WDDTY

WHAT DOCTORS DON’T TELL YOU

Your
Exercise Plan
Contents
2 Burning fat or keeping fit
4 Easy, and different, does it
5 The one-hour rule
6 Your aerobic fitness plan
7 Keeping your knees fit for life
9 Skiing safely
10 On the rebound
11 Walking towards fitness
12 Perfect timing, perfect workouts
13 A movement to fight cancer
14 Stretching: as good as they say?
15 Sound body, sound mind
16 Tai Chi: balancing your energy
17 Getting to the core
18 Step up to better balance
19 Good vibrations for more muscle
20 Training Jane, not Tarzan
22 Beating back pain

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Exercise
Burning fat or keeping fit?
We’ve all seen them: men and women religiously pounding away on
the treadmill, day after day, at our local gym, but never losing a single
ounce. We’ve all been imbued with the notion that regular exercise will
keep us trim.
WDDTY begins a special series on exercise: what does what for you,
and which is best for maintaining health and losing weight.
B
oth the UK and US
governments have stated
that at least 30 minutes of
moderately intense
physical activity five times a week
will maintain general health and
reduce the risk of chronic disease.
Other official reports argue that 30
minutes is not enough, and still
others, such as the British Medical
Journal, claim that just walking for
30 to 60 minutes a week is
beneficial.
Needless to say, these
instructions leave many of us still
wondering how much, doing what
and for what?
Whether aerobic exercise is
good for you depends on its
frequency, duration and intensity.
The benefits can range from
general health improvement and
disease prevention to cardio-
vascular fitness and weight loss.
But, if you want to lose weight
or be ‘heart-healthy’ through
aerobic exercise alone, it will
require far more work than the
officials tell you.
Weight control
Although most people believe that
regular exercise helps weight loss,
the truth is that basic regular
aerobic exercise, as suggested by
the government, may only prevent
weight gain.
In a Duke University trial
involving 175 overweight
volunteers, walking 11 miles a
week prevented significant fat
accumulation.
Indeed, 30 minutes or more of a
moderate-intensity activity on all
or most days of the week can
prevent weight gain.
However, losing weight requires
working harder. In this study, a
2 WDDTY Exercise
modest increase in exercise
resulted in a significant decrease
in body fat (J Appl Physiol, 2005; 99:
1613–8), but others find that you
have to work up far more of
a sweat to work off excess
poundage.
In 2002, the US Institute of calories. One calorie is the amount
Medicine recommended that to of heat needed to raise the
control weight required moderate temperature of one kilogram of
exercise for 60 minutes a day on water by one degree Celsius. One
most days—and the UK agrees. pound of fat equals about 3500
Then, the 2005 dietary guidelines calories, which takes quite a while
from the US Department to burn off, especially as the
of Health and Human Services and average aerobic session burns just
Department of Agriculture told us 152 calories (see box below). If
that losing weight requires 60 to this amount seems surprisingly
90 minutes of moderate exercise low, it’s probably because you’re
daily. used to the digital readouts on
Both food and exercise are exercise machines that may be
usually examined in terms of using conversion factors that
Why exercise doesn’t shift pounds
To determine your average daily caloric expenditure, first determine your unique
resting metabolic rate (RMR)—the amount of calories you burn at rest. Use the
following formulas:
! Men: 66.473 + [13.751 x (body weight in kg)] +
[5.0033 x (height in cm)] - [6.755 x (age in years)]
! Women: 655.0955 + [9.463 x (body weight in kg)] +
[1.8496 x (height in cm)] - [4.6756 x (age in years)]
To find out how many calories you burn per minute, divide your RMR by the
number of minutes in a day (1440). If your RMR is 1100, divide 1100 by 1440,
which means you burn 0.76 calories per minute at rest and at each metabolic
equivalent (MET) level.
Let's say you do an aerobics exercise class for 50 minutes, which generally
has a MET level of 6. You would then calculate 50 (minutes) x 6 (METS) x 0.76
(calories per minute) and—voilà!—you’ve burned 228 calories doing that class.
But remember: you’re always substituting one activity for another—at the very
least, your resting MET or, more likely, another activity such as sitting at your
desk working or fixing dinner. If you then subtract 2 (fixing dinner) from 6
(aerobics), you get a MET level of 4.
So, to determine the true number of calories burned per minute, you must
plug 4 METS into your calculations, not 6. In this case, you find that you only
burned 152 calories (instead of 228). A standard calorie counter will only show
what you’ve burned in total, not what you’ve burned more than normal.
overestimate caloric expenditure
(Phys Sportsmed, 2003; 31 [3]: e-pub).
So, exactly how hard do we have
to work to lose those love handles?
What the evidence says
The body uses different fuel for
different exercise intensities,
producing more carbon dioxide
when burning carbs compared with
fat. Burning fat is highest during
lower-intensity exercise and, as the
intensity increases, the body starts
breaking down carbs ( Dietary
References for Intakes for Energy,
Carbohydrates, Fiber, Fat, Protein and Amino
Acids [Macro-nutrients]. Institute of Medicine,
2002).
This doesn’t mean that low-
intensity exercise is better in
general, just that we can get away
with it and still shed pounds.
A retrospective analysis of the
US-based National Weight Control
Registr y found that long-term
weight loss can be successfully
maintained by an average energy
expenditure of 2800 kcal/week (Am
J Clin Nutr, 2003; 78: 669–70).
Another study compared two
different exercise regimes: one
burning 1000 kcal/week, the
other, 2500 kcal/week. The
subjects were all overweight and
on calorie-controlled diets. It took
12 months, but the higher-calorie
group eventually showed
significantly greater weight loss
(Am J Clin Nutr, 2003;78: 684–9).
One way to steadily lose weight
through aerobic exercise is to
engage in frequent bouts of low-to-
moderate exercise such as
continuous cycling, walking or
swimming. Not only will
you lose weight—and keep it off—
but you’ll also increase your levels
of ‘good’ (HDL) cholesterol
(Circulation, 1995; 91: 2596–604).
Scientists refer to calories
burned during exercise as METS,
or metabolic equivalents—the
amount of heat produced by the
body during exercise. Thus,
exercise levels are measured in
METS, with 1 MET used during
sitting and resting and, say, 8
METS if you are jogging. According
to the MET system, you need to do
around an hour of a
6 or 7 MET activity (such as hill-
climbing or skiing) every day to
lose weight. If you’re new to
exercise, expending this many
calories will require a lengthy
workout, so a more workable
strategy may be to split it into
several 20-minute sessions every
day.
However, weight loss involves
more variables than calories
expended such as metabolic type,
sugar-burning efficiency and
exposure to allergies, which can
cause bloating and weight gain.
Unless you’re prepared to spend 60
to 90 minutes a day on it, exercise
may be better viewed as a way to
increase your overall health—but
not the easiest way to lose weight.
Kim Wallace and Tina Tan
WDDTY Exercise 3
Exercise
Easy, and different, does it
W
hat aerobic exercise is with a substantial decrease in your risk
good for depends on the of chronic disease—or even death. As
frequency, duration and a spokesperson from The Cooper Insti-
intensity of the activity tute succinctly put it: “[This recom-
you do. You can gain different mendation] is all about good old-
benefits from aerobic exercise, fashioned health maintenance. It’s
ranging from general health about having a heart attack or no heart
improvement and disease prevention attack, alive or dead.”
to cardiovascular fitness and weight Moderate activity means that the
loss. exercise is non-competitive, builds
The bottom line: If you want to gradually and can be sustained for a
achieve weight loss or serious heart prolonged period of time with no
health through aerobic exercise alone, discomfort. A more specific way to part of your daily routine. Another
it will require more work than the measure the intensity of an exercise is secret for success is to keep changing
official recommendations tell you. to grade each activity in MET units, your activity so that your body doesn’t
There are three rungs to healthy where 1 MET is the amount of energy adapt to the exercise. You don’t have
activity, each demanding more sustain- burned while sitting quietly at rest to do structured exercises in the gym—
ed activity: maintaining your health; (equal to 1.2 kcal/kg/hour). ordinary day-to-day activities such as
losing weight; and achieving true However, it appears that exercise housework or gardening can be equally
cardiovascular fitness. duration is more important than its effective.
intensity. In a study of 133 overweight
Health maintenance sedentary men and women, those who Short bursts
For the first rung, maintaining health walked briskly for 12 miles each week The duration of your chosen moder-
and preventing illness, follow the (or for about 125–200 minutes a week) ately intense activity can also be
government’s minimum advice. If you showed significant improvement in broken up into three 10-minute—or
are sedentary, this means 30 minutes aerobic fitness as well as a lowered risk two 15-minute—sessions, to the same
a day of moderately intense exercise to of heart disease. More important, they effect. Trials have shown that shorter,
change key metabolic factors such as showed similar signs of fitness as those cumulative bouts of walking are as
your body-fat distribution and insulin who jogged 12 miles every week (Chest, effective as one long bout for
sensitivity (Arch Intern Med, 2004; 164: 31–9; 2005; 128: 2788–93). increasing aerobic power, improving
N Engl J Med, 1991; 325: 147–52). The key is to get up and get moving, body composition, reducing cardio-
This level of workout is associated and to make doing so a regular priority, vascular risk and raising your mood
(Scand J Med Sci Sports, 2002; 12: 99–105).
However, for some people, the
Preventing disease lowest rung of physical activity won’t
be enough. In a study of 742 out-of-
It’s common knowledge that aerobic exercise is good for your heart, but did
shape people who underwent a 20-
you know that it can prevent other chronic diseases as well? Being physically
week stationary-bicycle endurance-
active on a regular basis reduces your chances of falling victim to common,
training programme, some people
niggling ailments. One study found that employees who took no exercise had
simply did not respond. During the
more days of illness-related absenteeism compared with those who were
final six weeks, the subjects exercised
physically active (J Occup Environ Med, 2001; 43: 1019–25).
for 50 minutes three times a week at
The most basic daily exercise can add a few years to your life expectancy
75 per cent of the maximum output
and reduce your risk of a raft of diseases, including:
they could sustain before the study.
! Type 2 diabetes: people who exercise cut their risk of developing this form
Although training improved oxygen
of diabetes by up to half (JAMA, 1992; 268: 63–7)
consumption, some subjects showed
! Cancer: those averse to regular exercise are more susceptible to certain
no improvement at all.
types of cancer, including of the colon, breast, uterus, prostate and testicles
Similar results were seen for cardiac
(Crit Rev Oncog, 1997; 8: 219–72)
output, blood pressure, heart rate and
! Coronary heart disease (CHD): sedentary people almost double their risk
insulin sensitivity, suggesting that
of dying from CHD compared with more active people (Am J Epidemiol, 1990;
exercise alone doesn’t offer health
132: 612–28)
benefits without dietary changes as
! Stroke: Active or fit people have a 27-per-cent lower risk of stroke or death
well (New Scientist, 2004; 4 December).
compared with those who are sedentary or unfit (Stroke, 2003; 34: 2475–81).
Kim Wallace and Tina Tan

4 WDDTY Exercise
The one-hour rule
In our earlier reports, we covered how to achieve basic fitness and
weight loss. For full aerobic fitness, however, you need to exercise for
at least an hour.

