Physical Activity 101, Marcela Vinocur, MD

Physical activity offers a broad range of health benefits.  While there continues to be some controversy over the intensity and duration, there is no doubt that physical activity is good medicine.  A Medline search of ‘benefits of exercise’ yielded 1306 articles on the subject, while a similar search on Google yielded 45,400,000 results.

Despite so much written on the subject, relatively few Americans are physically active enough to experience health benefits.  According to a recent CDC report, 54.1% of adults do not engage in the minimum level of physical activity recommended for well-being, while 15% of adults are considered physically inactive. (CDC Morbidity and Mortality Weekly Report, Dec. 2, 2005)  Of note, lack of physical activity is similar in risk to having untreated high blood pressure or smoking a pack of cigarettes per day. (Goldberg L, Elliot DL. The Healing Power of Exercise. New York: John Wiley & Sons; 2000.)

While physical inactivity is associated with a number of chronic and serious diseases such as heart disease, type 2 diabetes, obesity, and some cancers, physical activity has been unequivocally linked to multiple health benefits.  Of note, according to a report from the Aerobics Institute in Dallas, the greatest health benefit was found in individuals who were the least fit and increased their fitness level by engaging in 30 minutes of moderate-paced walking 4 times per week.

Diabetes.  Physical activity has been clearly associated with reduced risk of type 2 diabetes.  Numerous studies have linked reduction in the risk of developing diabetes in high-risk individuals with weight loss and 150 minutes per week of moderate-paced physical activity.

Heart disease.  Physical activity can produce a reduction in heart disease risk by decreasing triglyceride levels, increasing HDL, reducing blood pressure, and improving glycemic (blood sugar) control.  While there is no doubt that moderate and high intensity exercise can provide cardiovascular risk reduction, even low intensity physical activity has been demonstrated to offer benefits. (Goldberg L, Elliot DL. The Healing Power of Exercise. New York: John Wiley & Sons; 2000.  Res Nurs Health. 2001; 24(5):390-401.)

Brain health.  Extensive research suggests that exercise may improve cognitive functioning, especially later in life.  The benefits of physical activity include increased levels of brain-derived neurotrophic factor (BDNF), stimulation of neurogenesis, increased resistance to brain insults, and improved learning and mental performance.

Depression, emotional well-being.  A recent study found that patients diagnosed with major depressive disorder experienced a sense of vigor and well-being, as well as a reduction in depressed mood, after 30 minutes of walking on a treadmill.  While not a substitute for medical treatment, this study concluded that physical activity may offer immediate, but transient improvement in mood. (Bartholemew J.  Med & Sci in Sports & Exer 2006;37(12):2032-2037)  A study by Da Costa et al found that pregnant women who engaged in physical activity experienced significantly less depressed mood, state-anxiety, and pregnancy-specific stress in the 1st and 2nd trimesters compared to non-exercisers. (Da Costa et al.  J Psychosom Obstet Gynaecol. 2003;24(2):111-9) 

Cancer.  There is strong evidence that physical activity reduces the risk of colon cancer by up to 50%. (Peters et al. Gut. 2001;48(3):435-9)  Physical   activity, in the form of walking   30 minutes daily, may also reduce the risk of lung cancer in men, as well as breast and prostate cancer. (Goldberg L, Elliot DL. The Healing Power of Exercise. New York: John Wiley & Sons; 2000.)

Fibromyalgia.  Approximately 20 years ago, exercise was established as an integral part of the treatment for fibromyalgia (FM).  In FM, short-term exercise programs consistently lead to improved physical function, physical fitness, and reduced tenderpoint pain. (Gowans SE, deHueck A. Curr Opin Rheumato. 2004;16(2):138-42)

Conclusion.  There is compelling and unequivocal evidence of both the dangers of inactivity and the health benefits of physical activity.  As little as 30 minutes of brisk walking most days of the week can have profound, beneficial effects.

