Tai Chi Tuesday: Holistic Approach to Fighting Pain Takes Root in American Medicine

There is no panacea for pain. We can take a pain reliever, but that masks the symptoms. Doctors are beginning to join forces with patients to alleviate the root of the problem — or, barring a cure, manage chronic pain.

According to the AARP, doctors have begun to use a holistic approach, joining mind and body, with long-term management options for chronic pain of arthritis, injury or other ailments.

Not surprisingly, one of the key elements of chronic pain management is exercise: tai chi, yoga and dance, to name a few. Doctors already have identified the value of tai chi with heart patients and stroke patients and also have identified its importance to bone health.

The AARP Bulletin article "Fight Pain" (April 2013) lists not only tai chi, but acupuncture and massage among the tools doctors have begun using to treat chronic pain (which, according to the article, "becomes a disorder in its own right").

In these cases, doctors prescribe pills and other medications cautiously because the relief is temporary and limited. Escalating doses don't always help and often lead to dependence on the medication.

To find a tai chi class near you, check with your local parks and recreation department or check with the International Taoist Tai Chi Society.

For those who can't easily make it to class: consider using a DVD at home. E-mail me for some suggestions.

Exercise for Menopausal Women: Less is More

"I'm getting a muffin-top for the first time in my life."

This wasn't the first time a 40-something female client lamented her unexpected weight gain, so I asked a few questions.

She hits the gym hard nearly every morning, early, taking only the rare day off.

Sleep? Maybe six hours a day.

I didn't even have to ask about her diet. I prescribed immediately:

"Stop!"

She looked at me, confused. She was doing what she had been told: work out hard and you'll get the shape you want. And here I was telling her something very, very different.

New research has revealed that the harder peri-menopausal and menopausal women work out, the more likely they are to not reach their weight goals. They're not gaining extra muscle and they're not losing extra fat.

Here are a few recommendations for women who have hit a plateau at that stage of their lives:

• Sleep, sleep, sleep. Adults need at least seven to eight hours of sleep every day. Any less than that, your body has lulls during the course of the day and your metabolism comes to a screeching halt. Your body needs more rest and recovery so you can reach your fitness goals.
• No high-intensity cardio. Keep your heart rate elevated but steady. Do not look for an extra-high heart rate to make extra gains because it won't work.
• Take time off. Work out no more three to four times a week. Make sure you have two consecutive days of rest after a workout.
• Add weight training. It helps increase bone density and burns more calories over the course of the next couple of days after a workout.

Don't forget your basics:

• drink enough water (aim to drink a glass of water when you wake up, a glass when you go to bed and a glass with each of your small meals) 
• eat five or six small meals rather than three big ones (but keep your total calorie count the same as you would for the bigger meals)

Be sure to check with your trainer if you have questions, or send me an e-mail.

Fitness Friday: Motivation Required

Some days you're the dinosaur, some days you're the human.

(Courtesy Hoist Fitness Systems.)

Fitness Friday: Time is On Your Side

Time will pass, no matter what you do — so why not use it the way you want, the way you know is best for you?

And if you're not sure how to start, ask an expert: make an appointment with a personal trainer. What have you got to lose, except doubt and confusion?

Should We Exercise if We're Sick?

It shouldn't be a struggle for a normal person: if you're sick, you take a break from your fitness routine.

Notice I qualified that sentence. "Normal person." I don't think I'm in that camp.

So, I have a sinus infection. (Again. I know. I know!) However, once the "can't move my head without wishing I was anywhere but in my own body" ends and the "feels miserable but not enough to stay home and curled up in bed" begins, I have to ask myself: Am I working out today?

Some days it's easy to answer that question. It's those days where I think I might be able to pull it off that are tougher.

My trainer would tell me to sit it out unless I was better. Of course, my trainer also eats breakfast before he works out (even first thing in the morning! At dawn!) and uses tools of destruction like Bosu and resistance bands. I can more easily sift through his recommendations and decide what works for me.

