Dedicated to my friend James who is battling memory loss following chemotherapy.

In 2012, I published a story that I called, “Forgetful? Go Jogging.” It described the findings from a study published in the July 2012 issue of the journal Neuroscience. It showed that exercising for a month, either walking or jogging four times a week, improved the results of memory and mood tests. A control group that did not exercise showed no change from the initial tests. This was not a surprise as previous observational studies had already suggested that exercise was beneficial for the brain.

What was the most interesting finding in the study was that the behavioral improvements were positively correlated with a rise in a blood and brain protein called Brain-Derived Neurotrophic Factor or BDNF.

Why you may be wondering, am I writing about the results of a 2012 paper in 2019? Let me explain.

More about BDNF

As its name implies BDNF is a protein that is secreted by neurons. Its function is to maintain the health and normal functioning of existing neurons as well as the generation of new neurons. What makes BDNF extra interesting is the location in the brain where it is secreted: the hippocampus (and specifically in an area called the dentate gyrus), the brain structure where memories are created and stored.

Now, just showing a correlation between A and B does not mean the two things are causally related. In other words, it does not mean that A caused B to happen. However, if we could show a molecular mechanism that plausibly explains the correlation, it would help a lot in lending credibility to the causality between the two.

Specifically, if one could show how exercise could affect the expression of the gene that controls the synthesis of BDNF, the case for a cause and effect becomes significantly stronger. It would support the hypothesis that exercise increases brain function.

Epigenetics

It is known that non-genetic factors, such as environmental chemicals and behavior, can affect gene expression. Such changes are called epigenetic.  Examples of mechanisms that produce such changes are DNA methylation and histone modification, each of which alters how genes are expressed without altering the underlying DNA sequence.

The November 2018 issue of The Scientist published an article titled, How Exercise Reprograms the Brain. It reported on an experiment performed by Hiroshi Maejima of Hokkaido University in Japan. He investigated the possible epigenetic effect of exercise on the synthesis of BDNF.

Maejima’s team found that the brains of mice that ran on a treadmill had greater than normal histone acetylation in the hippocampus, the brain region considered the seat of learning and memory. This epigenetic change resulted in higher expression of the gene Bdnf that controls the synthesis of the protein BDNF.

It turns out that BDNF is released by neurons when they fire and that happens when we exercise. The end result: exercise led to higher BDNF levels bathing the neurons.

The impact of BDNF

The high level of BDNF has two important consequences:

  • it causes the formation of new neurons, a process called neurogenesis, and
  • it increases the number of dendrites per neuron.

Dendrites are small “bumps” on the axon that are the points where adjacent neurons communicate with each other (called synapses).

The functional consequences of the anatomical changes are increased plasticity as well as increased capacity to form new memory circuits. These anatomical changes and their functional consequences are collectively called Long-Term Potentiation (LTP).

Long-term potentiation

Another study, published in the Proceedings of the National Academy of Sciences, titled “Running enhances neurogenesis, learning, and long-term potentiation in mice” reported on an experiment in which spatial learning and long-term potentiation (LTP) were tested in groups of mice. One group was housed with a running wheel (runners), the other lived under standard conditions (controls).

The researchers found that running improved water maze performance (a standard test for memory in mice), increased new neuronal cell numbers, and selectively enhanced dentate gyrus LTP, the hippocampus area involved in memory. These results indicate that physical activity can regulate hippocampal neurogenesis, synaptic plasticity, and learning.

Not just memory

By supporting the growth and maturation of new nerve cells, BDNF promotes brain health. Further, higher levels of it correlate not only with memory but with generally improved cognitive performance in mice and humans.

In 2014 Marily Oppezzo and Daniel Steinberg of Stanford University published an interesting article, “Give Your Ideas Some Legs: The Positive Effect of Walking on Creative Thinking,” in the Journal of Experimental Psychology.

They divided 176 college students and adults into two groups, one of which walked while taking a creativity test; the other was sedentary during the test. The walkers scored 81 percent higher. This seems to confirm numerous anecdotal reports of academics and business leaders who claim to get their best ideas while running or walking.

The Body-Brain Connection

When we refer to the brain-body connection, we are normally thinking about how the brain affects our body. But what about this connection flowing in the opposite direction? Can bodily function affect the brain? Indeed, the myriad experiments showing the effects of aerobic exercise on brain structure and function suggest the existence of such an influence.

An international team of scientists recently found that mice that ran frequently on wheels had higher levels of BDNF and of the ketone ß- hydroxybutyrate, a byproduct of fat metabolism released from the liver.

Injecting the ketone into the brains of mice that did not run helped to inhibit histone deacetylases and increased Bdnf expression in the hippocampus. The finding shows how molecules can travel through the blood, cross the blood-brain barrier, and activate or inhibit epigenetic markers in the brain.

Cathepsin B

In 2016, van Praag and her team found that a protein called cathepsin B, which is secreted by muscle cells during physical activity, was required for exercise to spur neurogenesis in mice. In tissue cultures of adult hippocampal neural progenitor cells, cathepsin B boosted the expression of Bdnf and the levels of its protein BDNF. It also enhanced the expression of a gene called doublecortin (DCX), which encodes a protein needed for neural migration.

The proof that Cathepsin B is indeed required for bdnf expression can be obtained by genetically creating mice whose Cathepsin B gene expression is suppressed, or knocked out. These mice, called Cathepsin B knockouts, had no change in neurogenesis following exercise.

Van Praag’s team also found that nonhuman primates and humans who ran on treadmills had elevated blood serum levels of cathepsin B after exercising. Following four months of running on the treadmill three days per week for 45 minutes or more, participants drew more-accurate pictures from memory than at the beginning of the study, before they started exercising.

Other exercise-induced changes

The 100 billion neurons that populate the brain require 20% of total energy consumption and 15% of blood flow. So it is not surprising that physical activity also prompts other hormone factors into action: Insulin-like growth factor (IGF-1), vascular endothelial growth factor, and fibroblast growth factor all cross the blood-brain barrier and work with BDNF to enhance the molecular machinery of learning. In addition, the hormone IGF-1 delivers the brain’s primary fuel — glucose — to neurons to spur learning.

Not so simple, and yet quite simple

As we can see BDNF is indeed important, but it doesn’t and probably cannot act by itself. A complex orchestra of proteins and other molecules has to play together to allow BDNF exert its full effect.

And yet, the bottom line is quite simple. We ordinary humans don’t have to understand the complicated mechanistic details of BDNF function because our physiology takes care of that flawlessly. All we need to know is that some kind of aerobic exercise, be it jogging, walking, bicycling, swimming – whatever makes you breathe hard and increases your heart rate for a minimum of 30 minutes, 3 times a week or more will help keep your brain and your body in good shape – proving once again that exercise is one of the best medicine’s known to man. Need more incentive? Think you are too old to start? Read this: A 92-year-old woman in Australia has broken several world records for racewalking since she started her athletic career about seven years ago. And she has no plans to slow down.

Related Content: 7 Simple and Not-So-Simple Strategies to Maintain a Healthy Brain

Yoga has been healing people for generations. Originating in the Indian subcontinent, it has provided physical, mental and spiritual support to humans. Throughout these years and eras, the yogic science has served people from all age groups and genders equally. However, there are some exercises that are of immense benefits for women in particular.

Women, according to the yogic philosophy are the manifestation of Goddess Durga, are the source of life on the planet and the union of all kinds of energy. A woman advances through multiple phases of life, from childhood to puberty and from motherhood to menopause. Yoga helps you deal with all these phases, changes and challenges coming into your life.

