Monday, November 30, 2015

How Much Should You Run In A Week?

This is the little guy I run with mostly now
I often get asked by my patients if I'm still training or how much I still bike or run etc. I tell them that I'm definitely not training seriously like before. I still swim occasionally and bike (if cycling my son to school is included). And I usually just run back after working at Physio Solutions twice a week. (For those who want to know- I take a bus there).

So I'm happy to read that a recently published review suggested that running a few miles a week can substantially improve your health. The authors specifically reviewed journals published in PubMed since 2000 that had a sample size of at least 500 runners and a 5-year follow up period.

The researchers found that you do not need to run a whole lot to get benefits. How much are we talking about here?

Based on the latest published evidence reviewed, the authors suggest that running 20 to 30 minutes or about one and a half to three miles (2.4 to 4.8 km) twice a week appears to be perfect.

Even with such low mileage, runners generally weighed less and and had a lower risk of obesity compared to people who did not exercise. The runners were also less likely to have high blood pressure, high cholesterol levels, diabetes, strokes, certain cancers and arthritis compared to non-runners, or those who ran less than five miles a week.

The authors also suggested that running a few additional miles will help if you need better weight control and it "allows one to eat more calories".

Those who are looking to be faster and better runners will definitely need to run more although some evidence suggest that running strenuously for more than an hour every day could slightly increase your risk for heart problems, running related injuries and disabilities.


Lavie CJ, Lee DC et al (2015). Effects Of Running On Chronic Diseases And Cardiovascular And All-cause Mortality. Mayo Clin Proce. 90(11): 1541-52. DOI: 10.1016/j.mayocp.2015.08.001.

Monday, November 23, 2015

Feels Good But May Be Unhealthy

I have always been a poor sleeper. Even when I was training very hard. In fact when I pushed myself too hard at training, I usually found it harder to fall asleep. And I could never sleep in. My internal body clock is set such that I could never sleep past 7 am.

Turns out not being able to sleep in may not be such a bad thing after all.

A group of researchers studied 447 men and women between the ages of 34 to 54. They wore devices that tracked movement and also monitored them when they slept and woke.

Nearly 85 percent of the group went to sleep and woke later on their off days compared to during their work days.

The researchers found that the greater the mismatch in sleep timing between their week days and week ends the higher the metabolic risk.

Sleeping late on off days (week ends) was linked to lower HDL (or good) cholesterol, higher triglycerides, higher insulin resistance and a higher body mass index. This is true even after adjusting for physical activity, caloric intake, alcohol intake and other factors.

The researchers are not sure if this is similar in the long term as the subjects were only studied for seven days. Several other studies have shown that there is an association between shift work and in increased risk for heart disease and diabetes, similar to what this study has shown.

Don't stay up too late on your off days.


Wong PM, Hasler BP et al (2015). Social Jetlag, Chrontype And Cardiometabolic Risk. J of Clin Endo and Metabolim. DOI:

Sunday, November 15, 2015

Running Injuries? Blame Your Genes?

Chromosome by Hey Paul Studios from Flickr
All right, it's finally been proven, some people are more prone to injury than others. So says a newly published article from the British Journal of Sports Medicine.

The researchers found evidence from family and genetic studies that DNA sequence variants (together with non-genetic factors) can increase your risk for tendon and ligament injuries. This is for both exercise-associated and occupational-associated acute and chronic injuries to tendons and ligaments.

Although research at this stage is still preliminary, there have been specific gene variants found (COL5A1 gene) that are less likely (58 percent less) to cause Achilles tendinopathy (degenerative change in the tendon).

A different gene (COL1A1) is associated with ACL (anterior cruciate ligament) and Achilles tendon ruptures (September et al, 2009).

In fact, several other genes have been associated with injuries ranging from carpal tunnel to tennis elbow.

The common link among these genes is that they affect collagen fibrils structure. Collagen fibrils are the basic structural building block for tendons, ligaments and other connective tissue including fascia. In simple terms, some Achilles tendons are built better than others.

So what do you do with this information then? Athletes and coaches beware, especially when there are now many genetic tests marketed for self testing promising to reveal potential injury susceptibilities.

The researchers reported that such tests should be requested by an appropriately qualified healthcare professional since results need to be interpreted together with certain clinical indicators and other lifestyle factors.

Personally I'm fairly sceptical about such over the counter/ online genetic tests that you can purchase to do a self test on whether you're more prone to injury.

Will knowing that really change your training habits? As a previously compulsive competitive athlete, I trained as hard as I could handle and more without getting injured. Knowing I'm say, 10-20 percent more likely to get a tendon injury will not alter my day to day training. On the contrary, because I've been training hard for so long (previously), I know what injuries I'm prone to because I've already had them previously.

Hmmm, maybe from now I'll ask my patients whether they have a family history of tendon or ligament injuries instead. (Standard practice for Physiotherapists is asking patients if they have any family history of hypertension, heart diseases and cancer etc).


Collins M, September AV and Posthumus M (2015). Biological Variation In Musculoskeletal Injuries: Current Knowledge, Future Research And Practical Limitations. BJSM. DOI: 10.1136/bjsports-2015-095180.

September AV, Cook J et al (2009). Variants Within The COL5A1 Gene Are Associated With Achilles Tendinopathy In Two Populations. BJSM. 43: 357-365. DOI: 10.1136/bjsm.2008.048793.

Thursday, November 5, 2015

Recovering From Bangkok Bomb Blast ST 051115

Straits Times (051115)
Sports Solutions is featured in the Straits Times today. One of our patients recovering after being injured on August 17 this year in the Erawan Shrine at the Rachprasong section in Bangkok while on holiday there with his family.

We wish him well for his recovery.

It's in the Straits Times today on page B10.


Sunday, November 1, 2015

Running After Total Hip Replacement

Picture by Cindy Funk from Flickr
I've had a patient who came in to our clinic this past week asking if she can still run after surgery as she was considering a hip replacement. Another patient recently had hip replacement surgery and wanted to get back to running quickly.

I told both of them what I knew was that under laboratory testing conditions, more pounding translates into shorter lifespans for artificial joints. That means when you load your joint more (after hip replacement surgery) during running, the artificial joint will wear out more rapidly than someone who participates in lower impact activities such as cycling or swimming.

Adverse effects could mean dislocations, fractures, loosening of the prosthesis and scraping off and scattering within the body of metal fragments.

In a 2014 study, researchers investigated 23 adults who returned or started running after hip replacement surgery reported few problems five years after their surgery. There was very little evidence that their subjects experienced the above mentioned adverse effects.

Theirs was quite a small group of subjects and the follow up period was relatively short too.

In another larger study, 804 hips from 608 patients were investigated. Among the subjects who ran (an average of four times a week covering 3.6 km), none of the subjects had any loosening, abnormal implant migration or excessive wear during the five year follow up as well.

I suggested to my patient (who had the hip replacement done) that she shouldn't rush back to running after surgery. She needs to regain full range of motion in the hip and get the muscles around the joint strong first before attempting to run. Of course I suggested deep water running/ aqua based rehabilitation first.


Abe H, Sakai T et al (2014). Jogging After Total Hip Arthroplasty. Am J Sp Med. 42(1): 131-137. DOI: 10.1177/0363546513506866.

Meira EP and Zeni J Jr (2014). Sports participation Following Total Hip Arthoplasty. Int J Sports Phys Ther. 996): 839-850.