FRACTIONIZED EXERCISE AND HYPERTENSION
Over 60 million Americans have hypertension and another 65 million have prehypertension. Prehypertension is a series of risk factors that place the patient on the path to the development of hypertension. Hypertension is a primary risk factor in stroke and heart disease. Left untreated, it can cause significant disability and early mortality. The good news is that hypertension and prehypertension respond very well to exercise. The bad news is most patients are either are unable or unwilling to exercise for any significant duration of time.
The commonly prescribed dose of exercise to treat hypertension (high blood pressure) is thirty minutes of uninterrupted activity at 65% to 75% of your age adjusted maximal heart rate. To produce results, the exercise must be performed every day. Many hypertensive patients also have physical limitations that limit their activity level. They are overweight, weak, and often have orthopedic problems that make thirty minutes of continuous exercise impossible. Many patients despise exercise activity and would rather die than spend thirty consecutive minutes walking or riding a bike. Researchers at Arizona State University recently tested different exercise prescriptions to see if shorter exercise session performed more frequently would produce positive responses in patients with hypertension.
Study participants wore blood pressure monitoring cuffs that took measurements twenty four hours a day. They walked three times a day for ten minutes on one training day. On the next day, they performed one thirty minute walking session. On the third day, they performed no exercise at all. While both doses of exercise helped control blood pressure, the brief ten minute sessions performed three times a day was significantly more effective than a single half hour session.
The “fractionized” exercise produced lower average blood pressure readings and fewer incidences of blood pressure spikes above 140/90. It turns out that short, cumulative exercise sessions are remarkably beneficial for vascular health. Compliance is king when it comes to exercise success. Compliance with three short bouts of exercise a day is more achievable than one thirty minute session. A ten minute walk at lunchtime. Ten minutes on the stationary bike after work and a ten minute evening walk can fit into most peoples lives.
One of my personal training clients has hypertension and he has been much more successful at controlling his blood pressure with abbreviated training sessions. He was running three times a week and doing yoga on the off days and his blood pressure did not improve. We changed his program so that he strength trains at the gym two days a week and on his off days, he rides a recumbent bike two times a day for only twelve minutes. The more frequent training has been more effective at lowering his blood pressure numbers, and he has been able to discontinue medications.
Michael S. O’Hara, P.T., OCS, CSCS
FOR MY LEGS, I JUST RUN
This is the response I get from many physical therapy patients referred for problems with hip, knee, and lower leg pain. The only exercise they undertake for the lower extremities is distance running. They perform resistance activities for their upper body, but do not spend any time on strength training or mobility work for the legs. Attempting to keep your legs healthy and strong for a lifetime by solely distance running is a flawed plan.
Your muscles consist of different types of fibers. Distance running stimulates the slow twitch type fibers, and if performed for a significant period of time, it will convert the fast twitch fibers to slow twitch. Fast twitch fibers produce quicker, more explosive movements. They are the muscles you use to sprint, jump, or catch yourself when you trip or fall. Aging alone reduces the number of fast twitch muscles and distance running artificially enhances this fast to slow twitch muscle fiber conversion. The good news is that some dedicated strength training can reverse this process.
Running is a single direction activity. The best parts of life and athletics happen in multiple directions. Our muscles are laid out in a spiral and diagonal pattern. We are designed to move in a combination of three directions. Distance running is predominantly a sagittal (forward-backward) movement pattern. Comprehensive lower extremity training must include mastery of the frontal (side to side) and transverse (rotational) planes of motion. Most of the running patients I treat have limitations in their ability to move in one or both of these other directions. The deficits they exhibit are usually the drivers of their pain problems.
Imagine you only have one set of tires for the lifetime of your car. Do you take car out and race around the hairpin turns of a country road or are you more conservative in your driving? You would probably make sure the wheel alignment was proper and that the tires were balanced. Your legs are similar to those tires. The replacements for a worn out knee or hip is not nearly as good as the original equipment. The process of getting the replacement is not as simple as a tire change. Distance running is a high level fitness activity that demands that you have all parameters of fitness plugged in to stay injury free. If your goal is a life time of fitness, you may want to consider other activities.
Distance running has never been a good fat loss activity. You see more thin people running because they are more successful at running. It is the same as seeing heavy men participating in sumo wrestling—heavy men are more successful at sumo. Overweight people are generally not very successful at distance running. The benefit to injury ratio is just not in their favor. The best fat loss results occur with dedication to dietary change and a program of strength training.