Below are eight Yoga poses that every woman should practice
for better health and mental energy.

Adho Mukha Svanasana (Downward-Facing Dog)

Photo Source: https://commons.wikimedia.org/wiki/File:Downward-Facing-Dog.JPG

Adho Mukha Svanasana is one of the most popular Yoga poses in the world. Thanks to its easy way of practicing and enormous benefits, people from all across the globe and age groups enjoy this pose to make the body physically fit. This asana is favorable for the female body and stimulates the flow of blood throughout the body parts. The whole weight of the body is held by the toes and palms on the ground, while the rest of the body is in the air. During the practice of Downward Facing Dog, the buttocks are at the highest point and the upper and lower halves of the body are completely straight.

Shishuasana (Child’s Pose)

Photo Source: https://pixabay.com/en/yoga-childs-pose-asana-2959214/

A practice of peace, Child’s Pose is highly influential for working mothers. Being a mother in this challenging world is not an easy task. You have to face a number of difficulties while dealing with your personal and professional life. When stress attacks you, find shelter in the calming shadow of this beautiful pose. Shishuasana (Shishu means a child) throws away all those unwanted thoughts from your mind to help you concentrate on things that matter. Kneel down on the floor with the toes kept together. As you inhale, bend forward to put your torso between the thighs and face on the ground. Press your hands on the ground and free up all your body parts to feel relaxed. 15 minutes of Shishuasana is a gem for a stress-free life.

Malasana (Garland Pose)

Image Source: Author

Malasana is all about stretching your thighs and feeling the strength of your body. Begin this pose by standing on the mat with the feet slightly wider. Bend your knees slowly in the squatting position. Bring your hands together to join the palms in Namaskar pose by gently pressing the inner knees with your elbows to make it wider apart. Bring your hips down a little but making sure your spine is elongated and the chest opened up. The asana is good for relieving tension from the thigh and neck region. It also stretches the hips, groin, and ankles.

Vriksasana (Tree Pose)

Photo Source: https://en.wikipedia.org/wiki/Vriksasana

Bring stability to your life with Vrksasana. Add self-confidence and inner faith to your mind and body by giving 5-10 precious minutes of your life to this amazing pose. Learn how to stand erect like a tree even in the scarcest of situations when you delve into the astonishing ocean of Tree Pose. This asana is practiced on one leg and the other foot is on the thigh. Keep yourself stable on one foot and join your palm near the chest to remember the ultimate God by closing the eyes. Make sure the body, from head to toe, is in a straight line. You can add beauty to this Yoga asana by chanting a couple of mantras.

Utkata Konasana (Goddess Pose)

Image Source: Author

Attain the fierce fire of Goddess Durga, knowledge of Goddess Saraswati and the prosperous power of Goddess Laxmi by delving into one of the most amazing Yoga poses, Utkata Konasana. Also known as the Goddess Pose, owing to its resemblance to various goddesses of Hinduism, this asana is a great way to reach a level of mental, physical and spiritual perfection. Stretch your thighs and hips along with strengthening the arms muscles with a regular practice of this pose.

Navasana (Boat Pose)

Image Source: https://hi.wikipedia.org/wiki/%E0%A4%9A%E0%A4%BF%E0%A4%A4%E0%A5%8D%E0%A4%B0:Paripurna-Navasana_Yoga-Asana_Nina-Mel.jpg

When you don’t have time for a longer Yoga session, embrace the beauty of Navasana to tone your abs and thigh muscles instantly. In today’s busy lifestyle, a woman has a lot of responsibilities to deal with without compromising with health and fitness. Navasana, which replicates a boat during the practice, can be of immense benefit for your physical wellness. Sit on your buttocks with the legs and upper body making a right angle between them. Make sure the body is balanced in this position, while your legs are in the air. It is one of the best ways to elongate your thighs bones and spine.

Kapotasana (Pigeon Pose)

Photo Source: https://commons.wikimedia.org/wiki/File:Kapotasana_-_Pigeon_pose.jpg

One of the most flexible Yoga poses, Kapotasana is an advanced practice and filled with numerous advantages for the body and mind. Also known as Pigeon Pose in English, this yogic exercise tones the abdominal muscles and nourishes the digestive organs in an awesome way. This pose should be practiced on an empty stomach to escape any negative effect. Begin by sitting on your knees with your legs completely in contact with the ground. Bend your body slightly backward to touch the elbow with the mat. Hold the toes with your hands and put the head on the ground between the hands. Remain in this position for a couple of minutes to experience the enormous serenity it offers.

Halasana (Plough Pose)

Photo Source: https://www.flickr.com/photos/nicholas_t/14155793547

An advanced Yoga pose, Halasana is extremely effective in stretching the whole body. It replicates a plow during the practice, for which it is known as Plough Pose. Lie on the mat with all the body parts freed up. Raise your feet and slightly bring them up in the air. With the help of your hands, push your back to bring your toes behind the head with just the shoulders, neck, and head on the ground. Bringing your arms into action, clasp the hands to press firmly onto the mat. This helps you remain in the position for a long time.

Related Article:  Proven Health Benefits of Yoga

Training injuries are inevitable. When pushing yourself to new fitness boundaries, you are bound to experience an injury at some point. Of course, accepting that fact is not necessarily a license to become reckless. You want to train as safely as you can in order to stay in the gym but off the bench. That’s half of the battle.

The other half of the battle is knowing the right steps to take when you have sustained an injury. Some coaches will tell you that you need to stretch an injury to encourage it to recover more quickly. But when you consider that some injuries occur because a muscle is stretched beyond its natural limits, this advice begins to sound pretty useless or even detrimental.

In this article, we are going to discuss the right steps to take involving stretching when you have an injury. Aside from stretching, one of the most effective and easiest measures to take when dealing with an injury is to use recovery wear. Like stretching, compression gear has the ability to increase blood flow to the affected area which helps those tissues to heal. Compression gear should be in every athlete’s toolbox, as recovering from hard training sessions is just as important as performing the session itself. If you’re injured currently, implementing stretching carefully and wearing compression gear will be your shortcut back to the gym.

Let’s talk about some of the do’s and don’ts

Do know what type of injury you are dealing with first

Not every injury should be stretched. Some are better left alone. A muscular strain (or a pulled muscle) occurs when a muscle is overstretched or torn. This can be the result of overuse, fatigue, poor form or simply lifting too much weight. The injury will cause pain and inflammation and more serious occurrences can result in bruising and swelling. A severe muscle tear can cause a complete rupture which needs surgical intervention to be reattached.

Don’t stretch a torn or pulled muscle

This will only aggravate the issue. If you’re unsure about the severity of the injury, it’s best to get the expert opinion of a medical doctor before you proceed. For mild pulls/strains, you can use the R.I.C.E. protocol:

  • Rest the muscle as much as you can
  • Ice the muscle to ease the inflammation
  • Compress the muscle by wearing compression gear
  • Elevate the limb while resting by using a pillow or folded blankes

Do wait until inflammation subsides before stretching

Within the first 72 hours after an injury, your body will create inflammation in the area as it brings more fluid and nutrients to the area to begin the repair process. Your tissues will be very sensitive during this initial period and stretching can cause more harm than good.

Don’t wait too long to begin stretching

After an injury, scar tissue will develop to reattach those muscle fibers. Scar tissue is your body’s natural response, but it is not as flexible or strong as your initial muscle fibers. To combat its inflexibility, begin stretching often once the inflammation subsides. This will help to keep your muscles flexible even while scar tissue fills in the gaps.

