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Sarcopenia And The Media

Older individuals have the most to gain from strength training. Six weeks of dedicated strength training will normalize balance, rejuvenate posture, revive the metabolism, and eliminate long-standing pain.  I often tell physical therapy patients that strength training is the “fountain of youth”.  Unfortunately, it is difficult to convince older individuals that they need to become dedicated to a routine of consistent resistance training.  I recently got some help from Jane Brody in the New York Times, *Preventing Muscle Loss Among the Elderly.

Drs. Evans and Rosenburg are Tufts University researchers interested in the physical attributes that keep humans healthy and vigorous over an entire life span.  They have determined that the top four biomarkers are:

  1. Muscle Mass.  What percentage of your body is made of muscle?
  2. Strength.  Can you use that muscle to push, pull, lift and carry?
  3. Basal Metabolic Rate.  The number of calories your body expends at rest.
  4. Bodyfat Percentage.  What percentage of your body is composed of fat?

They named these top four biomarkers, the decisive tetrad.  They are the prerequisites to maintaining healthy numbers in all of the other essential biomarkers.

  1. Aerobic Capacity
  2. Blood Sugar Tolerance
  3. Cholesterol / HDL ratio
  4. Blood Pressure
  5. Bone Density
  6. Internal Body Temperature Regulation

Drs. Evans and Rosenburg coined the term age related sarcopenia in their 1991 book Biomarkers.  It refers to the gradual loss of muscle mass that occurs as we age.  The keys to aging well; staying durable- no injuries, and maintaining control of all health parameters is maintaining or improving muscle mass / strength and eating properly.  An ongoing program of strength training and nutritional discipline are the foremost components of fitness and health.

I was happy to see that Jane recommended her elderly compatriots consume more protein.  Not enormous amounts of protein- just some protein.  Many fitness clients fail to make optimal gains because they have the protein intake of a bunny rabbit.  Adequate training recovery requires the building blocks of muscle in order to produce results.  A bagel for breakfast, a kale sandwich at lunch, a yogurt snack and a diner of soup, bread and ice cream does not supply the nutrients necessary for recovery.

So, take the time to read the amazing Jane Brody and then get those dumbbells out of the basement.

*Brody, Jane. Preventing Muscle Loss Among the Elderly, September 1, 2018, New York Times.   View article

Michael O’Hara, PT, OCS, CSCS

That pain in your arm or hand could be coming from somewhere else.  Read Mike O’Hara’s article, Changing Locations to find out more.  Jeff Tirrell gives nutrition tips and Mike discusses the benefits of using an agility ladder.

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8 Reasons Why You’re Sore–#8–Deloading

One of the most common complaints I get from new trainees (most often these come from middle aged men who are just now getting back into strength training) is that of being sore all of the time.  Many people associate muscular soreness with getting a good workout or getting results.  However, the research does not necessarily support this thought process.  Muscles tend to get sore anytime a new stimulus is introduced (new exercise, activity, etc), but this should typically subside within 2-3 weeks of starting the activity.  Anytime a new exercise is introduced, it is expected that some level of soreness will occur.  However, a good program will actually have an introduction phase where weight and volume are intentionally reduced in order to avoid excessive soreness, as this can negatively impact future workouts.  If you are chronically sore beyond the initial 2-3 weeks of starting a strength training program, there are eight areas that you may need to pay attention to.

Jeff Tirrell, CSCS, CSFC, Pn1

#8–Deloading

Deloading is a term used to describe an intentional period of time (usually 1-2 weeks) where intensity and/or volume are reduced in training.  In some cases, no training at all is performed (though this is probably not optimal, unless you are injured).  In my experience, this is usually not an issue with the majority of clients.  Most people end up missing time at the gym due to illness, work, kid’s activities, vacation, etc.  If you happen to be somebody that is highly dedicated to your training and don’t ever miss any period longer than a week in the gym, then a scheduled deloading period may be needed.  I usually recommend reducing training volume by 40-60%, and intensity by 10-20%.  In practice for a one week deload, this would look something like this:

Normal Week                                                                                     Deload Week

45 total weekly training sets of all exercises                                      24 total weekly training sets

e.g. squats: 200lbs lifted                                                                     squats: 160-180lbs lifted

If you don’t ever miss time in the gym in a 12 month period, I would recommend the following deload schedule for people who train 3, 4, or 5 times per week.  As mentioned earlier, training more than 5 times per week is likely not feasible for most adults, and less than 3 doesn’t warrant a deload period.