What he would tell you is the same thing he would tell me: if you don't feel well, don't work out, period. And eat before you work out.

And yet... I know this sinus infection is not forever. During that healing time, if I start to feel better, I want to take advantage of my new-found strength. I want to go to the gym, climb on my favorite machine and watch (bad) television for an hour. ("Bad" is not my choice, but the offerings by the management.)

Plus, what if healing takes longer than I would prefer? I've "started over" with running more times than I want, and it's less pleasant each time. I don't want to hurt like that — so if it won't kill me, shouldn't I go ahead and do a little? I'm not contagious. I'm going to be feverish anyway. Plus, I know the difference between feeling punk and being sick enough to go to bed (despite evidence to the contrary).

Should I stay on the sidelines until I'm fully healed? Or do I take to the road or gym and push just enough to make it worth the laundry?

- Chris

Those Who Do Not Find Time For Exercise...

This image says it all.

Do you agree?

Thanks to by blogsbyryan (via Photobucket)

Why We Don't Lose Weight (in TIME)

This article from the August 2, 2009 issue of TIME Magazine, was sent to me by a client.  

It discusses, in part, why we do not lose weight when we exercise.  I do agree with the author, to some extent, that some people do eat more after working out.

However, in my opinion,  the article falls short by failing to explain that we need to cross-train and add intensity to our workouts for best results.

Why Exercise Won't Make You Thin
by John Cloud
Time Magazine 

The findings were surprising. On average, the women in all the groups, even the control group, lost weight, but the women who exercised — sweating it out with a trainer several days a week for six months — did not lose significantly more weight than the control subjects did. (The control-group women may have lost weight because they were filling out those regular health forms, which may have prompted them to consume fewer doughnuts.) Some of the women in each of the four groups actually gained weight, some more than 10 lb. each.

What's going on here? Church calls it compensation, but you and I might know it as the lip-licking anticipation of perfectly salted, golden-brown French fries after a hard trip to the gym. Whether because exercise made them hungry or because they wanted to reward themselves (or both), most of the women who exercised ate more than they did before they started the experiment. Or they compensated in another way, by moving around a lot less than usual after they got home.(Read "Run For Your Lives.")

The findings are important because the government and various medical organizations routinely prescribe more and more exercise for those who want to lose weight. In 2007 the American College of Sports Medicine and the American Heart Association issued new guidelines stating that "to lose weight ... 60 to 90 minutes of physical activity may be necessary." That's 60 to 90 minutes on most days of the week, a level that not only is unrealistic for those of us trying to keep or find a job but also could easily produce, on the basis of Church's data, ravenous compensatory eating.

It's true that after six months of working out, most of the exercisers in Church's study were able to trim their waistlines slightly — by about an inch. Even so, they lost no more overall body fat than the control group did. Why not?

Church, who is 41 and has lived in Baton Rouge for nearly three years, has a theory. "I see this anecdotally amongst, like, my wife's friends," he says. "They're like, 'Ah, I'm running an hour a day, and I'm not losing any weight.'" He asks them, "What are you doing after you run?" It turns out one group of friends was stopping at Starbucks for muffins afterward. Says Church: "I don't think most people would appreciate that, wow, you only burned 200 or 300 calories, which you're going to neutralize with just half that muffin."(Read "Too Fat? Read Your E-mail.")

You might think half a muffin over an entire day wouldn't matter much, particularly if you exercise regularly. After all, doesn't exercise turn fat to muscle, and doesn't muscle process excess calories more efficiently than fat does?

Yes, although the muscle-fat relationship is often misunderstood. According to calculations published in the journal Obesity Research by a Columbia University team in 2001, a pound of muscle burns approximately six calories a day in a resting body, compared with the two calories that a pound of fat burns. Which means that after you work out hard enough to convert, say, 10 lb. of fat to muscle — a major achievement — you would be able to eat only an extra 40 calories per day, about the amount in a teaspoon of butter, before beginning to gain weight. Good luck with that.