Marcela Vinocur, MD is a graduate of Indiana University School of Medicine.  She completed her residency training in Psychiatry at Oregon Health Sciences University.  Her areas of professional interest include treatment and prevention of obesity, mood disorders, and anxiety disorders.  She is a member of the North American Association for the Study of Obesity and the Oregon Medical Association.  She maintains a practice specializing in psychopharmacology and serves as the Medical Director of the weight reduction program at Portland Health and Wellness.  Portland Health and Wellness is located at 1821 SE Ankeny Street, Portland, Oregon  97214.  For additional information, check the company website at www.portlandhealthandwellness.com or email her directly at mvinocur@portlandhealthandwellness.com

Sports Nutrition Tidbits, Nancy Clark, MS, RD, Sports Dietician

If you are eager to learn more about how to best fuel your body for top performance, you might enjoy muscling through three pounds and 557 pages of Sports Nutrition: A Practice Manual for Professionals .   The new fourth edition of this in-depth resource was recently released by SCAN, the sports nutrition practice group of the American Dietetic Association. (It is available at www.eatright.org; click on Shop Online .)

Although this resource book is written for primarily sports dietitians, strength coaches, athletic trainers and other health professionals who influence an athlete's eating practices, serious athletes might also like to feast on this hard-core (but well written and relatively easy to read) book that will answer all sports nutrition questions from A to Z,   including alcohol, carbs, calories, fats, fluids, protein, vegetarian diet, weight gain, zinc--plus   more!

• The average 150-pound athlete has only 1,000 to 2,000 calories of stored carbohydrates (glycogen), but over 80,000 to 120,000 calories of stored fat. Most of the fat is deposited in adipose tissue under the skin, but a little bit is also stored directly in the muscles and is an important source of fuel, especially during prolonged exercise.

• Don't try to eat a fat-free diet! The recommended intake for athletes is about 0.5 grams fat/lb body weight/day. This equates to 60 to 80 grams per day of dietary fat for athletes who weigh 120 to 160 pounds. That's 15 to 20 teaspoons of butter! Preferably, the fat comes from healthful sources: nuts, peanut butter, olive and canola oil, and avocado.

• While some fat is good, excess calories of fat are fattening. Your body easily stores excess dietary fat as body fat. That's why you want to carefully carbo-load on pasta and breads, not fat-load on Alfredo sauce, butter, cheese, chips.

• Your body stores carbohydrates in the muscles in the form of glycogen (1,200 to 1,600 calories) and also in the liver (300 to 400 cals); this feeds into the bloodstream (100 cals) and fuels your brain. During hard training that depletes your muscle glygogen, you enhance your body's ability to store even more glycogen; this enhances your ability to exercise for longer before "hitting the wall."

• Athletes should eat at least   2 grams carb/lb. body weight per day. That's a minimum of 240 gm carb (about 1,000 calories) per day for a 120 lb woman and equates to 10 pieces of fruit or 5 cups of cooked pasta. Athletes in hard training actually should eat 4 to 5 gm carb/lb. No Atkins diet here!

• Adult athletes require about 0.5 to 0.75 gram protein per   pound (1.2 to 1.7 g pro/kg). Scientific evidence suggests if you eat more than 0.8 gm pro/lb (1.8 gm pro/kg), you'll burn the excess protein for energy. In other words, eating a very high protein diet does not result in greater muscle gain, even with intense resistance training. To bulk up, eat more overall calories so you'll have abundant energy to build muscles.

• Because eating before exercise can enhance performance, you should target:

  0.5 gram carb/lb body weight	1 hour pre-exercise
  1.0 gram carb/lb	2 hours pre-exercise
  1.5 gram carb/lb	3 hours pre-exercise
  2.0 gram carb/lb	4 hours pre-exercise

  This means, if you weigh 150 pounds, you need about 75 grams carbohydrates--about 300 calories--of carb one hour pre-exercise, and 1,200 calories four hours out. This tends to be far more than most athletes consume. Experiment to learn how much your body can tolerate, and try to build up to this target if you currently eat less than this.

