diet recommendations for patients wit CKD change with the amount of kidney function remaining, requiring adjustments in intake of protein, calories and other nutrients.

The most common causes of reaching the end-stage of this disease is diabetes mellitus. If diagnosed with diabetes make sure you watch your blood glucose levels and follow your treatment (insulin and other medications) strictly to prevent renal failure. Another cause for moving on to dialysis is hypertension as it damages the small blood vessels inside the kidneys. Controlling blood pressure by way of medication (often two different types) and reduced sodium intake is essential when trying to reduce the risk of further kidney damage.

Healthy kidneys produce the hormone erythropoietin also known as EPO which stimulates the bone marrow to make red blood cells, responsible for oxygen transport in the blood. Patients with chronic kidney disease do not produce enough EPO and often suffer from Anemia causing fatigue and paleness. Severe Anemia also places undue stress on the heart causing a greater risk for heart failure in patients with chronic kidney disease. Treatment options include EPO injections and iron supplements as EPO treatment is only successful if blood iron levels are sufficient.

Other problems caused by kidney disease effect bone health as phosphorous levels often increase and Calcium and Vitamin D levels decrease. Periodic bone density check ups are therefore warranted.

Knowing about the problems that chronic kidney disease can cause and being aware of possible other contributing diseases is helpful when starting and deciding on an exercise program. Many dialysis patients believe that they can't exercise any longer. The opposite is the truth. A regular exercise program has shown to be very beneficial to both, patients with chronic kidney disease even when undergoing dialysis. A regular exercise program yields the same benefits as it does for healthy individuals including but not limited to:

• increased energy and endurance

• improved physical function and activities of daily living

• greater muscular strength and counterbalance dialysis associated muscular atrophy

• lowering blood lipids

• controlling blood pressure

• improving insulin resistance

• managing body weight

• greater sleep quality

• enhanced mental outlook

Exercising is extremely important for patients with CKD. Studies have shown that physically active individuals predialytic, on hemodialysis and after kidney transplant increase their overall quality of life and improve the outcome of renal disease.
Before starting any exercise program patients with CKD should consult with their physicians and discuss safe forms of exercise and possible risk factors and contra indications. Your nephrologist is aware how much, how often and what types of exercise are beneficial in your particular situation. In case a trainer or Physical Therapist is involved in your effort to exercise I strongly recommend a consult between the fitness expert and your physician ensuring successful and safe work-outs.

When starting an exercise program choose activities that are enjoyable as it increases the chances for better compliance. If you are a novice to exercising start out and progress work-outs slowly. Exercises that have proven to be of great benefit to patients include aerobic activities, such as walking, jogging, cycling, skiing, dancing and swimming. Try to work up slowly to 3-4 weekly sessions of 30 minutes or more. Chose a workout intensity that allows you to keep up a conversation without shortness of breath. Avoid exhaustion.

In addition to aerobic activities CDK patients should get involved in a regular resistance training program that helps increase lean muscle mass and strength. Work out loads should be light to moderate and focus on repetitions rather than load increases. Work-out intensities should be kept moderate to avoid excessive muscle soreness and fatigue. In order to be successful try two or three weekly sessions, strengthening all major muscle groups.

If exercising outdoors avoid the hottest hours of the day; avoid big meals right before exercising, and don't place your work-outs too close to bed time as it might interfere with the ability to go to sleep. Stop the work-out if you experience chest pain, excessive tiredness or shortness of breath. Do not exercise if you have a fever and changed your dialysis or medicine schedule before consulting with your nephrologist.

Conclusion: Not only can CDK patients exercise at any stage of the disease, it is encouraged and vital to the emotional and physical well-being, overall quality of life, and the outcome of the disease. The potential risk of physical activity can be reduced by medical evaluation, risk stratification, careful supervision, and education.

As always, your comments and questions are much appreciated.