Michael S. O’Hara, P.T., OCS, CSCS
FITNESS GOAL: FAT LOSS–HOW TO GET IT DONE
1) Get very well acquainted with what you are eating. Read the books written by Dr. Berardi and David Zinczenko. The information on precisionnutrition.com is easy to follow and free of the usual internet diet hype.
2) Become more aware of how much you are eating. Buy a kitchen scale and weigh every morsel of food you ingest over the next month. Keep a daily food log and learn the meaning of a “food portion”. If you will not do #1 and #2 on this list, then recommendations #3 through #10 are not likely to help you reach any fat loss goals.
3) Limit sitting. At work, get up and walk around every ten minutes. When you go to the gym, do not sit or lay down for any reason. Sitting reduces your ability to move, and if you do not move well ,you will never get fit. Sitting is analogous to cigarette smoking for your fitness.
4) Get better at the basics.—squat, hip hinge, vertical pull, vertical press, carries, horizontal pull and push. No single arm dumbbell laterals while you stand on a balance board with one eye closed. Basic movement patterns can be scaled down or ramped up to suit any fitness level.
5) Fractionize your exercise sessions. Two short bouts of exercise (15-20 minutes) performed every day will produce a greater change in your body composition than the 50 minute session you perform at the gym twice a week.
6) You must limit contact with people who knowingly or unknowingly sabotage your plans. For a period of time, you may need to get new friends, avoid some family members, and reduce contact with toxic coworkers. Long lasting body composition changes are derived from forming new healthy habits and altering habits takes time. Once your new fitness and eating habits are ingrained, you are far less susceptible to outside influences.
7) Set realistic goals that you commit to paper. The goals must be written and have a three month, six month, and one year time line. Many people ignore this recommendation—I think is scares them. Time sensitive, written goals are powerful.
8) Drop the “abdominal exercise” and “muscle isolation exercises” and spend that time on multi joint, full body exercises that help you move better and make you stronger.
9) Drop the “long slow cardio” and spend that time on interval training. Push hard for fifteen to thirty seconds and then recover. Perform six to eight of these intervals and get comfortable with being uncomfortable.
10) Get some help. The fitness knowledge base has expanded dramatically over the last ten years. What you learned about exercise fifteen years ago is probably outdated, less than optimal, and possibly detrimental. A trainer can also help temper any beginner enthusiasm that tends to send people to the doctor’s office.
Michael S. O’Hara, P.T., OCS, CSCS
Keeping You Playing and Not Aching
Strength and conditioning coaches are very concerned about the number of competition days their athletes lose to injury. Player competition days lost to injury are tracked by college and professional sports teams and the strength coaches performance is graded based on those days lost. For a professional athlete, staying healthy for an extra year of competition can mean another million dollar paycheck. The amateur athlete that avoids injury is far more likely to land the scholarship or make the leap to the professional level. Making athletes more durable—less likely to get injured, means job security for the strength coach. So what have strength coaches discovered that leads to greater durability?
Over the years, I have asked this question of well over twenty strength coaches working with professional and collegiate athletes. Their answers have consistently been the same regardless of whether we were discussing swimmers or football players. Keeping injury rates low and athletes healthy revolves around coaching for these attributes.
Every coach stated that getting athletes stronger is their biggest concern. The stronger athlete is less likely to get injured. If they do get an injury, the problem is usually less severe and they are quicker to return to the playing field than a weaker athlete. Every coach echoed the refrain that strength training was essential for the female population to stay injury free.
The ability to easily travel in and out of basic patterns of human motion is proper movement. Proper movement is all about neuromuscular control—communication between the brain and the body. Can the athlete squat, lunge, hip hinge, push, pull, and rotate in a fluid and pain free manner? Are these patterns of motion automatic and are they maintained during a state of fatigue? Proper movement and flexibility are not the same. Lots of flexible athletes have horrible movement.
Stable in the Right Places
Some areas of the body are meant to move and some are supposed to stay stationary. Athletes are masters of adaptation. If they cannot get motion from one joint, they will find a way to use another part of their body to get to the job done. Most of the athletic overuse injuries happen when a segment of the body that is supposed to stay stable is forced into a motion it was not designed to perform. The basketball player’s knee that crashes into valgus when she jumps, the runner whose lower back sidebends with every stride, the volleyball player with a floppy forefoot all are examples of stability issues. Stability can be trained just like any other athletic skill.
Bodies change. Poor nutrition, lack of sleep, postural stress, soft tissue trauma and poor training habits can all produce performance limitations. You cannot evaluate the athlete or fitness client once and be done. Consistent ongoing evaluation of basic strength, movement patterns, and joint stability is crucial. The Functional Movement Screen (FMS) is the best place to start for most general fitness folks. See the trainers for an assessment and get your score. The results can get you started on what you really need to do.
