Your Workout Today May Trigger A bright Idea Next Week

Picture from Triana et al (2024)

What if I told you your exercise session today can trigger a bright idea next week? That's exactly what a recent study by Finnish researchers found. They tracked a person's brain and behavioural activity for 5 months using brain scans and data from smart phones and wearable devices. 

This research (Trinan et al, 2024) was unusual since few brain scan studies involve such detailed monitoring over months. Using wearable technology in this study was crucial, especially since brain scans (while being useful) only shows the subject lying still for 30 minutes. 

2 distinct patterns were identified by the researchers. A short term wave that lasted under 7 days and a long term wave by up to 15 days. The short term wave reflects rapid adaptations like how focus is affected by poor sleep although it recovers quickly. The long term wave suggests more gradual, lasting effects, especially in areas tied to our attention and memory.

The study found that our brains do not respond to our activities of daily living in immediate, isolated bursts. Our brain activity evolves in response to our sleep patterns, physical activity, mood, and respiration rate over many days. This means that your exercise session or a restless night from the previous week can still affect your brain. Hence your memory, cognition and attention can be affected well into the next week.

It is a great study linking brain activity with environmental and physiological data as tracking our brain changes in real time can help detect mental health and neurological disorders early. This allows for earlier interventions and better outcomes.

Even though this study was not focused exclusively on exercise, the results showed that we definitely need a consistent exercise routine and maintain good sleep habits for our overall well being. I find myself particularly sensitive to these as I age. 

Reference

Triana AM, Salmi J, Hayward NME et al (2024). Longitudinal Single-subject Neuroimaging Study Reveals Effects Of Daily Environmental, Physiological, And Lifestyle Factors On Functional Brain Connectivity. Plos Bio. DOI: 10.1371/journal.pbio.3002797

Something You Do Not Know About Muscles

Picture from Burke et al, 2024

This is a very interesting finding about muscles. The muscles we use while exercising can actually communicate with our adipose (fat) stores in our body.

This study was done with 32 human subjects. A single bout of resistance exercise (or strength training) releases muscle specific microRNA-1 (miR-1) from muscles that are then transported to abdominal fat tissue via extracellular vesicles or EVs to stimulate lipolysis. Lipolysis is the breakdown of fats and other lipids to release fatty acids. This means you can use fats for energy, sparing your carbohydrate and protein.

I know what some of you reading must be thinking. Is spot reduction possible? Spot reduction means selective loss of body fat in regions involved in the exercise. Meaning can we isolate the fat in the abdomen (for men) by doing cruches or sit-ups?  Or doing lunges for the buttock and thighs (for women) and get rid of the fat there first? 

Well, sorry to disappoint you. In this study, the exercises were mainly done in the lower body- squats, leg press, leg extension and also lat pulldown (for the upper body). 3 sets of 8 reps at 80 percent of 1 rep max on the aboved mentioned exercises were performed. A fourth set to failure was performed straight after.

The lipolysis or fat breakdown in the adipose tissue was in a non specific area - the abdominal region. This was confirmed by the EV's found there.

Perhaps this is an interesting consideration suggesting that our muscles can function like a secretory organ. Like a giant endocrine organ in the body, more than we realize anyway. (Note : thoughts are my own, not from the study).

We are definitely only scratching the surface of understanding how exercise has so many other unknown benefits.

The women in the study did not have as strong an effect compared to the men in the study. Also note that is is a relatively small study with only 32 subjects.

If you are not already doing any strength training, you should. Not only it can increase your bone density, helps with insulin sensitivity, promote better sleep etc, it can also break down your stored fat.

Reference

Burke BI, Ismaeel A, Long DE et al (2024). Extracellular Vesicle Transfer Of miR-1 To Adipose Tissue Modifys Lipolythic Pathways Following Resistance Exercise. JCI Insight. DOI: 10.1172/jci.insight.182589

Best Grip For Strength Training

Pronated (overhand) grip

My son and I were discussing what grips work best while performing strength training exercises that require us to hold weights when we push, pull or carry. Especially also when doing pull-ups. He was really surprised that such a small detail like the orientation of his grip can have dramatic increase in weight lifted or reps done.

The pronated (or overhand grip) is probably the most commonly used when you do a pull-up or do a strict deadlift. While a supinated (or underhand) grip is used when you do a dumbbell curl or a chin-up. 

Alternate (mixed) grip

There is also the mixed (alternated) grip (pictured above) in which one hand is pronated and the other is supinated. A neutral grip is when both palms (or fists) face each other like when doing a hammer curl. A hook grip (pictured below)is often preferred by advanced lifters when using very heavy weights. The thumb is 'hooked' between the bar and wrapping your index and middle fingers around the thumb for a more secure hold.

