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World’s Best Diet Part 3–Weight Watchers

If you google the word diet, you will come up with over 200,000 results.  Every week, month, year, and decade a new study or article comes out claiming certain foods are killing us, or that some other food or nutritional approach will lead us to the promised land.  Unfortunately, articles are written to create traffic, so scientific research is often misreported or spun to sell magazines or generate website traffic.  The truth is, there are many ways to skin a cat.  All of the evidence on nutrition (in regards to weight loss) points to two undeniable truths.  First, that dietary adherence is king.  It doesn’t matter how perfect or evidence based a nutrition plan is, if you can’t follow it, it doesn’t matter.  Before starting any eating plan, you must ask yourself how easy it will be to maintain long term.  Second, you must achieve an energy deficit to lose weight (eat less energy than you expend each day).  Though “calories in, calories out” may be slightly over simplified, it is still the underlying rule to any weight loss success.   For any weight loss plan to work, you must consistently follow the pla, and you must be in a caloric deficit.  This series will highlight the nine most popular current nutrition approaches, and the pros and cons of each.

Weight Watchers

Claims: Weight Watchers markets itself as being flexible and livable.  They assign food points based on their “Smart Points System”.  They encourage the consumption of fruits, vegetables, and lean proteins, and discourage the consumption of sugar and unhealthy fats with this points system.  They even list 200 different foods as being “zero points foods”.  They encourage tracking of food and claim to be successful at helping people achieve long term sustainable weight loss.

Reality: Tracking your food intake in any way is usually helpful when it comes to weight loss–if done accurately.   The points system is really just a complicated marketing scheme similar to simply tracking calories, which anyone can do on their own for free.  There are no zero foods in existence that have no caloric impact, so the notion of “zero points” foods is ludicrous.  Any food eaten in excess can and will slow weight loss and/or lead to weight gain.  Every person I’ve ever met who was a lifelong Weight Watchers client had success with the program, but was 40+ pounds overweight..

Pros: Allows for dietary flexibility which should improve long term adherence.  Requires tracking of food and portion sizes.  If you opt into monthly meetings, there is an accountability factor built into it.

Cons: No minimum requirement given for protein intake.  Allows certain foods to be eaten with no limit.  Not a good long term success rate (think Oprah’s weight swings).

 

Jeff Tirrell, CSCS, CFSC, Pn1

World’s Best Diet Part 2–The Zone Diet

If you google the word diet, you will come up with over 200,000 results.  Every week, month, year, and decade a new study or article comes out claiming certain foods are killing us, or that some other food or nutritional approach will lead us to the promised land.  Unfortunately, articles are written to create traffic, so scientific research is often misreported or spun to sell magazines or generate website traffic.  The truth is, there are many ways to skin a cat.  All of the evidence on nutrition (in regards to weight loss) points to two undeniable truths.  First, that dietary adherence is king.  It doesn’t matter how perfect or evidence based a nutrition plan is, if you can’t follow it, it doesn’t matter.  Before starting any eating plan, you must ask yourself how easy it will be to maintain long term.  Second, you must achieve an energy deficit to lose weight (eat less energy than you expend each day).  Though “calories in, calories out” may be slightly over simplified, it is still the underlying rule to any weight loss success.   For any weight loss plan to work, you must consistently follow the pla, and you must be in a caloric deficit.  This series will highlight the nine most popular current nutrition approaches, and the pros and cons of each.

The Zone Diet

Claims: The Zone diet was built around the idea of keeping your macronutrients in a specific ratio.  The prescription is 40% carbohydrates, 30% fat, and 30% protein.  There aren’t as many robust claims with the zone diet that you find with many other trendy diets out there.

Reality: The Zone diet is a sensible diet approach.  Most Americans tend to overeat carbohydrates, and sometimes fat, and under eat protein.  This approach increases protein intake and typically reduces carbohydrate and overall calorie intake.  If calories are reduced, then this diet will work.  The simple act of giving people macronutrients  forces them to track their food intake, which in and of itself often reduces intake.  We typically recommend carbohydrate intakes of 35-60%, fat intake of 15-30%, and protein intake of 20-35%.  As you can see the Zone approach fits this nicely.