Do follow a consistent stretching routine

As previously mentioned, some of the most common sports-related injuries are strains and pulls. These injuries are the result of muscles that have been overstretched or used improperly. By adhering to a stretching routine that prioritizes your tight muscles, you can reduce the chances of suffering future injuries.

Don’t push your boundaries too far

Stretching involves some level of discomfort. The idea is to push a muscle beyond its current range slowly to build incremental increases in flexibility. You don’t want to push too far, though. Taking an aggressive approach to stretching can cause you to overstretch the muscles which can lead you back to strains and muscular pulls

Do incorporate different types of stretching

There is more than one correct way to stretch a muscle. Actually, a combination of different stretches works best to condition your muscles and prevent future injuries. Let’s go over the different forms of stretching:

  • Static Stretching–This is the most common form of stretching and the easiest method to start with. With static stretching, you slowly ease into the stretch and hold the position for an extended period of time–usually 20 to 30 seconds.
  • Active Static Stretching–This form of stretching is common in Martial Arts and Yoga positions. To perform an active static stretch, you would hold a stretch via the strength of agonist muscles (one group of muscles contract to support and lengthen the opposing muscle group).
  • Dynamic Stretching–This form of stretching makes the muscles more flexible through motion, as opposed to static stretching. The actual stretches are similar; however, the way you implement them differs. A dynamic stretch is basically performed for various repetitions. You can go through the stretching motion gradually and then return to a neutral position. You would repeat these movements to gradually stretch your muscles. While greater gains in a range of motion can be seen from the static approach, dynamic stretching has been scientifically proven to enhance athletic performance and seems to be a great way to warm up before a workout.
  • Ballistic Stretching–This form of stretching is very similar to dynamic stretching, except it involves more rapid movements that can generate momentum to stretch the muscles further. While we do not condone this type of stretch without supervision, prominent certified athletic training bodies have recently supported its benefits for strength and increases in flexibility.

Dealing with a serious injury?

Always seek medical attention before implementing a stretching program. You want to be sure that you know what you’re dealing with and take note that stretching can be counterproductive under some circumstances. There is a time and place for everything. Also, don’t underestimate the ability of a back brace to speed up your recovery from injuries or just general soreness from training.

Hamstring stretch injuries are really annoying and painful – if you’ve ever felt that sharp pain in the back of your leg or seen someone pull up while running and grab the back of their leg, you know what I’m talking about.

Unfortunately, hamstring injuries are the most common cause of lost training and playing time in activities that involve running1. They take significant time to heal and rehabilitate and are notoriously sensitive to re-injury. The average rehab and return to activity timeline following a hamstring injury is about 2 weeks, at a minimum,2 and in certain sports, like soccer, the average time lost has been pegged at nearly 20 days.3

Additionally, hamstring injuries have been shown to re-occur in more than 30% of athletes, with some studies reporting rates as high as 70%!4–7 Most recurrent hamstring strains take place in the first 2 months after return to activity, but the increased risk still exists thereafter.8–10  In one study, that persistent re-injury risk was 3 times greater for an injured athlete than a non-injured athlete for up to one year after the initial injury.11

For these reasons, I emphasize hamstring injury prevention with each and every client involved in any sort of running activity– whether that’s team sports, sprinting to catch the bus, individual sports, runners, weekend warriors, and so on.

The basis for hamstring injury prevention is what I call functional training – understanding which function of the hamstring stresses the muscle the most and then implementing a training program to build endurance and strength specific to that function.

The key function of the hamstring

The main function of the hamstring is to slow down your swing (lead) during the phase of the running cycle known as “terminal swing phase”, in other words right before the forward leg touches the ground.

Here’s what terminal swing phase looks like:

runner in terminal stance 2048 x 1365

This helps control the swing leg and put it in a better position for the next phase of movement while decreasing the amount of force (think: shockwave) that goes up through your foot and leg. In order to “brake” the swing leg, the hamstrings “eccentrically contract”, in other words, they contract while lengthening. This is termed “eccentric control of knee extension”.

This picture does a good job of explaining eccentric contraction using the biceps muscle as an example:

EZ Bar Curls. Exercising for bodybuilding Target muscles are marked in red. Initial and final steps. 3D illustration 2048 x 1858

And here’s an anatomical representation what a hamstring looks like in terminal swing phase:

runner with pointer showing eccentric contraction hamstring 2048 x 1225This eccentric control phase places the highest stress on the hamstrings of any movement12,13, and evidence shows hamstring injury is most common during this phase.14–16  Therefore, the goal of functional training is to improve the hamstrings’ tolerance of and ability to withstand this kind of stress.

Which brings us to…

Eccentric Training

Eccentric strength training has repeatedly been shown to prevent hamstring injuries17–22. For activities that involve sprinting, such as soccer, it’s been shown to improve speed and performance as well.19,22  The exercise with the highest level of evidence is the Nordic Hamstring curl17,20–23, with large-scale interventions showing a decrease in hamstring injuries by upwards of 50-70%!20,21,23,24 .  For a video of the Nordic Hamstring curl and detailed instructions, click here (https://exrx.net/WeightExercises/Hamstrings/BWHamstringRaise)

The Nordic hamstring curl, by itself, is a very powerful tool for preventing hamstring injury. However, recent research by Bourne et al25 shows that the Nordic Hamstring curl focuses predominantly on only 2 of the 4 hamstrings muscles – the semitendinosus (ST) muscle and biceps femoris short head (BFSH) muscle.

The same paper by Bourne et al25 showed “hip-dominant” hamstring exercises (the Nordic Hamstring curl is considered “knee-dominant), specifically, the stiff-legged deadlift, engage the other 2 muscles of the hamstrings group – the semimembranosus (SM) and biceps femoris long head (BFLH).

Graphic showing the 4 muscles that make up the hamstrings 474 x 600

Graphics credit: 3D4Medical and 3CBPerformance.com

This hamstring injury prevention program includes both the Nordic hamstring curl and stiff-legged deadlift to eccentrically train all 4 parts of the hamstrings group. For a video of the stiff-legged deadlift and detailed instructions, click here (https://exrx.net/WeightExercises/GluteusMaximus/BBStrBackStiffLegDeadlift)

The Training Plan

Based on training protocol evidence17–24, here’s the training plan & progression I created and use with my clients. It is a 10-week, incremental progression program that looks like this:

Week Nordic Hamstring Curl Stiff-Legged Deadlift
1 2 sets x 5 reps 2 sets x 5 reps
2 2 sets x 6 reps 2 sets x 6 reps
3 3 sets x 8 reps 3 sets x 8 reps
4 3 sets x 10 reps 3 sets x 10 reps
5-9 3 sets x 12/10/8 reps 3 sets x 12/10/8 reps
10+ 1 set x 12/10/8 reps 1 set x 12/10/8 reps

 

A couple things to note:

If you feel any sharp pain during the exercises, stop. Try decreasing the reps or weight and if that doesn’t help, don’t proceed further. Additionally, you shouldn’t feel any sharp pain in the days afterward.  You will feel some soreness – especially if you haven’t trained in your hamstrings in this way before – but that’s completely normal.

With that in mind and the dosage set, when should you do this training? I recommend adding the regimen to the end of your leg workout routine. If you’re working legs twice a week, then add it whichever day is less strenuous. If you don’t have a leg workout routine, then we need to talk. Additionally, give yourself a 2-day gap before or after a big run or match. This gives your legs time to recover and buffers against muscular overload and fatigue.