3 days per week: deload for 1 week, 1 time each year

4 days per week: deload for 1 week, 2 times each year

5 days per week: deloa for 1 week, 3 times each year

 

8 Reasons Why You’re Sore–#7–Program Hopping

One of the most common complaints I get from new trainees (most often these come from middle aged men who are just now getting back into strength training) is that of being sore all of the time.  Many people associate muscular soreness with getting a good workout or getting results.  However, the research does not necessarily support this thought process.  Muscles tend to get sore anytime a new stimulus is introduced (new exercise, activity, etc), but this should typically subside within 2-3 weeks of starting the activity.  Anytime a new exercise is introduced, it is expected that some level of soreness will occur.  However, a good program will actually have an introduction phase where weight and volume are intentionally reduced in order to avoid excessive soreness, as this can negatively impact future workouts.  If you are chronically sore beyond the initial 2-3 weeks of starting a strength training program, there are eight areas that you may need to pay attention to.

Jeff Tirrell, CSCS, CSFC, Pn1

#7-Program Hopping

As stated initially, any new exercise or activity added to a program will produce a novel stimulus that will almost always lead to some level of soreness.  Many individuals change their workout every day and never give themselves a chance to adapt.  Many people enjoy the feeling of being sore as they associate that with progress.  However, when you look at research, most of the gains in lean body mass actually occur 2-4 weeks into training after the majority of initial soreness has subsided.  It should be remembered that strength training is a skill.  It must be practiced.  It is recommended that the majority of your exercise selection remain basically the same for at least 3 weeks.  Workouts can be varied by the number of sets, reps, weight lifted, or time to completion.  After 3-12 weeks with a given exercise, you can switch it out if you are bored or no longer able to progress the aforementioned variables.

8 Reasons Why You’re Sore–#6–Training Frequency

One of the most common complaints I get from new trainees (most often these come from middle aged men who are just now getting back into strength training) is that of being sore all of the time.  Many people associate muscular soreness with getting a good workout or getting results.  However, the research does not necessarily support this thought process.  Muscles tend to get sore anytime a new stimulus is introduced (new exercise, activity, etc), but this should typically subside within 2-3 weeks of starting the activity.  Anytime a new exercise is introduced, it is expected that some level of soreness will occur.  However, a good program will actually have an introduction phase where weight and volume are intentionally reduced in order to avoid excessive soreness, as this can negatively impact future workouts.  If you are chronically sore beyond the initial 2-3 weeks of starting a strength training program, there are eight areas that you may need to pay attention to.

Jeff Tirrell, CSCS, CSFC, Pn1

#6-Training Frequency

The cold hard truth is that when we are younger, we recover quicker.  I remember when I first started training in 1998 (8th grade), I would train 6 days per week for 90-120 minutes.  I got bigger, stronger, and rarely felt overtrained.  There was a time in the summer my junior and senior year where I would train 6 days per week, and on 3 of those days. I would actually lift 2 separate times accounting for roughly 12 hours of training each week.  Even at this time, I still made great progress.  It wasn’t until my sophomore year of college that my 6 day per week plan was just more than my body could keep up with.  I scaled things back to 5x/week and did just fine again.  Once I started having kids and sleep got limited, the stress of providing for a family became real and I had to scale back to 4 days per week.  I find that most adult clients over the age of 40 can only tolerate 3-4 days per week.  There’s nothing that says you can’t train back to back days.  However, if you are always sore, and don’t feel that you’ve recovered, you may need to give yourself some extra days for recovery.