In good health,
Hartmut

Sources:
http://www.dciinc.org
http://nwkidney.org
http://www.renalresource.com
http://www.ncbi.nlm.nih.gov/pubmed/15742304
http://www.kidney.org
http://www.davita.com
Physical Exercise in Patients with Severe Kidney Disease
G.C. Kosmadakis, A. Bevington,  A.C. Smith a E.L. Clapp, J.L. Viana, N.C. Bishop, J. Feehall http://www.kidney.org/atoz/pdf/nutri_chronic.pdf
http://www.kidney.org/professionals/kdoqi/guidelines_ckd/p4_class_g1.htm
http://www.kidney.org/kidneydisease/aboutckd.cfm
http://www.physiciansweekly.com/ckd-incidence-prevalence/

Warm-Up and Cool -Down: Why and How

Dear Friend,

I wish you and your family a Healthy and Happy 2013.

Yesterday I watched my son's High School soccer game. As so often, my observations triggered a new blog. During the middle of the game one of my son's teammates, who just a few minutes earlier had entered the game as a sub, went down on to the pitch in a great deal of pain. No one knew exactly why. I thought it was the lack of proper warm-up before he entered the game that caused the injury. Turns out I was wrong. Upon further examination the boy showed all classical symptoms of Sciatica. However having observed his warm-up prior to coming into the game made me want to write a blog discussing the changes that have taken place over the past 4-5 years with respect to warm-up and cool-down and the scientific reasoning behind these changes.

The right warm-up and a proper cool-down need to be essential parts of every work-out and athletic competition. Correctly done they help minimize the risk for injury, increase physical performance and help with recovery after the competition or work-out.

The preferred warm-up of the past and that of my son's teammate included some form of gradually increased cardio vascular activity ( in his case way too little) like running, cycling, swimming etc. to increase the body's core temperature and blood circulation within the muscles. This phase was followed by static stretches to increase flexibility and range of motion (prolonged stretches that are used to increase the length of soft tissue and flexibility of the muscle). This warm-up procedure is flawed in at least two ways.

1. Static stretching is a very inactive warm-up method which leads to a decrease in muscle and body-core temperature that had just been elevated during the first phase of the warm-up. Therefore rendering the cardio-vascular warm-up part worthless. Reducing muscle temperature and core-temperature reduces physical performance ability (reduced oxygen supply, reduced neurological activation level) and increases risk of soft tissue injury as a colder muscle is less pliable/flexible and tears easier.
2. Besides that, several recent studies have shown that static stretches reduce the muscles ability to contract forcefully leaving that stretched out muscle weakened for up to an hour. This muscle weakness leads to an increased risk for injury and a muscle performance reduction.

Does this mean static stretches should be avoided all together? The answer is no. Static stretches are still a vital part of an athletes overall training. They do increase flexibility and improve joint biomechanics thereby reducing risk for injury to soft tissue and joints. Static stretches should based on today's knowledge be performed as part of a cool-down procedure and/or be done on off days.

Lately we are leaning more and more towards sports specific dynamic warm-up programs. These dynamic warm-ups focus more on the neuromuscular systems of the muscle. Dynamic warm-ups help with short term flexibility gains and lead to more adequate protective reflex responses from the Golgi Tendon Organs without compromising the strength of the muscle. Golgi Tendon Organs are lying deep within the muscles and protect the muscles from being overstretched. If not properly prepared and activated during warm-up these organs often over react during sports activities leading to muscle strains. Dynamic warm-up protocols help dampen the reaction of the Golgi Tendon Organs leading to improved muscle performance.

To properly warm-up I suggest you continue to start the same way you used to. Brisk walking, jogging or cycling etc. will help increase core and muscle temperature, improve oxygenation of muscle, and get your metabolic and nervous systems ready for action. After that skip the static stretches and move into dynamic sports specific exercises such as high knee jogging, butt kickers, multi directional lunges, bear walks, leg swings, arm circles etc.

After completing your work-out or competition slowly turn the system back down by gradually decreasing the intensity. Slow jogging and static stretches are a good way of returning physically and mentally to a real life activity level.

I hope I was able to shed some light on the recent changes to Warm-Up and Performance Readiness. As always, if you have any questions or comments please feel free to contact me.

A Sante,
Hartmut




Sources:
Mayo Clinic: http://www.mayoclinic.com/health/exercise/SM00067
Journal of Strength and Conditioning Research. ” 2008:
http://hpcsport.com/publications/staticstretching2.pdf
About.com: http://sportsmedicine.about.com/cs/injuryprevention/a/aa071001a.htm
IDEA: http://www.ideafit.com/fitness-library/pre-run-stretch-hampers-endurance

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!

