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In the world of exercise, there always seems to be a latest gimmick or piece of equipment that you need to own in order to have the changes in body composition that you want to see. Though the infomercials may seem tempting to help us achieve the results we want faster most of the time, the simplest exercises will work just as well and are much cheaper than what is being sold on TV.

One particular exercise that comes to mind when talking about cheap and effective exercises would be a Plank. Planks require no equipment besides a minimal amount of space and body weight to complete and have multiple benefits. A study completed by The Journal of Sports Science & Medicine concluded that plank exercises were more effective than trunk flexion exercises (sit ups) in engaging abdominals (Maeo et al). Some other benefits of a plank include:

• Planks engage multiple muscles groups simultaneously including the glutes, hamstrings, low back, and abdominals.

• Helping in reductions of low back pain

• Increases in flexibility

• Improvements in balance and posture

Planks are also an important exercise in any well rounded workout routine due to the ability to be completed anywhere. Planks can be done in the privacy of one’s home, at the gym or even at the office.

Proper form for a plank is critical in order to receive the maximal benefit from a plank. Form includes holding elbows directly under shoulder and wrists in-line with elbows. Then lift/lower your body into a straight line and brace abdominals, glutes, quadriceps and hamstrings, then hold for 30 seconds.

One stigma about performing a plank exercise is that if must be completed on the ground in order to be effective. This is not the case especially for beginners. Planks are effective as long as the person completing them feels the muscles of the trunk working. Good elevated surfaces to begin planks include kitchen counter, a table, or using the back of furniture if it is stable. After holding proper form for 30 seconds you can determine if a lower stable surface would be more beneficial for you.

Planks are a free and effective form of exercise requiring no equipment and only a minimal amount of space. Planks have many benefits including decreased low back pain and improve flexibility.

So next time you see an infomercial on TV, see how long you can hold a proper plank and see if a simple plank is harder than expected.  

It is common knowledge that fitness facilities across America see an incredible influx of new clients in January and February, but by March, where is everyone? People stop exercising for two main reasons:

(1) the intensity is too high and they cannot maintain this level of exercise, or

(2) weight loss is not forthcoming and they become frustrated.

Research has proven that high intensity interval training (HIIT) is an efficient means of losing weight. According to the International Journal on Obesity, HIIT is easily tolerated and results in higher losses in percentage body fat.

HIIT Training can be extremely beneficial, but if it works so well why are millions of people giving up on exercise by March? The reason is threefold. Understanding these reasons plays a large part why our clients have been so successful at Revolution Physical Therapy and Weight Loss.

1: High intensity exercise utilizes large amounts of carbohydrates. Cardiopulmonary test allows us to learn which fuels are used at specific heart rates such that we can efficiently utilize HIIT training.

2: Utilizing large amounts of carbohydrates may cause insulin spikes, which can then result in an increase in carbohydrate consumption post-exercise.

3. Exercise adherence is closely linked to enjoyment levels. In fact, the International Journal of Sport Psychology found that ratings of enjoyment predicted exercise adherence. Finding a balance between hard work and enjoyment is a necessary step to keep clients moving forward through March and beyond.

1: http://www.carnevalijunior.com.br/wp-content/uploads/2010/03/a-role-for-high-intensity-exercise-on-energy-expenditure-balance-and-weigth-control-1998.pdf

You may have heard the term “functional movement” and asked yourself what it meant or how we use it. Functional movement is a term to describe daily movements we use to perform activities such as lifting, carrying, walking, or even sitting. With specific exercises, we can strengthen muscles that are used for these activities. Below are three we use every day, both in daily life and in the clinic.

The Squat

Even though the squat seems like a technical movement, and we have many instructions for performing a squat correctly, we use squats every day. For example, getting in or out of the car, sitting down into a chair, or even getting out of bed are some examples of when we use the muscles necessary to perform a squat. 

The Deadlift

If you’ve ever had to pick up something heavy off the floor, you know it can be difficult or even sometimes cause injury. A proper deadlift requires posterior chain strength, meaning gluteal and hamstring muscles. Proper lifting technique also requires core strength to maintain good posture. In the clinic, we target gluteal and hamstring muscles with band exercises, lunges, and even squats. We can target core musculature with isometric exercises such as planks. We combine these when performing the deadlift and insure proper form to protect against injury. 

The Overhead Press

Have you ever needed to ask a fellow passenger on the plane for help put your carry-on bag into the overhead compartment? You’re definitely not alone. The overhead press can be difficult to perform and requires full shoulder range of motion in addition to upper extremity strength. We practice this in the clinic using medicine balls, kettlebells, dumbbells, cables, and body weight, and work on strengthening biceps, triceps, pectorals, deltoids, and trapezius muscles to achieve proper overhead technique. 

One of the new buzz phrases in the medical community is “metabolic syndrome."  Metabolic syndrome stands for an individual having a combination of 3 or more of the following:

• Waist circumference > 35 inches (88 centimeters) for women or > 40 inches (102 centimeters) for men

• Blood pressure greater than 130/85 mm/Hg

• HDL (good) cholesterol less than 50 for women or below 40 for men

• Fasting blood glucose greater than 100 mg/dL, 

• Triglycerides greater than 150 mg/dL

Metabolic syndrome has good reason to be gaining attention, as an estimated 1 in 4 Americans currently has it, placing them at a 3-fold risk of getting cardiovascular disease. Not surprisingly, it also puts them at an increased risk of developing type 2 diabetes. The frightening diagnosis of metabolic syndrome causes patients a great deal of anxiety, from not knowing what to do next, to a collection of costly medications.