T
he final rung of aerobic exercise, however, you have to slowly
conditioning is an overall work up to it.
improve-ment in fitness and This requires a commitment above
endurance. To arrive at a and beyond the recommendation of
peak level of cardiorespiratory 30 minutes every day of moderate
fitness, training intensity should exercise that you hear from both successful in treating depression.
remain between 50 and 80 per cent the UK and US governments. Mostly, Substantial research has found
of your aerobic capacity. Gradually, it means a commitment to keep exercise to be as effective in helping
you should aim to increase your moving, whenever you can. clinically depressed people as
training to one hour, five days a Besides preventing diabetes, psychotherapy and drugs (J Sport Exerc
week. This should include higher- cancer, coronary heart disease and Psychol, 1998; 20: 339–57, Arch Intern Med,
intensity exercise—activities that stroke, musculoskeletal health, of 1999; 159: 2349–56).
burn more than 6 METs (metabolic course, will also benefit from regular, Being physically active doesn’t
equivalents; see WDDTY vol 18 no 4), intense physical activity. The have to take place only in the gym.
or any activity that uses up strength of your bones and joints— Several energetic bouts of housework
more than 7 kcal/min—that leaves and the risk of developing musculo- or gardening could confer the same
you short of breath. Alternating be- skeletal problems such as osteo- benefits as an aerobics class or a
tween high-impact (running, tennis, porosis and osteoarthritis—will all circuit-training session.
dance) and low-impact (cycling, depend on the levels of physical This was clearly demonstrated in
swimming, rowing) exercise offers a activity during the critical developing two large randomized trials that
variety of movement and protects years. Sustaining physical activity in compared the effects of a lifestyle-
against injury. young children until they reach their activity programme with those of
Interval training, or alternating mid-20s will maximize peak bone structured aerobic exercise on
between high-intensity and low- mass (J Bone Miner Res, 1994; 9: 1089–96). weight loss and fitness levels. The
intensity activities, can be used to Nevertheless, for adults—and even lifestyle group was encouraged to
increase maximum oxygen intake for women after the menopause— introduce activity into their daily
and improve endurance performance. regular exercise will slow down the routine (mall-walking was one
In one study, a four-week high- rate of bone loss and may even lead example) so as to accumulate a total
intensity interval-training prog- to bone gain (J Gerontol A Biol Sci Med of 30 minutes of moderate-intensity
ramme increased the peak sustained Sci, 2000; 55: M489–91). activity every day, for most days of
power output and fatigue resistance the week. The other group of study
of eight competitive cyclists, Psychological wellbeing participants followed a traditional
improving their 40-km time-trial Physical activity has also been shown exercise programme that included,
performances (Med Sci Sports Exerc, to be beneficial in alleviating the for example, three step aerobic
1996; 28: 1427–34). symptoms of various mental classes each week.
To be able to do an hour a day of illnesses, and is particularly The results from both studies were
in agreement, and concluded that
Keep moving both the lifestyle and structured
activities produced significant and
! Walk or cycle to work instead of driving comparable benefits in terms of
! If you have to drive, park your car further away from your destination and physical fitness, and cholesterol,
walk the remaining distance mean body fat and blood pressure
! If you use public transport, jog or walk briskly to the station or bus stop levels (JAMA, 1999; 28: 327–334; 335–340).
! Get off the bus or train a few stops earlier and walk the rest of the way So, the main objective is to keep
! Take the stairs instead of the lift or escalator moving in a way that leaves you
! Carry your shopping around in a basket instead of pushing it in a trolley slightly out of breath for at least an
! Engage in more active pastimes such as dancing, swimming and rambling hour every day.
! Mow your lawn with a push lawnmower rather than an electric one Kim Wallace and Tina Tan
Next month: an exercise programme
! Wash your car by hand rather than running it through an automatic carwash.
for all ages

WDDTY Exercise 5
Exercise
Your aerobic fitness plan
T
he first step in creating Running
an aerobic exercise
programme is to deter- Week Distance Time Frequency/
mine the activity that suits (miles) (min : sec) week
you best. Choose an activity
(walking, cycling, running or 1 1.0 18:00 5
swimming) and stick with it for a 2 1.0 16:00 5
month and see if you have reached 3 1.0 15:00 5
your goal in terms of distance, Goal 1.0 14:00 5
time and frequency per week. Add 1 min if you are 50 or over, and Cycling
Structure your exercise in a way subtract 30 sec if you are 30–39 (e.g., if
that allows you to gradually build you are 38, your goal is to run 1 mile in Week Distance Time Frequency/
up to that goal. 13:30). If you are under 30, your goal for (miles) (min : sec) week
Before deciding on your activity, the first week should be 13:30, eventually
determine your current level of fitness. working your way down to your monthly 1 3.0 or 6.0 11:30 or 23:45 2 or 3
If you haven’t been exercising (you goal of 11:45. 2 5.0 or 6.0 19:00 or 23:15 3 or 2
know who you are!) and are relatively 3 6.0 23:00 5
out of shape, you’re a beginner, so start Swimming (front crawl) Goal 8.0 31:30 5
slowly. Don’t strain yourself in the first Goal (under 30): 8.0 miles in 28:30
month. Week Distance Time Frequency/ Goal (30–39): 8.0 miles in 29:30
The following guidelines are for (miles) (min : sec) week Goal (50 or over): 12.0 miles in 65:00
people aged 40 to 49 years.
1 92 2:30 5 Running
BEGINNERS 2 137 3:15 5
3 160 4:00 5 Week Distance Time Frequency/
Walking Goal 183 4:30 5 (miles) (min : sec) week
Add 15 seconds to the goal if you are
Week Distance Time Frequency/ 50 or over, but subtract 30 sec if you are 1 1.5 18:30 5
(miles) (min : sec) week 30–39. If under 30, aim to swim for a bit 2 1.0 or 1.5 10:45 or 16:30 3 or 2
longer—and a bit further—by the end of 3 1.5 or 2.0 14:15 or 20:30 3 or 2
1 1.0 18:00 5 the month (say, 229 metres in 5 min). Goal 1.0 or 1.5 8:30 or 13:25 1 or 2 or 2
2 1.0 16:00 5 or 2.0 or 19:30
3 1.5 24:00 5 ADVANCED Add about 1 min if you are 50 or over, and
Goal 1.5 22:00 5 subtract 1 min if you are 30–39. If you are
Subtract 30 sec for every decade you If you’ve been exercising regularly, under 30, subtract 1:30 from each 1-mile
are under 40, and add 1 min if you are are in fairly good shape and want to time, 1:45 for each 1.5-mile time and 2:00
50 or over (e.g., if you are 57, your goal remain that way, you’re an advanced from each 2-mile time.
is 1.5 miles in 23 min). exerciser. If the programme is too
easy for you, then you’re already Swimming (front crawl)
Cycling doing just fine on your own.
Week Distance Time Frequency/
Week Distance Time Frequency/ Walking (miles) (min : sec) week
(miles) (min : sec) week
Week Distance Time Frequency/ 1 366 or 457 8:30 or 10:45 2 or 3
1 2.0 11:00 5 (miles) (min : sec) week 2 457 or 640 11:00 or 15:30 3 or 2
2 2.0 10:00 5 3 640 15:00 5
3 3.0 15:00 5 1 2.5 or 3.0 35:30 or 43:45 4 or 1 Goal 732 16:30 5
Goal 3.0 14:00 5 2 2.5 or 3.0 34:45 or 42:45 3 or 2 If you are 50 or more, add 1:30 to the
Subtract 1 min from the goal for every 3 3.0 42:45 5 goal and arrange your workouts accord-
decade under 40, and add 2 min if you Goal 4.0 56:00 5 ingly. If you are under 40, your goal is to
are 50 or over (e.g., if you are 25, your Add 1 min if you are 50 or over, and swim 914 metres. Those under 30 should
monthly goal is to cycle 3 miles in 12 subtract 30 sec for each decade you are aim to do this within 19:30, and those
min), so structure your other workouts younger (e.g., if you are 33, your goal is 30–39 should aim for 20:30.
accordingly. to walk 4 miles in 43:30). Kim Wallace

6 WDDTY Exercise
Keeping your knees fit for life
We’ve all been indoctrinated with the idea that jogging or running is
good for the heart, lungs and bones. But what is the long-term effect
on our joints?

A
s the first generation of
wholesale distance runners,
we are, in effect, a gigantic
experiment. The benefits of
jogging on the cardiovascular system
are indisputable, but what we don’t
yet know is the long-term effect on
our skeleton, particularly the joints.
There’s now evidence linking osteo-
arthritis and permanent knee injury
with regular distance running.
This raises a fundamental and
disturbing question: are we as humans
meant to run for miles on end every
day? And are men and women so
anatomically different that what’s good
for one may not be good for the other,
without special training?
The most common concern centres
on the question of whether jogging or
regular running causes osteoarthritis
in the knees. This very question was
recently put to the residents of
Framingham, in Massachusetts, where
Harvard researchers have been follow-
ing two generations of its inhabitants,
carrying out health studies of every
description.
In a 12-year study, the researchers
wished to determine whether long-
term weight-bearing exercise had any
influence on either the development
or prevention of osteoarthritis of the
knee. In 1993–4, they asked a cohort
of nearly 1300 members of the Fram-
ingham Offspring cohort about their
exercise habits, evaluated their knee
pain and studied their knees using
x-rays. All patients with any evidence
of osteoarthritis were excluded.
Nine years later, the participants
were reexamined for any evidence of
osteoarthritis, or knee joint-space
loss. After controlling for a variety
of factors, the researchers concluded
that exercise neither prevented nor
caused knee osteoarthritis.
The risk of osteoarthritis was
virtually null among the most vigorous
exercisers—those who walked six or
more miles per week or engaged in an
activity that worked up a sweat three
or more times a week. The only risk
factor in developing osteoarthritis was
being overweight—whether in a jog-
ger or not. Nevertheless, the cohort
consisted mostly of walkers, rather
than runners, so the researchers
couldn’t specify that running would came to similar conclusions (J Am
not cause osteoarthritis with certainty Med Assoc, 1986; 255: 1152–4).
(Arthritis Care Res, 2007; 57: 6–12). More recently, a Dutch review of
Nevertheless, a Danish study, which 37 studies also found no strong
examined the hips, knees and ankles evidence that regular exercise was
of 30 men who’d been serious com- associated with the progression of
petitive runners in the 1950s, found knee osteoarthritis (Arthritis Care Res,
no differences in joint alignment, 2007; 57: 13–26).
range of motion, complaints of pain, Yet another study examining the
cartilage thickness, grade of degenera- insides of the knees of eight
tion or osteophytosis (development seasoned runners using magnetic
of bone spurs, or osteophytes, that resonance imaging (MRI) also
grow along the edges of bones) found no evidence of degenerative
between the 90 per cent who were disease (Am J Sports Med, 2004; 32:
still active runners of 40 years’ 55–9).
duration and those who’d given up
(Am J Sports Med, 1990; 18: 379–81). Arthritis risk in women
A further small-scale study While there seems to be little evidence
How to prevent knee injury
! Build up your hamstrings first. Scientists have found that, before training,
women have significantly different strengths between the hamstring (back
thigh) and quadriceps (front thigh) muscles. So, do squat jumps, ankle
jumps, and jump from one leg to the other.
! Do exercises that develop strong calf, thigh and ankle muscles, and
those around the knee. These will help to support your knees.
! Work in stretching and strengthening exercises before embarking on a
jogging programme. It’s vital that you are strong and supple when you
begin to run regularly. For strength training, focus on the hip abductor and
external rotator muscles.
! Incorporate agility exercises as well, including rapid directional
changes, which help to develop quick contractions of muscle pairs that will
increase reflex-response time and reduce surprise movements of the joints.
! Exercise on even, flat surfaces or soft surfaces like grass, and replace
your running shoes regularly, every three to six months, before they wear
out and their shock-absorbing capacity is gone.
! Work on keeping your centre of gravity slightly forward and stay on
your toes. If your foot is not aligned naturally, consider wearing inserts in
your shoes that maintain the correct alignment.
! Pay attention to odd cracking noises in your knees. If pain, swelling
or any changes develop, these could be the first signs of degenerative
disease.