Hooked grip

I explained to my son when it comes to grip positions, it is all about all about anatomy. Even slight variations in hand positions during a lift will change which muscles you are using. 

Let's look at the dumbbell curl. When you use the supinated grip, your biceps are the prime movers. When you rotate your hands 90 degrees to a neutral grip, the emphasis changes to a different elbow flexor, your brachialis. If you rotate your hands 90 degrres again to a pronated grip, you will target brachioradialis, yet another elbow flexor.

Supinated (underhand) grip

How do you choose between the supinated versus the pronated grip? It usually depends on the exercise. It will be difficult to do the standard deadlift with a supinated grip since it would be more difficult to hold the bar. Other than that, the main difference between the 2 grips will be the slight difference in muscle recuitment.

Similarly doing pull-ups with the pronated grip will target your latissimus dorsi and trapezius more while the supinated grip for chin-ups will involve your biceps more.

From previous experience,  a grip change is often useful for any exercise that you have not had a significant improvement in the last 4-6 weeks. Say you have not been able to increase weight in your bicep curl, try the hammer curl as it will target your brachialis, which is the strongest of the elbow flexors.

A word of caution, do not try to change your grip for the Olympic lifts (if you do them) since they already work best within the rules of the sport.

With other lifts, a small change can get bigger gains.

Still Doing Those Pendulum Exercises For Shoulder Pain?

Quite a few patients who came to our clinic this week had frozen shoulder. Almost all of these patients had been prescribed pendulum exercises (also know as Codman pendulum exercises) by their previous healthcare provider. The intention is to move/ rehabilitate the glenohumeral (or shoulder) joint while not worsening recently injured or operated tissue.

This is done with the patient standing with a slightly bent torso with the affected arm hanging downwards, using the momentum of the torso/ trunk to move the arm without activating the muscles in the shoulder girdle. The arm can be moved side to side, forwards and backwards, or in a circular motion. Codman pendulum exercises are also always  prescribed after shoulder surgery . In fact, they are the mainstay of many shoulder rehabilitation protocols.

However, Cunningham et al (2020) demonstrated that Codman pendulum exercises involved minmial glenohumeral and scapular-thoracic movement. Movement is mainly from the trunk. They may be a safe way to start early movement/ stretching of the upper limb but may be of limited further use in restoring passive shoulder range of motion.

In fact Gurney et al (2016) found that Codman pendulum exercises induced the least muscle contraction in rotator cuff activity when they investigated several tasks, common rehabilitation exercises and ambulation. Wearing and taking off a shirt induced the highest. Even walking produced substantially higher muscle activity than the Codman exercises. 

Of course if the movement is directly generated from the shoulder rather than the trunk as well as performing larger pendulum circles, there will be increased rotator cuff muscles activity.

Personally, in our clinic, I find that teaching patients 3 basic exercises with elastic resistance bands work much better for the shoulder. Intensity, dosage and exercise position will have to be modified dependent on the surgery and condition the patient has. 

I show them the one arm shoulder frontal raise (pictured above), the lateral raise and a simple basic rowing exercise where the shoulder blade is retracted (or pulled back). In fact, the same few exercises and the single arm reverse fly (pictured below) were found to be effective for office workers to perform daily for 10 minutes to reduce neck and shoulder pain (Saterbakken et al, 2020). 

From Saterbakken et al (2020)

You can definitely stop doing those Codman pendulum exercises.

References

Cunningham G, Charbonnier C, Ladermann A et al (2020). Shoulder Motion Analysis During Codman Pendulum Exercises. Arthrosc Sp Med Rehab. 2(4): e339. DOI: 10.1016/j.asmr.2020.04.013

Gurney AB, Mermier C, LaPlante M et al (2016). Shoulder Electromyography Measurements During Activities Of Daily Living And Routine Rehabilitation. Ex J Orthop Sp Phy Ther. 46(5): 375-383. DOI: 10.2519/jospt.2016.6090.

Saterbakken AH, Makrygiannia P, Stien N et al (2020). Dose-response Of Resistance Training For Neck-and Shoulder Pain Relief: A Workplace Intervention Study. BMC Sp Sci Med Rehab. 12:8. DOI: 10.1186/s13102-020-0158-0

When Does Your Body Age The Fastest?

Picture by Steven Gregor from The Guardian

I always thought that age was just a number. How you feel is more important. Definitely being young at heart helps too. Mentioned this to my friend who's in his 60's while cycling this morning and he said that's the problem when you are young at heart. He said that he feels young at heart but the problem is that his heart is not that young.

Newly published research from Stanford University suggest that humans age very quickly in 2 periods, once around age 44 and the other around 60 (Shen et al, 2024).