• Consuming carbs during endurance exercise can delay fatigue by 30 to 60 minutes. Target about 1 gram carb per minute of exercise--equivalent to 240 calories of carbs per hour if you weigh about 150 pounds. That's about 1 quart of Powerade per hour.

• Consuming carbs as soon as tolerable after hard exercise enhances muscle glycogen replacement because--

  1) the blood flow to the muscles is faster immediately after exercise, so carbs can get carried to the muscles faster;

  2) the muscles are better able to take up the carbs because of increased sensitivity to insulin, the hormone that helps transport carbs into muscles. Plan to have banana, fruit yogurt, fruit smoothie, and/or fig bars readily available.

• Both liquid and solid carbs refuel the muscles equally well, so take your choice: chocolate milk or a pasta dinner.

• While many athletes believe "thinner is better," don't try to get your body fat below 5% (men) or 12% (women). Each athlete has a fat percentage and body weight at which he or she performs best. Hence, you should listen to your body, and take note of how you feel and perform, as opposed to force your body to achieve a self-selected number.

• Warning: Body fat measurements--even under research conditions--can be plus or minus 3 to 4%. If you are told your body fat is 16%, it might be 13% or 19%. Just having a different person measure your body fat can significantly alter the measurement. Use body fat measurements only as a guide and give yourself a body fat range .

• At rest, your body burns approximately 0.45 calorie per pound per hour. If you weigh 150 pounds, you burn about--

  - 70 calories per hour of bedrest, or about 1,700 calories per 24 hours of doing nothing except staying alive.

  - about 375 calories per hour of moderate exercise, such as brisk walking at a pace of 15 minutes per mile.

  - about 1,200 calories per hour of high intensity exercise, such as running at a pace of 5.5 minutes per mile.

  Clearly, the harder you exercise, the more you can eat!

  But take heed: hard workouts followed by naps reduce your daily calorie needs. Athletes who turn into post-exercise couch potatoes commonly reward themselves with too much food and fail to attain their desired weight goals....

Sports dietitian Nancy Clark, MS, RD teaches active people how to eat to support their hard training. She has a private practice at Healthworks (617-383-6100), the premier fitness center in Chestnut Hill MA. Her best selling Sports Nutrition Guidebook ($23), Food Guide for Marathoners: Tps for Everyday Champions ($20) and Cyclist's Food Guide ($20) are available via www.nancyclarkrd.com or PO Box 650124, Newton MA 02465.

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"Osteoarthritis: To Walk or Not to Walk?", Dr. Ted Forcum, Back in Motion

Many believe that the body has a limited capacity for certain activities before damage occurs.   For example, you can eat so many "Big Macs" in your life before your heart will stop beating and your liver will clog up, or you can take so many steps before your joints will wear out.   Dr. Shrier of McGill University studied research on recreational runners and soccer players to see if there is an increased risk of osteoarthritis, specifically to the knee and hip.   He found regular running actually increased the joints space width indicating that running may actually preserve or reduce degeneration. Studies have supported the use it or loose it mod-o.     However, there was increased osteoarthritis in elite athletes. This may also be related to increased risk of injury in playing or running with minor injuries, which would increase joint stress due to accompanying weakness. Subjects older than 50 years of age appeared not to be affected by even large mileage.   Dr. Shrier hypothesized that when muscles are unable to contract adequately due to age, fatigue, disuse atrophy, decreased proprioception, or strain more force is transmitted to the bone leading to earlier degeneration. Proprioception is the ability to control body movement through space. Good proprioception is essential of proper form, posture and balance.