The good news is that there’s a catch:

In most cases, metabolic syndrome is completely reversible, even without the use of any medications! The secret is a sensible nutrition plan along with cardiovascular and resistance exercise. By losing weight this way, each of the 5 risk factors for metabolic syndrome can improve. In fact, the Diabetes, Obesity and Metabolism Journal published a study by Case et al. that included a group of 125 people with metabolic syndrome who had dramatic results in less than 16 weeks using a low calorie nutrition plan and exercise. By the end of the study, the group, who averaged having 3 out of the 5 risk factors, went from levels well above the cutoff point for metabolic syndrome to levels well below the cutoff point. In addition, many of the subjects no longer had metabolic syndrome at the end of the study and this all occurred in less than 4 months!

The costs of joining a specialized program designed to treat metabolic syndrome may be significant, but in reality, we should consider how much money is be saved by not having to buy insulin, cholesterol medications or hypertension medications for a lifetime. Even more importantly, incur the cost of heart or kidney surgery. 

The key is to look at being diagnosed with metabolic syndrome less like a disease and more like a second chance. 

I urge you to take your second chance at health and make the most of it!

At some point in life, an acute injury is imminent; if you are cleared for exercise, mindful resistance and cardiovascular training will bring a host of benefits.

Injured or not, we sometimes forget that exercise is a way of life. In fact, it is essential to life. Exercising will not only help maintain fitness but also, in the long run, increase your chance of survival. A study in The New England Journal of Medicine concluded that cardiovascular fitness is more important to survival than any other risk factor- including blood pressure and cigarette smoking! This reason alone should motivate you to exercise.

Another benefit of continuing cardiovascular exercise while injured is that it increases blood flow, which helps deliver nutrients to cells that repair the tissue. The increased amount of blood flow will carry the debris away from the injury into the liver to get processed and discarded. These two aspects can help to speed up your recovery time.

Resistance training during this time can provide equally important benefits, such as preventing muscle loss. This is important because muscle loss due to cessation of exercise could result in a lower metabolism.Therefore, maintaining muscle mass during injury can in turn fend off unwanted weight gain due to a reduced metabolism. So how can you prevent this from happening? Exercise! 

They key to overcoming setbacks is to become creative in the gym. There are many ways to work the muscles you’re accustomed to without compromising the injury or any other safety aspect of the exercise.

First, make sure the injured joint has been properly stabilized by a physical therapist or specialist, and take their advice seriously so as not to jeopardize your injury. The next step is to select exercises that target the muscles you are trying to work but does not require the injured joint to move.

Remember, it is better to exercise with limitations than to stop exercising all together. The science doesn't lie: exercising is essential to life. 

I recently came across an article that reminded me to keep perspective on how to succeed in becoming healthier and more physically fit (Finn, 2012). In today’s world, there are hundreds of programs that claim to be the best for losing weight. These programs range from Boot Camp, Interval Training, The Biggest Loser to P90X, on which I did my Master's Thesis.

The overwhelming amount of information and advertising about new exercise programs sends people into what Finn describes as paralysis from information overload. Essentially, people become so overwhelmed with the information that they choose to do nothing at all rather than try to pick the 'best' exercise regime. The good news is: choosing the best exercise regime is really quite simple. 

My master's thesis was performed on nearly two-dozen subjects on the effectiveness of P90X and found a clear and simple conclusion. It works….if you do it. The results of my study were that P90X is very effective for caloric expenditure, ability to improve cardiovascular fitness, and a dozen other measures. The problem with doing P90X or any other exercise program is that it does not work unless you do it.

The benefits of exercise are numerous. To name just a few benefits, exercise releases endorphins, which are hormones released in the brain that results in a good mood. Exercise dilates your arteries and reduces the stress on your heart for up to a day at a time. And, perhaps most pertinent of all, exercise also helps to expend calories that lead to weight loss. 

The bottom line is this: don’t make it harder on yourself than it has to be.

At Revolution Physical Therapy & Weight Loss, our exercise experts take into account your current fitness capabilities and goals, and work with each client to compose an exercise plan that is tailored to each individual client. But regardless of whether you work with an expert or follow a program such as P90X on your own, the most important step of all is to carry out your plan. Perform the exercises as outlined by the program, and finish the whole program. I can just about guarantee that you are successful. 

Finn, Christian. "The Most Important Muscle Building Tip You Will Read All year." Muscle Evo. N.p., 08 10 2012. Web. Web. 11 Aug. 2012. <http://muscleevo.net/muscle-building-tip/

Attention current and former Revolution patients! We want to thank you for trusting us with the care of your friends and loved ones. We are extending the offer of one free week of personal training with one of our talented Exercise Physiologists for those who refer a new patient.

If one of your friends or family members calls one of our seven conveniently located Chicagoland clinics, tell them to mention your name when scheduling and we will take note. Once your referred patient has started care, you are welcome to call any location and redeem your free week of training. Please note all patients must have an up to date physician referral before starting care. 

Clamshells or clams, as some call them, are one of the most common exercises prescribed by a physical therapist. The exercise targets specific muscles of the hip that tend to be weak in a large patient population. It is clinically relevant for treatment of a variety of pathologies including low back and knee pain, balance deficits, and following knee or hip replacements.

The exercise is performed with the patient on a table or the floor in a side lying position with the legs and feet stacked and heels together. Other than, that, physical therapists have taught patients the exercise with the hips, knees, and pelvis positioned at varying angles based on past clinical experience. A recent article came out in the Journal of Orthopaedic and Sports Physical Therapy discussing the effects of varying hip angles and pelvic positions on muscle recruitment during the clam exercise.

