Full House Today (Again)

Full house ....waiting to start

I didn't expect the Flossing course to be full today as earlier in the week Jane told me that there were still vacancies and asked if I could share the brochure on our clinic's Facebook page.

But it was filled just like the course two weeks ago and we even had families and friends of course attendees dropping by.

Explaining how it works

Hey whose bones are these?

Time to demo

Amy, Jane and Danny from Sanctband were early as usual setting up the place while I was still seeing patients, a big thank you to them.

Next course will be on 14/5/16, please contact Sanctband Singapore to sign up.

Calm before the start

Your Running Style Definitely Changes When You're Tired

Picture by richseow from Flickr

"I'm a fore/ mid foot runner, I don't land on my heels etc". I often get responses like this from my patients who are runners when I ask them if they have changed their running style recently.

To which I will reply, "How about when you're tired?"

I remember when I was still racing triathlons the official race photographer will email pictures of the race and I'll be quite amazed by the transformation. Often the smooth stride at the start of the run is often reduced to a not so pretty shuffle near the end of the race - (exception is when I'm sprinting or trying to out sprint another competitor at the end).

Is that the same for you as well? Well, I looked through pictures of my school boy track races I used to run, my stride looked pretty good all the way, but that's for track races (which are much shorter) and many moons ago (I was much younger then).

Most research so far has focused on fresh (and not fatigued) runners usually on a treadmill. Not much use then when your running style tend to fall to pieces when you get tired.

Well, I'm not the only person wondering if you running stride changes when you're tired. A small group of 14 habitual forefoot runners who typically ran about 30 miles (48 km) a week were studied. They ran to exhaustion (average of 15 minutes) while researchers took detailed measurements of their stride at both the start and end of the run.

There were significant changes even after only 15 minutes. Eight out of the 14 runners studied were landing farther back toward their heels by the end of the run. The ankles and knees were more flexed during the gait cycle suggesting that this may give a little more shock absorption when the ankle and calf muscles get too tired to provide sufficient shock absorption.

This shows that our running stride gradually changes as we fatigue, regardless of whether you start off heel striking, mid foot or forefoot striking.

Hence the authors suggest this can be a problem running in minimalist/ barefoot inspired type running shoes as your muscles fatigue during a long race and your land on your heels without sufficient cushioning. I've previously written that will reduce overall impact forces

You can of course gradually increase your mileage in your minimalist/ barefoot inspired type running shoes to increase your strength and build up fatigue resistance as I've previously written that your own muscles and tendons and a good running technique will reduce overall impact forces.


Reference

Jewell C, Boyer KA and Hamil J (2016). Do Footfall Patterns In Forefoot Runners Change Over An Exhaustive Run? J Sports Sciences. 22: 1-7. DOI: 10.1080/02640414.2016.1156726.

The Flossing Technique At Sports Solutions

All ears

After seeing patients in the morning and the early afternoon, I had > 30 minutes to get ready to teach others how to use the Floss bands. Fortunately, Amy, Danny and Jane from Sanctband arrived very early to get ready. Chapeau to them.

After explaining how the bands work, it was time to floss.

Putting to practice what they learnt

We had 20 people who came today. The course is organized by Sanctband Singapore and held at Sports Solutions. The next course is in 2 weeks. Please contact Sanctband  if you're keen to attend.

Concentrating ....

A big thank you to Amy, Danny and Jane today.

Exercise Is Not The Path To Strong Bones

This recently published New York Times article  definitely caught my attention. The author writes that "exercise is not the path to strong bones." In fact the author says that "exercise has little or no effect on bone strength."

The author then proceeds to discuss studies that showed increased bone density in subjects as a response to jump and weight training. However she wrote that "those studies failed to find anything more than a minuscule exercise effect - on the order of 1 percent or less, which is too small to be clinically significant."

So of course I went to look at the article she mentioned and it turns out I had written about that published study last year.

I looked up the article again. Here are my thoughts.

Consider that we reach peak bone mass at the end of puberty after which the normal course of ageing involves a steady loss of bone that is almost impossible to stop or prevent. This makes the 1 percent pretty important in my opinion. If you consider a decade or a lifetime of 1 percent effect instead of a single year, now that would be truly significant.

Hence when we treat patients with osteoporosis or patients who are osteopenic, just maintaining or slowing the loss of their bone mass is considered successful. Especially when this translates to a lower fracture risk.

What I also got from another article is that our bones do not get strong only because of weight bearing exercise. Two other important factors are jarring impacts and resistance training. Both make a big difference to the hip and spine - specific areas where bone density is most vulnerable.

Well, if you're a runner you can rejoice then since runners get repeated jarring impacts with each step you run. Turns out the authors found that runners have similar bone density to strength trained subjects, Cyclists have lower bone density since they not have have jarring impacts and if they do not strength train.

So don't stop running, strength training or your weight bearing exercises.

References

Hinton PS, Nigh P et al (2015). Effectiveness Of Resistance Training Or Jumping-exercise To Increase Bone Mineral Density in Men With Low Bone Mass: A 12-month Randomized, Clinical Trial. Bone. 79: 203-212. DOI: 10.1016/j.bone.2015.06.008.

Rector RS, Rogers R, Reubel M, Widzer MO and Hinton PS (2009). Lean Body Mass And Weight-bearing ActivityIn The Prediction Of Bone Mineral Density In Physically active Men. J Strength Cond Res. 23(2): 427-435. DOI: 10.1519/JSC.0b013e31819420e1.

Pepsi Light Dumbell?

Taken online with my Iphone 6 from AlmapBBDO

If you're thinking April Fool's you are absolutely correct.

The picture was circulated by an ad agency (AlmapBBDO) in Brazil. Turns out the bottle isn't real and there are no plans to create one according to a spokesperson from PepsiCo.