Michael S. O’Hara, P.T., OCS, CSCS
FIGHTING THE EPIDEMIC OF TYPE II DIABETES
25.8 million Americans have diabetes. More than 90% of those diagnosed with diabetes have the Type 2 variety. According to the Center for Disease Control and Prevention (CDC), 35% of the adult population are prediabetic, the precursor to Type 2 diabetes, and are at high risk of developing the disease. That means 79 million Americans are on their way to Type 2 diabetes. In 2011, 1.9 million adults received a new diagnosis of Type 2 diabetes.
In the most recent comprehensive survey of death certificates, Type 2 diabetes was listed as the underlying cause or contributing factor in 231,404 deaths. It is the leading cause of blindness among adults age 20-74 years of age. Your risk of heart disease and stroke is two to four times greater if you have diabetes. Hypertension or high blood pressure is present in 65% of the diabetic population. The CDC statistics in 2008 listed diabetes as the cause of kidney failure in 44% of the cases.
70% of the diabetic population will develop some degree of nerve damage. The damage to the nerves is called neuropathy. Diabetic neuropathy leads to weakness, sensory loss, and balance deficits. I have been treating patients in physical therapy since 1984, and diabetic neuropathy problems are far more frequent and severe.
If the current trends continue, more than 50% of Americans will have Type 2 diabetes by 2020. According to the United Health Center for Health Reform and Modernization, we are on track to spend 10% of our total health care dollars on diabetes care by the end of this decade.
The good news is that Type 2 diabetes is largely preventable through lifestyle and behavior changes. Weight loss, exercise, and consistent medical care can alter the impact of diabetes on your health. Reducing bodyweight by 7% is enough to improve blood sugar levels and reduce the health implications from Type 2 diabetes. Walking, biking, or lifting some weights every day is the prescribed minimally effective dose to improve insulin sensitivity. I know many gym members that have been able to control or abolish their Type 2 diabetes with a commitment to exercise, better eating habits, and the maintenance of a reasonable bodyweight.
Michael S. O’Hara, P.T., OCS, CSCS
GETTING THE ARROW OUT OF YOUR HEEL
Physical Therapy Treatment of Achilles Tendonitis
Tom started having pain in the back of his left heel after working out at the gym. He had no pain while exercising, running, or water skiing, but symptoms would occur later in the day. By the end of the summer, he was unable to walk a round of golf secondary to heel and lower leg pain. Tom was treated by his family physician with medications and rest, but the pain did not go away. He received two injections in the Achilles tendon that temporarily relieved his pain, but symptoms returned in two or three weeks. Tom was referred by his podiatrist to Fenton Physical Therapy for treatment of his Achilles tendonitis.
The left Achilles tendon was sensitive to pressure, and Tom had a build up of scar tissue in the middle of the tendon. His left ankle dorsiflexion range of motion (ROM) was half that of his right ankle. He had pain in his heel and the back of his left lower leg with attempting to rise up on his toes and with squatting. His physical therapy treatment consisted of ASTYM and a program of home stretching drills he performed three times a day. After six sessions, the pain was gone and left ankle active ROM was full range. Four months after discharge, Tom reports that he has been pain free and continues with his daily stretching exercises.
Inflammation and scarring in the Achilles tendon can be a debilitating and difficult problem to deal with. Over the last few years, aggressive conditioning programs involving repeated box jumps and obstacle course type races have brought more Achilles tendonitis cases to our physical therapy clinics. Achilles tendon problems often flare up and then go away with rest and icing. The repeated cycle of trauma and recovery results in a non-flexible scarring of the Achilles tendon. This is believed to be the precursor to a more traumatic Achilles tendon rupture. At our physical therapy clinics, we have found great success with the Augmented Soft Tissue Mobilization (ASTYM) method. ASTYM treatment consists of twice weekly treatment with specialized tools to aggressively mobilize the scar tissue that develops on the Achilles tendon and “kick start” the healing process. This approach encourages the patient to be active and engage in a functional stretching program instead of immobilizing and resting the lower leg. The ASTYM tools allow greater intensity and accuracy with manual therapy treatment of the lower extremity. The patient generally participates in eight sessions of therapy and is instructed on a home regimen of mobility exercises.
Fenton, Linden, and Milford Physical Therapy all utilize the ASTYM treatment technique. Fenton Physical Therapy was the first clinic in Michigan to offer the ASTYM method. We continue to bring our patients the most innovative and up to date Physical Therapy care.