Hartmut

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:

http://www.nourishinteractive.com/healthy-living/family-nutrition-exercise-facts/childhood-obesity/childhood-obesity-prevention-websites-childhood-resources

http://www.letsmove.gov/


http://www.shapingamericasyouth.org/Default.aspx


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


In good health,
Hartmut

Sources:
www.mayoclinic.com/health/childhood-obesity/
http://www.cdc.gov/healthyyouth/obesity/facts.htm
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html
http://backinform.com/services.php#fit4kids

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 107^th 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

Endurance,
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.

Strength,

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.

Flexibility,

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).

Balance,
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.


Conclusion
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,
Hartmut



Sources:
Andrew S. Jackson; Xuemei Sui; James R. Hébert; 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
http://www.acsm.org/docs/current-comments/resistancetrainingandtheoa.pdf
http://www.medicinenet.com/senior_exercise
http://www.arthritis.org/what-is-osteoarthritis.php
http://www.ncbi.nlm.nih.gov/pubmed/19363089

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,
Hartmut

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

Summer Round-Up

Dear Friends,

Each year during the summer time Back In Form is asking friends, colleagues as well as previous and current clients for their help with our "New Client Round-Up".

Our services include:
Personal Fitness Training
Rehab Exercises (Neurology, Orthopedics, Internal Medicine)
Fitness for Seniors (any level, fit to frail or healthy to ill)
Yoga
Pilates
Massage Therapy
Variety of Fitness Classes
Brown Bag Lectures

We offer our services to private individuals as well as companies and residential communities of any size. All services are conveniently offered at the clients home or work-site.

If you know of any friend, neighbor, relative or colleague that could be interested and benefit from our services please pass this information on and claim your reward.

REWARD: $50.00 to the referral source and the new client. Simply have the new client provide your name when signing a contract with BACK IN FORM and we will send you a check for $50.00 in the mail.

Thank you so much for your time and help!

 

Hartmut Broring -- M.S. Exercise Therapy
Founder & President
BACK IN FORM, Inc.
(408) 455-2887

Fitness Tips for Golfers

This article will try to explain the importance of fitness training for Golfers, discuss the elements of a Golf specific training program and offer a few exercises that can make a difference in your game.
Golf is a sport that requires a great deal of athletic abilities such as strength and power, flexibility, coordination, balance and endurance. The golf game itself does not provide enough of a training stimulus to anyone of these areas to significantly improve those abilities. To minimize age related fitness losses, to maintain or improve physical fitness a golf player has to participate in a physical fitness program off the course!
Why does a golf player need strength, flexibility etc.? The golf swing is a very complex movement requiring the use of a great number of muscles that takes coordination from both sides of the body to ensure a smooth motion and to secure the body’s position throughout the whole swing. Only an optimal conditioned body allows the golfer to use those muscle groups involved to create a fluid, consistent and powerful swing. A well conditioned body will further more reduce the risk for musculoskeletal injuries. Strength and power combined with good flexibility and greater range of motion translates to greater club-head speed, greater distance and more accuracy. Endurance means less fatigue which helps the player to stay focused throughout his whole game and make difficult puts even on the back nine!
When designing a training plan for golfers I usually divide the process into three phases.

• Off-Season: General conditioning including resistance training, stretching and aerobic cardio-vascular training.
• Pre-Season: Sport specific training, transferring the generally improved physical condition to build golf specific fitness
• In-Season: Maintenance, working on different skills at lower intensity to preserve energy and keep fitness peak level.

