Does Fitness Need to be so Complicated?

I wrote this comment in response to a CBC radio interview with a journalist Daniel Duane. http://www.cbc.ca/q/blog/2014/06/02/daniel-duane-beach-body-secret/

This interview was embarrassing - Daniel Duane has some reasonable arguments and grievances with the fitness industry, but unfortunately his reasonable statements are intertwined with many unreasonable ones.

The large body of science that supports the health benefits of exercise, refers to the types of exercise that get your heart rate up, and keep it up for extended periods. Lifting heavy weights with high risk exercises like deadlifts, bench press and overhead squats, not only puts people's joints at risk but also doesn't emphasize the component of fitness that matters the most - Cardiorespiratory fitness. And yes, you don't need a trainer to go for run and experience these benefits, fair enough. You do however need a good physio/ doctor/ trainer to make sure you are ready for exercise to begin with - someone to make sure your heart isn't at risk, and to help uncover limitations in flexibility, balance, joint stability and posture that also make a difference for your overall physical health.

Perhaps Duane chose poor advisors, or perhaps Duane just didn't 'get it'. Either way, I thought his arguments were weak and I didn't understand why the CBC aired him. My feeling was that he used his notoriety (NYT and Men's Journal Contributor) to simply complain about a bad fitness experience he had.

After thinking on it, I understand why Duane's ideas are popular - he is right that fitness professionals are often trying to be too fancy, and they are failing to keep their clients best interests in perspective.  However, his ideas that doing overhead presses and deadlifts in your basement is a better way to go is ludicrous, and his assessment of current scientific evidence for exercise was irresponsible and not at all helpful for promoting public health.

CON Mental Health and Obesity Conference

CON_OMH_program_2014_4 cover I just attended another great event put on the CON on mental heath and obesity.  Its great to see there is more study being done in this important area.  Rates of obesity and its related comorbidities are higher in people with mental illness, and yet many weight management programs deselect against people with mental health problems, for fear of destabilizing their mental illness or having poor outcomes in the program.  It looks like this worry is unjustified, and may even be discriminatory.

Bariatric Medicine/ Obesity Medicine Course

Last weekend I attended the Canadian Obesity Network's obesity course in Edmonton, Alberta. The high level of care and compassion that the CON staff bring to their work is inspiring and Dr. Arya Sharma is a terrific speaker and leader in the field.  I look forward to taking part in their courses and seminars more in the future.

I am happy to say that the course helped me to realize that I am right on track with the development of next year's 9-12 month weight loss program, and I hope to start recruiting patients soon for the new year!

Dr. Ryan Oughtred

Dr. Oughtred Joins Stein Medical Clinic

Dr. Oughtred is pleased announce that he has joined the team at Stein Medical clinic, in Downtown Vancouver BC.  Stein Medical Clinic is an integrative, walk in medical clinic that not only offers medical care, but also offers in-house physical therapy, massage therapy, and now with the addition of Dr. Oughtred, Naturopathic Medicine.  With this new addition, Stein Medical patients can benefit from a team approach, resulting in more efficient and comprehensive primary care.  Lets say for instance that have chronic fatigue; you can book an appointment with Dr. Oughtred, and if required you could also see an MD after your visit for further work up.  This saves you time as well as allows for a 'two heads are better than one' approach to your concerns.  If you have extended health care as well as MSP coverage, your 1-hour of services could cost you nothing and you will be well on your way to better health and well being. Both Dr. Ryan Oughtred and Stein Medical Clinic believe that a pro-active, multidisciplinary approach to patient care is the way of the future.  Dr. Oughtred hopes his presence at Stein Medical will be a step toward making the future a reality.

Ryan Oughtred

Naturopathic Doctor, Vancouver BC.

Enhancing Muscle Recovery

Enhancing the ability of your muscles to recover better is a popular topic these days.  Here is my advice for anyone wanting to ensure they are recovering properly:  

Sleep

 - Sleep is quite possibly the most effective tool for recovery from any stress.  Sleep is the only time that your muscles totally relax, which I believe is essential in order for blood to properly circulate and for your connective tissues to heal and get stronger for the next day.  Your body instigates many anabolic (tissue healing and growth promoting) processes once you are asleep, and your hormones shift to reflect this process.  After falling asleep, your body produces Growth Hormone, a hormone essential for growth and repair as well as combating normal processes of aging and degeneration.  Some athletes try to nap several times per day in order to increase their growth hormone secretion and promote a state of increased healing and repair.  The position of sleep – lying down – is also healing in itself.