! Consider altering your weekly exercise programme so that, besides
just running, you introduce other non-impact activities such as swimming,
walking or biking.

WDDTY Exercise 7
of a risk of arthritis in men, the same
doesn’t hold true for women. A study
of 81 elite British female athletes—
mostly runners—found that ex-athletes
had a greater risk of osteoarthritis in
the hips and knees than did non-
athletes, particularly where the knee
joins the upper leg bone, or femur
(Arthritis Rheum, 1996; 39: 988–95). The
researchers concluded that weight-
bearing sports activity in women is
associated with a two- to threefold
increased risk of osteoarthritis (espec-
ially the presence of osteophytes) in
the knees and hips.
However, there was one other
important factor: joint alignment.
One health risk for both genders is
injury to the ligaments that attach to
the knee. Evidence shows that distance
runners may risk laxity of the knee
due to loosening of the ligaments that
attach to and support the knee. A lax
knee is, in essence, a wobbly one that is
more prone to joint displacement (J
Electromyogr Kinesiol, 2004; 14: 475–83).
The primary ligaments involved are
the anterior and posterior cruciate
ligaments, two finger-sized pieces of
tissue that crisscross within the knee
joint, and support the joint as well as
allow it to rotate comfortably.
At present, the statistics for female
athletes is sobering. Women involved
in running and jumping sports are four
to eight times more likely to do their
knees in then men (Clin J Sport Med, 2004;
14: 281–6). In the US, women collegiate
athletes suffer some 10,000 knee
injuries a year.
Several theories propose that anat-
omy predisposes women to running
injuries: the wider pelvis exaggerates
the angle of the knee when running
and moving, and female hormones—
present in knee ligaments—cause them
to be naturally more stretchy than
those in men. Also, the lesser leg
strength of women and slower reaction
times increase the risk of injury. With
three times the hamstring strength of
women, men are built to stride faster.
The bony space in the femur through
which the anterior cruciate ligament
passes is also smaller in women than in
men, allowing for less range of motion.
Studies of women taking the Pill,
which suppresses menstruation and the
normal hormonal cycle, show that they
are less likely to develop knee injuries,
which suggests that hormones, which
make women naturally more flexible,
also make ligaments more prone to
8 WDDTY Exercise
Checking for knee laxity
! Have yourself tested with an arthometer. This device measures the
‘drawer’ movement of the lower leg bone against the thigh bone. If it can
move forward too much—called the ‘anterior drawer sign’—you are likely to
have a lax anterior cruciate ligaments.
! Test the range of motion of all of your major joints. This will help to
determine the looseness of all your ligaments; General laxity of joints in
women has been linked with a tendency to have ligament tears. Test whether
you can:
" touch your thumb to your forearm while your wrist is bent
" bend forward and touch your palms to the floor while keeping your knees
straight
" hyperextend your knee
" extend your elbow beyond the ordinary range.
A ‘yes’ to any of the above could indicate a greater tendency to suffer ligament-
related injuries (Orthopedics, 2005; 28: 656–60).
injury (Clin J Sport Med, 2004; 14: 281–6). One study of distance runners found
an 18-per-cent increase in laxity after
Exhausted muscles exercise, partly caused by a true perma-
Because ligaments have a high collagen nent stretching of the ligaments, and
content, making them highly elastic, partly by a decrease in the resting tone
exhausting the muscles through of the muscles (Br J Sports Med, 1989; 23:
exercise may stretch the ligaments— 165–8).
possibly permanently. What does running do to cartilage?
To test this possibility, researchers Some answers may lie in the research
devised a rigorous exercise protocol, conducted on beagles trained by a
then examined the flexion/extension special running programme to run
power of the leg muscles, and degree beyond their normal activity. After
of knee laxity using an arthrometer, some months, the researchers found
before and after exercise. Joint laxity that endurance-type running exercise
was found in both knees, although this caused a reduction in articulating
was significant only in the left knee, cartilage, which “indicates either a
and not on the right (Am J Sports Med, disorganization or a reorientation of
1986; 14: 30–4). . . . the collagen network” (Ann Rheum
Assuming that most of the study Dis, 1996; 55: 253–64). These results may
participants were right-handed, these not apply to humans, but they do raise
results suggest that joggers, both men obvious concerns. If dogs, which are
and women, run a greater risk of born to run, can have their collagen
developing laxity on their non-domin- affected by constant running, what
ant side. This has been borne out by does it do in people?
studies among soccer players, which As always, a middle course may be
showed that the knee on the non- the most sensible. For men,
dominant side is generally more prone osteoarthritis is not a worry, but
to laxity (Int J Sports Med, 2004; 25: 594–8). effects on the ligaments may be a
The risks of a loose ligament has possible concern. Ensure that you
nothing to do with weight-bearing. carry out some of
Research comparing the laxity of the the suggestions in the box (page 7)
knee among runners, basketball players before bursting into a run. To avoid
and weightlifters shows that power- exhausted muscles, think twice before
lifters who do frequent squats don’t put punishing them regularly beyond the
as much pressure on their ligaments minimum for cardiovascular training,
as basketball players and runners do, and consider doing a milder jog.
suggesting that it’s the constant flexion For women, long, punishing daily
and extension of the knee—without a jogs may be a case of a workout too
chance to relax and recover, such as far—unless you are prepared to
during constant running—that puts engage in special training to
greater stress on the knee (J Electromyogr strengthen the muscles supporting
Kinesiol, 2004; 14: 475–83; Am J Sports Med, the knee.
1986; 14: 24–9). Lynne McTaggart
Skiing safely
If you yearn for Christmas on the slopes, bring along a helmet.
T
here’s no doubt that skiing
is good for you. Downhill
(also called ‘alpine’) skiing
is a highly aerobic activity
(Clin Orthop Relat Res, 1987; March: 34–8),
and cross-country skiing is said to
be the most aerobically complete,
involving an intense workout of most
of the joints, tendons and muscles
of the upper, as well as the lower,
body (Sports Med, 1989; 8: 346–70).
A low-impact sport, cross-country
skiing is also a healthy option for
the 80 per cent of people who have
a bad back. Beyond that, you engage
with the outdoors and breathe in
clean mountain air surrounded by
breathtaking scenery.
Advances in equipment have
decreased injuries on the slopes
overall from the 1960s to 1990s,
from 7 injuries/1000 days of skiing
down to 2 injuries/1000 ski days,
where it’s remained ever since
(Sportverletz Sportschaden, 1994; 8: 73–82).
Most safety measures focus on
preventing injury to the extremities,
and may also be responsible for the
decreases in fractures, particularly
of the clavicle (collar bone), forearm
and hand; torn muscles; strained
ligaments; and dislocated shoulders
(Injury, 1996; 27: 423–35).
CNS injuries on the increase
In 1998, Sonny Bono died when he
collided with a tree while skiing near
Lake Tahoe. Later that year, Michael
Kennedy, one of Robert Kennedy’s
children, died in a similar accident.
These shocking deaths brought
home to many that the dangers of
skiing extend beyond broken legs.
Neurological injuries involving
the head or spine are the one type
of injury that is on the rise (Semin
Neurol, 2000; 20: 233–45). A study from
McGill University in Montreal found
that the rate of head and neck injury
in US and Canadian skiers is rapidly
increasing (Can J Public Health, 2003; 94:
558–62; Epidemiology, 2004; 15: 279–86).
Injuries to the head now comprise
3–15 per cent of all skiing and snow-
boarding injuries, with spinal injury
accounting for 1–13 per cent, and
peripheral nerve injuries, for a
further 1 per cent (Semin Neurol, 2000;
20: 233–45).
These types of injuries are more
common in Europe, where the
slopes are far more crowded. One reach speeds of 60–80 km per hour
study in Italy’s South Tyrol found an (Sports Med, 1989; 8: 346–70).
incidence 200 times that of the US, Men tend to outrank women for
with more than two neurological injuries. The Italian study also found
injuries for every 1000 skier days, that, besides men, the older skiers
and 1.6 deaths/1 million skier days and those unfamiliar with the slopes
(Inj Control Saf Promot, 2004; 11: 281–5). are more likely to get hurt. And most
The problem has to do with tech- fatalities are among skiers who aren’t
nology that enables skiers to wearing a helmet.
progress to higher skill levels and So, you may be better served by
faster speeds before they’re ready leaving your Prada ski hat at home
to. Special track machines, for and adopting a helmet instead.
instance, allow advanced skiers to Lynne McTaggart
Playing it safe on the slopes
! Train for at least four weeks beforehand. All forms of skiing require
muscle and aerobic capacity. The best training includes cross-country
equipment, stairmaster, aerobics or spin classes, swimming, hiking or
specialist ski training. Also work on upper- and lower-body exercises
that promote muscular fitness. Work on your knees (the patellofemoral
joints), in particular, and be sure to include exercises that strengthen
your core, back and shoulders.
! Warm up by stretching the hamstrings and quadriceps, lower back,
shoulders and neck for at least 10 minutes. Chiropractor and skiing
expert Terry Weyman recommends doing vertical and diagonal ‘hops’
with your ankles together, using a double arm swing as you leap—rather
like a small skiing jump. Land with a deep knee bend to absorb the
jump, and leap again in the air. Repeat several times on each side, and
then change to vertical jumps followed by side-to-side jumps.
! Don’t stint on equipment; use the latest multimode-release bindings
and modern midcalf boots. Ensure that your boots fit well. If your ski kit
has been sitting for any length of time, have it checked by a qualified
ski technician, who should ensure that it all works properly. Use poles
without a broad superior plate to avoid injury to the thumbs.
! Start below your level of competence. If you haven’t skied for a while,
take some ski-school lessons. Pack it in at the first sign of tiredness;
injuries peak during states of fatigue, usually during the last run of the
day and on the third day on the slopes.
! Ensure that you are well layered in terms of clothing; many skiing
accidents involve hypothermia.
! Don’t ski after drinking a lot of alcohol. Be especially careful during
the first run of the day and the one after lunch. In both cases, you are
more likely to hurt yourself.
! Vary your activities. Much as you may love to ski, consider alternating
with activities such as snowshoeing, or even a good massage to give
your muscles a chance to recover.
WDDTY Exercise 9
Exercise
On the rebound
In the mid-1970s, rebounding was exalted as the exercise with a
difference—but is it aerobic?
T
ownsend Letter for Doc-
tors and Patients column-
ist Morton Walker once
referred to rebounding as
‘lymphatic exercise’. Not only was
jogging or bouncing on mini-
trampolines a powerful form of
exercise. It was also, as the jargon
of the time put it, ‘lymphasizing’.
The lymphatic system—lymph
nodes and glands, tonsils, adenoids,
appendix, spleen and thymus
gland—constitutes much of our
body’s immune system. The
lymphatic interstitial fluid carries
waste and toxins from tissues and
organs to the bloodstream, where
they are then eliminated from the
body via the liver and kidneys.
Keeping this fluid moving is
essential for health and for treating
minor conditions like allergies,
eczema or inflammation.
Because the lymphatic system
doesn’t have its own pump, as does
our circulatory system, any exercise
that involves the major muscle
groups or forces the lungs to work
harder will also prime the flow of
lymphatic fluid. Deep breathing, as
occurs during hard exercise, also
squeezes the thoracic duct, which
is responsible for the flow of lymph
into the bloodstream.
Although running, jogging or
brisk walking all encourage the flow
of lymph, rebounding is said to be
the most effective of all: jumping,
then landing with twice the force
of gravity, is thought to boost our
lymphatic network.