Studies found that individuals with knee osteoarthritis actually had a reduction of pain and increase levels of function by regular walking and strengthening exercise. Surprisingly, when reviewing past injuries with individuals, osteoarthritis that occurred may not be directly related to degeneration of the joint at the site of the muscle injury.   In other words, an injury to a muscle near the knee may not result in osteoarthritis of the knee; however, stress may be transferred to the next adjacent joint such as the hip or ankle.

Based on these findings, it is becoming apparent that proper muscle strength and proprioceptive rehabilitation is required, not only for major injuries, but also minor injuries which occur over time and lead to decreased muscle shock absorption and eventual osteoarthritis. Often these injuries get over looked as insignificant by the athlete and at times the physician, hence proper treatment and rehabilitation is negated.

The take home is to exercise regularly and properly rehabilitate all injuries to avoid osteoarthritis. If you already have degenerative arthritis research shows that exercise will help you. The key is to start out slow and easy, gradually building up duration, frequency and intensity.   Softer surfaces, such as a trail, chip path or track should be encouraged especially when beginning a new exercise program or with advancing degeneration.

Our goal at Back in Motion is to restore your normal kinematics to insure proper function and motion occurs as well as proprioception, which is the ability for the body to guide itself through space.   This latest literature review supports our philosophy of "use or lose it" in that the human body is not designed with built in obsolescence.

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Walking: A challenging, low-impact, high-benefit,
total body workout.
Walking brings significant health benefits to body and mind. Research shows that regular walking contributes to your overall health and fitness in important ways:

• Strengthens your heart
• Delays or prevents major diseases or illness
• Reduces blood pressure and the risk of stroke
• Reduces cholesterol
• Strengthens joints and bones
• Helps control weight
• Improves mood and self-esteem
• Contributes to "brain fitness"
• Gives you energy and a good night's rest
• Relieves stress and worry
• Improves balance and circulation
• Boosts immune system

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Protecting your Feet - Foot care Tips

Dr. Ray McClanahan, NW Foot & Ankle

footdr@nwfootankle.com

Did you know that the most important part of caring for your feet is choosing the right shoes for your feet? Most foot problems are caused by shoes. There are few shoes available to consumers that are truly shaped as a foot is shaped, and function as a foot should function. We would encourage you to begin learning about shoes and how to achieve a correct fit as a preventive measure against needing the services of a podiatric surgeon or an orthopedic surgeon. Dr. Ray McClanahan, Podiatric Physician and Surgeon and owner of NW Foot and Ankle ( 725 NW 19 th Ave. , Portland , OR 97209 , 503-243-2699 and 783 Commerce Ave., Suite 120 , Longview , WA 98632 , 360-575-9161) states that most foot problems are preventable, if the causes are understood and addressed early on. One of our goals at NW Foot and Ankle is to help you access information that will enable you to make the best possible decisions about the health of your feet and your family's feet.

Now that you have already started your training for WVR (at least, you should be!!!), ensuring you have the right shoes will help you overcome problems in the long run. When purchasing your shoes, be sure to share any issues you have or have been experiencing. They are trained to help you get the right shoe to meet your needs.

• Wash your feet daily, including between the toes.
• Dry your feet well, including between the toes.
• Get regular exercise which helps the circulation in the feet.
• Don't smoke, or if you do, stop smoking. It hinders the circulation in the feet.
• Wear socks that wick moisture away from the feet (not cotton). This decreases the likelihood of blisters or athletes foot infection. Today's athletic and casual shoes have cushioning built into them, so don't overdo it on sock thickness. Extra thick socks actually can allow your feet to move too much within the shoes and cause blisters.
• Invest in the health of your feet by having a regular yearly foot exam. Exams should be more frequent if you have diabetes.
• Wearing high heeled or narrow shoes is not recommended. If you do, make sure to wear a proper insole specifically designed for these shoes, and limit the time you do wear them.

Did you know that the most important part of caring for your feet is choosing the right shoes for your feet?

Most foot problems are caused by shoes. Shoes that are appropriate for length and width by today's standards often cause deformity within the feet and ankles.