 

8 Reasons Why You’re Sore–#5 Training Volume

One of the most common complaints I get from new trainees (most often these come from middle aged men who are just now getting back into strength training) is that of being sore all of the time.  Many people associate muscular soreness with getting a good workout or getting results.  However, the research does not necessarily support this thought process.  Muscles tend to get sore anytime a new stimulus is introduced (new exercise, activity, etc), but this should typically subside within 2-3 weeks of starting the activity.  Anytime a new exercise is introduced, it is expected that some level of soreness will occur.  However, a good program will actually have an introduction phase where weight and volume are intentionally reduced in order to avoid excessive soreness, as this can negatively impact future workouts.  If you are chronically sore beyond the initial 2-3 weeks of starting a strength training program, there are eight areas that you may need to pay attention to.

Jeff Tirrell, CSCS, CSFC, Pn1

#5-Training Volume

When referring to training volume, we are typically talking about one of two things.  Total number of sets performed in a given session, week, or month is one way to look to volume.  Another way to look at volume is as volume load.  Volume load is calculated as weight lifted x sets x reps.  So, if you lifted 100 pounds for 3 sets of 10 reps, your volume would be 3 sets, but your volume load would be 3000lbs (100 x 3 x 10).  Simply looking at volume (total sets performed) is a better way to compare different individual’s workloads.  Volume load is very relative depending on an individual’s training background, strength, etc.  If training volume gets too high, then you may be outworking what your body is capable of recovering from.  I find that most adult clients over the age of 40 struggle to handle more than 24 total sets in a single session or more than 72 sets in a given week.  There are some who can handle more than this, and some who struggle to recover from volumes half of this.  When increasing volume, it can be helpful to look at volume load for an individual and try not to increase by more than 5-10% in a given week.

Stay independent longer by increasing your stair climbing capacity.  Mike O’Hara shows you how in his article, “Keep Climbing”.  Mike also discusses standing desks and the many benefits of standing while working.  Jeff Tirrell explains the effect of exercise on appetite.

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Bad Man Break

Men Need To Be More Aware Of Bone Density

Allen was getting out of his fishing boat when he twisted his left leg and fractured two bones in his ankle.  Six weeks after ankle surgery, he landed in our clinic with considerable pain and a very limited lifestyle.  Allen reported lower back pain that he attributed to his limping and use of the boot on his left leg.  On recommendation from his physical therapist, Allen had further medical assessment of his lower back pain.  An x- ray of his lumbar spine revealed two lumbar vertebrae fractures.

On a recent vacation, Mike went on a horseback ride with his grandchildren.  During the ride, he developed pain in his upper back that “took his breath away”.  A visit to the emergency room with what he thought was a cardiac issue revealed a three-level compression fracture in his thoracic spine.  Further assessment showed significant osteoporosis in his hips, pelvis, and lumbar regions.  Allen started on some bone rebuilding medications and physical therapy.  It took over four months to fully recover from this injury.

Randy was working on his garden and fell onto the lawn.  He had right hip pain and was unable to stand.  His wife called the ambulance and he was diagnosed with a hip fracture.  Four days after the surgery to repair his hip, he suffered an embolism and at the age of seventy-one, he passed away.

All three of these older guys had testing that revealed a significant loss of bone density.  Unfortunately, the tests occurred after and not before injury onset.  We are getting better at keeping men alive longer–less smoking and better medications.  As men get older, the need to monitor bone density becomes a crucial aspect of healthy aging.  Men need fewer commercials for the latest in testosterone replacement and ED medication and more awareness of how brittle their bones can become.

The general public views osteoporosis as a “women’s health issue”, but management of osteoporosis is just as important for men.  Although men are less likely than women to sustain an osteoporosis related fracture, they are much more likely to become permanently disabled or die from the fracture.  Since 2008, the rate of osteoporosis related hip fracture in the American male population is going up at an alarming rate.

Osteoporosis is a silent disease.  Most people do not realize they have a problem until something breaks and they are in the middle of a medical crisis.  Even after a fracture, many physical therapy patients are reluctant to follow up with a bone density screening.  Being proactive is the only method of managing osteoporosis.