- Improving sleep is simple for some people and not so simple for others.  Ensuring someone has proper sleep hygiene is essential: keep constant wake times, take an hour to relax before bed, avoid stimulants such as caffeine, a noise free environment, temperature that is not too hot or cold, etc.  Some people may have underlying medical causes of their

 

Muscle Tension Prevents Healing

- If your muscles have excess tension, they aren’t healing as well as they could if they were relaxed.  Causes of muscle tension include poor posture, repetitive activities (like running or biking), stress, inflammation, or general overuse.

- Regular massage therapy and other self massage therapy techniques likely increase circulation and decrease the amount of ‘strain’ that is happening through your muscles and joints.  The key point is regular here

- Stretching works to reduce muscle tension, the problem is that people often don’t know how to stretch properly on their own, and often put their body out of balance with poor selection of the types of stretches they perform.

- Heat (hot tubs, saunas, contrast therapy, etc) is an effective way to promote muscle relaxation, this is an evidence based method of enhancing recovery that is underutilized and sometimes forgotten because of its simplicity.

 

Stop Stressing and Take breaks in your day

- Our nervous system and hormones are probably designed to deal with stress in short bouts, after which we would experience a period of time to allow for rest from that stress.  The classic example of having to escape a predator applies here; 1- get scared, 2- run away from the animal for an hour or so, 3- Lick your wounds and have a nap in a safe place.  Our bodies are well adapted for this type of stress, but not the ‘all-day-long’ type of stress that many people put themselves through.  Chronic stress prevents your body from going into a rest and repair mode and your muscles and other tissues will slowly break down.

- Not working too much or taking on too much responsibility at one time is the most obvious measure you can take to prevent chronic stress.  Build breaks into your day in which you do relaxing things like taking a quick walk, exercising, talking to friends or family, laying down, listening to music or meditating.  Try to make these breaks every 90 minutes or less in frequency.

- Some people can’t seem to relax no matter how hard they try.  Addressing the underlying cause of this inability to relax is very important for proper recovery; sometimes this might involve changing how someone things through self help or cognitive behavior therapy is often helpful, or perhaps an underlying medical condition needs to be addressed and supplements or medications might help.

 

Change your body positions

- Standing around for long periods during the day, and generally staying in the same position for long periods of time is also hard on the body’s tissues; the more you can vary your positions while at work or even during exercise, the better.  For instance, while you are resting during an exercise session – sit down with a good posture, or even lay on your back to rest your tissues that always have to work while you are standing.

 

Periodize your exercise

 

- Taking a scientific approach that systematically overloads your tissues and them provides a proper rest period is the best way to train and avoid injury.  For instance, in our group exercise sessions, we progressively increasing the volume and/ or intensity of exercises throughout the month, and then provide a week at the end of the month or start of the following month for rest.   Different components of exercise require different amounts of rest, and following a well planned exercise plan allows you to make the most of your time and get the most ‘bang for your buck’ when exercising.

 

Active Recover

- Your muscles will heal better, and will also develop a better ability to recover long term if you incorporate low intensity movement into your rest time.

 

Pay attention – you can tell if you are recovering well:

- Measuring how well you are recovering is difficult – you might want to experiment by using a journal to track your body for signs of overtraining:

- Morning heart rate elevations

- Grip strength

- Resting Lactate elevations

- Monitor sleep quality, body pain, moods, skin health, and other signs that the body is becoming taxed.

 

Supplements:

- The way you eat can certainly affect how you recover.  The first step is ensuring you have adequate nutrients.  Because most people are omnivores that typically eat too much food in general, true nutrient deficiencies are quite rare.  However, conditional deficiencies are probably more common; these are nutrients that are considered non-essential, but when under stress they can become depleted.  Examples include amino acids like arginine or glutamine and supplementing with these when ‘the going gets tough’ probably makes sense.   Glutamine is also essential for making the hormone GABA, which is an essential neurotransmitter in the brain for relaxation.