Rebounding (or ‘urban rebound-
ing’, a term coined by J.B. Berns,
one of its major popularizers) is
thought to send oxygen and other
nutrients into cells, while encour-
aging the flow of toxins and waste
via the lymphatics. Dr Walker claims
that white blood cells, the backbone
of immunity, increase dramatically
during rebounding. Others claim
that this form of movement detox
will produce every sort of improve-
ment—from eliminating cellulite to
10 WDDTY Exercise
quickening hair growth. Walker
quoted a study of rebounding by
the Karolinska Institute in Sweden
from 25 years ago that showed that
heart patients using a rebounder
dramatically resolved most of their
symptoms of breathlessness, palpita-
tions, and cold hands and feet.
“Rebounding . . . gives any damaged
or sick cells the opportunity to heal
themselves,” wrote Walker (Walker M,
Shah H. Everything You Should Know about
Chelation Therapy. Stamford, CT: Freelance
Communications, 1980).
Rebounding is also extolled as a
superior aerobic exercise because
bouncing on a forgiving trampoline
spares the knees and hips, feet and
ankles. Indeed, Berns maintains
that it is 87-per-cent less hard on
the musculoskeletal system than
workouts on a hardwood floor.
Indeed, NASA researchers consid-
ered rebounding as a remedial
procedure for astronauts, who were
routinely exposed to long periods
of weightlessness. They concluded
that rebounding was more than two-
thirds more effective than working
out on a treadmill (J Appl Physiol, 1980;
49: 881–7), and kinder because it is
low-impact.
Rebounding’s main advantage is
that it feels a good deal less
punishing on the body and takes less
time than pounding on a pavement
or an outdoor track. You can even
get into your 20-minute ‘run’ in
front of the TV set.
A real workout—or not?
But is this easy-does-it form of
jogging on a soft target aerobic?
The NASA research showed that
rebounding put less stress on the
heart and consumed less oxygen.
More recent studies of rebounding
suggest that it doesn’t work you as
much as was originally thought.
Researchers from the Human
Performance Laboratory at the
University of Alabama found that
rebounding on its own produced
only minor improvements in overall
fitness. In one study, 15 men, aged
20–43, worked out on mini-trampo-
lines at a particular pace. Oxygen
uptake and heart rate were measured
while rebounding on its own, then
compared with rebounding while the
volunteers pumped various sizes of
handheld weights.
The researchers found that any
size of weights produced significantly
higher oxygen uptake and heart rate
than simple rebounding alone.
Other evidence from the Alabama
lab showed that 1-, 2- or 3-lb hand-
weights increased oxygen require-
ments from 26 to 60 per cent (Sports
Med, 1988; 5: 6–10).
The Alabama researchers conclud-
ed that, for true cardiovascular
training, people using a mini-
trampoline need to consider the
additional use of handheld weights
(J Cardiopulm Rehabil, 1995; 15: 34–8).
Furthermore, studies of strength
training, aerobic power and mobility
in inactive older men show that
higher-intensity training produces
greater gains in strength power, and
whole-body physical function (Br J
Sports Med, 2005; 39: 776–80).
So, rebounding is useful for senior
citizens, the physically handicapped,
those who have certain types of
physical conditions and those who
are recuperating from an accident
or injury. But for the rest of us, as
fitness guru Kenneth Cooper recom-
mends, nothing seems to beat having
your feet hit the ground.
Lynne McTaggart
Walking towards fitness
Most people’s New Year’s resolution to start exercising soon collapses because they can’t find the time
to do it in their busy day. Yet, a brisk walk for just a half-hour a day can provide extraordinary benefits.
W
alking at just a moder-
ate pace—say, 3 mph (5
kph)—expends enough
energy to meet the def-
inition of ‘moderate physical exer-
cise’, according to a recent review of
physical exercise (Med Sci Sports Exerc,
2000; 32 [9 suppl]: 5498–516).
Furthermore, walking can provide
the kind of preventative benefits
usually seen with the more vigorous
forms of exercise. It can help stave off
degenerative diseases. The Nurses’
Health Study of 70,000 middle-aged
women found that the risk of type
2 diabetes was the same for walking
vs vigorous activity like running,
providing that the energy expenditure
in doing the activity was equivalent.
Even among those whose daily
activity levels weren’t vigorous, the
risk of diabetes fell, so long as they
walked on a regular basis. The risk
was lowest among the most brisk
walkers (JAMA, 1999; 282: 1433–9).
In the US Women’s Health Initia-
tive Observational Study, involving
more than 73,000 postmenopausal
women, walking was just as good as
vigorous exercise for preventing
cardiovascular events (N Engl J Med,
2002; 5: 347: 716–25).
Although most people believe that
running expends more energy than
walking, in fact, ‘power’ walking at a
pace of at least 5 mph (a 12-minute
mile) burns more calories than
running at a similar speed (J Sports
Med Phys Fitness, 2000; 40: 297–302).
Walking also appears to promote
identical oxygen consumption to
running. When sedentary men began
a six-month programme of endurance
training, those asked to jog six times
a week for 30 minutes consumed the
same volume of oxygen as walkers
walking for the same length of time
and frequency. The only difference
was that the joggers had higher levels
of high-density lipoprotein (HDL; the
‘good’ sort) cholesterol. Nevertheless,
another study of previously sedentary
women (mean age: 47 years) found
that brisk walking decreased heart
time. Whether in one session or
accumulated throughout the day,
just 30 minutes of brisk walking can
reduce blood fats and increase fat-
burning (Int J Obes Relat Metab Disord,
2000; 24: 1303–9). In women, short
bouts of brisk walking resulted in
similar improvements in fitness and
decreased body fat as did long bouts,
so long as they were of the same total
rate and skin folds (an indicator of duration (Med Sci Sports Exerc, 1998; 30:
fat), and increased HDL cholesterol 152–7). Indeed, three 10-minute bouts
(Br J Sports Med, 1994; 28: 261–6). were also as effective as one contin-
Furthermore, it appears that just uous, 30-minute bout in reducing
three months of brisk walking can stress, tension and anxiety (Med Sci
lower levels of blood insulin (Metab- Sports Exerc, 2002; 34: 1468–74).
olism, 1995; 44: 390–7), and even a single Nevertheless, you should probably
fast walk will improve blood go for a brisk walk at least five times
cholesterol levels (Metabolism, 1994; 43: a week to benefit. A bare minimum
836–41). Brisk walking can also reduce of 20 minutes three times a week is
bone loss in postmenopausal women not enough to lower your risk of
(Clin Sci, [Lond], 1997; 92: 75–80). cardiovascular disease (Prev Med, 2005;
Interestingly, exercise intensity 41: 92–7), but three 10-minute bouts
also doesn’t seem to matter in fat- a day can reduce cardiovascular risk
processing. In a study by UK’s and improve mood (Med Sci Sports Exerc,
Loughborough University comparing 2002; 34: 1468–74).
low- and moderate-intensity walking, So, simply taking the decision to
fat levels in the blood and fat walk more during your day—whether
oxidation were similar among men to and from work, to catch the train
with normal cholesterol levels (Med Sci or get to school, or even with the
Sports Exerc, 1996; 28: 1235–42). dog—can pay big dividends in terms
The best news of all is that walking of preventative medicine.
doesn’t have to be done all at one Lynne McTaggart
Walking is better than running
Running is undoubtedly hard on your lower limbs. A year-long Australian study
found that distance-running injuries were the second most common sports
injury seen at a sports clinic. (Clin J Sport Med, 1997; 7: 28–31). Runners commonly
suffer from overuse injuries of the lower limbs, including stress fractures, and
soft-tissue injuries such as shin splints, Achilles tendonitis, knee pain and other
problems, ranging from simple inflammation to structural degeneration (Scand
J Med Sci Sports, 1996; 6: 222–7).
The best preventative for such injury is to slow down, cut down the duration,
add stretching and/or warm-ups and cool-downs to your routine, and change
or improve your running shoes (Cochrane Database Syst Rev, 2001, 3: CD001256).
But even walkers have to walk with care, so here are a few useful tips:
! Walk with your abdominal muscles tightened, and roll back your shoulders,
lift your chest, keep your head up and your arms in a rhythmic swing
! Push off from the toes and land squarely on your heels with each step, then
roll from heel to toe
! Make each stride a comfortable length
! Wear good-quality, well-fitting walking shoes and replace them regularly.
WDDTY Exercise 11
Exercise
Perfect timing, perfect workouts
Some people swear by their early-morning workout, while others like to let off steam at the gym after work.
But is there a best time in the day to exercise?
N
ew evidence shows that
keeping fit leads to better
mental health and can
help to stave off biological
ageing by 10 years or more (Br J Sports
Med, April 2008; doi:10.1136/bjsm.2008.
046243 & doi:10.1136/bjsm.2007.044800).
But is there an optimal time of day
to exercise? Should we drag ourselves
up at the crack of dawn for a half-
hour of jogging, or are we better off
working out later in the day?
There’s growing evidence that how
you schedule your exercise can maxi-
mize the benefits. The secret lies in
our circadian rhythms, the daily
cycles that regulate our physiological
processes, such as body temperature,
metabolism and blood pressure.
According to the American Coun-
cil on Exercise (ACE), body tempera-
ture is important for getting the
most out of your workouts. It is
lowest at one to three hours before
waking up in the morning, and peaks
in the late afternoon. Later in the
day, muscles are warmer and more
flexible, and reaction times are
quicker, which means less injury and
better performance. It’s also likely
that exercise will seem easier at this
time of day, too (Student BMJ, 2003; 11:
219–62).
In fact, studies consistently show
that physical performance is better
in the afternoon and evening than in
the morning. In male physical-educa-
tion students, their strength, energy
production and aerobic contribution
increased from morning to afternoon
along with the rise in body tempera-
ture (Chronobiol Int, 2007; 24: 739–48). A
similar trend was seen in swimmers,
suggesting that swimming trials are
best held in the evening, and not in
the early morning (Br J Sports Med, 1983;
17: 122–7).
It also appears that we exercise
harder and for longer later in the day
than first thing, which means that
we’re likely to burn more calories. In
high-intensity exercise tests with
both men and women, the total work
performed and time to exhaustion
12 WDDTY Exercise
with feeling tired and less motivated
to exercise, our bodies are, in fact,
geared up for physical exertion at
that time.
But what about early risers who
swear by their morning routines?
Everyone has his own rhythm and if
beginning your day with exercise
makes you feel good, then stick to it.
According to the ACE, morning
exercisers are also more successful
at making it a habit, and exercising
was nearly 10 per cent greater in the regularly is more important than the
afternoon than in the morning (Can J time of day that you do it.
Sport Sci, 1992; 17: 316–9; J Sports Med Phys Also, morning exercise may help
Fitness, 1996; 36: 155–60). The greater you to sleep better. A year-long study
tolerance for more intense exercise in postmenopausal women found
is also related to body temperature that evening exercisers had more
(Br J Sports Med, 1983; 17: 128–30), trouble falling asleep than morning
although increased levels of cortisol, exercisers (Sleep, 2003; 26: 830–6). A
which boost the amount of energy possible explanation is that morning
available for muscle activity, may also exercise aligns the body clock, while
play a role (Am J Physiol Regul Integr Comp evening exercise upsets it. However, a
Physiol, 2003; 284: R714–24). study in fit male cyclists found that
Lung function is better in the vigorous exercise before bedtime had
afternoon, too. Looking at nearly no effect on their sleep (Med Sci Sports
5000 patients, researchers found Exerc, 1999; 31: 864–9).
that overall airway resistance peaked In addition, if you exercise out-
at noon, and dropped to a minimum of-doors, air-pollution levels are
at 4–5pm (Chest, 2004; 126: 744S). typically at their lowest in the
According to Dr Boris Medarov, lead morning, so you’re less likely to be
author of the study, this suggests exposed to hazardous pollutants.
that exercising or engaging in other Ultimately, though, it’s important
physical activity in the late afternoon to find the time of day that works for
is ideal as optimal breathing capacity you. The best time is the time that
contributes to optimal performance. helps you to make exercise a regular,
This means that, although we consistent part of your life.
associate the end of the work day Joanna Evans
Timing tips
! Find your peak. To determine your own daily peak in body temperature,
record your temperature every few hours for five consecutive days. It will
usually fluctuate by about 1.5 degrees throughout the day. Try exercising
during the period three hours before and after your highest temperature.