Fundamentally, humans are not a species that evolved to dispose of many extra calories beyond what we need to live. Rats, among other species, have a far greater capacity to cope with excess calories than we do because they have more of a dark-colored tissue called brown fat. Brown fat helps produce a protein that switches off little cellular units called mitochondria, which are the cells' power plants: they help turn nutrients into energy. When they're switched off, animals don't get an energy boost. Instead, the animals literally get warmer. And as their temperature rises, calories burn effortlessly.(See TIME's health and medicine covers.)

Because rodents have a lot of brown fat, it's very difficult to make them obese, even when you force-feed them in labs. But humans — we're pathetic. We have so little brown fat that researchers didn't even report its existence in adults until earlier this year. That's one reason humans can gain weight with just an extra half-muffin a day: we almost instantly store most of the calories we don't need in our regular ("white") fat cells.

All this helps explain why our herculean exercise over the past 30 years — all the personal trainers, StairMasters and VersaClimbers; all the Pilates classes and yoga retreats and fat camps — hasn't made us thinner. After we exercise, we often crave sugary calories like those in muffins or in "sports" drinks like Gatorade. A standard 20-oz. bottle of Gatorade contains 130 calories. If you're hot and thirsty after a 20-minute run in summer heat, it's easy to guzzle that bottle in 20 seconds, in which case the caloric expenditure and the caloric intake are probably a wash. From a weight-loss perspective, you would have been better off sitting on the sofa knitting.

Read the entire article in TIME Magazine.

Exercise: An Important Lifelong Practice

Being a 50-year-old father of three, I can tell you the world now is a much more competitive place than it was when I was in school.  

There are high school students with 4.3 and 4.5 grade point averages not being accepted to their first choices of college. Back when I was in school, there was no such thing as an above 4.0 grade point average.

We need our children to remain focused and stress-free throughout their day in order to keep them on the road to success. As parents, we can help by ensuring our children receive proper nutrition, sufficient rest and daily exercise.

If we can do these things for our children, here are some benefits they receive as a result:

• Nutrition: vitamins, minerals and phytochemicals are essential for proper physiological body function. This aids in cleansing the liver and kidneys and holding proper hydration levels in our cells -- plus, they provide cancer-fighting abilities and build healthy immune systems.
• Rest: repairs the body from the daily grind we call life. This allows the body to manufacture amino acids for muscle repair. Proper rest also aids in keeping us alert and dexterous.
• Exercise: burns more calories to help maintain a healthy body mass index (BMI). Create better lung capacity for better blood and oxygen flow. Exercise also makes the heart strong and healthy.

Aside from these immediate benefits, our children also get healthy life style habits that will carry on to adult hood.

We are responsible for bestowing upon them these practices for a healthy lifestyle, so let's do it right.

Kettlebell Workouts: How Good Are They?

A client asked me my opinion on kettlebell workouts. Because I am always looking for good blog material, here we are.

I think most people will agree with me: kettlebell workouts are amazing — they're fun and effective on many levels.

They are effective because when you perform the exercises, you are using many muscle groups at the same time. (As you know, I am a huge fan of this type of training.) What looks like a basic maneuver, like a one-arm overhead swing, in reality is a squat-anterior shoulder-middle shoulder-core stabilization exercise. This effort will result in great cardiovascular benefits, muscular strength and endurance.

I do, however, offer one word of caution: start out light. You may find it very easy to swing a heavy weight — but less so to slow down and stabilize the weight.

My recommendation here is the same as for launching any new exercise: begin with a lighter weight. This allows you to develop some muscle memory for the motions required for the exercise. Later, you can move on to heavier weights.

To find some kettlebell exercises, drop me a line. You also can check out GoFit.net, whose kettlebells come with a instructional DVDs and can be found at many sporting good stores.