In a previous study, it was determined that the best position for the knees to be in during the exercise was with the knees bent at 90 degrees, so this knee position was utilized for this study. In a current study, it was found that the most important position to facilitate activation of multiple muscle groups of the posterior hip was related to pelvic positioning. Specifically, when performing clams, it is important to make sure that the spine and pelvis are in a neutral position. When the pelvis tilts/rolls backwards, it decreases the activation of the muscles in the back of the hip (the targeted muscles for the exercise.)  

Furthermore, it was found that the best angle for the hip to be positioned at for proper muscle recruitment was at a 60 degree angle as compared to 90 degrees or fully extended (0 degrees).

References:

Willcox, EL, and Burden, AM: The influence of varying hip angle and pelvis position on muscle recruitment patterns of the hip abductor muscles during the clam exercise. J Orthop Sports Phys Ther 43:5, 2013.

Achieving, and maintaining, weight loss is a significant challenge. The journey can become much harder when movement is difficult due to stiffness or even pain. Most people have experienced achy muscles or joints. However, another less common but equally restricting symptom is dizziness.

Dizziness is sometimes referred to as vertigo, which is often described as a sense that the room is spinning. This can also often be accompanied by nausea. Anyone who has experienced this in the past will be quick to say that it is nearly incapacitating when it occurs.

There are many causes of dizziness and vertigo, but a common and rapidlycurable variation is called Benign Paroxysmal Positional Vertigo, or BPPV for short.

Up to 2.4% of the population may experience BPPV in their lifetime, with up to 30% of all dizziness and vertigo complaints stemming from BPPV1.

BPPV is typically triggered when performing certain movements like turning the head or looking up, as well as when changing body position such as when getting into and out of bed.

A physical therapist can examine you and use their objective findings to differentiate between BPPV and another condition.

BPPV can often be resolved rapidly, taking as little at 3-5 sessions in some cases. Don’t let your dizziness or vertigo slow your weight loss journey, if you suffer from dizziness reach out to a physical therapist today!

Sources: 

1. Von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. Journal of Neurology, Neurosurgery, and Psychiatry. 2007;78(7):710-715. doi:10.1136/jnnp.2006.100420.

Throughout the mid-stages of one's life, the skill of balance can be taken for granted. In which one has the ability to effortlessly use balance to walk, run, and climb stairs without conscious thinking. However, as we age and venture into the later stages of life, balance should become a more conscious effort due to its correlation with accidental falls.

The Centers for Disease Control and Prevention states accidental falls are a leading cause of injury related deaths for populations of 65 years of age and above. Such falls in the elderly population are due to decreased balance. A recent study showed that weight shifting and stumbling influenced falls at a higher percentage rate when compared to slipping. Additionally, gradual changes throughout life such as inflexible muscles, decreased muscle tonality, slower reflexes, and eyesight can affect the sense of balance thus increasing uncontrollable weight shifting and stumbling. However, structured exercise can help with improving balance to assist with reducing the risk of falls and injuries.

At Revolution Physical Therapy Weight Loss, healthcare personals such as Physical Therapists and/or Exercise Physiologists can help develop a structured exercise regimen that is individualized and safe. Such exercise will focus on improving balance through increasing muscular strength, muscular endurance, and flexibility.  By incorporating exercises to enhance these components, one can also see multiple benefits in conjunction with improved balance such as Motor Coordination, Reaction Time, and Neuromuscular Control.

As mentioned before, balance is an important skill we utilize in everyday life during basic movements. However, as age increases, research shows there is a regression in the ability to control that skill. No matter your age, structured exercise can help improve balance. Rather it be for a young adolescent looking improve their skating abilities for hockey, or an elderly individual hoping to decrease their chances of falling. Take the step to be more conscious about your balance and talk to a health care professional today.

Sources:

Centers for Disease Control and Prevention. WISQARS leading causes of nonfatal injury reports .2006. [Accessed November 13, 2006]. http://www​.cdc.gov/ncipc​/wisqars/nonfatal​/quickpicks/quickpicks_2006/allinj.htm.

El-Khoury, Fabienne, Bernard Cassou, Marie-Aline Charles, and Patricia Dargent-Molina. "The Effect of Fall Prevention Exercise Programmes on Fall Induced Injuries in Community Dwelling Older Adults: Systematic Review and Meta-analysis of Randomised Controlled Trials." BMJ. British Medical Journal Publishing Group, 29 Oct. 2013. Web. 27 Feb. 2017.

LeWine, Howard. “Balance training seems to prevent falls, injuries in seniors.” Harvard Health Publications. OCTOBER 31, 2013.

Publications, Harvard Health. "Better Balance: Easy Exercises to Improve Stability and Prevent Falls." Harvard Health. N.p., n.d. Web. 27 Feb. 2017.

Robinovtich, Stephen N., Fabio Feldman, Yijian Yang, Rebecca Schonnop, Pet Lueng, Thiago Sarraf, Joanie Sims-Gould, and Marie Loughin. "Video Capture of the Circumstances of Falls in Elderly People Residing in Long-term Care: An Observational Study." The Lancent. N.p., 5 Jan. 2013. Web.

There are many ways that stretching is incorporated into physical therapy rehabilitation for a variety of orthopedic conditions and injuries treated here at Revolution Physical Therapy Weight Loss. In addition, we recommend stretching as part of a comprehensive exercise program for weight loss and/or overall health and wellness. Stretching is prescribed to increase muscle length and joint range of motion (ROM), or to facilitate proper alignment of collagen fibers as the healing process occurs. Stretching can also decrease pain associated with a musculoskeletal condition such as a herniated disc or from compressive forces on a joint secondary to being overweight.