- Many of the body’s water soluble vitamins can become taxed with high stress, including ascorbic acid, folic acid, B12, pantothenic acid, or pyridoxine.  Fat-soluble vitamins like the carotenoids and minerals like magnesium or calcium are probably important to add.  If you prefer to stick with food for your essential nutrients, then doing things to enhance your body’s digestion with the use of bitter herbs or digestive enzymes should be helpful when you are having to eat high amounts of calories and your digestive capabilities are being overloaded.

 

Tweak your hormones

- Your hormones are your body’s chemical signals to repair and recover.  Stress, medications, certain diseases, toxins, and normal aging can throw them out of balance.  Combining a good medical history along with some blood work can help shed light on possible excesses or deficiencies that might help your body recover better.  Salivary cortisol testing is cheap and easy to do, and it can often shed light on why people are not sleeping or recovering very well, and can help give people another encouragement to follow through more rigorously with their exercise routine.

- Anabolic hormones like testosterone or growth hormone can be modulated with the types of exercises used, certain supplements (albeit very slightly), and of course with the use of exogenous hormones themselves when medically required.

 

Summary

 

Here is a summary of the various recommendations you could try to enhance your ability to recover:

 

Sleep

- >7 hours for the average adult

- >8 hours/ night for adults that exercise >250 minutes/ week.

- >9 hours/night for active adolescents

 

Stress Reduction

- Time management

- Breaks in your day – every 90 minutes.

- Relaxation – meditation, yoga, walking, progressive relaxation exercises, social time, etc.

- Cognitive, “change how you think” exercises. (CBT)

 

Self Monitoring for Burnout/ Overtraining

- Morning heart rate elevations

- Grip strength

- Resting Lactate elevations

- Monitor sleep quality, body pain, moods, skin health, and other signs that the body is becoming taxed

 

Adequate Nutrition/ Supplements

- Omnivorous diet, high vegetable content.

- Possible supplements:

- B-Vitamins, Carotenoids, Magnesium, Amino acids, Essential Fatty Acids, digestive enzymes, anti-inflammatory herbs, digestive and relaxing herbs.

 

Balance Hormones

- Stress hormones

- Anabolic hormones

 

Periodized Exercise:  Scientific approach to progressing your exercise program.

 

Other Regeneration activities (to be done 3-5 times/ week):

 - Active Recovery – 30 minutes or more

- This is any rhythmic exercise like spinning on a bike, swimming, hiking, or any other continuous type of activity that keeps your heart rate around 50-60% of max (100-120 bpm) for a sustained period.

- This type of exercise is best if performed immediately after strenuous exercise.

- Massage – 30 minutes or more

- This can be self-massage or massage from a professional.  Professional massage is almost always better, but it has cost limitations and you can’t always have your massage therapist with you when you are traveling the world skiing!

- Self-massage can be performed with various types of small balls or rolling devices.

- Thermotherapy (Heat) – 15-30 minutes

- Warm therapies should not be used in excess!  Start with small amounts of time (10 minutes) and work up (30 minutes max).  Too much heat can also be stressful to the body.

- Hot therapies are not recommended prior to exercise.  Always be sure not to burn yourself.

- Examples

- Saunas

- Regular doses of 30 minutes in a humid sauna at 90 degrees Celsius can aid recovery after hard workouts.

- Warm or Hot Water Baths

- 15 minutes at roughly 38 degrees is a typical recommendation.

- Too much time in the hot tub can cause the body to be too relaxed.  Contrast hydrotherapy is probably better than warm baths alone.

- Steam Rooms

- Cryotherapy (Cold) – 30 minutes

- Cold therapies can be used after exercise to limit inflammation and enhance recovery.  Usually, cold therapies are used on specific body parts to help injuries heal or prevent old injuries from coming back.

- Do not use cold therapies prior to exercise.  Do not lie on cold applications and be careful not to put ice directly on skin because it can cause frostbite.

- Apply Cold to the desired body parts for 10 minutes, then remove for 10 minutes, then place back on for another 10 minutes.

- Body parts – Legs only, knees only, arms only, etc.

- Cold packs, bags of ice, cold water baths

- Whole body immersion for 10-20 minutes after exercise can be done (12-18 degrees), but it must be used with caution, as it causes stress to your heart and has caused fainting in some individuals.  Start with warmer temperatures and go colder with each session.