Exercise is Beneficial at Every Age

Last week, my family received some disturbing news about my 80-year-old mother's health — but exercise provided better treatment options for her and her doctors.

She was complaining of poor balance and loss of dexterity, and her doctor referred her to a neurologist. They did find some issues – but, instead of pursuing an invasive procedure, the doctor prescribed rehab and a regular yoga class.

As a result, my mother's neuromuscular functions have improved and the doctor has taken the procedure option off the table. Good news all around.

The moral to this story is: do not neglect your fitness at any age.

The True Effects of Exercise and Weight Loss

Today, two of my clients gave me an interesting article: "Why Exercise Won't Make You Thin" by John Cloud (Time, August 9, 2009), in which the author states that weight loss usually does not occur when people exercise.

Needless to say, I take exception to this.

The author cited multiple medical studies in support of this conclusion. In a nutshell, the studies showed that weight loss was not typical for people in three different groups: sedentary people, fairly active people and those working with a personal trainer for an hour or more a day.

The author noted that, in many cases, people who regularly work out feel more hungry — which is true — and people who are hungry naturally eat. However, he concluded that if exercise makes you more hungry, you will eat more — and if you eat more, you won't lose weight.

This is not necessarily an accurate conclusion.

There are two important keys to weight loss the author did not seem to take into account:

• Calorie deficit — 3,500 calories equals a pound. You will gain one pound for every 3,500 calories you ingest above what you burn. Burn 3,500 calories more than you take in, you lose a pound.
• Raise your metabolism — eat five times a day, get enough sleep and drinking sufficient fluids.
  

I suspect the people in the studies were not monitored for sufficient sleep and fluid intake. They also probably ate three bigger meals, rather than five smaller meals. They might also have failed to eat light snacks after their workouts, which lowers the number of calories eaten at meals and cuts down on total daily calorie intake.

The author states that doctors recommended exercise to their patients for weight loss. With such dismal responses from the exercise study, why would doctors be so in favor of exercise for their patients? Drum roll please: because in addition to burning extra calories (remember that whole 3,500 calorie thing?), it's good for developing balance, building strength and improving overall daily living. In addition to recommending exercise to their patients, I am sure the doctors also discussed lifestyle changes and diet.

No doctor believes exercise alone is a prescription for weight loss. Even infomercials for exercise plans and fitness devices post disclaimers that include a nutrition plan and (subtly) remind viewers that the more fantastic results are not typical for most consumers.

In this Time article, the author correctly states that the people in the studies who filled out diet journals lost more weight than those who didn't keep a journal. Thinking about what you eat before you eat it definitely aids in cutting down on calories.

Trainers and doctors agree: exercise by itself is not the be-all and end-all to weight loss. (If it were, I am sure everyone would have gym memberships and personal trainers.) Without controlling calorie intake, getting enough sleep and drinking enough water, you most likely will not lose weight, no matter your exercise level.

Trainers assist you in this endeavor by providing more interesting and intense workouts than you would most likely provide yourself, which helps burn more calories and hopefully provides a calorie-deficit situation that allows for the possibility of weight loss. They also help you monitor your fluids and sleep, as well as other habits that might not be conducive to your goals.

In conclusion, the article was interesting, but misleading. Weight loss depends on multiple factors that need to all be considered for success.

Protein Shakes, Part Two

Fourth in a series.

On our last blog, we talked about the criteria for the use of protein shakes. We discussed protein requirements based on our training.

I need to add one more point to this before we move on: remember, along with the contents of the shake itself, you also are consuming more calories. Depending on serving size and what you mix it with (milk or water), you can take in anywhere from 150 to as much as 300+ calories.

If you are trying to lose weight, my recommendation is to stay away from protein shakes.

Here is my experience with protein shakes as a 48 year old male who is 6 feet tall, weighs 205 pounds and works out almost everyday. I have experimented with shakes on three separate occasions. The shakes I used did have more to offer than just protein, but there is not enough space on this blog to list all ingredients, benefits and side effects.