! Adapt. If you’re training for an event, research shows that it’s best to
train consistently at the same time of day that you will be competing
(Ergonomics, 1989; 32: 79–92).
! Use trial and error. If you haven’t established a routine, try working out
at different times of the day, then ask yourself which you enjoyed most
and which made you feel the best afterwards.
! Warm-up properly. If you enjoy early workouts, make sure your warm-
up emphasizes stretching to ensure that your body is ready for action.
A movement to fight cancer
The benefits of regular exercise go far beyond losing weight, according to the latest research.
W
e all know that exercise
is an important part of
a healthy lifestyle. But
more and more evidence
shows that regular physical activity is
more than just good for your heart and
body weight: it can also dramatically
reduce your risk of cancer.
In one of the latest studies,
researchers from the National Cancer
Institute in the US found that
exercising five times a week or more
was associated with significant
reductions in colon and rectal cancer
risk. Interestingly, it wasn’t only the
vigorous exercisers who benefited, but
those who could only manage
moderate- and low-intensity physical
activity, too. Conversely, more time
spent doing sedentary activities, such
as watching TV, was associated with an
increased risk of colon cancer (Cancer
Causes Control, 2008; Apr 25; Epub ahead of
print).
The study is another addition to
the consistent and convincing body of
evidence showing that exercise plays a
key role in colon-cancer prevention.
Indeed, according to one review,
physical activity is not merely a marker
of a healthier lifestyle, but it has an
independent protective effect. On
average, the cancer-risk reduction is
40–50 per cent, and reductions up to
70 per cent have been seen in some
studies (Cancer Epidemiol Biomarkers Prev,
2001; 10: 287–301). It appears that the
more exercise the better, although
even just one hour of walking a week
can protect against the disease (Int J
Cancer, 2007; 121: 2776–81).
There is also strong evidence for a
positive effect of physical activity
against breast cancer. Here again,
studies have observed up to a 70-per-
cent reduced risk among those who
are most active in their occupational
and/or recreational activities. How-
ever, a certain level of activity may
be needed to invoke a protective
effect, and the effect may vary among
particular subgroups of women (Cancer
Epidemiol Biomarkers Prev, 2001; 10: 287–301).
Indeed, in one study, researchers
found a significantly reduced risk of
from their breast cancer, but there was
little evidence of any further benefit
with more exercise than this (JAMA,
2005; 293: 2479–86).
Breast-cancer patients who exercise
also have better mood, better body
image and better self-esteem, and an
improved quality of life (CA Cancer J Clin,
2005; 55: 265–6; JAMA, 2005; 293: 2479–86).
Other types of cancer that appear
to be related to exercise include
prostate, and endometrial and lung
cancers. Regular exercise can reduce
invasive breast cancer only for women the risk of developing these diseases
who were physically active for six hours by up to 40 per cent (J Nutr, 2002; 132:
or more per week. They also observed 3456S–64S).
that this risk reduction was limited So how does exercise help to fight
to women without a first-degree against cancer? Exercise can reduce
family history of breast cancer (Cancer obesity, which predisposes to several
Epidemiol Biomarkers Prev, 2007; 16: 236–43). types of cancer. It can also change the
Nevertheless, other studies have body’s hormone levels, which may
reported a beneficial effect with lesser have a beneficial effect. Finally,
amounts of exercise. And some show a physical activity may improve immune
reduced risk even for women with a function. However, the likelihood is
family history of the disease (Cancer that several, interrelated actions are
Epidemiol Biomarkers Prev, 2006; 15: 57–64). involved (J Nutr, 2002; 132: 3456S–64S).
Breast-cancer studies also show Although more research is needed
that exercise can improve the chances on the subject, what is clear is that
of survival after the diagnosis. An exercise should be recommended to
analysis of nearly 3000 women found everyone as a simple, natural way to
that those who engaged in physical reduce the risk of cancer as well as
activity equivalent to walking one hour other diseases. A number of public
per week or more had better survival health organizations now recommend
rates compared with those who at least 30 minutes of moderate-to-
exercised less than that or not at all. vigorous exercise on most days of the
Women who walked three to five hours week for cancer prevention.
a week had the lowest risk of death Joanna Evans
Other benefits of exercise
! Lower rates of heart disease (N Engl J Med, 2002; 347: 716–25; JAMA, 1995; 273:
1093–8)
! Reduced risk of stroke (JAMA, 2000; 283: 2961–7)
! Better mental health (Br J Sports Med, April 2008; doi:10.1136/bjsm.2008.046243)
! Enhanced cognitive (executive-control) function (Psychol Sci, 2003; 14:
125–30)
! Reduced risk of falls and related injuries such as bone fractures (BMJ,
1997; 315: 1065–9)
! Better blood pressure control (J Clin Epidemiol, 1992; 45: 439–47)
! Better glucose control in type 2 diabetics (JAMA, 1999; 282: 1433–9)
! Reduced joint swelling in older people with knee osteoarthritis (JAMA,
1997; 277: 25–31)
! Lowered likelihood of gallstone disease (N Engl J Med, 1999; 341: 777–84)
! Better quality of sleep (Sleep, 2003; 26: 830–6; JAMA, 1997; 277: 32–7).
WDDTY Exercise 13
Exercise
Stretching: as good as they say?
Most coaches and exercise gurus extol the virtues of stretching before aerobic exercise and strength training.
But is there any evidence to show that it prevents injury?
A
sk any jogger or step-class
instructor, and they will insist
on a series of stretches before
launching into your exercise
regime. Indeed, most exercise classes
do warm-up and cool-down stretches
before and after the aerobic workout.
The idea is that the increased flexibility
from stretching will prevent muscle
injury.
But is there any evidence for this?
As with so much of sports, preexercise
stretching has entered the lore of good
practice without much proof.
In fact, there appears to be no
evidence that stretching will prevent
injury. When the US Centers for
Disease Control and Prevention did a
review of all randomized trials and
cohort studies in sports medicine, they
found only six studies that compared
stretching with other ways to prevent
injury. The CDC found no significant
association between stretching and a
reduction in total injuries (Med Sci
Sports Exerc, 2004; 36: 4). Indeed, those
who stretched were no more or less
likely to suffer injury, although a warm-
up did increase blood to the muscles.
Stretching does not appear to
benefit male runners. In one study, 47
per cent of all male runners who
stretched regularly were injured during
a one-year period compared with only
33 per cent of those who didn't stretch
(www.pponline.co.uk/encyc/0396.htm). How-
ever, this increased risk did not apply
to female marathon runners, suggest-
ing that stretching may be overextend-
ing men’s muscles.
Stretching also has no effect on
oxygen use. A 10-week study compar-
ing the treadmill runs of volunteers
who’d spent 40 minutes doing calf and
thigh stretches beforehand with those
jumping on the treadmill cold found
that regular stretching did not affect
oxygen levels while running (Scand J
Med Sci Sports, 2001; 11: 260–5).
Does stretching prevent injury or
loss of muscle strength in novice
exercisers? Researchers at Umea Uni-
versity in Sweden asked 10 women to
perform 10 deep, full knee flexes with
14 WDDTY Exercise
three weeks of stretching increased a
joint’s range of motion. Even just five
repeated stretches caused the muscles
and tendons to elongate (Scand J Med Sci
Sports, 1995; 5: 342–7).
The type of stretch can also make a
difference. The most common form is
static stretching—stretching a muscle
group to a length or angle just short of
pain, and holding it for between six
seconds to a minute. This is thought
both legs after a five-minute warm-up to increase the length of a muscle’s
on a stationary cycle. However, before stretch reflex.
the flexing, they also did four 20- With ballistic stretching, an athlete
second static hamstring stretches on uses quick repetitive bounces, alter-
only one leg. The scientists measured nately stretching and resting the
their soreness and loss of contractile muscles, but this has been largely
force after one, two and four days, and abandoned because of a possible risk
found no differences between the non- of muscle strain.
stretched and stretched legs (Scand J Proprioceptive neuromuscular facili-
Med Sci Sports, 1999; 9: 219–25). tation, or PNF, is a systematic resist-
The same researchers carried out a and-relax technique designed to
more extensive experiment with seven stimulate muscle receptors to prevent
women working on their quadriceps the body from straining or tearing
muscles until exhaustion. Seven days muscle fibres. When a muscle is
later, they repeated the experiment, stretched to its maximum, the pro-
but with passive stretching before and prioceptors signal the central nervous
after the exercise. Again, they found no system to contract and then relax the
difference in muscle response between muscle.
the two experiments—and once again, When doing PNF, the athlete holds
passive stretching didn’t prevent mus- a stretch, but contracts the muscles
cle soreness (Scand J Med Sci Sports, 1998; against the resistance of a partner for
8: 216–21). Stretching before strength 10 seconds, then relaxes the muscle
training also did not prevent increased for 10 seconds, after which the partner
muscle stiffness (Scand J Med Sci Sports, slowly moves the muscle into another
1998; 8: 65–77). stretch.
In fact, the true benefit of stretch- The most effective PNF technique is
ing may have more to do with elongat- said to involve stretching the muscles
ing the muscles and tendons for doing and their antagonists (the muscles
activities that require it (such as dance that move a limb in the opposing
or yoga) (Trans Orthop Res Soc, 1989; 14: direction) because this will rapidly
294). This theory is supported by a cause the muscles to lengthen (Trans
Danish study of skeletal muscle during Orthop Res Soc, 1989; 14: 294).
stretch manoeuvres that showed that Lynne McTaggart
How long to stretch?
If you decide to incorporate preexercise stretches into your regime, some
studies suggest working at it. On comparing four-week with eight-week
bouts of hamstring stretching, passive resistance of the joint was still seen
in the four-week group. However, as reduced resistance can lower the
chances of injury, the researchers recommended training with stretches for
at least eight weeks (Scand J Med Sci Sports, 2001; 11: 81–6).
Sound body, sound mind
Most of us know that an active lifestyle is good for our general health, but did you know that physical activity
is also good for your brain?
T
he benefits of exercise on
the body are well known,
given the legion of studies
showing that regular
physical activity can help to keep the
heart healthy, the bones strong and
numerous diseases at bay. But now,
researchers are also finding that
exercise has a remarkable effect on
the brain, too, giving us yet another
reason to tackle that treadmill.
Dutch researchers have reported
that aerobic physical activities that
improve cardiorespiratory fitness are
beneficial for cognitive function in
healthy older adults (Cochrane Database
Syst Rev, 2008; 2: CD005381). “This would
imply,” they said, “that a physically
active lifestyle resulting in enhanced
fitness could affect people’s cognitive
abilities in the future and would
enable them to partially influence
their mental health.”
The report was a review of 11 ran-
domized controlled trials conducted
in the US, France and Sweden,
involving a total of 670 adults aged
55 and over. Eight of the 11 studies
found that aerobic exercise increased
VO2 max, an indicator of respiratory
endurance, by around 14 per cent.
[VO2 max is the maximum amount
of oxygen (O2 in mL) utilized in one
minute per kg of body weight.] The
improvement coincided with better
mental capacity. Compared with non-
exercisers, and those following a
yoga- or strength-based programme,
or any other intervention, the
aerobic exercisers saw significant
improvements in motor function,
cognitive processing speed, memory,
and auditory and visual attention.