Researchers in this study collected and analyzed more than 135,000 biological samples from 108 subjects ranging from 25 to 75 years. Cytokines, skin, oral, nasal microbiome, proteins, lipids, bacteria, ribonucleic acid etc were studied. They found that at around 44 years, those studied had a dramatically different mix of molecules than others just a few years younger. This indicates a spike in the risk of a heart attack, faster skin and muscle aging and slower alcohol and caffeine metabolism.

The next period of acclerated aging happened around age 60. More signs of aging for the heart, skin and muscles. Once into the 7th decade, our immune systems are weakened, kidney function reduces and decreased carbohydrate metabolism that can lead to Type II diabetes.

This shows that biological aging is not linear. It depends on our lifestyles primarily and genetics secondarily and how they interact. For many people, the early 40's and 60's tend to align with major life changes. Your children leaving for university, stopping work, downsizing your home etc.These changes may influence your diet, exercise, social exposure and other factors that affect how your bodies work.

Can we slow the biological aging? The researchers suggest adopting healthy lifestyle habits and ditching the bad ones to delay the aging in the 40's and 60's. If you are not yet 40, start paying attention to heart healthy habits, monitoring especially your cholesterol and triglycerides levels. Have a healthy diet, get enough exercise, minimise smoking and sugar.

Research suggests calorie restriction may protect health and longevity by protecting DNA from age related changes. Subjects who ate less calories by an average of 12 percent slow down their rate of aging by 2-3 percent (Waziry et al, 2023).

Bad sleep does not only make you tired, but makes you look old and haggard. Sleeping less than 6 hours each night can add about 15 months to your biological age and speed up the pace of aging (Kusters et al, 2024). Make sure you get enough shut eye.

Steven Gregor from The Guardian

Those who are yet to hit their 60's definitely need to strength train since muscle loss accelerates. Losing 1 to 2 percent of your muscle mass every year causes you to lose your ability to move freely and easily. Your health plummets as a result. A recent study by Da Silva et al (2024) showed that middle aged and older adults who did 12 weeks of progressive strength training delayed or even reversed sarcopenia (age related muscle loss). 

Now you know.

References

Da Silva AC, Mapa V, Ferreira-Junior JB et al (2024). Progressive Strength Training Can Reverse Sarcopenia Stage In Middle-aged And Older Adults Regardless Of Their Genetic Profile. Arch Geron Geriatrics. Vol 117. DOI: 10.1016/j.archger.2023.105182

Kusters CDJ, Klopack ET, Crimmins EM et al (2024). Short Sleep And Insomnia Are Associated With Accelerated Epigenetic Age. Pysch Med. 86(5): p453-462. DOI: 10.1097/PSY.0000000000001243

Shen X, Wang C, Zhou X et al 92024). Nonlinear Dynamics Of Multi-omics Profiles During Human Aging. Nat Aging. DOI: 10.1038/s43587-024-00692-2

Waziry R, Ryan CP, Corcoran DL et al (2023). Effect Of Long-term Caloric Restriction On DNA Methylation Measures Of Biological Aging In Healthy Adults From The CALERIE Trial. Nat Aging. 3(6): p249-257. DOI: 10.1038/s4357-022-00357-y

Can You Prevent Running Injuries?

We have been seeing some runners in our clinic recently. Some seasoned runners, but quite a few new, novice runners. My definition is unless the runners have been training, running and/ or racing for at least 5 years, they are still considered novice runners.

As a runner I would love to run long and hard daily, alas if we do that injury definitely beckons. How do we prevent that from happening? Can we actually prevent running injuries?

I came across an article investigating if it was possible to prevent running injuries. In this particular study (Leppanen et al, 2024), there were 325 participants who were fairly new runners (less than 2 years of running experience) and aged between 18-55 years. Interventions were completed before the actual runs. The runners attended group training twice a week with a physiotherapist for 6 months.

They were divided into 3 training groups, 2 intervention and 1 control group. All 3 groups followed a similar training program and all runners were taught about the basics of running technique. The first intervention group (108 runners) did strength and conditioning exercises for the hip and core. The 2nd group (111 runners) did exercises to strengthen the ankle and foot, while a third control group (106 runners) did static stretching.

Each training session lasted about 30 minutes twice a week with the exercises and difficulty level progressing over the course of 6 months. Each exercise had 4 different versions with different levels of difficulty and intensity. After the training session, the participants ran outdoors for 30-75 minutes. The participants reported all running related injuries each study week using a mobile application.

Results show that the group that focused  on hip and core training sustained the least injuries among the 3 groups. They had 39 percent lower prevalence of all overuse injuries and 52 percent lower prevalence of overuse injuries compared to the control group. 

I was surprised that the  ankle and foot exercise group did not prevent running related injuries compared to the stretching group. The incidence of acute injuries was lower in the control group than ankle and foot exercise group perhaps suggesting that stretching may help prevent acute running injuries. However, do take note that there were a low number of acute running injuries in this study so this observation should be approached with caution.