There are few shoes available to consumers that are truly shaped as a foot is shaped, and function as a foot should function.

One of our goals at NW Foot and Ankle is to help you access information that will enable you to make the best possible decisions about the health of your feet and your family's feet.

To that end we would encourage you to begin learning about shoes and how to achieve a correct fit as a preventive measure against needing the services of a podiatric surgeon or an orthopedic surgeon.

Most foot problems are preventable, if the causes are understood and addressed early in a person's life.

The primary cause is footwear. Shoes and boots mostly, but also socks.

The primary driving force for wearing footwear is protection, but the shoes available today far surpass what is required for safe and protected use of the feet. They actually prevent the foot from developing the strength and flexibility that the unshod foot assumes naturally through prolonged use.

Dr. Ray McClanahan, Podiatric Physician and Surgeon is the owner of NW Foot and Ankle ( 725 NW 19th Ave. , Portland , OR 97209 , 503-243-2699 and 783 Commerce Ave., Suite 120 , Longview , WA 98632 , 360-575-9161 ). One of the goals at NW Foot and Ankle is to help you access information that will enable you to make the best possible decisions about the health of your feet and your family's feet.

For more information on foot care, please visit http://www.nwfootankle.com

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Tips for Preparing for the Relay: Conditioning Hydration/Nutrition, and Rest

Ask Dr. Bryan at www.wondersofwalking.com

Bryan Baisinger, Clearwater Chiropractic
1201 SW 12th Ave. Portland , OR 97205
Phone: 503-223-2149, Work phone: 503-279-0205
bryan@clearho.org

There are three health related items to keep in mind while preparing for the Willamette Valley Relay: conditioning, hydration/nutrition and rest.

Let's start with conditioning, it is normal to have muscle soreness that lasts as long as 3 to 5 days after exercise when you are building up primary mover muscles like the hamstrings, gluteus group and quadriceps muscles. When conditioning for endurance stretching after exercise will reduce muscle stiffness by allowing more circulation and chemical exchange within stiff muscle tissue where pain is felt. Stretching for increased range of motion is best done after the muscles are warm, holding times for stretches should be approximately 45 seconds long and performed without any joint pain, only a mild muscle "burn" sensation that subsides after the stretch is completed. If any unstable joints are present within the pelvis, knees or ankles, it is important to restore integrity with stabilization exercises.

Hydration and individual nutrition needs are important variables to have understood well before the event itself. In general it takes approximately 4 days consuming adequate water volume to obtain a fully hydrated status. This means all the cellular tissues have the proper water balance they need for optimal biologic function. On race day, don't consume water or fluid replacement until you have begun to sweat and loose water. It is a common mistake wait until the morning of race events to drink extra water to try and catch up on hydration. Doing this will most likely put you in the restroom line a few times for relief. Calculation of the exact amount of water you need can be tough, 250 calories of food need about 8 ounces of water to process. This means without considering important factors of heat, sweat and urination, the average person needs 8-eight ounces of water for a 2000calorie diet. Be sure to consume small amounts throughout the day many days in advance for the relay.

Rest is often overlooked as an essential part of training and health maintenance. When preparing for the relay be sure to get 8 hours for restful sleep. This allows your body to cycle thorough its natural healing states and restores full healthy function. If you have trouble sleeping or staying asleep consider seeking help. Inadequate sleep will not allow for proper tissue repair and cause excess healing time from what is normal for you.

If you have specific health questions please check out the ask Dr. Bryan section and I will reply with more individualized information for specific health concerns. http://www.wondersofwalking.com/ask_dr_b.php

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Excellent Tips for Dealing with Plantarfascitis & Ankle Instabilities!