The findings echo those of a
number of other reviews examining
the relationship between physical
activity and mental function. In three
recent meta-analyses, which pooled
the results of several independent
studies, all found physical activity to
have a positive effect on cognition
(Nat Rev Neurosci, 2008; 9: 58–65).
Moreover, it appears that it’s not
only healthy adults who can benefit,
but those who already have cognitive
impairment can, too—for example,
those with early signs of Alzheimer’s
disease. One meta-analysis of more
than 2000 people from 30 different
trials looked solely at this population
and concluded: “Exercise training
increases fitness, physical function,
cognitive function, and positive
behaviour in people with dementia
and related cognitive impairments”
(Arch Phys Med Rehabil, 2004; 85:
1694–704).
Exercise early in life can also have
beneficial effects on the brain. In this
meta-analysis, there was a positive
correlation between physical activity
and cognitive performance in school-
age children (4–18 years). Benefits
were found for all of the categories
analyzed (including perceptual skills,
IQ, academic readiness, and verbal
and mathematical tests), except for
memory, which was not related to
physical activity (Pediatr Exerc Sci, 2003;
15: 243–56).
Also, it appears that aerobic
fitness in particular has a positive
effect on children’s brain function.
In one study, aerobic fitness was
correlated with better academic
performance in third- and fifth-grade
students, whereas body mass index
(BMI) was inversely related (J Sport
Exerc Psychol, 2007; 29: 239–52). In addi-
tion, greater aerobic fitness was also
related to better performance on a
paper-and-pencil version of the
Stroop colour-word task (Med Sci Sports
Exerc, 2008; 40: 166–72).
According to Dr Charles Hillman,
one of the leading researchers in this
field, “These findings suggest that,
although physical activity might be
beneficial at all stages of life, early
intervention might be important for
the improvement and/or mainten-
ance of cognitive health and function
throughout the adult lifespan” (Nat
Rev Neurosci, 2008; 9: 58–65).
The mind–body connection
So, exactly what is the mechanism
behind this relationship between
physical activity—specifically, aerob-
ic activity—and brain function?
According to the lead author of the
Cochrane review, Dr Maaike Ange-
varen, improvements in cognition as
a result of improvements in cardio-
vascular fitness can be explained by
increases in cerebral blood flow that
lead to increased brain metabolism
which, in turn, stimulates the
production of neurotransmitters and
the formation of new synapses.
In fact, research in animals has
revealed molecular and cellular
changes produced by exercise that
appear to underlie the effects of
physical fitness on mental perform-
ance (Cochrane Database Syst Rev, 2008; 2:
CD005381).
However, Dr Hillman, the lead
author of the study of the third- and
fifth-graders, believes that there may
well be different mechanisms in play
between younger and older people as
a child’s brain is still developing
whereas the brain of an adult isn’t
(Nat Rev Neurosci, 2008; 9: 58–65).
Yet, a number of questions still go
unanswered. What are the best
varieties, intensities, frequencies and
durations of exercise? Is aerobic
exercise necessary for cognitive
improvement, or can the same
benefits be achieved with any type of
physical exercise? Is it ever too late
to start an exercise programme?
Despite the current gaps in the
research, what is clear right now is
that physical activity is beneficial
across the human lifetime. So, the
simple advice is: get moving!
Joanna Evans
WDDTY Exercise 15
Exercise
Tai Chi: balancing your energy
This ancient Chinese form of martial arts has drawn more and more attention because of its health benefits.
As the latest studies suggest, it may be useful for patients with sleep disturbances, arthritis and even cancer.
T
ai Chi, or Tai Chi Chuan, is a
traditional Chinese exercise
that has been around for
some 2000 years. It combines
deep breathing and relaxation with a
series of postures that flow smoothly
from one to the next while using only
slow, gentle, graceful movements.
Only recently has it been the subject
of scientific study, with the result that
Tai Chi does appear to offer numerous
health benefits—from better balance
and flexibility to less anxiety and
depression.
Researchers at UCLA have discover-
ed that doing Tai Chi can promote
better sleep compared with attending
health-education classes that include
advice on stress management, diet and
sleep habits. After 25 weeks, patients
in the Tai Chi group reported greater
improvements in self-rated sleep
quality compared with the health-
education group. Also, it appeared that
the amount of benefit with Tai Chi was
comparable to that with drugs, with
better sleep efficiency and duration, as
well as sleep quality—and no adverse
side-effects (Sleep, 2008; 31: 1001–8).
These results mirror those of a
previous study that compared Tai Chi
with low-impact exercise. Those doing
Tai Chi were more likely to improve
their sleep quality compared with
those doing the low-impact exercise
(J Am Geriatr Soc, 2004; 52: 892–900).
However, the benefits of Tai Chi go
far beyond a good night’s sleep. It is
a promising form of exercise for
improving balance and preventing falls,
a major cause of injury and even death
in older people (BMC Geriatr, 2006; 6: 6).
Indeed, it has been shown to improve
the characteristics in older adults that
place them at increased risk of falls
such as poor balance, loss of strength,
limited flexibility and fear of falling
(Med Sport Sci, 2008; 52: 124–34). Eight to
16 weeks of Tai Chi training improved
balance, flexibility and heart health
(Arch Intern Med, 2004; 164: 493–501), and
reduced the risk of multiple falls by
nearly half (J Am Geriatr Soc, 1996; 44:
489–97).
16 WDDTY Exercise
James P. Wilmot Cancer Center in
Rochester, NY, breast-cancer survivors
practising Tai Chi experienced signif-
icant improvements in quality of life
compared with those receiving only
psychosocial support therapy. The Tai
Chi group also showed better aerobic
capacity, muscle strength and flexi-
bility (Med Sport Sci, 2008; 52: 209–17).
However, it’s not clear whether or
not it is Tai Chi per se that brings about
these effects or simply any type of
exercise, so more research is currently
Chronic conditions underway on this topic (see http://
Besides promoting better physical clinicaltrials.gov/ct2/show/NCT00246
fitness and sleep, Tai Chi may also be 818). Nevertheless, according to one
useful for patients with musculo- review, it may be the combination of
skeletal diseases such as arthritis. One meditation and aerobic exercise that
randomized, controlled trial reported makes Tai Chi especially beneficial for
that 12 weeks of Sun-style Tai Chi cancer survivors (Integr Cancer Ther, 2006;
significantly improved joint symptoms, 5: 192–201).
balance and physical functioning in Other chronic conditions that have
women with osteoarthritis (J Rheumatol, responded positively to Tai Chi in
2003; 30: 2039–44). scientific studies include high blood
Another osteoarthritis study found pressure (Prev Cardiol, 2008; 11: 82–9), type
that Tai Chi relieved joint pain and 2 diabetes (Med Sport Sci, 2008; 52: 230–
stiffness as well as promoted positive 8), fibromyalgia (Orthop Nurs, 2003; 22:
behaviours such as a healthier diet and 353–60), multiple sclerosis (Altern Ther
better stress management (Taehan Kanho Health Med, 1999; 5: 70–4) and tension
Hakhoe Chi, 2007; 37: 249–56). headaches (Evid Based Complement Alternat
In patients with rheumatoid Med, 2007; 4: 107–13). Tai Chi may also
arthritis, Tai Chi led to improvements reduce stress and anxiety, boost
in disability, quality of life, depression immunity, and improve cardiovascular
and mood (Med Sport Sci, 2008; 52: 218–29; and respiratory health (Arch Intern Med,
Rheumatology [Oxford], 2007; 46: 1648–51). It 2004; 164: 493–501).
was also able to slow bone loss (Arch These findings show that you don’t
Phys Med Rehabil, 2007; 88: 673–80), have to exercise hard and fast to
suggesting that it may be useful for achieve significant benefits. In fact,
osteoporosis. this gentle, low-intensity form of
Other research suggests that Tai Chi exercise appears to be an effective way
may even help cancer survivors. In a to improve both your body and mind.
recent study by scientists from the Joanna Evans
How does Tai Chi work?
Tai Chi is based on the traditional Chinese concept that all disease stems
from an imbalance of qi (chi, prana or vital energy), which is said to flow
through the body along invisible pathways called ‘meridians’. We are in
good health when qi flows freely, but symptoms such as headaches,
anxiety, high blood pressure and fatigue are signs that energy flow is
congested. Tai Chi is one of a number of means of restoring or enhancing
the balanced flow of qi through the body’s meridians. Other techniques
include acupuncture, reiki and Chi Gong.
Getting to the core
Achieving core stability not only gives you a strong set of abdominal muscles, but also prevents injury to
your lower back and extremities.
C
ore stability has become the
new ‘buzz’ word in the gym.
Most of us equate a strong
core with a well-toned abdo-
men and supple waist. What isn’t well
understood is how core stability is
essential for preventing injury.
Core stability is ‘trunk dynamic
control’, which refers to all muscles of
the trunk—front and back—encasing
the spine within abdominal muscles,
the hip muscles running into the legs
and muscles of the buttocks. A strong
trunk stabilizes your entire body,
increases your ability to move with
greater control and helps to keep an
aligned posture when you move.
A strong core affects every other
muscle group because movement is
dynamic, continually changing from
one muscle group to another. If fact,
when leg movement is studied, it’s the
muscles of the abdomen and core that
move first (Phys Ther, 1997; 77: 132–44).
Because the body’s core is the
master muscle group, a weak core can
cause all manner of seemingly
unrelated injury to the extremities. For
instance, it was found that athletes
with weak core control were more
likely to develop foot/ankle injuries
due to excessive movement of the hip
when moving the legs (Arch Phys Med
Rehabil, 1995; 76: 1138–43).
Other studies show that people
predisposed to leg injuries are more
likely to have weak hip abductors (the
muscles that move the legs away from
the midline) and weak hip rotation
(Med Sci Sports Exerc, 2004; 36: 926–34).
Also, among young female athletes,
those with knee-joint pain were had
significantly weaker hip abductors and
hip rotators compared with controls (J
Orthop Sports Phys Ther, 2003; 33: 671–6).
The chief hip external rotator
muscle is gluteus maximus, the main
muscle of the buttocks. As unlikely as
it seems, weakness in this important
muscle, and a lack of core strength in
general, is related to ankle injuries (lnt
J Sports Med, 1994; 15: 330–4).
Sometimes, injury to an extremity
creates a vicious circle: the poor core
walk. This kind of core weakness can
persist for years after the initial injury
(Arch Phys Med Rehabil, 1995; 76: 1138–43).
The degree of core stability required
may depend on gender, and women
may need to work harder than men. In
male and female athletes assessed for
hip abduction and rotation strength,
and strength and endurance of abdom-
inal muscles, and of the back and lower
spine, it was found that men had more
strength and movement in the hip and
lower back muscles. Also, it appears
that the athletes who avoided injuries
had strong hip abduction and rotation.
Further analyses showed that a
stability makes a repeat injury more restricted hip rotation capacity was
likely as well as other knock-on effects. the only reliable predictor of injury.
Indeed, if core weakness is ignored, The researchers concluded that
just one ankle injury can lead to a gender-based postural differences
chronically bad back and poor motion could be behind the greater injuries
control (lnt J Sports Med, 1994; 15: 330–4). sustained by athletic women (Med Sci
Back problems in general are due Sports Exerc, 2004; 36: 926–34).
to core instability, especially weak or This is another reason, besides
atrophied buttock muscles (lnt J Sports vanity, that active women should work
Med, 1994; 15: 330–4). Weak buttocks on that six-pack.
cannot hold the pelvis properly as you Lynne McTaggart
Correcting core weakness
Core strength includes strong hip and buttock muscles, and strong and
supple lower back muscles. You can achieve this with Pilates, certain yoga
exercises (the Salute to the Sun, in particular) and a Swiss ball, which
works the core muscles as you need to use them to maintain your balance.
