10 Bodyweight Squats Or Walk 30 minutes?

Last week I wrote about how a fast or slow metabolism does not influence your weight gain or weight loss. For those of us who run or exercise to manage our weight, it definitely does burn calories while you are exercising, but it does not boost your metabolism, at least not in the long term. 

Well, I can suggest a fairly simple way to improve your blood sugar regulation better than a single 30 minute walk if you're pressed for time. Also helps to lower cancer and cardiovascular related mortality.

A recently published study (Gao et al, 2024) on overweight and obese subjects who either sat uninterrupted for 8.5 hours or had interruptions while sitting with matched energy expenditure and duration. A 30 minute walk at 4 km/hr, sitting with 3 minutes walking at 4km/hr or squatting 10 times every 45 minutes.

The authors found that doing 10 body weight squats every 45 minutes or short frequent walking breaks during a 8.5-hour period of sitting improved blod sugar regulation better than a single 30 minute walk (at 4 km per hour).

These superior benefits seemed to be associated with increased muscle activity intensity in their targeted muscle groups during frequent transitions from sitting to activity.

These brief, intense bursts of activity (bodyweight squats in the study) termed 'exercise snacks' offer a simple yet strong strategy to mitigate the health risks associated with our sedentary lifestyles. It is not too difficult to get up from sitting and do 10 bodyweight squats every 45 minutes (or when you can). You can also do burpees or run up stairs to break up sedentary periods. Those at home may want to do some dumb bells/ kettle bells swings.

Of course some other people may prefer to walk outside for fresh air, sunlight meeting other people and psychological/ mental health benefits. Or a combination of exercises and walks. Works well too. Go on and add some some exercise snacks into your day.

References

Gao Y, Li QY, Finni T ey al (2024). Enhanced Muscle Activity During Interrupted Sitting Improves Glycemic Control In Overweight And Obese Men. Scan J Med Sci Sp. 34(4): e14628. DOI: 10.1111/sms.14628

Stamatakis E, Ahmadi MN, Gill JMR et al (2022). Association Of Wearable Device-measured Vigorous Intermittent Lifestyle Physical Activity With Mortality. Nat Med.28: 2521-2529. DOI: 10.1038/s41591-022-02100-x

Will My Metabolic Rate Slow Down As I Age?

Picture from Genesispersonalfitness

Looks like we have been very wrong about our metabolic rates. Whether our metabolic rate is fast or slow, it cannot predict weight gain. 

Metabolisms varies by 20 percent or more from person to person regardless of activity level or body composition (Rimbach et al, 2022). So for those of us who run or exercise to manage our weight, yes it does burn calories, but it does not boost our metabolism, at least not in the long term. 

The researchers also found that if you happen to be on the skinnier side, it is not that you have a faster metabolism (Rimbach et al, 2022).

The researchers measured metabolism using doubly labeled water. Participants in their studies drank water containing hydrogen and oxygen isotopes, which researchers can track in the body. How quickly they lost the isotopes through peeing, sweating and even breathing were monitored. These enabled them to ascertain how many calories are burned in that time, or what is known as total energy expenditure i.e. metabolism.

The total energy expenditures studied were measured at 2 time points, ranging from 2 weeks to more than 8 years. Body size and composition were adjusted for since more cells burned more calories and fat and muscle burned calories at different rates. 

The researchers found that the subjects' daily energy expenditures did not change over time. A person with high metabolism today will have it high in a few months or even a few years. Likewise, a person with slow metabolism today will still have it slow in a few months or a few years.

Here's the good news. The researchers found that having a slow metabolism did not make people more likely to gain weight. Nor did having a fast metabolism less likely to gain weight.This is attributed to the human brain's outstanding ability to match calories consumed to calories burned in the long run.

So, running or any exercise is not a magic metabolism booster. Exercise is complex and it affects how our body regulates all its cells, which in turn affects hunger, fullness, immune function and even behaviour. 

Those who exercise will obviously see day to day fluctations in the calories burned. More on long runs/ hard days compared to recovery days. Our bodies adjust how much energy we use during our non exercise hours to keep the total caloric burn within a fairly narrow range.

So, you do not gain weight as you age because your metabolism slows down (Pontzer et al, 2021). We have all been mislead by this myth. We should not use it as as excuse. You gained weight because we do not move and/ or exercise as much and because we may have lost some muscle mass.

Reference

Pontzer H, Yamada Y, Sagayama H et al (2021). IAEA DLW Database Consortium. Daily Expenditure Through The Human Life Course. Science. 373(6556): 808-812. DOI: 10.1126/ science.abe5017

Rimbach R, Yamada Y, Sagayama H et al (2022). Total Energy Expenditure Is Repeatable But Not Associated With Short-term Changes In Body Composition. Nat Commun 13,9. DOI: 10.1038/s41467-021-27246-z

Cold Play?