The benefits of including a stretching routine into one’s exercise program is clear, however the best type of stretching remains a controversy. As is true of most treatment/with most treatments, stretching outcomes are often is based on the individual patient and are affected by factors such as gender, pain tolerance, orthopedic condition, general mobility, and compliance.3

Recent research has looked into the effectiveness of various types of stretching, specifically active versus passive stretching, and compared how much they improved hamstring flexibility and thus joint ROM. Much of the research has focused on the hamstring muscles, likely due to the ease of measuring/measurement and common presentation of tight hamstrings in a clinical and the general population.  Passive stretching is defined as “a form of static stretching in which an external force exerts upon the limb to move it into the new position”3. This external force could include assistance from a partner, a strap, gravity, or a person’s body weight. On the other hand, active stretching is when a muscle is stretched by actively contracting its opposing or antagonist muscle.

Meroni et al. (2010) compared active stretching with static passive stretching of the hamstrings. The study assessed hamstring flexibility following 3 weeks of stretching and then 6 weeks (performed twice a day, four days a week).  In this study, it was found that the group who performed active stretching of the hamstrings had a significant increase in ROM relative to the passive stretching group following both 3 weeks and 6 weeks of stretching. This was the outcome despite the fact that the total duration of the passive stretching session lasted four minutes longer than that of the active stretching session. In addition, four weeks following the conclusion of the study, a subset of the initial group was reevaluated. Results demonstrated that the active stretching group maintained more than a 6 degree ROM improvement, while the passive stretching group maintained a 0.1 degree ROM  improvement.2

Fasen et al. (2010) also compared active stretching of the hamstring versus passive stretching in a randomized control trial. Four different techniques were used; two active hamstring stretches and two passive hamstring stretches, with a control group (no stretching routine) assessed as well. The study assessed evaluated the participant’s hamstring flexibility at the four and 8 week mark following initiating of stretching (performed five days a week). Results of the study demonstrated that both active and passive stretching is more effective in increasing hamstring flexibility than the control group. Although the study demonstrated that at the four week mark, three of the groups (two performing active hamstring stretches, one performing one of the passive stretches) showed improvement in hamstring flexibility, the two active stretching groups showed the greatest improvement. However, interestingly enough, the group that performed the passive stretch and showed improvement at four weeks, achieved the greatest gain in hamstring flexibility at the eight week conclusion of the study.1

Based on these studies and more, it can be concluded that six to eight weeks of stretching, either passively or actively, is effective in improving hamstring flexibility as well as other muscle groups. Clinically, stretching is often proscribed twice daily over a six to eight week period for maximum gains. Once flexibility goals have been met, frequency of stretching can be decreased. The duration and repetitions of a particular stretch tend to be at the discretion or clinical judgement of the clinician. ?

As part of a weight loss program or general fitness program, the American College of Sports Medicine (ACSM) recommends individuals should perform passive or active stretching following a light aerobic warm-up (to increase blood flow and warm muscles up), at least 2 to 3 days per week. It is recommended that each stretch is held for a duration of 15-30 seconds and repeated 2 to 4 times.

In conclusion, stretching is an important component of both physical therapy treatment and as part of comprehensive exercise program. Both active and passive stretching are effective in increasing flexibility and range of motion. Depending on the patient and clinician preference, one type of stretch may be more beneficial than the other in particular cases. Please seek guidance from a physical therapist or other medical professional prior to initiating a stretching routine for maximum benefits and to decrease the likelihood of injury.

Reference:

1. Fasen, J.M., O’Connor, A.M., Schwartz, S.L., et al.(2010). A Randomized Controlled Trial of Hamstring Stretching: Comparison of Four Techniques. Journal of Strength and Conditioning, 23(2), 660-667.

2. Meroni, R., Cerri, C.G., Lanzarini, C., et al. (2010). Comparison of Active Stretching Technique and Static Stretching Technique on Hamstring Flexibility. Clinical Journal of Sports Medicine, 20(1), 8-14.

3. Page, P. (2012). Current Concepts in Muscle Stretching for Exercise and RehabilitationInternational of Journal Sports Physical  Therapy, 7(1), 109–119.

Ever started a weight loss program, kept up the same routine for a long time, but notice the results dwindling? More often times than not, it can be difficult to achieve consistent results due to poor understanding of proper overload during your training. As corny as it may sound, the only way to get better is to challenge your body (overload). This can be as simple as walking faster on the treadmill, more incline, more resistance on the bike, anything that makes the exercise more difficult. Overload leads to adaptation, adaptation leads to result, in our case; weight loss. However, what most weight loss patients lack is a proper variable to monitor this intensity. Many patients use calorie estimations on aerobic equipment or rate of perceived exertion (RPE) to monitor intensity of their workouts. While variables like RPE and estimated calories expended are most certainly a start, limitations include lack of validity and reliability. One workload variable that can control for such limitations is heart rate (beats per minute or bpm).

Heart rate zone training (HRT) is defined as the integration of the heart rate variable (bpm) into a training program to measure intensity of a workout (Friel, 2009). Historically, HRT has been primarily used for endurance athletes such as runners, cyclists, or swimming to improve performance gradually over time. More recently, HRT has emerged as an effective strategy for optimizing training efficiency for individuals trying to lose weight during their aerobic exercise (walking, cycling, stairs, elliptical, etc.).