- Contrast Therapy (Hot/ Cold) – 20-30 minutes

- Hot therapies relax muscles and increase blood flow.  Cold therapies contract muscles, decrease blood flow, and limit inflammation.  The combination to the two probably leads to a ‘pumping’ effect of fluids, thus enhancing the rate of circulation and enhancing recovery from exercise and injury.

- Any combination of hot and cold is reasonable:

- Hot therapies – 37-44 degrees

- Cold therapies – 7-20 degrees

-A common recommendation is 4 minutes hot and 1 minute cold X 5 (20 minutes).

- Examples

- Hot bath: Cold Shower

- Sauna: cold bath (legs only)

- Hot Tub: Ice knees (5 minutes: 5 minutes X 3)

- Hot bath: Cold Bath (advanced – start slow!)

- Hot shower: Cold water hose (outside?)

 

Fitness: How to Avoid Overtraining

Many athletes fail because they think that if they just work harder and do more workouts than the next athlete, they will succeed.  True, working out harder and more often leads to better fitness, but there comes a time when this strategy can cause harm.  When training too much causes harm, we call it overtraining; this is in contrast to overreaching which occurs from the intentional, planned overloading that occurs as part of a well designed exercise program.  Overreaching is mainly a short term phenomenon (days to weeks) that sometimes leads to small amounts of fatigue and decreased performance; overtraining usually causes more severe and longer term symptoms that can be present for a month or more. The primary cause of overtraining is usually a lack of rest and recovery in the training program.  In our training program, we purposefully try to overreach for at least one week each month.  During that week, you may find that you experience fatigue, muscle soreness, and other symptoms that would suggest your body is not performing optimally.  The following week when the training volume is lower, you should notice those symptoms subsiding and your fitness will gradually improve as your body adapts to the high training stimulus the week before. This adaptation phenomenon is call Super-compensation, and it is the foundation upon which all of exercise methodologies rest.

Training too much, with too high intensity, or without proper variety is certainly the leading cause of overtraining, but other factors that limit recovery can also lead to overtraining.  For example, chronic psychological stress can limit the body’s ability to heal between exercise sessions.  Hormone imbalances created by a poor diet or medications can lead to an imbalance between catabolic and anabolic hormones which decreases the body’s ability to recovery from stressful workouts.  Poor sleep is a very common complaint, and people who don’t sleep well are notoriously weak and tired when they show up for the workout sessions.

So how do you prevent overtraining?  The old adage about listening to your body applies.  Athletes will go so far as to keep a training journal in order to monitor various physiological parameters.  If they start to become abnormal for any sustained period, then they would change their exercise program or focus harder on enhancing their recovery.  Signs and symptoms of overtraining are:

  1. General Fatigue, lack of motivation and even depression and other mood changes.
  2. Poor performance in workouts or on key measurements.  For example:
    1. Decrease vertical jump or leg power
    2. Poor grip strength
    3. Muscle stiffness
    4. Joint Pain
    5. Skin complexion and presence of acne.
    6. Athlete gets sick easily.
    7. Changes in the resting heart rate.
      1. A common practice among elite athletes is to take your resting heart rate every day at the same time – usually in the morning.
      2. Higher and more variable resting heart rates are signs of overtraining.

The better you get at monitoring these aspects of your health, the better you can match your training with your goals.  You may start to notice that you never experience any of these signs and symptoms, and that you may not be pushing yourself hard enough.  Or, you may notice that you get many of these symptoms and you realize that you don’t vary your workouts enough.  Quite often the reasons for the symptoms are obvious, but you never would have noticed them unless you forced yourself to take a look!  Its very difficult to be objective about yourself.

Some of the general methods for avoiding overtraining are similar to those that provide for good health:  Eat well, sleep well, avoid chronic stress and have some fun once in a while.  For those that train really hard, you will benefit from extra stimuli to the body, like massage, hot/cold applications, nutritional supplements and active recovery.

In summary, “Whatever doesn’t kill you will makes you stronger.”  Both in exercise and in life, the optimal doses of stress seem to be right in the middle – not too much or not too little.  Because we live in a sedentary society, we don’t pay much attention to overtraining in exercise, because most people don't push to the point where overtraining is an issue.  However, many people push too intense with their exercise when their body is not ready - this is a type of overtraining that is becoming more common now, with the gaining popularity of Crossfit and other intense types of workouts.  The solution to this is to perform lower intensity exercise in higher quantities at first, then build up to doing lower amounts of activities at higher intensities.   This allows the body to be prepared to do high intensity activities, and helps to prevent injury.