Prevention is the best medicine

Prevention truly is the best medicine for the hamstrings due to the substantial rehab time and high rate of re-injury. This 10 minute, 2 exercise eccentric strength training program can save you considerable time and anguish for a low amount of time and energy investment – no need to move around your entire schedule or worry about a whole other workout. It’s efficient, effective, pragmatic, targeted training. That’s my kind of high ROI program.

Give it a try and let me know how it goes.  If you have any questions, feel free to contact me.  Here’s to a life free of hamstring pain and annoyance!

References:

  1. Opar DA, Williams MD, Shield AJ. Hamstring strain injuries: factors that lead to injury and re-injury. Sports Med. 2012;42(3):209-226. doi:10.2165/11594800-000000000-00000.
  2. Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther. 2010;40(2):67-81. httpss://www.ncbi.nlm.nih.gov/pubmed/20118524.
  3. Ekstrand J, Waldén M, Hägglund M. Hamstring injuries have increased by 4% annually in men’s professional football since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. Br J Sports Med. 2016;50(12):731-737. doi:10.1136/bjsports-2015-095359.
  4. Mason DL, Dickens VA, Vail A. Rehabilitation for hamstring injuries. Cochrane Database Syst Rev. 2012;12:CD004575. doi:10.1002/14651858.CD004575.pub3.
  5. Orchard JW. Intrinsic and extrinsic risk factors for muscle strains in Australian football. Am J Sports Med. 29(3):300-303. doi:10.1177/03635465010290030801.
  6. Prior M, Guerin M, Grimmer K. An evidence-based approach to hamstring strain injury: a systematic review of the literature. Sports Health. 2009;1(2):154-164. doi:10.1177/1941738108324962.
  7. Sherry MA, Best TM. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther. 2004;34(3):116-125. doi:10.2519/jospt.2004.34.3.116.
  8. Arnason A, Sigurdsson SB, Gudmundsson A, Holme I, Engebretsen L, Bahr R. Risk factors for injuries in football. Am J Sports Med. 32(1 Suppl):5S-16S. doi:10.1177/0363546503258912.
  9. Bennell K, Wajswelner H, Lew P, et al. Isokinetic strength testing does not predict hamstring injury in Australian Rules footballers. Br J Sports Med. 1998;32(4):309-314. httpss://www.ncbi.nlm.nih.gov/pubmed/9865403.
  10. Gabbe BJ, Bennell KL, Finch CF, Wajswelner H, Orchard JW. Predictors of hamstring injury at the elite level of Australian football. Scand J Med Sci Sports. 2006;16(1):7-13. doi:10.1111/j.1600-0838.2005.00441.x.
  11. Hägglund M, Waldén M, Ekstrand J. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br J Sports Med. 2006;40(9):767-772. doi:10.1136/bjsm.2006.026609.
  12. Yu B, Queen RM, Abbey AN, Liu Y, Moorman CT, Garrett WE. Hamstring muscle kinematics and activation during overground sprinting. J Biomech. 2008;41(15):3121-3126. doi:10.1016/j.jbiomech.2008.09.005.
  13. van den Tillaar R, Solheim JAB, Bencke J. COMPARISON OF HAMSTRING MUSCLE ACTIVATION DURING HIGH-SPEED RUNNING AND VARIOUS HAMSTRING STRENGTHENING EXERCISES. Int J Sports Phys Ther. 2017;12(5):718-727. httpss://www.ncbi.nlm.nih.gov/pubmed/29181249.
  14. Connell DA, Schneider-Kolsky ME, Hoving JL, et al. Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. AJR Am J Roentgenol. 2004;183(4):975-984. doi:10.2214/ajr.183.4.1830975.
  15. Koulouris G, Connell DA, Brukner P, Schneider-Kolsky M. Magnetic resonance imaging parameters for assessing risk of recurrent hamstring injuries in elite athletes. Am J Sports Med. 2007;35(9):1500-1506. doi:10.1177/0363546507301258.
  16. Verrall GM, Slavotinek JP, Barnes PG, Fon GT. Diagnostic and prognostic value of clinical findings in 83 athletes with posterior thigh injury: comparison of clinical findings with magnetic resonance imaging documentation of hamstring muscle strain. Am J Sports Med. 31(6):969-973. doi:10.1177/03635465030310063701.
  17. Brukner P. Hamstring injuries: prevention and treatment-an update. Br J Sports Med. 2015;49(19):1241-1244. doi:10.1136/bjsports-2014-094427.
  18. Goode AP, Reiman MP, Harris L, et al. Eccentric training for prevention of hamstring injuries may depend on intervention compliance: a systematic review and meta-analysis. Br J Sports Med. 2015;49(6):349-356. doi:10.1136/bjsports-2014-093466.
  19. Askling C, Karlsson J, Thorstensson A. Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scand J Med Sci Sports. 2003;13(4):244-250. httpss://www.ncbi.nlm.nih.gov/pubmed/12859607.
  20. van der Horst N, Smits D-W, Petersen J, Goedhart EA, Backx FJG. The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players: a randomized controlled trial. Am J Sports Med. 2015;43(6):1316-1323. doi:10.1177/0363546515574057.
  21. Arnason A, Andersen TE, Holme I, Engebretsen L, Bahr R. Prevention of hamstring strains in elite soccer: an intervention study. Scand J Med Sci Sports. 2008;18(1):40-48. doi:10.1111/j.1600-0838.2006.00634.x.
  22. Mjølsnes R, Arnason A, Østhagen T, Raastad T, Bahr R. A 10-week randomized trial comparing eccentric vs. concentric hamstring strength training in well-trained soccer players. Scand J Med Sci Sports. 2004;14(5):311-317. doi:10.1046/j.1600-0838.2003.367.x.
  23. Petersen J, Thorborg K, Nielsen MB, Budtz-Jørgensen E, Hölmich P. Preventive effect of eccentric training on acute hamstring injuries in men’s soccer: a cluster-randomized controlled trial. Am J Sports Med. 2011;39(11):2296-2303. doi:10.1177/0363546511419277.
  24. Seagrave RA, Perez L, McQueeney S, Toby EB, Key V, Nelson JD. Preventive Effects of Eccentric Training on Acute Hamstring Muscle Injury in Professional Baseball. Orthop J Sports Med. 2014;2(6):2325967114535351. doi:10.1177/2325967114535351.
  25. Bourne MN, Timmins RG, Opar DA, et al. An Evidence-Based Framework for Strengthening Exercises to Prevent Hamstring Injury. Sports Med. 2018;48(2):251-267. doi:10.1007/s40279-017-0796-x.

Oftentimes, when you read stories about people who attain a remarkable milestone in aging, you will find that they have been asked the following question:

“What is your secret to a long and healthy life?”

The stories usually relate one or two things that the oldster supposedly pointed to as the key to living to such an advanced age. For instance, Emma Morano, an Italian woman who died at the advanced age of 117 was said to attribute her longevity to her genetics and a diet of three eggs a day, two of them raw. Jeanne Calment of France was verifiably the longest living human ever. Her story noted that she smoked cigarettes from age 21 to age 116. She also ate 2 pounds of chocolate a week. She died at age 122. American Sarah Knauss lived to be 116 years old. She credited not letting things upset her as being the “secret” to her longevity. The “secrets” shared by these supercentenarians make it seem like anyone could live to a ripe old age without really working at it. But, alas, if it were that easy to live to a ripe old age, many more of us would be doing it.