We know that individuals that participate in consistent resistance training exercises are more likely to have better bone density.  Just like muscle, bone is a living thing that grows stronger in response to the force that is placed upon it.  The best bone building exercise activities produce a stimulus through your skeleton.  Bone building exercises are easy to understand, but they do require more effort than swallowing a pill or having an injection.  Everyone can perform some form of bone reinforcing exercise.  Proper exercise prescription and consistent progression can work wonders.  See the trainers and physical therapists at Fenton Fitness.

Jane Brody of the New York Times wrote a helpful *article on bone density testing. It covers the latest medical guidelines for testing and the when and why of testing for both men and women.

Michael S. O’Hara, P.T., OCS, CSCS

*New York Times, July 16, 2018, Jane Brody, When to Get Your Bone Density (View Article:here)

8 Reasons Why You’re Sore–#4 Carbohydrates

One of the most common complaints I get from new trainees (most often these come from middle aged men who are just now getting back into strength training) is that of being sore all of the time.  Many people associate muscular soreness with getting a good workout or getting results.  However, the research does not necessarily support this thought process.  Muscles tend to get sore anytime a new stimulus is introduced (new exercise, activity, etc), but this should typically subside within 2-3 weeks of starting the activity.  Anytime a new exercise is introduced, it is expected that some level of soreness will occur.  However, a good program will actually have an introduction phase where weight and volume are intentionally reduced in order to avoid excessive soreness, as this can negatively impact future workouts.  If you are chronically sore beyond the initial 2-3 weeks of starting a strength training program, there are eight areas that you may need to pay attention to.

Jeff Tirrell, CSCS, CSFC, Pn1

#4–Carbohydrates

Carbohydrates are the primary nutrients that drive insulin secretion.  Insulin is an anabolic hormone that drives protein and fat into cells where these nutrients are used to repair tissue.  Though there are other pathways that do allow protein and fat to make their way into the cell, they are not as quick or efficient.  Carbohydrates are also stored as glycogen in the muscles, which is the body’s preferred fuel source at higher intensity exercise levels.  Carbohydrate levels can vary greatly depending on activity levels, goals, and training frequency.  Most people will operate best on a minimum carbohydrate intake of 100 grams per day.  Ideally, these are coming primarily from fruits, vegetables, potatoes, rice, beans, and whole grains.

Play It All

How To Keep Your Child On The Field And Out Of The PT Clinic

Taylor was recently referred to physical therapy with a painful shoulder and a right hand that frequently went numb. For the last five years, she had been a year round participant in softball. At the age of fifteen, she was missing out on softball and a good night sleep secondary to the pain and limited function in her right arm.

Andy played soccer, and at the age of thirteen, he developed knee pain that prevented him from changing directions and sprinting. Andy practiced or played soccer four days a week for 50 of the 52 weeks in a year. It took four years of year round soccer to create the knee damage that required surgery and an twelve week rehab.

Many of the young athletes we treat in physical therapy are the victims of over exposure to the same training stimulus for far too long a period of time. Gymnastics, dancing, baseball, soccer, and softball are worthwhile endeavors, but a developing body needs a break in order to stay healthy. This becomes even more important as the athlete becomes stronger or more skilled.

Take a moment and read the *article by Jane Brody in the May 7th, 2018 edition of the New York Times. Jane interviews several Orthopedic Surgeons that are treating younger patients with injuries that usually occur ten or fifteen years later in an athlete’s career. The research they present is clear; year round single sports participation is not the best way to excel in athletics or remain healthy.

The recent popularity of the club system has children playing the same sport year round. In the clinic, we are treating more young athletes with old person overuse injuries. Participation in a variety of athletic activities is infinitely more beneficial and safer than single sports specialization. It is no coincidence that most successful collegiate and professional athletes are the product of multi-sport participation.

*New York Times, Jane Brody, May 7, 2018, How to Avoid Burnout in Youth Sports. View article: https://www.nytimes.com/2018/05/07/well/how-to-avoid-burnout-in-youth-sports.html

Michael S. O’Hara, PT, OCS, CSCS

 

 

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