ST 100524

I just wrote about how cold (ice) immersions were not effective last week! And Straits Times does a full page article on the front of their Life Section today (100524).

"I noticed a significant improvement in my alertness and reduced muscle soreness after including cold therapy ....." said a business owner selling ice baths.

No, evidence says cold immersions does not help with recovery. Actually cold immersions inhibits recovery. Researchers (Roberts et al, 2015) have found that cold water immersion after hard exercise suppressed signaling pathways associated with recovery. This suppression lasted for several days.

The newspaper article also credited Wim Hof (the Dutch iceman) for popularising cryo or ice therapy - just like my post. Purveyors of commercial health and wellness have definitely jumped on the same bandwagon. I cannot comment on the various beauty and skincare benefits (such as reduction in cellulite and what not) as touted by the wellness professionals quoted. Please do your due diligence.

Reference

Roberts LA, Raastad T, Markworth et al (2015). Post-exercise Cold Water Immersion Attenuates Acute Anabolic Signaling And Long-term Adaptations In Muscle To Strength Training. J Physiol 593(18) : 4285-4301. DOI: 10.1113/JP270570.

Can Cycling Lower Your Risk Of Knee Arthritis?

Picture by Dennis Thong

I have written previously on what causes osteoarthritis (OA). Definitely not because of overuse nor a mechanical wear and tear process. Especially for those without any previous history of knee truma/ injury, there is very good evidence that OA is actually due to metabolic factors. Well, now a new study (Lo et al, 2024) suggests that cyclists are less likely to develop OA in their knees.

Lo et al (2024) studied 2600 older adults with and without knee OA using knee X-rays, subjective knee pain, and a questionnaire regarding their lifetime history of various physical activities during 4 periods of their lifes: 12 to 18 years old, 19 to 34, 35 to 49 and over 50. 

The study used 3 different outcomes. Persistent knee pain, OA based on X-rays (radiographic OA) and symptomatic OA (having both knee pain and radiographic OA. Note that what is seen on X-ray (OA knees) does not always correspond to pain. This means that some subjects had knee radiographic OA but NO pain.

Almost half the subjects reported some history of cycling and these subjects were less likely to have OA in their knees. How much less? Those with any history of cycling were 17 percent less likely to have knee pain, 9 percent less likely to have radiographic OA and 21 percent less likely to have both. 

Half of those who cycled reported only cycling regularly during one of the 4 age periods, usually the youngest age period from 12 to 18 years old.

Those who cycled during 1,2,3 or 4 of the periods studied reduced their risk of symptomatic OA (i.e. painful knees) by 17, 19, 28 and 43 percent. Meaning lifelong cyclists reduced their risk of symptomatic OA by nearly 50 percent.

The researchers also found that subjects with a history of swimming, strength training and running had lower rates of OA. This is consistent with previous evidence that running DOES NOT ruin your knees despite what every non runner and ex runner you know will insist running does.

You may love watching the beautiful game, but a history of playing the beautiful game (football) even just as a teenager bumped up knee OA risk by a factor of 2. This elevated risk remained even after adjusting for BMI, suggesting that the problem is likely related to acute knee injuries suffered while playing football. 

Picture by Dennis Thong

The researchers concluded that more cycling is associated with less knee pain and favorable to knee health and should be encouraged. 

If you have never cycled previously and would like to start, do note that almost half or the current or former cyclists in the study had radiographic evidence of OA. A quarter of them had symptomatic OA (painful knees). Is cycling better for OA once you do develop OA compared to say running? Is cycling capable of slowing its progression? Currently, we still do not know.

Those of you who have been always been cycling, you definitely have another reason to do so. 

Reference

Lo GH, Richard MJ, Kriska AM et al (2024). Bicyling Over A Lifetime Is Associated With Less Symptomatic Knee Osteoarthritis : Data From The Osteoarthritis Initiative. Med Sci Sp Ex. DOI: 10.1249/ MSS 0.0000000000003449

All pictures by Dennis Thong. Many thanks to Dennis and Eugene Phua for the pictures.

Are Cold (Ice) Water Immersions Effective?

Picture from Scienceforsport

I used to have lots of ice packs in the freezer when I was still competing. The commercial ones plus bags of peas and mixed vegetables (pictured below). Used to put it on my shin or anywhere that hurts. However, I did not do the ice/cold water immersions. It was way too cold for me (since I had less body fat then) and I did not feel it helped. 