Pros: Doesn’t take any food off the table entirely.  Allows flexibility with food choices.  Tends to increase protein intake in most people.  Creates awareness of food intake and requires monitoring intake.

Cons: Doesn’t directly require attention to overall caloric intake.  Ignores micronutrient intake (vitamins and minerals) and food quality isn’t necessarily monitored.

Jeff Tirrell, CSCS, CFSC, Pn1

How To Start Working Out

*How to Start Working Out, is a great article by Anahad O’Connor.  Most media articles on developing the fitness habit are fairly flawed, but Mr. O’Connor has done well.  I am encouraged because he discusses two of the more important aspects of fitness success: process goals and strength training.

Process Goals

Developing and maintaining the fitness habit is a motivational mind game.  Having a goal provides the emotional reinforcement necessary to be successful.  Most fitness clients set outcome goals—they want to lose twenty pounds, get stronger, or run a 5 kilometer race in record time.  Outcome goals are achieved through proper nutrition and consistent training.  Outcome goals are achieved through the development of a better life process.  I try to steer clients toward process goals—eat more protein, sleep better, daily mobility sessions, etc…  Process goals are the building blocks of fitness success and focus on your life outside of the gym.  Setting and achieving process goals creates the environment for achieving nearly everyone’s outcome goals.  Stronger, leaner, pain free, and faster will all follow when you have better life processes working in your favor.

Every expert on habit development recommends a paper and pen.  Writing it down is part of the commitment to fitness.  Record your process goals in an exercise log book or a nutrition diary.  Process goals that have worked well for fitness clients are listed below.

-Perform a daily five minute foam roll / mobility session for the next forty days.

-Weigh every serving of food you consume for the next two weeks.

-Take a thirty-minute walk for forty consecutive days.

-Get an extra hour of sleep every night for the next two months.

-Drop all sweetened drinks (juice, soda, sports drinks) for three months.

-Learn how to prepare a new healthy meal every week for six months.

Older, deconditioned, and metabolically challenged fitness clients will develop the fitness habit more readily with a dedication to process goals.  Build on the habits created by achieving ever more challenging process goals and you will reach all of your outcome goals.

Strength Training

When you get stronger, the magic happens.  It is really that simple.  If you want to be leaner—get stronger.  If you want to chase away the pain—get stronger.  If you want to improve your performance—get stronger.  If you want to prevent injuries—get stronger.  If you want to be active and vital into old age—get stronger.  The problem is that many barriers exist to the strength solution.

For best results, we need to start early.  An adequate strength level keeps you functioning well for a lifetime.  If in your early years, you were fairly sedentary, you need to get busy and strength train.  As we age, we lose a portion of our lean tissue, and if you have less muscle and bone “in the bank” you will reach your fifties and sixties in a weak and frail body.  Age related sarcopenia (loss of muscle mass) is one of the primary drivers of metabolic problems such as diabetese, hyperlipidemia, and chronic inflammation.  Today’s children are growing up with fewer episodes of bone and muscle building lifting and carrying activities.  I see teens nearly every day with lower back, knee, and hip pain all related to glaring strength deficits.

A lack of proper coaching and progressive programming are barriers to your strength training success.  Strength training is like medicine; given the proper prescription and dose, the results are consistently good.  Many of the people that have tried strength training and had bad results have taken the wrong medicine at the wrong dose.  They utilize advice from magazines, celebrity trainers, and the internet.  They confuse pharmaceutically assisted bodybuilding programs as appropriate strength training for a forty year old.  The best results are achieved when you work closely with a qualified coach who can monitor your results and teach you how to get stronger.

Michael S. O’Hara, PT, OCS< CSCS

*New York Times, Health Section, Anahad O’Connor, How to Start Working Out. View here.