Michael S. O’Hara, P.T., OCS, CSCS
DEATH OF A GOOD GOVERNMENT IDEA
Tobacco and Our Judicial System
I am rarely enthusiastic about anything that happens with our Congress, but in 2009, they passed a law that would require the addition of large graphics and text warnings about the harms caused by smoking. Somewhat disturbing pictures and more direct verbiage was supposed to cover the top half of every package of cigarettes beginning in September 2012.
However, in an act of judicial activism, this rare good government idea has been stopped. Federal District Court Judge Richard Leon has recently blocked the implementation of the new labeling plan. He feels the labels are “calculated to provoke the view to quit”—ah duh! He feels that this crosses the line. He feels the new labeling requirement violates the tobacco companies’ free speech rights. The judge has no concern for consumer protection, the cost of health care, or the fact that this product continues to enslave millions of Americans every day.
Tobacco companies have a problem. Their product kills a significant number of their customers every year. They need new addicts to replace the dead ones, so cigarettes are pedaled to the most easily influenced and impressionable of our country’s citizens. Almost everyone gets hooked on cigarettes when they are young and naïve. I have never heard of anyone starting the smoking habit once they get past 25 years of age.
Gran for gram, nicotine is the most addictive chemical on the planet. It provides more withdrawal discomfort for your money than opiates and amphetamines. The severity of the withdrawal symptoms keep people hooked on this poisonous product through a lifetime.
“Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.”—Mark Twain
No other consumer product adds more to the cost of health care than tobacco. Cancer, emphysema, and heart disease are all extremely expensive health care problems in this country. I can think of no greater cost saving tactic than reducing the use of tobacco products. If stronger warnings can produce a once percent reduction in the number of American smokers, they are well worth the alleged infringement on the poor tobacco companies’ freedom of speech.
Our government needs to make tobacco products more expensive and the gruesome consequences of smoking more evident. The federal tax on a pack of cigarettes is only $1.01 and the State of Michigan excise tax is $2.00. Increase both of these taxes by 100% and use that money for smoking cessation programs and the enormous burden smoking places on the US healthcare system. The courts need to overturn this judicial silliness and get those pictures and warnings on every package of cigarettes.
Michael S. O’Hara, P.T., OCS, CSCS
YOU, A BOSU, and WHEW!
A New Twist On An Old and Much Hated Exercise
I had a basketball coach who was a Burpee fanatic. You lost–Burpees, turn the ball over—Burpees, late for practice—Burpee Eternity. I hated doing Burpees, but I was never, ever tired in a practice or a game. I believe Burpee conditioning drills gave me the physical stamina and mental toughness to stay strong an entire game.
Fitness engineering has developed a new training tool and now we have the Bosu Burpee. A Bosu is an inflated half dome with a hard, flat bottom. It has handles on either side that you use when performing the Bosu Burpee.
The Bosu Burpee gets you moving from the ground up, at a quick pace with a strong core stabilization demand. Too many gym activities are seated, slow, and neurologically numbing. Neurologically and metabolically, we need to practice moving the entire body at faster speeds to stay fit. The Bosu Burpee is a total body conditioner that brings us up to speed.
Start with your hands on an inverted Bosu—bottom side up, in a push up position. Perform a push up with your chest touching the Bosu. Jump both feet up under the hips. Try to get your feet planted flat on the floor. Rise up from the floor and lift the Bosu overhead. Return the Bosu to the floor and repeat the movement from push up to overhead lift. Learn to do this movement slowly, and then once you have the motion “neurologically grooved”, pick up the pace. Bosu Burpees are a conditioning drill that should be performed at a fast pace. They work best if performed for set periods of time. Try starting with twenty second intervals and build up to 60 seconds.
Bosu Burpee Modifications
If you cannot do a push up or your arms give out way before the rest of the body, try performing the push up from the knees or keep the elbows fully extended and eliminate the push up portion of the exercise. As you practice this exercise, your arm strength will improve. If your middle sags and/or the Bosu wobbles, you need to dedicate more time to core stability training. Add some physioball roll outs, TRX fall outs, and front hovers to your exercise program.
Scoring the Bosu Burpee
Set a timer for sixty seconds and count how many Bosu Burpees you can perform. Remember you must start from the bottom and only full repetitions are counted. The best I have ever done is 18 repetitions. My middle gives out before my arms or legs—I need more core training. I believe this scoring system is a fair representation of Bosu Burpee performance.