Good for icing

However, the more we know about cold water immersion (from research), the more it seems we (athletes and non athletes) have it wrong. Regular immersion in cold water significantly inhibits recovery from strenuous exercise. 

When our muscles feel sore after strenuous exercise, it is a consequence of doing physical activity to which we are unaccustomed or not used to. That can be a hard run, gym session, a few hours of golf or a repetitive household chore that took longer than you expected.

Here's an example of how our muscles get overloaded. If you continuously stretch a rubber band, the rubber band becomes frayed. Likewise your muscles sustain micro tears when you exert too hard. The damage causes a few hours to days of inflammation, swelling and soreness. When it's severe, you get delayed onset of muscle soreness or DOMs.

This is normal and also an essential part of muscular adaptation to exercise, also known as the overload principle. If the stress (exercise) is applied regularly, and you get enough recovery, the muscles adapt, get stronger and bigger by laying down new fibers. Just like a construction crew assembling steel beams to support the infrastructure of a building.

Ice immersion inhibits this process. Researchers (Roberts et al, 2015) have found that cold water immersion after hard exercise suppressed signaling pathways associated with recovery. This suppression lasted several days. Another group of researchers (Fuchs et al, 2020) showed that ice bathing reduced the body's muscles uptake of dietary proteins, which is important for growth and cell maintenance.

The conclusions of 2 recent meta-analyses support the suppressed signaling pathways and reduced dietary protein intake mentioned above. Grgic (2022) showed that cold water immersion reduced exercise related strength gains while (Pinero et al, 2024) showed that ice bathing immediately after weight training inhibited muscle growth.

So, whether you are strength training to improve athletic performance or just about anyone who needs to repair and rebuild your muscles after exercise, you need to reconsider if you should use cold water immersion after your exercise/ training.

Why are athletes and non athletes still doing cold water immersions? Social media is probably the cause. Wim Hof (the Dutch iceman) says that cold "activates" your metabolism and strengthens the body's immune response. Others on Tik Tok swears that ice baths improves alertness and concentration. Purveyors of commercial health and wellness have likely jumped on the same bandwagon.

Perhaps sports scientists and researchers have to share some of the 'blame'. These articles are written and published in scientific language, using unrelatable sequence and you have to pay to access them.

Possibly, only the articles with the most sensational findings/ conclusions make it out of academia. Since it is not communicated well with the public, there is a gulf between the lab and the average lay person. This gulf is then filled gleefully by fitness influencers and wellness 'gurus' who share their knowledge on unregulated social media platforms.

I ice my sore body parts still, because it does reduce muscle pain. I fell and bruised my elbow last week and the icing provided pain relief as the ice numbs the skin and blocks pain signals to the brain. 

Pain is subjective. To you it may be a 3/10 pain, to me, it may be 7/10 or vice versa. Pain cannot be studied objectively. Pain perception is definitely different to cellular recovery and to actually speed up recovery, you need to sleep well.

References

Fuschs CJ, Kouw IWK, Churchward-Venne TA et al (2020). Postexercise Cooling Impairs Muscle Protein Synthesis Rates In Recreational Athletes. J Physio. 598: 755-772. DOI: 1113/JP278996.

Grgic J. (2023). Effects Of post-exercise Cold-water Immersion On Resistance Training-Induced Gains In Muscular Strength: A Meta-analysis. Eur J Sp Sci. 23(3): 372-308. DOI: 10.1080/17461391.2022.2033851.

Roberts LA, Raastad T, Markworth et al (2015). Post-exercise Cold Water Immersion Attenuates Acute Anabolic Signaling And Long-term Adaptations In Muscle To Strength Training. J Physiol 593(18) : 4285-4301. DOI: 10.1113/JP270570.

Pinero A, Burke R, Augustin F et al (2024). Throwing Cold Water On Muscle Growth: A Systematic Review With Meta-analysis Of The Effects Of Postexercise Cold Water Immersion On Resistance Training-induced Hypertrophy. Eur J Sp Sci. 24: 177-189. DOI: 10.1002/ejsc.12074

Shouder Keeps Clicking But No Pain

I had a patient come in to our clinic this week complaining that his shoulder keeps clicking and popping with occasional discomfort (but not pain).

I shared with him an article published earlier this month where 100 patients with suspected rotator cuff tendinopathy and/ or tearing underwent MRI investigation. 

Indication for MRI was when the patients had weakness on testing of the rotator cuff muscle(s) or symptoms resistant to conservative treatment . This is inclusive of at least a 6-week course of physiotherapy. The presence of subjective mechanical symptoms, including clicking or popping was recorded prior to MRI.What the researchers were looking for was the presence of full or partial thickness rotator cuff tearing and biceps long head subluxation.