Based on our previous blog entry, “Pain does not always equal gain”, we have established that proper intensity for weight loss during aerobic exercise should be lower and intensity should be longer. It is now important to take this one step further and quantify the measurement of this intensity. Typical quantification of exercise is done so in an absolute format. For example, a patient starts a weight loss program that includes walking on the treadmill at 3.0 mph for 30 minutes, 3x/ a week. Let’s say they are motivated to keep this routine up for 8 weeks. However, it is often overlooked is that their body will adapt to this initial overload, and therefore will burn less calories each week (Brooks and company, 2014). Burning less calories each week will minimize the calorie deficit, leading to a slowing of weight loss.

Now let’s take that same individual and put them on a relative HRT program. At RPTWL, we assess HR zones using indirect calorimetry. More simply put, we measure oxygen consumption and ventilation during exercise to assess exactly how many calories you're burning at every heartbeat. Let's take that same patient and put them on the same 3x/week 30 minute program, but instead of saying walk at 3.0 mph, we prescribe maintaining a HR of 110 BPM. The same progression will happen over time in terms of initial overload and adaptation. However, different from our first example, this patient will have to continuously increase the speed and incline of the treadmill to achieve that 110 BPM. In conclusion, their calorie expenditure will not be compromised over time, as they are continuously increasing the absolute workload (speed and incline) to achieve the prescribed HR zone.

Furthermore, HRT allows the individual to control the choice of their modality (treadmill, bike, elliptical, etc.). When you are prescribed a HR zone, it is all about doing whatever it takes to get in that zone, however you choose. Patients are not limited to one modality like our first scenario with 3.0 mph of treadmill walking. HRT provides the flexibility and practicality to personalize your exercise program and freedom for variety while still being effective.

They say the best program is the one you keep doing. At RPTWL, we feel HRT is not only the most effective, but safest way to measure the intensity of your exercise. For more information on how to assess your most optimal HR zones, please reach out to one of our Exercise Physiologists.

Despite our recent spell of warm weather it is true that our winter season is in full swing.  Midwesterners know that inclement weather can be just around the corner and with the snow and ice comes an increase in weather related injuries.

A recent study by researchers at the Center for Injury Research and Policy found that over a 16-year period there was an average of 11,500 snow shoveling related injuries treated each year in U.S. emergency departments.  The injuries were largely musculoskeletal with the lower back being the most frequently affected area.  If you have symptoms that persist for a few days following snow shoveling head into a PT clinic for a free injury screen to see if you would benefit from physical therapy services.

So, before we clean off that sidewalk or dig out that car and parking space let’s take some steps to ensure our safety and prevent injury.

Proper Gear

First things first, make sure you wear the appropriate outerwear for the conditions.

It is important when out in the snow and cold that your layers stay dry.  You become more vulnerable to the cold when you are wet.  Exposed skin is more susceptible to frostbite and hypothermia than covered skin.  Make sure to cover your ears and nose.  Wear waterproof gloves and boots to protect your extremities.

Equipment

It is important to have a good shovel and one that is sized right for you.  A smaller shovel blade is better in that you will not be tempted to carry a load that is too heavy.  Plastic blades are lighter than metal and that is also a help.  Use a shovel with curved shaped handle.  This will help you keep your back straighter and decrease the need for bending while shoveling the white stuff.  It is also recommended that you purchase a shovel with the correct length handle.  Try out your shovel in the store if the handle is too long you will find that you need to flex your back too far for comfort.

Technique

And, yes, snow shoveling is exercise!  So just as before any physical exercise you should warm up your muscles.  Stretch and loosen up before you tackle that driveway.  You can warm up your muscles by performing some jumping jacks and high knees exercises.  When possible, try to push the snow rather than lifting and hurling it.  When you do need to lift take small amounts and walk to wear you can dump it. Avoid twisting and hurling.  The American Academy of Orthopedic Surgeons recommends: “If you must lift the snow, lift it properly.  Squat with your legs apart, knees bent and back straight.  Lift with your legs.  Do not bend at the waist.”  Take your time, take breaks when necessary.  Remember, the snow will wait for you!

Let’s hope our mild winter continues but if a storm strikes keep these tips in mind for snow shoveling safety.  And, remember spring is just around the corner!

Sources:

Snow Shoveling Techniques to Prevent Low Back Injuries. Retrieved January 18, 2017 from http://www.spine-health.com/wellness/ergonomics/snow-shoveling-techniques-prevent-low-back-injuries

In the Bleak Mid-winter: 10 Tips for Safe Snow Shoveling. Retrieved January 20, 2017 from http://www.coloradospineinstitute.com/subject.php?pn=wellness-snow-shoveling

Prevent Snow Shoveling and Snowblowing Injuries. Retrieved January 18, 2017 from http://orthoinfo.aaos.org/topic.cfm?topic=a00060

Oddly enough, Jane Fonda actually came out and apologized for the “No pain, no gain” mantra that we all spent 80’s and 90’s reciting while cranking out some Richard Simmons aerobics. Not that there is anything wrong with Richard or Jane, they both have helped millions of people move towards a healthier lifestyle. That being said, it is time to use what we know about the science of exercise to clear the air regarding exercise intensity and its relevance with weight loss.