Levels Men Women
Beginner 10 4
Intermediate 16 9
Advanced 22 14
Michael O’Hara, P.T., OCS, CSCS
CORE-TEX TRAINING PLATFORM
The New Tool In Our Training And Rehabilitation Toolbox
The latest addition to our rehabilitation and training toolbox is the Core-Tex. This thirty inch round platform floats on three roller bearings that permit it to tilt, translate, and rotate. The tri planar motion of the Core-Tex creates an ideal environment for us to work on retraining our patients’ balance, coordination, and proprioception. It can also be used to create challenging core and shoulder girdle stability activities.
One Stop Shopping For Better Proprioception, Balance, and Coordination
You can improve all three of these critical components of function with one or two Core-Tex activities. Beginners can use the handrail to create a more supportive environment, and as they improve, progress to reducing the assist from the arms. Integrating head movement, arm reaches, and weight shifts into the drills enables the clinician to design activities specific to the patient’s needs.
Keeping The Loads Level
The Core-Tex reveals any deficits in weight distribution. If the patient is unconsciously avoiding loading one side the body, the movement of the Core-Tex platform quickly reveals the flaw. The therapist can then prescribe training to increase tolerance of loading on the affected side and return for re-evaluation on the Core-Tex.
Tuning Up Your Righting Reflexes
Many of the sensors that keep our body in an upright position are located above the neck. I don’t care how strong or flexible you are, if these neural feedback systems do not work properly, you will not move well. Evaluating and improving the function of righting reflexes centers in the inner ear and the neck is a frequently neglected area of rehabilitation and fitness. Incorporating activities that involve moving the head and neck while standing on the unstable Core-Tex platform has proven to be very beneficial in patients with slow reflex response times.
Rotation In The Right Places
Being able to rotate through the thoracic spine and hips is an important aspect of optimal function and pain free existence. Many physical therapy patients have neck and shoulder pain driven by a lack of thoracic spine range of motion in rotation. Deficits in hip rotation produce undue wear and tear and eventually pain in the knees and lower back. The Core-Tex turns 360 degrees and allows us to teach transverse plane motions at the hips and thoracic spine in a fully functional upright, weight bearing position.
Michael S. O’Hara, P.T., OCS, CSCS
BODY COMPOSITION 101
“I am just not seeing any results.” “I haven’t lost any weight.” I hear this from gym members nearly every day. They get frustrated at the lack of a change in their appearance despite dedicated attendance in the gym. After hearing this from so many members for so long, I have some suggestions to share that I hope will be of value.
Get your nutrition right.
Go to Dr. John Berardis’ web site and listen to his advice. Buy a Kitchen Scale and learn portion size. Positive body composition changes will only occur when sound nutrition is in place. Combine a solid program of diet along with consistent training and let the magic happen.
Change your routine.
Proper exercise prescription should create a stimulus that causes your body to change. Unfortunately, your body adapts to an exercise stimulus fairly quickly–four to six weeks. If you are taking the same step class from 1990, it is a good bet your body has adapted to that activity. Try different classes and new exercise activity. Our understanding of fitness has changed dramatically over the last fifteen years, and a fitness coach can help you implement the best practices.
Women must focus on lower extremity exercises.
More than two thirds of a women’s muscle mass is below the waist. To change body composition, you must put more effort into training the metabolically active (calorie burning) muscles in the legs. Arm curls and triceps pressdowns will never change your metabolism or your appearance. Most of your efforts should be spent on leg training.
It is called progressive resistance exercise for a reason. If you have been lifting the same size dumbbell for the last two years, you are not progressing. Lifting heavier loads creates greater muscle mass and therefore a faster metabolism. A faster metabolism burns more calories all day long and decreases body fat. Becoming stronger reduces your risk of injury. Ladies, unless you have a hormonal issue, you will not turn into the Hulk.
Keep a record of your training.
It is difficult to analyze where you are going if you do not know where you have been. Reviewing a training log is often very revealing in regards to the consistency, quality, and quantity of the work you are actually performing.
Bring on the intensity.
Training that changes your body composition is never going to be easy. You must “get comfortable with being uncomfortable” when you exercise. If it is easy to do—it will not work!
Throw out your scale.
Any well designed exercise program is going to create more muscle and diminish stored body fat. Muscle is denser than fat and takes up less space. It is not uncommon to get heavier as you get fitter. If you need indicators of body changes, try a digital camera and a tape measure. Pictures and girth measurements are easy to perform, and unlike fat calipers, they are repeatable and very consistent.
Michael S. O’Hara, P.T., OCS, CSCS