Related Content: Healthy Life Extended by Eight Years in a Landmark Study

The rest of the story

Of course, these stories don’t really tell the whole story. If it were that easy to live to a ripe old age, more of us would be doing it, no? And, do we really just want to hit the old age milestone, whether it is 80, 90, or 100 or do we also want to be robustly healthy and sound in mind and body? I don’t know about you, but I want to keep it all as long as I can…and that takes work.

So I thought I would share with you a story about one of the healthiest and hardiest 80+-year-olds that I know. This story (and accompanying video) is a tribute to Dov Michaeli, MD, Ph.D, my husband and role model for healthy aging on the occasion of his 83rd birthday. Let me tell you, there are no raw eggs or cigarettes in this story, rather there is hard work and discipline, the underpinnings of a long and healthy life for the rest of us.

 

Oh, no, if you want good health at 80+, you actually have to work at it.

Now, Dov would be the first to tell you that one of the most important things you can do is to be born to the right parents. He certainly was. His dad, Shaul, lived to his mid-90s dying from a treatable mouth cancer because he wanted to. Although he was living independently in his own apartment in Tel Aviv, many of his friends had already passed away. And, he found that although his mind and body were still strong, he was slowing down and was burdened with various aches and pains as he approached 90. He complained to me frequently during those years saying, “Don’t let anyone tell you about the golden years, they are really the rust years.” Dov’s Mom, Annie, also lived to her mid 90’s, living independently until close to the end. Her cheerful good nature kept her surrounded by family and friends and an astonishing number of men friends well into her 90’s.

But the gift of good genetics can be wasted, Dov says if you don’t actually work at staying healthy. His prescription for a healthy old age: exercise, nourish the body and nourish the mind. Here’s how he does it:

 

Exercise

Years ago, we gave up the guest room and converted it into a gym (free weights, a bench, an elliptical, and a treadmill). And then, we hired a personal trainer to keep us motivated and to be sure we were doing it right. Since then, Dov has been working out 1-2 hours per day (that’s right, a day!). He starts with aerobic exercise, a high resistance, fast-paced elliptical workout for 35 minutes every morning (watch the video to see what that looks like). Afterward, he does strength training exercises with free weights alternating biceps one day, with push-ups and flies the next, and (groan) 6 sets of 30 pull-ups the next. He includes a variety of yoga stretches interspersed with the strength training. He credits these stretches with keeping his chronic back pain in check for years.

Having a dog means at least an hour long walk or hike almost every day. Dogs are great exercise motivators. Our vacations are usually activity-oriented. Dov summited Mt. Kilimanjaro at 78 followed by hiking New Zealand’s Milford track at 79. No vegging out on the beach for this guy.

 

Nourishment for the body

You would think with all that working out, Dov could eat whatever he wants. But he is disciplined in that aspect of life as well. Every morning, breakfast is the same: a big bowl of bran cereal topped by oodles of fresh berries, melon, and grapes…with non-fat milk, of course. He supplements the cereal with two hard-boiled egg whites (the dog gets the yolks). Dinner is almost always salmon—but also occasional lamb or chicken—with a salad and a glass (or two) of red wine. His primary indulgence is a tiny piece of dark chocolate which he notes is good for his memory.

 

Nourishment for the brain

Because the body is no good without the mind (and the mind is no good without the brain), Dov reads constantly—mostly nonfiction, sometimes quite dense. His current book is a history of Ancient Mesopotamia (a real sleeper for me) supplemented with online news and opinion as well as audiobooks of a lighter sort, including novels. He also writes weekly for The Doctor Weighs In—mainly evidence-based stories about how different parts of the brain affect our behavior. Playing chess, learning a language, engaging in sometimes heated political discussions are all a part of his workout for the brain.

 

So there you have it…

The key to killer abs and a sharp brain at 80 is hard work and discipline. Exercise your body, feed it well, and stimulate your brain. It works. In fact, it works even better if you also have good genes.


First published on June 23, 2015. It was updated on May 2, 2017 and is being republished on May 28, 2018 in honor of Dov’s birthday.

Doing too much of anything can have negative consequences. This is definitely true for those of us who have jobs that require us to stand all day. If you’re wondering, “how long should you stand at a standing desk,” there is no correct answer. But we do know that jobs that require you to stay on your feet for the majority of the day can cause health problems if you’re not careful.

Standing every now and then is good for you. However, spending an entire day upright on the hard floor can work against you. If you have a job that forces you to be on your feet all or if you overdo it with your standing desk, you can develop knee pain, hip pain, heel pain, backaches, and more.

Here are six standing desk tips that can help you avoid the pain

1. Find the right shoes

Good shoes keep your feet cushioned and comfortable and may help prevent plantar fasciitis. The shoes should provide solid support for your feet since you will be on them the most of the day. Many people with jobs that require long hours of standing like to invest in specialty athletic shoes. These types of shoes are designed to protect the feet of athletes who regularly pound the pavement, so they are likely to be a great fit for a long day of walking around and standing.

Before buying any old pair of shoes, it may help you to visit a running store to consult with a professional to help you find a shoe to meet your needs. The wrong choice of shoe will likely make your aches and pains even worse, eventually causing more harm than good. As you search for a shoe, keep in mind that long hours of standing may cause swelling in the feet. This means that any new pair of shoes you buy should have enough room to keep your feet comfortable in the event of swelling.

2. Stretch regularly

There’s a reason athletes stretch before and after any physical activity. Stretching helps keep your muscles and joints flexible, preparing you for the wear and tear of everyday life. Definitely, stretch before you start your working day, but be sure to stretch throughout the work day as well. It may help to search for exercises to do while standing at your desk to keep your body active throughout the day. Whether that means stretching your legs out at your lunch break or simply reaching for your toes at the end of the day, it is important to give your legs and feet a break from the regular standing position.

3. Keep your posture straight

Learning how to stand at a standing desk is all about developing the right posture. A good posture can be difficult to maintain but will help you in the long run. Keep your head up and your shoulders from slouching. Keep adjusting your posture throughout the day to make sure that you are always in the correct position. Additionally, you should walk going heel to toe. This will help keep your hips and spine in line with your shoulders.

4. Make time to sit

While you may have to spend the majority of your hours standing, that doesn’t mean that you should never sit. You should make a conscious effort to find a chair every so often. Take full advantage of any breaks that you might have in order to give your feet and the rest of your body a break.

5. Give Your Feet Extra Attention

When you’re off the clock, be sure to give your feet the right attention. If you have heel pain from standing all day, that means it’s time to splurge for massages, special baths, slippers, and socks to ensure that your feet are properly comforted when you are at home. Try to avoid putting any unnecessary pressure on your body by making time to lay on the couch or sit in a chair.

6. Avoid Unnecessarily Tight Clothing

Tighter clothing like spandex pants and slim-fitting dresses can affect your posture and cause back pain. If you plan to spend an entire day wearing your outfit, it’s best to choose something that is both presentable and comfortable. While tighter options may look better to you, it’s simply not a good choice if it’s putting you in pain.

The bottom line

While we all need to make money, it shouldn’t be at the cost of your health. Make it a point to make to learn how to relieve pain in feet from standing all day by putting these tips into practice at your place of work and your home. By taking care of yourself now you can ensure more healthy years for your future.

There are conflicting views on the value of weight-loss diets. Some believe that if individuals have enough willpower to stick with a diet, they can lose an unlimited amount of weight. Others believe that weight loss attempts are rarely successful and weight regain invariably occurs.