Finding that sweet spot where you get the least down sides and the most upsides with your exercise routine is both your job and your health care provider’s job.   I hope you found this article helpful and good luck finding your sweet spot this month!

Dr. Ryan Oughtred, ND

Sample Vancouver Group Fitness Session

Here is a quick video demo of one of our small group personal training sessions in Vancouver, BC.  These clients are new to the program, so the exercises use fairly light weights, involve the whole body, and there is very little rest provided from one set to the next.  Notice this is a small group - only 3 people - so the session is like a personal training session but much more cost effective.  Almost all of our fitness programs will involve several components of fitness, such as balance, strength, endurance, agility, or flexibility training.

Lactate Testing - It's That time of Year Again

DrO's Lactate Test
DrO's Lactate Test

It's that time of year for lactate tests everyone:

Dr. O just had his lactate test done, see the attached graph.  I was surprised to see that I was fitter this year, because it sure didn't feel that way during the Peak to Valley Ski race!  The test shows how useful lactate testing is - I pushed to the same max wattage and my perceived exertion was similar to my test from last year. Without the lactate I wouldn't get to appreciate all of that hard work I put into my fitness this year.

Stop playing small everyone, lactate testing is for everyone that exercises, not just elite athletes!

Dr.O Whistler and Vancouver BC

60 Minutes on Depression

60 minutes last week aired a segment that featured the work of Dr. Kirsch from Harvard University. His work compares the effect of placebo against that of antidepressant medications. The results if his studies and many other studies is that antidepressants are no better than placebo in the treatment of most types if depression, except for the small group of patients that have severe depression. This is not new to Canadian and British physicians who no longer recommend the use of antidepressant medications for moderate to severe depression. It was good to see this topic making news, but it's unfortunate that the message is arriving so late. What is also unfortunate is the amount of patients that I still see that have been prescribed antidepressant medications for short term and mild types of depression. Obviously we need more media messages to drive the point home, thank you 60 minutes. Ryan Oughtred Naturopathic Doctor Vancouver, BC

Dr. O and Northlands Medical Clinic win Peak to Valley Ski Race

[gallery] My Northlands Medical Clinic team won the Peak to Valley ski race again this year, and I took the fasted time on Friday, it was a great weekend.

I look forward to seeing new patients out of the Northlands clinic starting in May of this year. Finally there is a Naturopathic Doctor in Whistler that is here to stay!

DR O

 

Build Maximum Strength: December Fitness Theme

The emphasis for December is to build maximal strength.  Hopefully after last month you are noticing that you have a little more muscle bulk than you had before.  This increase in muscle doesn’t necessarily make you stronger however, because muscles still rely on the nervous system to make them contract.  Lifting heavier weights stimulates the brain to talk to your muscles and causes more muscle fibers to contract at once.  For athletes, this is the holy grail of strength training; the more muscle fibers you can use at once, the stronger you will be and the faster you can move.  Lots of muscle means nothing to an athlete unless they can use it quickly and forcefully, and this is why they follow muscle-building programs with maximal strength training programs. For non-athletes, training for strength can be enjoyable because there are usually longer rest periods and the exercises are usually fairly simple and satisfying by nature.  Women like strength training because it makes them very strong but it doesn’t make them bulky or puffy looking.

So how do we train for strength?  Whereas last month our focus was on taking each set to the maximum amount of repetitions, this month you should focus on trying to lift as heavy a weight as possible without losing your proper form.  This means that advanced trainees will perform sets of very low reps (4-5) and very high weights, and during week 2 and 3 they will shoot to complete 5 sets of these exercises.  Less experienced athletes will perform sets of 6-8 reps and will shoot to complete 4 sets of everything on our high volume weeks.  In order to facilitate maximal exertion, we will allow more rest between sets this month, and you will notice the use of balance exercises following intense lower body movements in order to allow your heart rate to come back down before moving on.

I have also introduced a suggested strength workout that you can perform on your own each week if you aren’t making it in for a second strength session with us.  It is outlined below.

As always, please show up on time or early for week 2 and 3’s sessions because they are busy weeks, and you will be pushed very hard during those sessions.

Good luck and see you soon!

Dr. O