If PepsiCo eventually does manufacture the two litre dumbell lookalike bottle, it'll be a good advertisement for them but a nightmare for gym goers trying to lose weight. What I suggest is to fill the bottle with water or sand instead. Now that would be good for a workout.

Perhaps Gatorade (a brand owned by PepsiCo) would be more suitable to manufacture it.

Happy April Fool's Day.

How Much HIIT Is Beneficial?

Picture by Irving Henson from The PIT

A young lady I spoke to in the clinic today told me she has been attending HIIT (or high intensity interval training) sessions recently and gotten injured. (HIIT involves alternating very intense bouts of exercise with low intensity recovery exercise. It can be done in the gym with weights or on the bike or running set times or distances).

Being on the slightly plump side, she was tempted by the many benefits promised by the trainer conducting the HIIT sessions and the fact that she could lose weight and become stronger quickly whilst spending little time training.

Sounds too good to be true?

Considerable evidence definitely exists to support a role for low volume HIIT as a potent and super time efficient training method for inducing both central (cardiovascular) and peripheral (skeletal muscle) adaptations that are linked to improved health outcomes (see references below).

HIIT is designed to briefly strain your body to its limits. And these short bursts of very intense exercise lead to beneficial physiological changes similar to those much longer duration workouts. How much or how little do you need is still debated.

Leading interval training researcher Professor Martin Gibala found that 30 seconds worth of sprint intervals (four to six repeats of all out efforts three times a week) in young active but trained males produced just as good results as endurance training (subjects rode continuously for 40-60 mins five times a week). This is also known as the Wingate Test. The subjects generally hated the process though.

I clearly remember doing this while I was a young physiotherapy student in our Exercise Physiology lessons. It's extremely demanding and may not be safe, tolerable or appealing for some individuals. Definitely not for the faint-hearted.

With a less taxing program in which subjects did 60 seconds interval (or HIIT) training at 90 % effort (10 reps), the subjects found it more bearable although they had to do more repetitions (10x) to get the same benefits as the 30 seconds all out effort (Gibala et al, 2012).

Here's another workout that may be more palatable. Dr Gibala studied a group of obese/ overweight group of men and women on a program of 20 seconds of all out intervals followed by a recovery of two minutes.

They started with a 2 minute warm up on a stationary bike, followed by 3 x 20 seconds of all out sprints with two minutes recovery followed by a three minute cool down. A grand total of three minutes of intense work per week within a total training time of 30 minutes. Results were very encouraging as he subjects become fitter and improved their health (their VO2 max increased by 12%).

And if you find even 20 seconds of all out effort too difficult, there's the 30-20-10 workout which "only" requires 10 seconds of sprinting.

My take? Clearly, despite its many benefits, HIIT is not suitable for everyone, especially if you're just starting on an exercise program. As I've written before, we live in an instantaneous society now where we want results at the snap of a finger. Train don't strain is still important, or you risk a visit to your physiotherapist or doctor soon.


References

Burgomaster KA, Howarth KR et al (2008). Similar Metabolic Adaptations During Exercise After Low Volume Sprint Interval And Traditional Endurance Training in Humans. J Physiol. 586(1): 151-160.

Gibala MJ, Little JP et al (2012). Physiological adaptations To Low-volume, High-intensity Interval Training In Health And Disease. J Physiol. 590(5): 1077-1084. DOI: 10.1113/physiol.2011.224725

Gillen JB, Percival ME et al (2014). Three Minutes of All-out Intermittent Exercise Per Week Increases Skeletal Muscle Oxidative Capacity And Improves Cardiometabolic Health. PlosONe. DOI: 10.1371/journal.pone.0111489.

Not All Sitting Is Bad

He rarely sits like this .... always running around

Remember I wrote about active couch potatoes? And you've also read that sitting can negate some of the benefits of your exercise. Or worse still, some have said that sitting is the new smoking.

Well fret not, it seems that some sitting is not quite as bad as it seems.

Published research seems to suggest that not all sitting is the same. Well, at least sitting on your sofa and watching television is different from sitting at your desk at work.

Researchers studied over 3000 subjects who completed a series of surveys and had the thickness of their carotid artery walls measured with ultrasound (this is a good measure of heart disease risk).

The surveys measured television viewing time (in increments of two hours a day) and sedentary time at work (never, seldom, sometimes, often and always). Levels of physical activity were also measured.

The results showed that the more television the subjects watched, the thicker their artery walls, regardless of how much they exercised.

Surprise surprise, it was different however for workplace sitting. Those who sat more at work seemed to have better arteries, even after factoring in income levels and level of education.

This suggests that the nature of your sitting matters. The researchers mentioned that television watching is often completely uninterrupted and may be directly after high calorie meals like dinner. I guess I'm guilty of this sometimes and what's more, I am snacking while watching TV as well.

Workplace sitting may require the subjects to get up periodically to go to the printer, look for a colleague or going to the pantry etc.

The researchers also suggested potential confounding factors. Those who sat more at work were younger and likely to be employed full time while those who watched more TV seemed to be older, less educated or made less money. Results were adjusted to account for those differences.

I felt that there were some imitations in the study. The study may be more accurate if activity trackers were used instead of using surveys/ questionnaires to measure sedentary time.

Short breaks (from your sedentary sitting) seems to be critical in making a big difference. So whether you work from home or in an office, or work alone or in a group, meet your clients of spend time on the phone, make sure you get up and move every so often.

And if you've been sitting there too long reading this, you know you gotta move.

Reference

Diaz KM, Booth JN III et al (2016). Sedentary behaviour And Subclinical Atherosclerosis in African Americans: Cross-sectional Analysis Of The Jackson Heart Study. Int J Behav Nutr Phys Act. DOI: 10.1186/s12966-016-0349-y.