There are many questions to ask when evaluating “does dieting work?”

  • Do dieters continue to lose weight?
  • Does some of the lost weight return?
  • Do some dieters gain back more weight than they lost?

In one study, women participating in a weight-loss program reported their goal weight as an average 32% reduction in body weight. After 48 weeks of treatment and an average loss of 35 lbs., 47% of women did not achieve weight loss they associated with success. Thus, what are achievable goals?

 

What is occurring in the USA?

In the USA, obesity has increased dramatically. The number of adults trying to lose weight by dieting and the amount of money spent on weight-loss has also increased. Using the most recent data from the CDC’s National Center for Health Statistics [NCHS], more than one-third of U.S. adults (34.9%) were obese in 2011 to 2012. Approximately half of all adults are trying to control weight, with about one-third of men and nearly one-half of women trying to lose weight. Additionally, we spend approximately $50 billion per year on weight-loss efforts.

 

Why should I lose weight?

From a medical perspective, preventing metabolic disease, such as hypertension, type 2 diabetes, coronary artery disease, and dementia, is the single most important health issue today. Obesity is associated with all of these common chronic diseases.

Meanwhile, sustained modest weight loss is associated with health improvements:

  • Decreased risk for type 2 diabetes
  • Reductions in blood pressure
  • Improved lipid profiles

Health improvements begin to appear with weight loss of 5-7% of body weight. In 1998, the National Institutes of Health recommended weight loss for persons with a BMI (body mass index) of 30 or more and for persons with a body mass index between 25 and 29.9 with two or more risk factors (i.e. hypertension, type 2 diabetes, abnormal lipids, coronary artery disease). BMI is a person’s weight in kilograms (kg) divided by his or her height in meters squared. BMI is useful in population studies because it is easy to obtain and, in general, is a useful measure of health and longevity. It does not distinguish body fat weight from muscle or bone weight.

 

What are the results of most diets?

HealthPartners Health Behavior Group in collaboration with Kaiser Permanente’s Care Management Institute completed a review of long-term weight-loss interventions. Weight-loss studies reviewed were categorized into eight types of interventions: advice alone, diet alone, diet and exercise, exercise alone, meal replacements, very-low-energy diets, and weight-loss medications. The purpose of the systematic review was to answer the question raised above: Do diets work?

In studies with a minimum follow-up of 12 months, mean weight loss of approximately 11 lbs. to 18 lbs. (5-9%) was observed during the first six months with a reduced-calorie diet and/or weight-loss medications. However, a weight-loss plateau usually occurred at approximately 6 months. In weight loss studies involving low-calorie diets extending to 48 months, a mean loss of 6 lbs. to 13 lbs. (3-6%) occurred and was maintained. In studies with advice only and exercise alone, groups experienced minimal weight loss. In summary, weight loss interventions utilizing a reduced calorie diet and exercise are associated with the best moderate weight loss outcome at six months.

Weight regain after a diet is your body’s evolved response to starvation. Additionally, your genes are involved in regulating your weight. To compare the effect of genetics versus the environment on the body-mass index, A.J. Stunkard studied samples of identical and fraternal twins, reared apart or reared together in Sweden. Stunkard concluded that genetic influences on body mass index (BMI) were more important than the childhood environments.

“Genetic factors appear to be major determinants of the body mass index in Western society, and they may account for as much as 70% of the variance.”

If the environment has no influence, then external factors such as culture, exercise, and dietary choices have no influence on your BMI. This sounds counterintuitive but this is part of the rationale of those who recommend “no diets”.

The above research is correct; the interpretation, however, is incorrect. The BMI has only two components: height and weight. Height in western societies is approximately 100% determined by genetics. With BMI, 70% is determined by genetics, suggesting that 40% of your weight is determined by genetics. Thus, environment has a major role in determining your weight and diet is very important.

 

Diet and exercise together

The combination of diet and exercise together will achieve greater weight loss and will allow longer maintenance of weight loss than either intervention alone. Exercise can include many different activities, but, in general, can be divided into two main categories: cardiovascular or endurance exercise and resistance training.

 

Why do diets fail?

The main reason diets fail is that we are addicted to eating unhealthy food and modern society misinforms us. Sugar can be a substance of abuse and lead to a natural form of addiction. Food addiction occurs because the brain pathways that evolved to respond to natural rewards are also activated by addictive drugs and by sugar. Sugar is noteworthy as a substance that releases opioids and dopamine and has addictive potential. The four components of addiction are:

  • Bingeing
  • Withdrawal
  • Craving
  • Cross-sensitization

Each can be demonstrated to be present with sugar bingeing. These behaviors are related to the neurochemical changes in the brain that occur with addictive drugs and with sugar.

The obesity epidemic in this country has been aided by the low cost of high glucose-containing carbohydrates. These foods are inexpensive because their production and storage are subsidized by the U.S. government in the Farm Bill. For the past 50 years, U.S. farm policy has been directed towards driving down the price of farmed storable carbohydrates.

At the same time, the cost of growing fruits and vegetables has increased, as has their retail price. Low costs incentivize the food industry to use more of these unhealthy commodities. High-fructose corn syrup is now commonly added to many processed foods.

In summary, the food industry has a huge financial incentive to make food with high-glycemic carbohydrates (sugars). They also use sophisticated marketing tools. “Marketing” is defined as “whatever it takes to make you buy a specific product.” One of the most useful marketing techniques is to aim marketing messages at children, who then nag their parents to buy this or that product; then, the child may continue to buy that product well into adulthood. The food industry spends over $1.6 billion dollars marketing food to children. Most of these products are processed foods high in calories and addicting sugar.

We continue to eat poorly in the belief that “labels do not lie.” Marketing companies have created labels using a selection of words that make us believe we are eating healthy food when, in fact, we are not. “Whole grain” refers to a cereal product containing the germ, endosperm, and bran, and, thus, not refined or man-made. Yet, the stamp “whole grain” from the Whole Grains Council means the product must contain only 8 grams of whole grain per 30 grams of product, and, thus, is mostly not comprised of whole grains. The label stating “Made With Whole Grain” actually may mean that only a tiny amount of whole grain is present. The label “Heart Healthy,” sold by the American Heart Association for use on foods, refers to the fat and salt content of a product but not the sugar content of the product; thus, one real cause of heart disease is not even accounted for. The term “all natural” should be labeled “stay away!” The USDA does not define foods labeled “all natural” as any different than those labeled “natural.” Foods with this labeling are usually not any different than “natural” foods, and may not be regulated because they are not defined by the USDA. Foods labeled “natural,” per the USDA definition, do not contain artificial ingredients or preservatives, and the ingredients are only minimally processed. However, they may contain antibiotics, growth hormones, and other similar chemicals. People often confuse “natural” with “organic” and marketers will continue to do whatever it takes to sell their products.

In summary, diets may fail but a healthy lifestyle always prevails. It takes knowledge to remain healthy. A healthy lifestyle is a path with no end. Knowledge of how your body works is the key to this path. If it is a race, it is the race won by the turtle and not the hare.


This was first published on November 20, 2016. It has been reviewed and republished on January 1, 2018.

Thanksgiving is the season of delicious meals with family and remembering what you’re thankful for. Unfortunately, it’s also a time where trips to the ER rise and health issues surface. Hospitals report a 30% spike in ER visits on Thanksgiving, with many people experiencing shortness of breath, heart failure, and arrhythmias. Health issues can be severe at this time, so much so that heart-related deaths increase by 5% during the holiday season.