Training For Less Fat, More Muscle

How To Induce A Growth Hormone Response

Human growth hormone (hGH) has been a newsmaker because of athletes’ illicit use of synthetic versions of this hormone to help them perform better on the baseball diamond, football field, or bicycle race.  Bodybuilders inject synthetic hGH to help sink bodyfat levels to single digits, all the while maintaining optimal muscle mass. The last ten years of exercise science has shown what type of fitness activities induce the greatest natural growth hormone response.  Specific exercise and recovery activities have a positive effect on our body’s daily hGH production.

Human growth hormone (hGH) is secreted in a pulsatile fashion throughout the day.  A number of physiological stimuli can initiate hGH release, the most powerful of which are sleep and exercise.  Human growth hormone has many varied roles throughout your life.  For adult athletes and fitness clients, hGH helps increase fat metabolism–you get leaner, enhance muscle recovery from challenging exercise or injury, you stay stronger, and produce a healthier body composition as you age.

Resistance Training

Resistance training produces a significant exercise-induced growth hormone response (EIGR) that can last for 24 to 36 hours.  The response is greatest with full body training sessions that involve multi joint lifts and carries.  EIGR is not limited to traditional barbell or dumbbell training, but is also produced with the performance of bodyweight resistance training.  The post training hGH response gets better as the trainees became more proficient (gets stronger) with strength training.

Anaerobic Exercise

The exact mechanism that causes EIGR with anaerobic exercise is not known, but it appears to be related to higher lactic acid levels in the blood.  The activities that produce the greatest EIGR are high intensity exercise intervals lasting at least 30 seconds.  The researchers’ current recommendations for optimal EIGR are six to eight 30 second intervals of high intensity activity.  Bicycle sprints have been the most commonly used exercise modality in research studies, but other activities can be used as long as your joints and muscles can tolerate the stress.  Treadmill, stairclimber, rower, as well as track sprints and hill runs are good interval training choices.

Sleep

Human growth hormone is released in response to our natural circadian rhythms.  If your sleep-wake cycle is disturbed, the cyclical release of hGH is blunted.  Maintaining good sleep hygiene is important for optimal hGH production.  Avoid stimulants such as caffeine and alcohol before retiring to sleep.   Falling asleep and waking at consistent times creates more consistent hGH blood levels.  Just a few nights of interrupted or decreased sleep duration have been shown to reduce fat metabolism, slow muscle recovery, reduce insulin sensitivity, and decrease hGH levels.

Natural HGH Production Activity

Inducing optimal human growth hormone production is easy:  Get adequate and consistent sleep.  Every week, perform two or three high intensity interval style training sessions for six to eight sets of 30 seconds duration.  Two or three times a week perform a full body strength training program made up of full body multi joint exercises.

Michael S. O’Hara, PT, OCS, CSCS

In the February issue of our newsletter, Mike O’Hara discusses ways to improve hip mobility and strength.  Read Jeff Tirrell’s article on why dairy products may actually be good for you.  Having back pain doesn’t mean you can’t have a fitness program.

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Finding Fitness With Lower Back Pain

The number of USA emergency room visits, pain medication orders, injections, imaging studies, and surgical interventions directed at lower back pain continue to rise.  I frequently meet people who report their fitness efforts have been hampered by low back pain.  I have five recommendations that can help fitness clients with lower back pain have more success in the gym.

#1 Do not exercise first thing in the morning:  Ergonomic experts have found that many more industrial lower back injuries happen in the morning.  The theory is that the discs in the lower back imbibe or gain fluid overnight and are more likely to deform with a physical challenge.  Give your lower back one or two hours of walking around time before starting an exercise session.

#2 Isometric strengthening of the spinal stabilizers:  The function of your “core” muscles is to limit movement of the lumbar spine and pelvis.  Stop all crunches, toes to bar, sidebends, sit ups, seated twisting, and learn how to perform bird dogs, side hovers, Pallof press, planks, and carries.  Compliance with this single hint would reduce USA expenditures on lower back pain dramatically.