Results showed that 60 percent of the patients reported subjective mechanical symptoms in their affected shoulder. However only 42 percent of patients had full thickness rotator cuff tearing, 69 percent had partial tears while only 14 percent had biceps long head subluxation.

The authors concluded that subjective mechanical symptoms were not associated with any rotator cuff tearing, biceps long head subluxation. 

However, older age was associated with partial and full thickness rotator cuff tearing. Subjective shoulder mechanical symptoms has the ability of only 44 percent in predicting partial and full thickness rotator cuff tears. Patients may be reassured that clicking or popping sensations alone does not necessarily mean structural shoulder damage.

This article highlights the difficulty of diagnosing shoulder pain/ disorders based solely on symptoms like clicking and/ or popping. I have previously written and explained about this before. The clicking and popping sounds do not really matter, especially when there is no pain. Plus abnormal MRI findings happen in patients with no pain as well.

Reference

Zhang D, Dyer GSM and Carp BE (2024). The Significance Of Subjective Mechanical Symptoms In Rotator Cuff Pathology. J Shd Elbow Surg. 3: S1058-2746(24)000227-1

Help! My child Is Pigeon Toed

I saw a concerned parent this week who brought her child in to our clinic. She was told that her child had her feet pointing inwards while walking. This is also called in-toe or pigeon-toed walking. (If a child walks with their feet pointing onwards it is called out-toe walking or duck-footed).

These childrens' walking patterns are often termed "rotational deformities" which often cause parents to seek the opinion of podiatrists, physiotherapists or an orthopaedic surgeon for more specialized assessments and treatments.

Often when a baby is born, bowed or curved legs are normal due to the position they may be inside the mother's womb. This sort of bowed or curved legs can remain for a while and seem more obvious when the child starts to walk. It may appear that their feet face inwards (or outwards). Often the child may even trip or fall over their own feet while walking.

There may be different reasons why the child's leg or foot faces inwards or outwards while walking. When a child's leg or foot faces inwards or outwards during walking, it can be due to a number of changes in the leg or foot. If the foot is curved in ('banana' shaped feet ), or when there an inward twisting of the shin or thigh bone (tibial or femoral torsion), in-toe walking can occur.

Tibial torsion occurs when the shin (tibia) bone turns in or outwards. An inward-turned tibia is common in children under the age of 3. It almost always straightens after this age after this age (3) with NO treatment. Sometimes the shin bone even turns slighly outwards as the child grows order. This is perfectly normal. These changes occur in children up to the age of 8.

The are health professionals who will recommend that children with in-toe walking wear a type of orthotics called gait plates. While gait plates may provide some cosmetic effect when worn, there is insufficient evidence they will result in long term change. 

Parents please be very cautious about claims that such devices will fix your child's in-toe walking. Please consider if the expense, time, and your child's well being is worth it for something that will naturally get better on it's own. Do not let these health professionals prey on your fear.

Femoral torsion is when the femur (thigh bone) is turned in or outwards. Children may appear to walk with their feet tuning inwards or outwards. It then looks like their knees point inwards or outwards. 

The femur goes through many changes up to the age of 12 and this inward turn of the of the femur is more commonly seen in girls than boys. Please note that this rotational changes in the femur are a very normal part of growth.

W sitting

This inward turning at the top of the femur and hip sometimes appear in children who W-sit (pictured above) as well. There is however, no research proving that W-sitting is harmful.

There are no shoes, orthotics, garments, stretches etc that have evidence showing them being effective to change in-toe or out-toe walking associated with these rotational changes. Children walk in-toe or out-toe for many reasons. 

Unless your child is tripping often because of the leg position at the ages past 8 years of age, or if one leg turns significantly more in or outwards than the other. Unless one leg seems a lot longer or looks very different compared to the other, there is no reason to be worried. For the majority of children, in-toe or out-toe walking is just part of growing.

Actually, famous athletes like Michael Jordan, Bjorn Borg, Andre Agassi, Andy Murray, Vera Zvonareva, Zinadine Zidane and Ronaldinho are all pigeon toed. There is some anecdotal evidence and indirect research evidence to support that pigeon toed athletes have faster feet reaction times. And that will have to be in another post.

Reference

Mudge AJ, Bau KV, Purcell LN et al (2014). Normative Reference Values For Lower Limb Joint Range, Bone Torsion, And Alignment IN chldren Aged 4-16 Years. J Ped Orthop. 23(1) : 15-25. DOI: 10.1097/BPB.0b013e328364220a