First things first, there are three fuels for exercise; fats, carbohydrates, and proteins. For time sake, let’s ignore protein, as it is only a primary fuel source used for aerobic exercise when an individual is fasted for a long period of time. Simply put, at lower intensities, primarily fat is burned as fuel. Low intensity being defined a rate at which you can comfortably converse with an exercise partner. As the intensity of the exercise increases (i.e, speed or grade of treadmill), the body shifts the preferred substrate from fats to carbohydrates. The term for when this switch from fats to carbs occurs is known as the Anaerobic Threshold. The carbohydrates used for fuel at this higher intensity initially come from blood glucose, which accumulates from the food we eat. As exercise continues, this blood glucose is maintained first by glucose stored in liver (glycogen), and when those stores deplete, stores of glucose in the muscle keep the blood replenished with glucose.  To summarize, low intensity exercise equates to fat burn whereas high intensity results in carbohydrate utilization.

Now that we understand the nuts and bolts of metabolism during exercise, let’s discuss the proper intensity for weight loss. For starters, weight loss is achieved primarily by expending more calories than we consume on a consistent basis. However, similar to nutrition, it is important to identify the TYPE of calories an individual is expending during exercise. According to the findings of Connolly (2015), exercising below anaerobic threshold (lower intensity, higher fat burn) is more productive for weight loss than a higher intensity, even though more calories are burned at this higher intensity. Connolly (2015) provides the following both physiological and practical justifications for such a statement: Lower intensity allows the body oxidate lipids more effectively (burn fat); lower intensity exercise results in less fatigue and the increased likelihood an individual would exercise longer and burn more calories; finally, lower intensity exercise is better for cardiovascular adaptations, which in turn helps patients breakdown and mobilize fat more for fuel during rest and recovery.  

So what does all this great information mean for the average person trying to lose weight? Turn down the intensity, increase the duration, and find an activity that you actually ENJOY doing. Although fat burn activity burns less calories in the short term, there is not only a physiological benefit of mobilizing and expending more fat calories at rest, there is the benefit that you will actually KEEP exercising. Remember, the most important exercise plan isn’t the one that works, it’s the one that you keep doing. Even if it works, that doesn’t mean you will keep doing it. Tune in next week for Revolution’s Lead Dietitian Claire Allen’s take on the power of seeds and sustainable weight loss.

Sources:

Connolly, D. A. (2015). Slow Down to Speed Up: Using Intensity Threshold Indicators to Optimize Lipid Utilization during Exercise. Journal of Diabetes & Metabolism, 2015.

http://www.omicsonline.org/open-access/slow-down-to-speed-up-using-intensity-threshold-indicators-to-optimizelipid-utilization-during-exercise-2155-6156-1000532.php?aid=53129

During the course of my time treating patients at Revolution Physical Therapy Weight Loss, I have encountered several who have been given the diagnosis of osteoarthritis, most commonly in the knees.  Depending on the extent of the knee pain, it may limit a patient’s mobility and quality of life.  So what does this mean for exercise, especially with regards to the weight loss program?  In order to answer that question it would be helpful to examine the aspects of the diagnosis and prognosis of osteoarthritis related knee pain.

What: The Knee Joint

Synovial joints such at the knee and shoulder are important parts of the musculoskeletal system at which point two bones articulate (come into contact) with one another. The ends of these bones are lined with hyaline articular cartilage, which creates a smooth surface for load transfer during motion (Ateshian & Mow, 2005). The main function of cartilage at joints is to distribute the load equally across the surface of the bones and decrease friction during motion (Eckstein et al, 2006).  This allows us to perform many activities uninhibited: walking, running, jumping, climbing stairs, etc. In the presence of osteoarthritis, patients are more aware of their knees than previously, however this does not mean they are doomed.

How: The Process of Osteoarthritis

First of all, it is important to recognize the diagnostic process. Osteoarthritis is typically diagnosed with radiograph (x-ray), the results of which are not necessarily indicative of damage (Hunter & Eckstein, 2009). Imaging provides physicians and the medical community with information regarding the state of your joints, but is not the sole factor in diagnosis. It is important to remember that an image is a static snapshot of an area of your body, but does not necessarily indicate factors at play while your body is in motion.

In cases of osteoarthritis, synovial joints undergo structural and functional failure due to loss/erosion of cartilage, bony alterations, and meniscal degeneration (Nuki, 1999). This means that there are several physiological alterations that occur within the joint that may cause pain. Osteoarthritis is a result of excessive mechanical stress specifically in the context of systemic susceptibility, which is related to genetic factors, age, ethnicity, diet and female gender (Hunter & Eckstein, 2009). Therefore, not only does an individual have to undergo the process of joint changes, but one must also be susceptible to this process. A concept similar to that of predisposing factors associated with other disease processes.

Factors such as abnormal joint mechanics, muscle weakness, and structural changes at the joint itself can increase the potential for osteoarthritic progression and can be affected by joint loading (Hunter & Eckstein, 2009). The good news is that muscle weakness and abnormal joint mechanics are not permanent and can be improved over time with physical therapy and exercise. Resistance exercises increase muscle strength over time, which in turn gives greater support to the joints. Abnormal joint motion can be altered by feedback from a physical therapist or simple changes in squat form to execute a basic sit to stand motion.

Joint loading can occur through joint injury (acute or repetitive overuse) or increased weight gain related to obesity. For example, during walking body weight is transferred to the knees, and each additional kilogram of body mass increases the compressive load over the knee by about 4 kilograms, or about 8.8 pounds (Messier at el 2005). If you do the math, a weight gain of 20-30 pounds over the course of a year increases the compressive force through the knees by about 80-100 pounds. Weight gain can also be modified with proper exercise, nutrition and motivation, as seen in a well-rounded program offered at Revolution.

Why: Just Keep Moving!