#3 Enhance the function of your hip flexors and gluteal muscles: Please cease all the forward spine flexion, toe touching, spine twisting activities.  Greater lumbar spine range of motion is associated with more–not less, lower back pain problems.  Learn how to foam roll and mobilize the hip flexors and gluteal muscles.  Prolonged sitting and most popular “cardio training” deadens these muscles.  Properly functioning hip flexors and gluteal muscles keep the pelvis stable and take stress off the lower back.  Reawakening dormant gluteals and hip flexors is the magic that resolves long term lower back pain.

#4 Focus on single leg strength training:  Ditch the front loaded hip hinges–deadlifts, cleans, snatch, and drop the loaded squats.  Swear off the lower lumbar deranging leg press.  Reduce spinal compression and train the legs, one at a time.  Single leg training reveals the right / left side movement asymmetries that drive lower back pain.  Resolving these asymmetries and sparing the spine goes a long way to abolishing back pain.  You will need some guidance on exercise selection and execution- this brings me to #5.

#5 Get some help:  Exercise is the most powerful medication on the planet.  Nothing else comes close.  Take the proper dose of appropriate training and the results will be amazing.  Take the wrong dose of an inappropriate activity and the results can be devastating.  This is especially true for people with a history of lower back pain.  Find a qualified physical therapist to guide you through your fitness journey.  One way or the other, you are going to spend time and money on your health.  Proactive spending is always cheaper and more beneficial than reactive spending.

Michael S. O’Hara, PT, OCS, CSCS

 

The Coldest of Shoulders

Understanding and Not Understanding Adhesive Capsulitis

Marilyn first noticed the right shoulder pain when she was sleeping on her right side.  Over the next month, the pain became more frequent and more intense.  Her shoulder ached in the morning and after any repetitive activity.  Marilyn tried medications and ice, but the pain persisted.  After eight weeks, the pain decreased, but her shoulder movement had become restricted.  Her shoulder became so tight that she developed difficulty with activities of daily living such as fixing her hair, dressing, and bathing.  Marilyn had developed a “frozen shoulder” and the frustrating thing was that she had no idea why it had happened.

No one fully understands why a frozen shoulder develops.  For some reason, the envelope of tissue that surrounds the glenohumeral joint–the joint capsule, shortens and develops thickened adhesions or scar tissue.  The medical term is “Adhesive Capsulitis”.  This tissue restriction limits the ability of the humeral head (upper arm bone) to rotate and glide properly so your shoulder becomes tight and painful.

Most of the time, a frozen shoulder occurs with no associated injury or activity.  Frozen shoulder most commonly affects patients between the ages of 40 and 60 years old.  It is far more common in women than men.  Individuals with diabetes are at far greater risk.  If you have undergone a surgery or sustained a trauma to the shoulder, you can develop a frozen shoulder.  This is especially true if you have held the joint immobile for a period of time.  Several studies have linked Parkinson’s disease, thyroid problems, and heart disease to a greater incidence of frozen shoulder.  Patients that develop a frozen shoulder are more prone to getting it in the opposite shoulder.  Despite all of this knowledge, we continue to see many frozen shoulder patients that have none of these predisposing factors.

I would add another condition to the commonly mentioned predisposing risk factors for frozen shoulder.  In my career as a physical therapist, it has been a rarity to find a frozen shoulder patient who was strong.  From grip strength in the hand to the muscles that hold the shoulder blade on the rib cage, these patients are usually weaker than their same age and sex peers.  The strength in the unaffected arm is often as limited as the arm with the frozen shoulder.  My belief is that the most common risk factor for developing a frozen shoulder is upper body weakness.  The glenohumeral joint is a fairly unstable joint that relies on the integrity of the muscles to kept it free from trauma.  If the shoulder muscles are unable to properly control the joint, then excessive stress is transmitted to the joint capsule and an inflammatory response ensues that scars and tightens the capsule.