I was lifting almost every day and doing 30-60 minutes of cardio three or days a week. I was consuming shakes after weightlifting sessions that I knew to be hours before my next main meal. Despite the fact that I continued to watch my calorie intake, I put on weight — and it was not muscle because I got bigger around my middle.

The second time I used shakes, I was taking them before my workouts because I figured the carbs would help fuel my workout and the BCAAs (amino acids) would help to preserve muscle mass while I lifted. Also, ideally, we should consume our biggest meal of the day 30-90 minutes before a workout. My results were the same: I put weight on across my middle.

The last time I used protein shakes, I was only taking them when I felt I just did not get enough calories through the course of my day. Guess what? Same results: weight across my middle.

This does not mean I definitely don't recommend using protein shakes. However, I do recommend taking a careful look at the label. Before purchasing or consuming any supplements — and protein shakes are supplements — go online and research the supplement in which you are interested. Look up all ingredients on the shake label, weigh the benefits versus the side effects (if any), then decide if that protein shake is right for you.

Here is my final thought: if your metabolism is naturally fast and calories are not a concern, you may want to try a shake in order to put on some extra muscle.

If that does not work for you, remember: there are other excellent sources for protein "supplements." Back in the day before shakes, weightlifters ate cottage cheese to fulfill their protein requirements.

Next Creatine

Exercise Really is a Cure-All!

Alright, it's a bit of an exaggeration. But not by much.

According to Marilyn Moffat, a professor of physical therapy at New York University, exercise goes a long way toward healing what ails you ("You Name It, Exercise Helps It," New York Times, 4/29/2008).

If you suffer from an ailment such as diabetes, arthritis, high blood pressure, dementia, depression, cancer or erectile disfunction, exercise can help.

Congestive heart failure? Multiple sclerosis? Diverticulitis? Yep, you, too.

It's not a panacea, and you do not leap off the operating table to land at the marathon starting line. Moffatt is much more restrained than I would be. Moderate exercise, as much as one feels comfortable doing, is the key.

A lot of times, would-be athletes are self-conscious about their body shapes — which might make them less inclined to go to the gym, the pool or wherever else exercise might include stretchy pants.

Others may not think themselves athletes, or have not felt strong enough to consider themselves capable of athletic activities. The thing is, they are. Everyone can be an athlete. Remember, you don't have to run a marathon to be a "runner."

There are lots of reasons to not exercise — such as when the physician recommends against it, or when you truly do not feel capable. After my shoulder surgery, Dr. Thal told me I could start running as soon as I felt like it. I took off two weeks, which I would have fought against had the good doctor said that very thing. And it was heck starting again, but I didn't give myself a choice. Not running, for me, was worse than re-starting.

Exercise is not easy, especially when athletes are starting a new regimen. However, even a beginning athlete knows the difference between sore muscles and their illness. They also know the difference between "not feeling like it" and being unwell.

Always consult with a physician before starting an exercise regimen — but start one. Do it for the endorphins, do it for the muscle tone, do it for the confidence it will give you. But do it. Your body will thank you.

- Chris

Slow Down Aging by Staying Active

If you want to live forever, take up running.

Okay, that's my personal take on it. However, ask Vonda Wright, an orthopedist at the University of Pittsburgh, and she will tell you the same thing. Almost.

According to Wright's recent study, those who continue with or even take up athletics in their later years slow down deterioration that appears to be the hallmark of aging: loss of balance and bone density, slowing movements, loss of flexibility and more .... or less.

Most importantly, it's not just the lifelong athletes who benefit from this. Indeed, those who take up sports later in life — middle age or later — show signs of benefit.

And don't say an old dog can't learn new tricks: many older athletes are training harder and performing better than their younger counterparts, according to "Staying a Step Ahead of Aging" (New York Times, 1/31/2008).

Now that doesn't mean you dash out and play daredevil soccer with your local cutthroat teen team, of course. Train smart, train safely — and start out with a full physical before taking up the hurdle or lance. That's just common sense for any age athlete.