However, you don’t need a gym for a strong core. Simple floor exercises
can work just as well.
! The plank: Holding yourself in a straight position, supported by your
elbows and toes, tightly clench your abdominal muscles for up to one
minute to strengthen them.
! The classic bridge (for gluteal muscles): Lie on the floor, then with your
shoulders on the floor and knees bent, squeeze your buttocks together
as you push your hips up to make a straight line from your knees to your
chest.
! Hip abduction: Lie on your side, making sure that your hips are
‘stacked’ (aligned); while holding your abdominal muscles tight, lift the
top leg slowly up and down. Do several sets of at least 5–10 repetitions
on each side.
! Hip rotation: Lying on your back with your arms out to the sides, lift your
legs up to a 90-degree angle—soles to the ceiling—and, keeping both
legs together, slowly swing them down to the floor, alternating sides.
Then, keeping your lower back and trunk on the floor, bend your legs
and allow the knees to fall to the floor on each side of your body.
WDDTY Exercise 17
Exercise
Step up to better balance
Step aerobics, invented some 20 years ago, remains one of the most popular forms of aerobic exercise in
the world. But is it good for you or, indeed, any better than ordinary workouts?
T
o the uninitiated, step aero-
bics looks like a gentle form
of exercise, suitable for all
ages and fitness levels. Its
creator Gin Miller’s belief is that step
aerobics offers the cardiovascular
benefits of running, but without the
wear and tear on the joints.
The latest studies bear this out.
Step classes provide a more vigorous
workout than regular aerobics, and
raises both cardiorespiratory and
muscle fitness (Br J Sports Med, 2006;
40: 860–6). In one study, step training
burned significantly more calories
than running at 8.05 kph (J Strength
Cond Res, 2006; 20: 593–6).
Besides boosting cardiofitness,
step aerobics, combined with dieting,
appears to be especially effective for
decreasing body fat, compared with
diet plus walking, or dieting alone
(Ist Tip Fak Derg, 2007; 70: 064–9).
This may be because step aerobics
combines lifting your entire body
weight against gravity while moving
aerobically. It also requires the use of
many muscle groups—those directly
involved in the exercise as well as
those that support the main muscle
groups, plus the stabilizing (balanc-
ing) muscles. While stepping, some
90 per cent of your muscles are used.
However, the biggest benefit is
balance, particularly for the over-50s.
Comparing step and walking with a
Ballates programme (designed to
strengthen the central core muscles
through balance techniques), the
surprise finding was that both step
aerobics and walking resulted in
better improvements in postural
stability and general balance than did
Ballates (J Sport Sci Med, 2006; 5: 390–9).
This advantage is likely related to
the fact that stepping makes use of
all planes of movement—forward and
back, side to side, up and down,
rotational and diagonal. Having to
constantly avoid tripping over the
bench enhances our ‘proprioceptive
awareness’—our sense of the body’s
position in space, and the location
and movement of some of its parts in
relation to others.
Maintaining balance is critical for
women over 50. Around 30 per cent
18 WDDTY Exercise
Other studies show that any sort
of step exercise has positive effects
on the bone and joints, and improves
mechanical strength, too (Br J Sports
Med, 206; 40: 860–6).
Stepping also lowers cholesterol
and modifies blood fat levels. In
college students doing eight weeks
of either step training or aerobic
dancing, both groups improved their
of Americans over 65 fall at least total cholesterol levels, but only the
once a year, and 15 per cent suffer steppers also improved their ‘good’
from recurrent falls. Falls are the high-density lipoprotein (HDL)-
cholesterol levels, and their ratio of
most common cause of bedridden
conditions, particularly hip fractures. total cholesterol to HDL (J Sports Med
As we age, our musculoskeletal, neur- Phys Fitness, 2001; 41: 380–5).
Given the need for coordination
al and sensory faculties decline,
affecting our balance. Regimes that to negotiate the bench in time to
work on maintaining these systems music, injuries are inevitable, but
help to retard the process. they are still less than with other
Step classes also appear to be sports. Steppers sustain less than
good for bone health—but only if you half the number of injuries as do
work hard and step high. The osteo- runners (J Sports Med Phys Fitness, 1998;
genic index, or amount of bone 38: 221–6) and, of those injuries, most
formation with exercise, increased were related to muscle soreness,
significantly with stepping at 135 particularly in the calf and shoulders.
beats per minute (bpm). However, As with other skills in life, your
some believe this rate is too fast and technique—and your chances of
risky, and suggest a slower speed (see avoiding injury—will improve with
box below) (Br J Sports Med, 206; 40: experience.
860–6). Joanna Evans & Lynne McTaggart
Stepping safely
Experts agree that, to minimize injury, it’s important not to do step at too high
a tempo. The Human Performance Laboratory at Auburn University in Montgom-
ery, Alabama, reported in the June/July 1997 issue of the Reebok Alliance
Newsletter that tempos above 128 bpm significantly increase impact on the lower
limbs. While experienced steppers may be able to cope at this speed, novices
are at an increased risk of injury. So, to ensure your safety while stepping:
! Keep platform height to a minimum. Although experienced steppers can
use a 10-inch platform, 4 inches may be more appropriate for the elderly,
beginners, very young people, pregnant women and those who have had
a previous knee injury or are undergoing rehabilitation. According to Step
Reebok guidelines, all steppers should never use a platform height that
causes the knee joint to flex deeper than 90 degrees on the first upward step.
! Learn the correct posture—head up, shoulders down and back, chest up,
abdominals lightly contracted and buttocks gently tucked under the hips.
! Perfect your technique. When stepping up, land with the entire sole of the
foot completely on the platform, and step softly; when stepping down, step
close to the platform, with the heels on the floor to help absorb shock. If you
need to step away from the platform, keep the weight on the forefoot.
! Avoid using hand weights. According to Reebok, this offers little, if any,
benefit and only increases the risk of injuring the shoulder joints.
Good vibrations for more muscle
A drive along a rough road was once prescribed for kidney stones because of the therapeutic effects of the
bumpy ride. Now, machines offering ‘whole-body vibration training’ have hit the mainstream fitness scene.
V
ibration exercise devices
such as Power Plate and
Soloflex are among the
latest fitness technologies
to promise maximum results with a
minimum amount of time and effort.
Simply standing, sitting or lying
on one of these vibrating machines
for a few minutes a day, say the
manufacturers, can increase muscle
strength, flexibility and bone mass,
as well as improve cellulite and speed
up metabolism.
But are these ‘miracle machines’
merely a gimmick, or could vibration
really be a valuable fitness tool?
The American Council on Exercise
says it’s too early to either endorse
or denounce these devices. However,
there’s a growing body of evidence
that this minimal-effort form of
exercise may live up to the hype.
In both athletes and untrained
people, whole-body vibration training
(WBVT) can indeed increase muscle
strength, power and flexibility with
as little as four minutes a day, three
times a week, for two to four months
(Am J Phys Med Rehabil, 2006; 85: 956–62;
Med Sci Sports Exerc, 2002; 34: 1523–8).
Comparative studies of WBVT and
traditional resistance training have
found similar gains in strength and,
in some cases, more gain in explosive
power (Med Sci Sports Exerc, 2003; 35:
1033–41; J Am Geriatr Soc, 2004; 52: 901–8).
The explanation, according to the
current theory, is that WBVT stim-
ulates the body’s natural stretch
reflex (contraction), activated when
a muscle is under a static stretch or
quickly stretched. WBVT continually
stimulates this reflex until the vibra-
tion stops. According to the makers
of Power Plate, each vibration causes
the body to reflexively relax and
contract 25–50 times per second.
Moreover, the activation of one
muscle reflex is thought to affect the
adjacent muscles, too.
In other words, all the user needs
to do is assume various positions on
the platform to target different
muscle groups.
2.13 per cent of spine and femur
BMD, respectively (J Bone Miner Res,
2004; 19: 343–51).
WBVT is also promising in a num-
ber of other age-related conditions
(see box below).
Is vibration training safe?
Despite the potential benefits of
WBVT, there are negative effects of
vibration on the body.
However, while it boosts flexibility Research from the workplace
and muscle strength, people looking shows that prolonged exposure to
for a quick-fix weight-loss solution vibration—from drills or chainsaws,
may be disappointed. A 24-week for example—can damage the
study in Belgium found that WBVT peripheral nerves, blood vessels,
did not reduce weight, total body joints, and visual/sensory percep-
fat or subcutaneous fat in untrained tion. In animals subjected to high
women. However, it did significantly levels of vibration, there have been
increase fat-free mass (2.2 per cent), reports of lung damage, gastrointes-
the part of the body that is not fat, so tinal bleeding and even fatal heart
the women may have gained muscle haemorrhage (J Strength Cond Res, 2005;
instead (Int J Sports Med, 2004; 25: 1–5). 19: 459–66).
Nevertheless, the greatest benefit However, these reactions depend
of WBVT may lie in its potential to on the frequency, magnitude, dura-
increase bone mass. Postmenopausal tion and type of vibration, and the
women who engaged in WBVT three evidence so far suggests that the
times a week for six months achieved current WBVT technology, when
significant increases in bone mineral performed in short bouts a few times
density (BMD) of the hip, as well as a week, is unlikely to cause harm.
improved strength and balance. It Indeed, a recent review reported
appears that vibration training may that “it is possible to confirm that
help to reduce falls and bone frac- the procedure seems safe when
tures in older women (J Bone Miner subjects stand on vibrating plates for
Res, 2004; 19: 352–9). a relatively short time with knees
WBVT also prevented bone loss in semiflexed to limit transmission of
the spine and femur in postmeno- vibrations to the head” (Br J Sports
pausal women, whereas those using a Med, 2005; 39: 585–9).
placebo device lost 1.6 per cent and Joanna Evans
Other potential uses of WBVT
! Diabetes. Whole-body vibration training (WBVT) enhanced glycaemic
control in type 2 diabetics (Int J Med Sci, 2007; 4: 159–63)
! Stroke. WBVT improved postural control in stroke patients (Am J Phys
Med Rehabil, 2004; 83: 867–73)
! Parkinson’s disease. Parkinson’s patients undergoing WBVT saw
significant improvements in tremor and rigidity (NeuroRehabilitation, 2006;
21: 29–36)
! Sarcopenia (age-related loss of skeletal muscle mass, strength and
function). WBVT was as effective as a traditional fitness programme
in increasing muscle strength and mass in men over the age of 60
(J Gerontol A Biol Sci Med Sci, 2007; 62: 630–5).
WDDTY Exercise 19
Exercise
Training Jane, not Tarzan
According to Paul Chek, women can build a better body by focusing
on exercise regimes that don’t involve machines.
G
od may have created
man and woman equal,
but they were not
created the same. The
female body is smaller, including
joint structures such as the wrist,
shoulder, knee and ankle. Women
are more energy-efficient than men
are, with men being stronger when
calculated pound for pound or by
absolute strength (Zachazewski JE et
al. Athletic Injuries and Rehabilitation. W.B.
Saunders, 1996: 843, 841).
A woman’s energy efficiency is
likely to be a physiological
necessity when you consider that
the female body is designed to
carry a developing fetus for nine
months in what would have been
unpredictable times over the span
of human development. In fact,
Australian researcher Robbie
Parker—in the handout for a pre-
sentation entitled ‘Fat Loss in
Pre-Menopausal Women’ at the
Network New Zealand National
Health and Fitness Convention,
held in Auckland, NZ, in June,
1998—reported that females use
approximately 40 per cent less
energy when walking the same
distance as males.