Although there is an increasing awareness of the importance of exercise within the general population, the majority of individuals also believe that exercise is additionally damaging to one’s joints, especially in the lower extremities (Hunter & Eckstein, 2009). It is a common misconception regarding lower body joint pain and mobility. However, there is no strong evidence to suggest that vigorous low-impact exercise is associated with an accelerated rate of development of osteoarthritis (Hunter & Eckstein, 2009). In fact there are benefits from low-impact exercise (such as cycling and aquatic exercise) in comparison to high-impact (running, jumping) exercise. It allows patients to maintain cardiovascular health, increase joint mobility and stay healthy, while avoiding the potentially damaging effects of high-impact exercise (Hunter & Eckstein, 2009).

Individuals with osteoarthritis are likely to experience a sensation of joint stiffness, especially in the morning and after prolonged sitting. This is because the joints have been still for a long amount of time. It is important to keep moving and be aware that gentle walking is not going to cause any additional damage. In fact, not moving can have deleterious effects just as much as high-impact activity. Research has shown that cartilage undergoes a process of atrophy (thinning) in the absence of mechanical stimulation, such that there is a decrease in cartilage volume or thickness with reduced weight bearing (Eckstein et al, 2006). This means that without consistent activity, the cartilage that allows for that smooth motion at the joints may depreciate.

The joints of the body are constructed in such a way to manage increased mechanical loads over lifetimes without deteriorating (Ateshian & Mow, 2005). We are built to last and withstand lots of motion. Motion is lotion and it helps to lubricate our joints in order to be able to keep moving. A diagnosis of osteoarthritis is not a moratorium on your lifestyle and activity. Proper education regarding exercise and a strengthening program supervised by a physical therapist or licensed clinician can set you up for success with your weight loss program or your general return to activity.  

1. Ateshian G, Mow VC (2005) Friction, lubrication, and wear of articular cartilage and diarthrodial joints. In Basic Orthopaedic Biomechanics and Mechanobiology, 3rd ed (ed Mow VC, Huskes R), pp. 447-494). Philadelphia: Lippincott, Williams & Wilkins.

2. Eckstein F, Hudelmaier M, Putz R (2006) The effected of exercise on human articular cartilage. Journal of Anatomy, 208, 491-512.

3. Hunter D, Eckstein F (2009) Exercise and osteoarthritis. Journal of Anatomy, 214, 197-207.

4. Nuki G (1999) Osteoarthritis: a problem of joint failure. Z Rheum 58, 142-147.

Obesity, defined as having excessive amounts of adipose, or fat tissue, is classified as a chronic disease that affects more than one-third of the American population according to the Centers for Disease Control and Prevention (CDC). This disease is also a common comorbidity in adults with prevalent health conditions such as diabetes and heart disease. However, many people do not consider how one’s weight can affect weight-bearing joints, such as the hips, knees and ankles.

An increase in body weight caused by excessive adipose tissue can increase the load placed on weight-bearing joints when completing daily activities, as well as physical exercise. For every one pound of additional weight, about four pounds of additional pressure are exerted on those joints. For example, an individual who weighs 200 pounds would be placing approximately 800 lbs pounds of pressure on their knees when walking. In combination with weak musculature around the joints, these additional forces can lead to discomfort and the possibility of additional damage on the joints,

Eventually, damage can result in Osteoarthritis (OA), or the breaking down of cartilage within the joint. As cartilage is lost, additional friction between adjacent/articular bones occur. This can lead to knee pain with daily activities including transitioning from a seated to standing position, as well as walking, especially when added forces such as body weight are factored in. Even though OA is present in individuals who maintain a healthy weight for their height, studies have shown there is an increased risk of developing OA in individuals categorized as overweight or obese. However, studies have also indicated that weight reduction in obese individuals diagnosed with OA can lead to a significant decrease in pain and improvement in daily function.

Sources: 

Astrup A., Bliddal H.,Christensen R., (2004). Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis and Cartilage, vol. 13, pp 20-27.

Centers for Disease Control and Prevention. June 16, 2016. Overweight & Obesity. Retrieved fromhttp://www.cdc.gov/obesity/data/adult.html

Davis, C., DeVita, P., Gutekunst, D.J., Messier, S.P. (2005). Weight Loss Reduces Knee-Joint Loads in Overweight and Obese Adults With Knee Osteoarthritis. Arthiritis & Rheumatism, vol. 52, pp 2026-2032.

Kane, A.  How Fat Affects Arthritis. Being overweight can make arthritis, gout, lupus, fibromyalgia and other joint diseases and conditions worse. Retrieved from

http://www.arthritis.org/living-with-arthritis/comorbidities/obesity-arthritis/fat-and-arthritis.php

1. Know how much exercise you are getting

Work out for at least 150 minutes (2 1/2 hours) per week when completing moderate exercise (eg brisk walking/light jog) or 75 minutes (1 hour 15 minutes) of vigorous activity (eg running).  This is the amount of exercise recommended by the American Heart Association to improve health.   Exercise is a great way to reduce your chance of heart disease and stroke. Heart disease is the leading cause of death in the United States, and stroke is the fifth leading cause of death.  Increasing your physical activity can decrease high blood pressure, reduce high cholesterol, decrease high blood sugar and increase oxygen efficiency. If your goal is weight loss you will need more exercise.  The American College of Sports Medicine recommends 200 – 300 minutes of moderate exercise for weight loss.  Whatever your goal, just get moving. At Revolution we use polar watches to track your heart rate, and your activity, which helps keep you on track.