Physical therapy for a frozen shoulder consists of manual therapy to stretch out the shortened joint capsule and a program of exercise to restores shoulder range of motion, coordination, and strength.  Most of the time, we get the patient when the shoulder is at its tightest point and recovery takes six to ten weeks.  As with so many conditions, the patients that get to therapy earlier or before the shoulder is fully frozen do better with therapy.

In many ways, Marilyn is the typical frozen shoulder patient.  She is the correct, age, sex, and fitness level.  Further medical work up revealed that she was prediabetic and in need of some ongoing medical attention.  Marilyn was a model physical therapy patient and her shoulder function was restored with six weeks of physical therapy.

Michael S. O’Hara, PT, OCS, CSCS

In the January 2018 issue, Mike O’Hara focuses on strengthening your hamstrings.  Exercises to make your hamstrings stronger, not longer are given along with video demonstration.  Jeff Tirrell tells us how to make incremental changes in our diets to see positive changes, and the spotlight is on Fenton Fitness member, Robin Forstat–a nationally ranked power lifter.
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Modern medicine has lengthened our lives, but unfortunately, many older people physically deteriorate to a level that makes them vulnerable to minor health setbacks.  Frailty is a syndrome marked by weakness, poor mobility, a slow gait, and excessive fatigue.  Frail individuals are unable to adequately recover from physical activity or a challenge to their health.  Minor illnesses send them to the hospital, nursing home, or assisted living center.  Frail individuals are often unable to tolerate beneficial medical procedures and must live with pain and physical restrictions.  Frailty is a problem that responds very well to treatment.

In the 65 year old plus population, frailty syndrome is common.  Fifteen percent of the non-nursing home population is frail and forty five percent is pre-frail.  Frail individuals are far more likely to fall.  Forty percent of the frail and twenty two percent of the pre-frail individuals are hospitalized every year.  Frailty is a marker for adverse health outcomes and a means of identifying opportunities for intervention in patient care.

Physical activity has been shown to be the best preventative and treatment for frailty.  Patients bounce back from surgery much better if they under take a program of prehabilitation exercise prior to surgery.  Research on rehabilitation has demonstrated the benefits of exercise to restore strength and mobility in the frail population.  Take the time to read, One Last Question Before the Operation: Just How Frail Are You? by Paula Span in the October 27, 2017 issue of the New York Times.  Read the article here: https://www.nytimes.com/2017/10/27/health/elderly-surgery-frailty.html

In the senior population, fitness activities must focus on training that maintains functional mobility and an independent lifestyle.  You need to stand up and train to be a more graceful and competent walker.  Practice drills that improve your capacity to transfer from the floor to standing.  Always include balance and reaction exercises that keep you free from falls.  Foremost are strengthening activities that maintain bone density and restore capacity to lift, carry, push, and pull.

Michael S. O’Hara, PT, OCS, CSCS

* New York Times, One Last Question Before the Operation: Just How Frail Are You? Paula Span, October 27, 2017

With the start of a new year, many of us will be making the resolution to return to the beneficial habit of exercise.  We will purchase treadmills, rowing machines, recumbent bikes, Yoga DVDs, running shoes, or perhaps join a gym.  We set off with an iron will and a fierce determination to reach our fitness goals.  Sadly the statistics are against us.  Most of us will not stay compliant with the exercise habit past mid February.  Dr.Jordan Metzl wrote an excellent *article in the New York Times on how you can improve your chances of making the exercise habit “stick”.  Give it a read and send the article to your friends.  View the article here: https://www.nytimes.com/2017/12/19/well/move/this-year-make-your-fitness-resolution-stick.html?_r=0

Michael S. O’Hara, PT, OCS, CSCS

*This Year, Make Your Fitness Resolution Stick, Dr. Jordan Metzl, New York Times. 

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