Golf Ball Trigger Point (GBTP): This is an excellent way to help reduce the symptoms of Plantarfascitis. In a seated position place a golf ball under your right foot, bare or with a sock on. Very gently move your right foot over the ball identifying a point of significant muscle and fascia pain. Stabilize the golf ball with your left foot and slowly apply downward pressure on to the golf ball to 80% of your maximum comfort level without moving over the golf ball. After the pain reduces and tissue elongates (approximately 20 seconds) slowly apply more pressure up to the 80% of maximum level again. After the pain reduces repeat the application of pressure to 80% again. After 1 minute release all pressure and gently roll over the ball to find another Trigger Point and repeat the 3 step pressure sequence. In general, trigger 3 to 5 points on each foot for one-minute 1-2 times per day. It is important not to roll on the golf ball with high force as this will cause inflammation and promote plantarfascitis. GBTP provides gentle stretching of the painful tissue allowing more normalized circulation

Around the World: For those of you dealing with weak and instable ankles, this is an excellent technique to start to build that back. Stand with feet shoulder width apart hands on hips. Keeping both legs straight balance on the right leg moving the left forward away from the right to 45 degrees for 15 seconds. Keep the right foot/ankle completely still throughout the set. Next move the left leg behind to 45 degrees for 15 seconds. Next move the left leg to the side 45 degrees for 15 seconds. Next move the left leg in front and across the right as much as possible toward 45 degrees for 15 seconds. Next move the right leg behind and across the right as much as possible toward 45 degrees for 15 seconds. Switch legs and repeat the same movements standing on the left leg.

Preparing for the Willamette Valley Relay: It is our desire for all in whatever endeavor you embark upon to be ready for fun and success. As you begin your preparation for the 2006 Willamette Valley Relay (which should begin now!) and on into Spring and Summer, it is important your training take into consideration the increase in heat and its affect on your training.  Here are a few tips on how to be safe in the heat. A few of the hints are specific to the relay, most are exercising in the heat in general .

• Wear sensible, porous, light-colored, loose-fitting clothing while exercising in the heat. Choose fabrics which whisk moisture away from the skin.
• Drink to stay hydrated. Avoid over drinking water. Adding an electrolyte (i.e. Gatorade, etc.) will help fuel your muscles. Use only what you've been training with. Don't try something new on the day of the race.
• Maintain a salty diet to make certain you replace all of the salt lost during training - which can be considerable in some athletes over time. During a long race consider eating salty snacks such as pretzels.
• Wear sunscreen! Don't forget your ears and neck. Be cautious with forehead area. Sweat dripping into eyes can cause a burning of eyes.
• Stay close to your walker- please don't drop off your walker with miles to go to head for the next exchange. Be sure to have your walker indicate how soon they need to have aid so that you can drive ahead accordingly.
• Most important, have your walker carry their own aid!
• Wearing a visor or hat is helpful! Putting ice in your hat before you put it on is very refreshing!
• Bring a scarf! Adding ice to your scarf and then wrapping around your neck is also very refreshing!
• Help everyone on the course - not just your walker. Make sure those you pass are Ok, that they don't need anything. This goes for volunteers, too!
• Spray bottles are great to have - back of neck and behind knees feels nice!
• If you have someone that is experiencing heat exhaustion or heat stroke (dizziness, cramps, disoriented, light-headed, nausea, clammy or cold skin, or weakness), get assistance at an exchange or other vans and volunteers to call for medical assistance. Don't be too proud to quit if any of these symptoms should occur. If you have medical professionals on your team, use them! (Until you get assistance get them out of the sun, keep cool, give cool water as sips.
• Slow down - the key is to get to the staging area and have fun. Don't push yourself. With heat your heart rate increases as the heart must beat harder in an attempt to provide blood to both the skin surface and the exercising muscles. You will be working harder, but not walking faster.
• Watch your health. Make sure you are aware of both medical conditions and medications that can affect your tolerance for exercise in the heat.
• Be safe!
• Have fun!

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Dr. Bryan Baisinger, Clearwater Chiropractic, answers your questions on issues affecting you and your walking, training and conditioning

To see Dr. Bryan's responses to your questions, click here.

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