This study shows that beginner or novice runners injury rates can be significantly reduced by training the hip and core muscles. Overuse injuries can be cut by about half by strengthening this area compared to stretching which has always been traditionally thought to prevent injuries. And it's really easy to do with just body weight and/ or resistance bands.

Come see our physiotherapists at Physio Solutions and Sports Solutions to learn about what stregthening exercises would help prevent running injuries for you.

Reference

Leppanen M, Viiala J, Kaikkonen P et al (2024). Hip And Core Exercise Program Prevents Running-related Overuse Injuries In Adult Novice Recreational Runners: A Three-arm Randomised Controlled Trial (Run RCT). BJSM. 58: 722-732. DOI: 10.1136/bjsports-2023-107926.

Are Good Athletes Born Or Made?

Unleash the ROAR

I brought my son to football practice earlier today and noticed that some kids were really athletic, a lot quicker and stronger than most of the children of the same age. Of course some were not so. 

Which begets the question of whether good athletes are born with physical gifts or can hard work trump talent?

Here is what a recently published study (Silventoinen et al , 2024) says. This really interesting study involving 198 twins (6-18 years old) used 15 tests to assess for genetic contribution or environmental contributions. In short, the twins completed a battery of tests to analyze whether it is just talent or training that made them good or not so good athletes. Genes versus environment. 

40 percent (78) of the twins were monozygotic (or identical twins), sharing the same DNA. The rest were fraternal, meaning they share about half their DNA. This would mean that if the results of a certain test are more similar within identical twins than fraternal twins then that suggests a larger genetic influence.

The results (below) show that genes played a big role in the results. Between 52-79 percent of your flexibility, power and strength is determined by your genes. Thank your mum and dad for those of you blessed in those areas. I will definitely thank mine for what they gave me.

Picture from Silventoinen et al, 2024

See the figure above, 52 percent in the standing long jump, and a whopping 79 percent for sit and reach showing that the girls performing better than boys in flexibility. The boys performed better than girls in cardiorespiratory endurance and muscular strength. Most of the tests actually showed modest to moderate genetic correlations. 

The 3 tests that were most correlated with the rest of the tests were push-ups, standing long jump (standing broad jump for us Singaporeans) and the Beep Test. Need a simple and quick way of assessing someone's overall fitness, these 3 are the easiest. Perhaps our schools' DSA, Singapore Armed Forces and sports talent ID department should take note when assessing talent.

What about the role of the environment? We need to consider 2 components here. Shared environmental factors, like the area you grew up in, socioeconomic status, opportunities to play sports etc. There are also unique environmental factors, which reflect your own path through life. Whether you joined a sports team, broke your leg /arm or had a great physical education teacher that believed in/ motivated you.

The effects of shared environmental factors appear to be negligible in this study. This is in contrast to earlier published data. So this study's analyses focused on genetic and unique environmental factors.

From my previous readings, work and experience, I would have thought running fast (sprinting) and explosive power (jumps) were 'gifts' from your parents more so than endurance. You may have heard the saying that sprinters are born while endurance runners are made. You may also know a runner that trained loads before becoming a great marathon runner. 

The results in this study do not totally back those assumptions since standing long (or broad) jump (the best measure of explosive power in the tests) had the lowest genetic contribution. But that may be the difference between 2 facets of talent : untrained performance levels and trainability. 

The standing long jump performance may show the explosive properties in their muscles, but it does not reflect a determined and serious effort to train.

Similarly, the 12 min run results do not tell what happens when you clock 100 km of training a week. They are all estimates of 'starting points' but will not tell us how much, with sufficient hard (and smart) work, where we might end up. 

In 2001while representing Singapore

A physiotherapist that treated me after I had stress fractures in both my shins (when I was 20) told me that I would not become a good triathlete. Happy to prove that person wrong later (pictured above with Dimitry Gagg, 1999 World Triathlon Champion And Daniel Lee, 2006 Asian Games Silver medalist) and doubly so when I overheard that same physiotherapist telling another colleague that our physiotherapy department had athletes too after I joined them.

You may be blessed with the best genes, but if you do not train smart and hard enough, there will be others with less talent who will be able to be better than you because they trained smarter and harder.

Some of those ideas are not solely my own. They are discussed in detail by David Epstein in his 2013 book The Sports Gene. 

Whatever genes you have, remember to thank your parents.

Reference

Silventoinen K, Maia J, Sillanpaa E et al (2024). Genetic Regulation Of Physical Fitness In Children: A Twin Study Of 15 Tests From Eurofit And Fitness gram Test Betteries. Med Sci Sp Ex. DOI: 10.1249/MSS.0000000000003496