Golf is a sport utilizing upper extremity, torso and lower extremity strength and flexibility and that should reflect in your choice of exercises. Whatever you do, do not simulate your golf swing while strength training. Using free weights while going through the swing motion will only ruining your mechanics!
Recommended Strength/Resistance Training:
3 days per week 2 sets of 12-15 repetitions, moderate workloads
I suggest you start with multi joint exercises progressing to single joint exercises such as:

• Leg Extremity Exercises: Squat, Lunge, Leg Press, Leg Curl, Leg Extension, Heel Raises
• Upper Body Exercises: Chest Press, Push Up, Bent Over Row, Upright Row, Military Press, Lateral Deltoid Raises, External/Internal Shoulder Rotation
• Torso Strength Exercises: Abs Crunch, Oblique Crunch, Back Extension

Recommended Flexibility Training:
3 days per week

• Upper Extremities: Deltoid Stretch, Triceps Stretch, Rhomboids Stretch, Wrist Flexor/Wrist Extensor Stretches
• Lower Extremities: Hamstring Stretch, Quadriceps Stretch, Piriformis / Hip Oblique Stretch,
• Torso Stretches: Trunk Rotation Stretch, Quadratus Lumborum Stretch, Lateral Trunk Stretch

Recommended Aerobic Training:
3-4 days per week

• Intensity: 65-75% of Maximum Heart Rate
• Duration: 20-30 Minutes
• Treadmill walking/jogging, stationary cycling, stair climbing etc.

Please be advised to check with your physician before starting any exercise program. Use good common sense and caution while exercising. I hope this handful of exercises will help you to improve your game, reduce your risk for injury and ensure a lifetime of fun on the course!
A Santé,

Hartmut Broring – M.S. Exercise Therapy

Happy New Year: "How to choose a Fitness Trainer"

Happy New Year

As at the beginning of every New Year I am certain many of you have made New Years Resolutions for 2011. Whether it’s to loose weight, exercise more regular, make better food choices, or improve your overall level of health and fitness, a Personal Trainer can make the difference and turn resolutions into results.
A trainer can be your regular guide on the way to accomplish the desired goals or you can hire the Trainer on a consulting basis, designing a personalized program and update it periodically.
No matter who you choose, the trainer should have a motivating personality and a sound educational background in exercise science. Before hiring your trainer I suggest you interview several different ones to separate the good from the bad.
IDEA offers a Personal Trainer search engine that can help you find trainers in your area and give valuable information regarding their experience education and specialties. Visit www.ideafit.com for more information. You can find trainers also by looking in your local newspapers, yellow pages or check for referrals with your physician and therapist.
The following questions can be helpful when choosing a quality trainer (adapted from IDEA work-sheet “How to Choose a Quality Personal Trainer”):

1. Does the Personal Trainer have a sound background in exercise physiology, anatomy, and injury prevention as evidenced by a degree or a certification through a nationally recognized organization (ACE, ACSM, NASM etc.)?
   A certification is proving at least basic knowledge in the field of fitness training!
   
2. Is the trainer experienced in fitness training or a novice? Does he/she keep up with the latest in exercise science and research through memberships and associations?
   Membership in organizations such as IDEA, ACSM or ACE show that the trainer is making an effort to stay current!
   
3. Is the trainer certified in CPR and first aid?
   A current certification gives you assurance that the trainer knows how to respond in an emergency!
   
4. Is the trainer screening your health risk situation and ask for your physicians consent?
   Only if your trainer asks about past and current health risks can he/she design an appropriate exercise regimen!
   
5. Does the trainer keep records of your meetings and progress?
   A professional trainer will help you establish realistic short and long term goals and assess your progress to help motivate you!
   
6. Does the trainer have liability insurance?
   A professional trainer will be able to provide you with a copy of his/her insurance policy that will cover your expenses should you get injured through the trainer’s negligence!
   
7. Is the trainer interested in helping you to maintain an overall healthy lifestyle?
   Exercising is only a part of a healthy lifestyle. Positive food choices, plenty of rest and sleep as well as stress management are other important pieces to the puzzle!
   
8. Does the trainer demonstrate good listening and communication skills?
   Only if the trainer listens can he/she retrieve information necessary for a successful program design. Communicating effectively the hows and whys of the program will increase your motivation and ensure better results!
   
9. Do you and your trainer click?
   In order to have a successful professional relationship it is important that you and your trainer get along!
   

I hope this year your resolutions make it past February and turn into the desired results so that 2011 is going to be the Healthy and Happy New Year you deserve!

In good health,
Hartmut Broring – M.S. Exercise Therapy