So why is Thanksgiving such a health hazard? Two words: stress and overeating. The anxiety that comes with travel and family reunions can be hard on the heart. Meanwhile, the fat, sugar, and sodium that make everyone’s favorite Thanksgiving meal so delicious are also bad for your heart. One Thanksgiving meal can contain as much as 2,000 milligrams of sodium—that’s the recommended intake for an entire day.

Don’t worry, it’s not the time to panic and give up Thanksgiving dinner just yet. Implementing a heart-healthy routine and taking care of your heart year-round means you can splurge on a turkey dinner and dessert while gathered with your family and friends. That means practicing simple healthy habits like moderate exercise, plenty of fruits and veggies, and avoiding smoking. If you haven’t been good to your heart this year, there are still steps you can take during Thanksgiving to protect it. In order to avoid a trip to the ER, use these five heart-healthy tips.

Eat your breakfast

Many people skip breakfast on Thanksgiving in order to save their appetites for dinner. Skipping breakfast has been linked to an increased risk of cardiovascular disease, as well as high blood pressure and cholesterol. Binging on a large dinner later in the day can also lead to higher blood pressure. Be sure to eat breakfast every day, especially before a large Thanksgiving meal. Fruits and veggies are good for your heart, and you can keep your blood pressure in check with a healthy diet low in sodium and cholesterol. Choose heart-healthy foods like nuts, berries, oatmeal, or flax seeds for breakfast.

Stay hydrated

It’s important to stay hydrated during Thanksgiving. No, that doesn’t mean you can reach for the soda or the wine. Choose water instead. Not drinking enough water can spark feelings of false hunger that may cause you to overeat. Avoiding alcohol has also been shown to lower your risk of developing the heart rhythm disorder atrial fibrillation (AFib). Cut back your alcohol intake during Thanksgiving and keep it simple with a glass of water

Choose healthy options

If you’re worried about your heart health, skip the heavier dishes and choose recipes with less fat, sugar, and calories. A simple roast turkey that isn’t slathered in butter and gravy can actually be a healthy choice. Choosing light meat over dark meat makes it even healthier. Potatoes are a good source of potassium, fiber, and vitamin C, while sweet potatoes are especially nutritious. Choose potato recipes that skip the heavy butter, cream, or sugar. When in doubt, go with fruits and veggies. Fill your plate with side dishes like squash, green beans, cranberries, or brussels sprouts.

Exercise regularly

Your body loves exercise, and it’s healthy for you on so many levels. In addition to helping lower your blood pressure and lose weight, exercise can reduce the risk of stroke and heart disease. Just 30 minutes of moderate exercise per day has been shown to reduce the risk of stroke, heart attack, and heart failure. This includes a variety of physical activity, like walking to work, going to the gym, and even doing household chores. If your gym is closed on Thanksgiving, enjoy a walk with your family after dinner.

Identify and treat AFib

AFib is an abnormal heart rhythm that is a leading cause of stroke. Thirty-three and a half (33.5) million people worldwide have AFib, but many do not realize it, since it may go undetected. You can save time and money monitoring your heart health by using an FDA-cleared smartphone device that reads your heart rhythm in seconds, anytime, anywhere. In fact, you can even test your family and friends for AFib at the Thanksgiving dinner table, as this retired cardiologist does. If AFib is detected, you should send your mobile EKG results to a doctor who can provide further treatment if necessary (if you’ve been diagnosed with a heart condition, follow advice from your doctor).

As you’re sitting down to a delicious Thanksgiving dinner with friends or family this year, be thankful for your heart health. These healthy steps can be applied to Turkey Day and to your everyday life. Once you’ve digested the turkey, stuffing, and gravy, continue to take care of your heart with small lifestyle changes. Moderate exercise, eating healthy, and limiting alcohol can go a long way. Your heart will thank you!

The transition between medical school and residency is quite possibly one of the most difficult things you will ever have to do. We all start off with the knowledge that residency training is going to be extremely challenging and we mentally prepare ourselves for the endeavor. Unfortunately, actually going through residency training is a lot different than the mental anticipation of it.

Depending on your specialty, there is a high probability that you will be sleep deprived, underfed, and overworked. After you add in the stress of high expectations and real patient lives at stake, the experience has the potential to be extremely overwhelming.

In order to meet the demands of work life, you have to carefully pick and choose the hobbies/activities you will participate in. Unless health and fitness are a major priority in your life, they will likely be neglected. Unfortunately, residency isn’t the ideal time to ignore these things.

Here’s why…

Residency is destroying your fitness

The emotional stressors caused by a demanding residency schedule can have a lasting impact on your mental health. According to a meta-analysis done in 2015, approximately 29% of resident physicians are depressed or experience depressive symptoms.1 It is well documented that depression could lead to cognitive decline, which could have serious consequences in acute medical settings.2

Suicidality is also a major concern in the medical field. Sadly, approximately 300-400 physicians die by suicide every year. Fortunately, hospitals have begun to take the matter seriously, as residents are being provided with free mental health services and other wellness initiatives.

Residency can also impact your physical body in many ways. One small study done in a cohort of 375 residents at Yale University found that on average, residents were more likely to be overweight at the beginning of PGY3 as compared to PGY1.3 Additionally, other smaller studies have seen statistically significant increases in resident weight gain throughout the course of their training.4

While it may not sound like much, 1 in every 3 adults is either overweight or obese. Any increase in body fat will decrease your lean muscle mass percentage, lower your, quality of life and increase your risk of all-cause mortality.

Becoming overweight/obese during your late 20s and early 30s can have major consequences that could be prevented. These include the development of chronic conditions such as diabetes mellitus, hypertension, and dyslipidemia.

Simple strategies to maintain your health & fitness in residency

While these negative effects sound grim, all hope is not lost. Even as a resident physician, there are ways to take care of your health and improve your fitness.

Exercise has been shown to have tremendous benefits on both the body and the mind. A study done by Duke University found that exercise was just as effective as antidepressants (SSRIs) in decreasing major depressive symptoms in individuals with a clinical diagnosis of Major Depressive Disorder.5 In addition, a subsequent follow-up study found that those individuals who continued to exercise at the 4-month mark were less likely to relapse into depression.6

Most residents say that they do not have time to exercise. Unfortunately, having that mindset will create a procrastination habit and keep your health and fitness spiraling downhill. After residency, you may be starting a family, or trying to establish your own practice. If you don’t develop the mindset and the habit of making time for yourself now, it will only get more difficult to do so later in life.

It is absolutely possible to carve out 30 minutes a day, three times a week to exercise. One of these sessions could even be on your day off.

Make sure to find a fitness center that is near your hospital so that you can go straight to your workout after your shift. Additionally, bring your gym clothes with you to work so that you don’t have to waste time going home to change. Expecting to go home and then go back out to the gym is a set-up for failure.

You could also get a fellow resident to join your fitness journey so that you could hold each other accountable.

But what if I hate going to the gym/exercising?

There are some people who truly dislike physical activity. If you really hate exercising, you could still benefit from exercise by increasing the amount of walking that you do.

Related story: 12 common exercise excuses debunked

Walking is by far the most underrated exercise of all time. It increases your body’s circulation, decreases the risk of chronic metabolic conditions, and helps to keep your weight in check.

Studies have demonstrated that 10,000 steps a day is a great goal to aim for, as this threshold has been associated with increased levels of fitness and decreased rates of chronic conditions in young adults.7,8

Fortunately, it is very easy to keep track of your steps. Many devices of various price ranges have entered the market that could be used as fitness trackers.