Many athletes train to the pain. I'm of two minds. I've been running nearly non-stop since I was 13 (and boy, are my arms tired! er...). I've tried the whole pain thing. In fact, I'm trying it right now: I've begun running again after a month on a stairclimber (due to cold weather and illness). I work out hard on the machine, sweating buckets and making my muscles tremble.

And yet, there's nothing quite the same as propelling myself down the street with no handles to balance against when I am weary. (I didn't cheat by draping myself all over the machine, but I might have relied on balance aids from time to time.) Work to the pain? No, thank you. I'll work hard and push myself, but not to where my muscles are begging to crawl off my body and be folded with my pajamas. I'll do interval and weight training, I'll mix up my workouts, I'll change distances and terrain, but I don't want to hurt like this again.

And yet I am in awe of retirees who run faster (and train harder) than I do. A 74-year-old man ran a marathon in less than three hours. Yes, my retired elders have more time to train and work out than I do. Yes, they have muscle memory that makes me look like a young'n. They also have the good sense to work with a personal trainer and listen to their doctors. (Maybe with age comes wisdom.)

This youthful vigor may not last forever. In time, we all slow down to a certain extent. Reduced lung capacity and reduced blood flow to extremities will happen, no matter how strong the ticker is. In the end, our bodies age, and our performance will change.

We just don't have to go willingly into doterage. We can stay healthy and fit, active and flexible — and feel better — for longer. As our longevity continues to increase, I am glad to see this trend, and I hope to continue it as I join the ranks of the older athletes.

- Chris

Never Too Cold to Exercise

On days like today, when the Green Bay Packers are playing the New York Giants in temperatures of -23ºF, one can wonder if there is ever a time when it's too cold to exercise.

The answer from experts: No.
(The answer from my friends Alicia and Karen: Chris, are you out of your mind????)

But back to the experts. John W. Castellani, an exercise physiologist at the Army Research Institute of Environmental Medicine, says heat causes more injury to athletes than the cold ("Too Cold to Exercise? Try Another Excuse," New York Times, January 17, 2008).

The key I have found, and experts agree, is dressing for success. Wear the right clothes: warm and dry makes a difference. Layer to prevent overheating with layers that can be adjusted as the athlete warms up, wear a hat, consider gloves and wear lip balm.

(Hint: cotton t-shirt under a cotton sweatshirt covered with a windbreaker won't help, no matter how many t-shirts you wear. Trust me on this one; some of us make mistakes so others don't have to. Sweat means wet clothes, and wet means cold. Remember that sweat is designed to cool down your body.)

Layers should include clothing that wicks away moisture. Check athletic stores and catalogs for suggestions.

Never underestimate the power of the hat. The body's heat quickly escapes from your head, the part of your body that always has plenty of blood supplying your brain. Even on cool (not cold) days, I wear a headband that keeps my ears warm.

I don't wear gloves, but my shirts all have really long sleeves. Wait, I take that back: I wore gloves in Central Park when the temperature didn't quite reach the 20s.

When you step outside, you should be cool — not toasty warm, or you'll overheat.

If you're worried that you'll freeze your lungs by breathing frigid air, don't. Your body warms up your breath before it reaches your lungs. Dry air, however, is a problem, no matter the temperature; athletes with respiratory problems should visit their physicians for guidance.

Freezing air can be dangerous for extremities, such as ears and fingers. Beware frostbite and protect yourself with gloves, hats and, if it's bad enough, balaclava. However, watch for overheating (as noted above).

Finally, experts say to keep moving. Hypothermia occurs when the body's core temperatures drops below 96ºF, and exercise generates heat. Water, or sweat, takes heat away from the body, so don't overdress and don't wear clothing that stays wet from sweat.

So, don't stay inside out of fear. Take to the road, the field, the diamond, the track — and be safe and smart.

See you outside!

- Chris