A structural byproduct of being
designed to bear children is a
wider pelvis. The wider female
pelvis results in the femur (the
long bone of the thigh) angling
downward and inward, creating an
angle at the knee that is greater
than that of a male. This angle is
called the ‘Q’ angle and its greater
magnitude in females is associated
with the increased prevalence of
knee injuries among female
athletes. Surgeons also note that,
in females, there is less space in
the notch through which the
anterior cruciate ligament (ACL)
passes. The ACL is the most
commonly injured ligament in the
knee, and it passes through the
middle of the knee joint. When the
condylar notch is small, the ACL is
predisposed to unwanted friction,
20 WDDTY Exercise
restore adequate flexibility to
muscles that are restricting or
altering joint motion (Chek P. Scientific
Back Training Correspondence Course &
Video Series. Encinitas, CA: C.H.E.K Institute,
1994).As specific flexibility is being
improved, women should always
particularly if the legs are not seek to choose exercises that
functionally stable. improve functional stability,
Many experts clearly indicate the particularly in the core/pelvis
increased incidence of injury to region.
females when compared with males
participating in the same sports Exercise tips
(Strauts Z. ‘Thoracic outlet syndrome’, in for a better female body
Muscles–Nerves–Joints, Chicken or Egg, By improving stability of the core
1989 conference, Vancouver, BC, Canada; and pelvis, we are affecting the
Antoniotti T, Rocaobado M. Exercise and entire body through the kinetic or
Total Well Being for Vertebral and mechanical linkage systems that
Craniomandibular Disorders. Tucson, AR: are present. The most important
IFORC Publications, 1990; Clin Sports Med, muscle for a woman to restore and
1985; 4: 345–66). Clinical experience maintain at optimal levels of
reveals that non-athletic females function in is the transverse
suffer a similar incidence of the abdominis (TVA; the so-called ‘six-
same injuries as female athletes pack’ muscles of the abdomen)
relative to that of men. ( Chek P. Scientific Back Training
Aside from alignment factors, Correspondence Course & Video Series.
increased joint laxity is suspected Encinitas, CA: C.H.E.K Institute, 1998).
The
to be a contributing factor (Clin TVA is intimately involved with the
Sports Med, 1985; 4: 345–66 ). Joint breathing apparatus, the paraspinal
laxity has also been reported to and deep stabilizer muscles of the
increase in association with the spine, the hamstrings, the muscles
premenstrual cycle ( Daly J, Ey W. of the lower leg and foot, and the
Hormones and Female Athletic Performance. pelvic floor.
Australian Sports Commission, 1996). Although seldom appreciated by
There is a formula for success exercise professionals, incontinence
with any exercise programme: is surpassingly high among exer-
Flexibility—Stability—Strength— cising women. Nygaard et. al. found
Power. This means that we must first that 47 per cent of exercising
Testing TVA strength and endurance
! Lie prone (face down) on the floor, fully relaxed, then place a blood-
pressure cuff under the belly button (Manual Therapy, 1995; 1: 2–10)
! Exhale, then pump the BP cuff to 70 mmHg (a measure of pressure used
in reading blood pressure)
! Pull in the umbilicus (belly button) toward the spine. Ensure that you are
not pushing down with the shoulders or knees, nor changing the
curvatures of the spine
! The pressure on the BP cuff should decrease, optimally by 10 mmHg.
Any reading less than 10 mmHg shows a loss of function equal to 10
times the lower reading: for example, if the pressure decreases by 8
mmHg (2 mmHg less than optimal), then this means there’s a 20 per cent
loss of function
! This test may be used as an exercise by decreasing the pressure in the
cuff as much as possible (ideally by at least 10 mmHg), and holding it for
bouts of 10 seconds followed by 10 seconds of rest. Repeat as many
times as possible. Once 10 repetitions can be achieved, the rest period
between contractions can be cut in half and, finally, eliminated
completely when the pressure can be reduced by around 10 mmHg for
100 seconds straight.

women at an average age of 38.5
years suffered from incontinence
(Obstet Gynecol, 1990; 75: 848–51). By
exercising the TVA, the exerciser
often improves both continence
and stability of the spine, pelvis and
legs—a double benefit! This is
because the TVA is neurologically
linked to the muscles of the pelvic
floor and the deep stabilizer
muscles of the back (Chek P. Scientific
Back Training Correspondence Course &
Video Series. Encinitas, CA: C.H.E.K
Institute, 1998).
Free weights
for a functional body
Another ver y important step
toward improving function in the
female body is to minimize the use
of machines. Machines are bolted
to the floor, have guided resis-
tance and most often require that
exercises be performed from a
seated position.
Such a training environment
does not develop the stabilizer or
postural mechanisms of the body,
leaving the door wide open to
injur y in the work or sports
environments. This is a frequent
occurrence even after achieving
what would appear to be high
levels of fitness using a machine-
based programme.
To develop functional stability
and strength, start all workouts
with the free-weight or free-body
exercise that requires the use of
the greatest number of muscles
and joints—for example, lunges or
standing dumbbell presses. Then,
if your conditioning level is high,
choose another similar, but
slightly less challenging, free-
weight exercise.
Finally, progress to machine
training for an additional two to
four exercises. If your condi-
tioning level is moderate to low,
your goal should be to increase
the number of free-weight exer-
cises and to reduce the number of
machine-based exercises as your
fitness level improves.
Women need not be concerned
about getting ‘big’ through adding
free-weight exercises to their pro-
gramme, as this is an unfounded
fear. Women naturally have higher
levels of oestrogen and much lower
levels of the muscle-building hor-
mone testosterone than do males.
Female body builders spend
between three and five hours per
day in the gym trying to achieve
the size that other women dread.
In fact, putting muscle mass on a
female is so challenging that many
female body builders turn to
anabolic steroids for assistance. All
you need to do is walk into any
body-building gym and yell the
word ‘oestrogen’, and body build-
ers will run like a vampire that has
just seen the cross!
Powering up
Power exercises—or high-speed
exercises—should only be performed
after a woman has restored optimal
flexibility to all major working joints,
as well as achieved adequate levels of
functional stability and strength for
her work or sports environment.
Whenever the amplitude or velocity of
an exercise is increased, the forces
running through the joints, muscles
and connective tissues are also
significantly increased. In fact, most
sports are won and lost through the
performance of ‘power movements’,
which most female athletes are not
adequately prepared for—usually
because of inadequate stability or
strength. The statistically proven
result is greater levels of injury.
Tips for female fitness
! The woman wanting the most from
her body both functionally and
aesthetically will reap significant
benefits from restoring function to
the TVA, which is frequently
dysfunctional after childbearing,
caesarean section or hysterectomy.
! By performing Swiss-ball and free-
weight exercises at the beginning
of an exercise programme, and
moving on to machine exercises
only when the nervous system is
fatigued from the more complex
exercises, women will begin to see
enhanced functional stability and
strength.
! Only after a course of 8–16 weeks
of progressive stability- and
strength-training exercises should
a woman attempt power-training
exercises.
In short, the best thing in the world
for Jane is Tarzan’s exercises.
Paul Chek
Paul Chek is an internationally
recognized lecturer and consultant
in the fields of corrective and
performance exercise. He has
served as consultant to many
elite sports teams internationally,
including the Chicago Bulls. For
more information on the C.H.E.K
Institute, visit the website at
www.paulchekseminars.com.
WDDTY Exercise 21
Exercise
Beating back pain
Many people who suffer from back pain fear that physical activity will
do more damage. But now, research shows that staying active may
be the key to beating back pain for good.
M
ost people know that
regular exercise will
improve their physique
and fitness levels, but few
realize that keeping active may also
be beneficial for low back pain, one
of the most common causes of
disability in the West.
According to Wisconsin-based
spine expert Dr Peter Ullrich, “When
done in a controlled, gradual, and
progressive manner, active exercise
distributes nutrients into the disc
space and soft tissues in the back to
keep the discs, muscles, ligaments
and joints healthy. Consequently, a
regular exercise routine helps to
avoid stiffness and weakness, mini-
mize recurrences of low back pain,
and reduce the severity and duration
of possible future episodes of low
back pain” (www.spine-health.com).
But you don’t have to take his
word for it. There are numerous
studies supporting the benefits of
exercise for low back pain.
Indeed, just a few weeks ago, a
review by the Lausanne Institute of
Sports Science and Physical Educa-
tion concluded that exercise is
effective for both the prevention and
treatment of low back pain. As a
treatment, exercise reduced pain and
improved physical function in
patients whose condition was chronic
or recurrent (Joint Bone Spine, 2008 Sep
16; Epub ahead of print).
Other studies have looked at
specific types of exercise to find out
what works best. According to one,
the most effective exercise strategy
is an individually designed exercise
programme carried out under limited
supervision—for example, home
exercises with regular follow-up by a
therapist. Stretching and muscle-
strengthening exercises proved best
for improving pain and function (Ann
Intern Med, 2005; 142: 776–85).
For those who don’t have the time
or money for personal training,
however, joining a yoga class may be
another useful option. In one study,
22 WDDTY Exercise
patients participating in a 12-week
yoga programme enjoyed significant
improvement in back pain and
function compared with those given Technique (AT) is beneficial for back
a self-care exercise book. What’s pain. This discipline emphasizes the
more, the benefits persisted for self-perception of movement, and was
several months (Ann Intern Med, 2005; recently found to be more effective
143: 849–56). than the usual care or massage as a
In yet another study, just one week treatment for chronic back pain.
of intensive yoga practice—including Also, just six lessons followed by
postures, breathing practices, medi- prescribed exercises was nearly as
tation and philosophical concepts— successful as 24 lessons of AT on its
reduced pain-related disability and own (BMJ, 2008; 337: a884; doi: 10.1136/
improved spinal flexibility signifi- bmj.a884).
cantly better than a conventional Pilates, another discipline with a
exercise regime (J Altern Complement focus on posture, has also produced
Med, 2008; 14: 637–44). impressive results (J Orthop Sports Phys
Precisely why yoga is so effective Ther, 2006; 36: 472–84).
for back pain is not clear, but it But what about aerobic activity?
appears to be a combination of Do the more vigorous forms of
mind–body factors. As one report exercise cause more harm than good?
noted: “Yoga may be beneficial for It appears not. A study of patients
back pain because it involves physical aged from 30 to 60 with low back
movement, but it may also exert pain found that those who indulged
benefits through its effects on in aerobic exercise—walking or
mental focus.” Mental focus may help cycling for 45 minutes four times a
people to relax tense muscles, relieve week—required significantly fewer
mental stress, and increase their pain-medication prescriptions and
awareness of how they are moving were given fewer physical-therapy
and positioning their body (Ann Intern referrals than those who did not
Med, 2005; 143: 849–56). exercise. The researchers also noted
This synthesis between physical that exercise improved the patients’
movement and mental focus might mood—yet another excellent reason
also explain the results of a study to stay active (Spine J, 2001; 1: 95–101).
showing that the Alexander Joanna Evans
Stretch the pain away
According to Dr Peter Ullrich, daily stretching is an important part of any
back pain exercise routine. The most important muscles to target in any
back pain regimen are:
! hamstrings, which run along the back of the leg, help to correct posture
while sitting and standing; they also support the gluteus muscles in the
buttocks and the hip flexors, and minimize stress on the low back
! piriformis, which runs from the back of the femur (thigh bone) to the
sacrum (the base of the spine); when tight, this muscle can cause
sciatica-like pain, and has been linked to sacroiliac joint dysfunction
! psoas major, which is attached to the front portion of the lower spine
and can greatly limit lower back mobility if tight, making it difficult to
stand for extended periods of time or to kneel on both knees
! gluteus muscles of the buttocks, which support hip flexibility as well
as the pelvis.