2. Have a workout partner

The Department of Kinesiology at Indiana University found that couples who worked out separately had a 43% dropout rate, while those who went to the gym together had only a 6.3% dropout rate. Whether your workout partner is a friend, or a professional, like a physical therapist or exercise physiologist, you are much more likely to stick with your program in a pair than going at it solo.  At Revolution you will always see either a physical therapist or exercise physiologist each exercise session.  We hold you accountable, increase your safety, add variety to your work out and make the experience more fun.

3. Work out 4-5 days per week

Consistency is important. Making exercising part of your routine will help you maintain a healthy lifestyle.  If you only work out when it is convenient, exercising will not become a habit.  Most likely you will soon find yourself back on the couch binge watching your favorite show.  Exercising 4-5 days per week will keep you on a schedule and keep you off that couch!

4. Include cardiovascular and strength training

Improving your aerobic capacity and muscle strengthening are both important to overall health.  When completing cardiovascular exercise you are using an aerobic source of energy which will raise your heart rate.  This will help strengthen your heart and lungs.  When completing strength training you are using an anaerobic source of energy which will cause your body to burn more calories after the workout.  This is due to the recovery process the muscle undergoes when overloaded.  The overload process is what causes the muscle to become stronger.  Stronger muscles support your joints, help you to complete your activities of daily living with greater ease and allow you to have more energy.

5. Do something you enjoy!

The fact that you will be more likely to do something you enjoy is a no-brainer.  There are so many activities you can do for exercise, there is bound to be one you enjoy!  Enjoy nature?  Take a walk outside. Like group activities?  Join a sports team such as volleyball, basketball, soccer or softball. When we were kids we used to call these activities play; so find your inner kid and go outside (or inside) to play!

6. Set realistic goals

If your goal is to lose weight don’t make a goal of losing 10 pounds in a week.  If you goal is to build strength, don’t set a goal of bench pressing what you did in high school so you can look good for your 30 year reunion 2 weeks from now. When you put your body through extreme measures this is not only unhealthy, but also not sustainable.  Set realistic goals and progress these goals as your body adapts to your new regimen. At Revolution we have a goal of 1 -2 pound weight loss/ week. This has been proven to be healthy and sustainable. 

7. Create a plan that works for your lifestyle

An exercise plan is not a cookie cutter item that should be the same for everyone.  It is important to create a plan that works for your lifestyle, otherwise it will not be sustainable.  Plan a time to workout when it is best for you.  There is no right or wrong time to exercise; morning, afternoon or evening.  The best time is what fits into your life. At Revolution we have both morning and evening hours to accommodate your schedule. Exercise is a vital part of a healthy lifestyle. If exercise was a pill, it would be the most prescribed medicine in the world. The best time to start is now. At Revolution we would love to show you how to safely and effectively start exercising to a healthier you!

Before starting at Revolution, many patients arrive not knowing the exact cause of their irritability and constant lack of energy. As they start care, nutrition is improving and daily activity levels are progressing, but many excuses could be made as to why they cannot get over the “hump” with energy levels, even though they are losing weight and feeling stronger. Rather than trying to reinvent the wheel and focusing on hard numbers and data, sometimes problems can be identified from the most basic areas. One simple component is often missing in the journey with exercise and weight loss: adequate sleep. 

Sleep is vital for everything, but specifically let’s discuss its importance in your body’s performance during resistance exercise and more strenuous activities. It provides the energy and recovery needed for full mental and motor capacities. Although sleep loss may not limit measures of maximal power output during resistance training, the body will certainly tire more quickly and be prevented from the comprehensive health and fitness benefits of resistance and aerobic exercise (VanHelder & Radomski, 1989) as compared to someone with proper rest that can keep going.

Without enough time to recover and restore the body to its needed homeostasis, it continues to lack the proper level of hormones like testosterone (which “anabolically” builds and protects the muscles from excessive damage) and insulin growth factor (which appropriately breaks down blood glucose). Your body suffers as a result and is slowly broken down itself while gaining fat and losing muscle (Patel, 2009). Cortisol is a hormone directly related to sleep which allows the body to respond to stress; it assists in regulation of blood glucose and metabolism in the body (Haff and Triplett, 2016), similarly to adiponectin which is also correlated to sleep in relationship to loss of body fat (Sawamoto et al., 2016). Have you heard of REM sleep? This is the deepest and most important cycle of your nightly sleep for recovery, often lacking in individuals with lowered hormone levels.

This goes beyond your physiology related to exercise. Appetite can also be affected as feelings of fullness, and conversely, hunger cues, can be impacted with lack of sleep (Taheri et al., 2004) to further complicate progress toward weight loss goals. Make no mistake, plenty of research is out there in support of sleep for fat loss and weight loss: One study showed that people who slept 8 hours per night as compared to those with a measly 5 hours, even with the same weight loss goals in their exercise programs, demonstrated 55% greater fat loss and 60% greater preservation of muscle (Patel, 2009). These examples are numerous in the literature, but let’s greatly simplify the subject.

Resources:

Haff, G., & Triplett, N.T. (2016). Essentials of Strength Training and Conditioning. (4th ed). Human Kinetics: Champaign, IL.

Patel, S.R. (2009). Reduced sleep as an obesity risk factor. Obes Rev. 10 Suppl 2:61-8.

Sawamoto, R., Nozaki, T., Furukawa, T., Tanahashi, T., Morita, C., Hata, T., … Sudo, N. (2016). A change in objective sleep duration is associated with a change in the serum adiponectin level of women with overweight or obesity undergoing weight loss intervention. Obes Sci Pract. 2(2):180-8. Epub 2016 Mar 14.