If you want to be a superstar, you can do both. Begin exercising and walking more!

Simple ways to improve your diet in residency

As a resident physician, it is difficult to make good food choices. Being on a 24-hour call or on the night shift increases the chances of consuming low-quality foods. Making the matter worse, vending machines at every corner provide a constant supply of soda, potato chips, and candy bars.

One simple way to circumvent many of the problems caused by poor food choices is to add high-quality food choices into your current diet. Instead of having to find good substitutions, just try eating healthy foods with whatever meal you’re already having.

One of the best food groups you could consume is green vegetables. Aim to consume some type of leafy green with each of your major meals. They are loaded with calcium, magnesium and many other micronutrients that your body probably doesn’t get enough of.

Another great food group to add is nuts. Try consuming a packet of nuts as a quick snack whenever there is minimal time to eat. They are loaded with healthy fats that can help satiate your appetite and decrease the risk of splurging later.

One of the best things you could do is to limit the amount of non-water drinks that you consume. Soda and juice are the major players and contain very high levels of sugar and calories. Do your best to drink plain water. Don’t say that you don’t like water. You are water. Try drinking water and nothing else for one week and see how you feel.

Final words

Once you begin to prioritize your health and fitness, you will notice significant improvements in your mood, your energy levels, and your overall quality of life.

Take action and don’t delay any longer. Residency is the time where you will obtain the vast majority of your medical training and also probably a lot of unhealthy habits. Don’t become a statistic. Don’t let residency destroy your fitness.

References

1. Mata, D. A., Ramos, M. A., Bansal, N., Khan, R., Guille, C., Di Angelantonio, E., & Sen, S. (2015). Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. Jama314(22), 2373-2383.
2. Lam, R. W., Kennedy, S. H., McIntyre, R. S., & Khullar, A. (2014). Cognitive dysfunction in major depressive disorder: effects on psychosocial functioning and implications for treatment. The Canadian Journal of Psychiatry59(12), 649-654.
3. Leventer-Roberts, M., Zonfrillo, M. R., Yu, S., Dziura, J. D., & Spiro, D. M. (2013). Overweight physicians during residency: a cross-sectional and longitudinal study. Journal of graduate medical education5(3), 405-411.
4. Battles, S. M., Williams, C. J., & Duldner, J. E. (2004). Body composition change during the intern year of emergency medicine residency. Annals of Emergency Medicine44(4), S76-S77.
5. Blumenthal, J. A., Babyak, M. A., Moore, K. A., Craighead, W. E., Herman, S., Khatri, P., … & Doraiswamy, P. M. (1999). Effects of exercise training on older patients with major depression. Archives of internal medicine159(19), 2349-2356.
6. Blumenthal, J. A., Babyak, M. A., Doraiswamy, P. M., Watkins, L., Hoffman, B. M., Barbour, K. A., … & Hinderliter, A. (2007). Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic Medicine69(7), 587.
7. Tudor-Locke, C., & Bassett, D. R. (2004). How many steps/day are enough?. Sports medicine34(1), 1-8.
8. Murtagh, E. M., Murphy, M. H., & Boone-Heinonen, J. (2010). Walking–the first steps in cardiovascular disease prevention. Current opinion in cardiology25(5), 490.

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Lack of health literacy is often cited as one reason why patients fail to follow their doctors’ instructions. It makes sense. If you can’t understand what your doctor is talking about then not doing what you are told is a logical outcome. The problem is further compounded when you are too embarrassed to say that you don’t get it or too pressured by the physician’s time constraints to get a word in edgewise.

Lack of health literacy impacts our health broadly

Health illiteracy extends way beyond failure to follow doctors’ instructions. We may see our physician once or twice a year—or more frequently if we have an acute or chronic condition. But we, as individuals, make hundreds of decisions each day that favorably (or unfavorably) impact our health:

  • Do I get out of bed and exercise or do I roll over for an extra 30 minutes of sleep?
  • Should I have a second helping of Chocolate Decadence or should I exert my willpower and push away from the table?
  • Buckle up? Or just forget it since I am only going two blocks away?
  • Should I vote for or against the city resolution that would require earthquake retrofitting of houses built before 1950? And what about the one requiring asbestos removal?
  • Should I quit smoking today? Or wait until next month?
  • How many drinks will I have at the party tonite?  And, should I drive home or take an Uber?

We are our most important health decision-makers. But what training do we have to take on such an immense responsibility? The answer is, in most cases, little or none.

Public health campaigns try to educate us so that we can make the right decisions on certain issues (smoking, for example), but all too often private sector media campaigns—both overt and covert—send much more powerful messages to get us to do what they want instead.

Who should be responsible for teaching health literacy?

So, who should be responsible for teaching health literacy? Our parents? Yes, but unfortunately, they may not be health literate themselves.

Health professionals…as if they don’t have enough to do already. And how often do we see them during adolescence anyway? For most teens, the answer is rarely even tough it is the time in our lives when we are forming many of our health habits?

Well then, how about the educational system? Isn’t being health literate as important as knowing your ABCs or how to add and subtract? Why not teach health in high school? Not as an elective or afterthought, but as a required course that is considered every bit as important for future success as math and American history.

And, while we are at it, why not teach health skills, such as self-directed physical activities, like weight training or yoga, that young people can use over their lifetimes instead of primarily focusing on team sports that many won’t be able to participate in once they have left school. 

The High School health curriculum

According to the most recent CDC sponsored School Health Policies and Practices Study (SHPPS 2016), although the majority of middle/high schools in the study required health education, some did not, in fact, actually cover all of the 15 topic areas considered essential:

school health education stats (708 x 354)

Screenshot from SHPPS 2014 report

Health literacy is not only about getting trained in 15 different topics (even if one thought these were the most important 15 topics). Rather it is about understanding how all of the different decisions one makes will result in health (or lack of it). And,  it is about practicing healthy living until it becomes routine.

By the way, what better place to begin practicing healthy living than in school. So it is disturbing to see that only 65.3% of schools in the SHPPS 2014 report prohibited all tobacco use during any school-related activity. And, while more than 90% of schools provide administration of medications, CPR, and first aid, “less than 66% provide prevention services, such as tobacco-use prevention, in one-on-one or small-group settings.”

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Also, 75% of high schools had either a vending machine or a school store, canteen, or snack bar where students could purchase food or beverages. It is definitely good news that, in all schools, the most common beverage sold was bottled water (34.6%) and the most common foods sold were low-fat salty snacks (25.7%), low-fat baked goods (21.7%), and low-sodium snacks (20.8%). However, what is missing from the report is a listing of the other foods being purchased, the ones that were chosen most of the time.  

Unfortunately, the topic is often not given the same weight as math, science, English, and social studies. Although 94% of high schools offered students opportunities to participate in interscholastic sports, only 4% required daily physical education or its equivalent. And many times, PE classes and after school activities focus on group sports instead of the teaching the type of individual physical activities types, such as strength training and yoga that can be sustained once kids graduate and are out in the “real” world.

Elevating health education

Elevating health education to a core part of the high school curriculum would mean requiring a comprehensive program, hiring trained professionals, and providing oversight and accountability, such as including health education questions on required and/or important examinations. Health education programs should also look at health outcomes—have kids improved one or more aspects of their health as a result of taking the classes?

All of this will require money and a willingness to depart from the status quo. In these times of resource constraints (to put it mildly), the former seems unlikely. And, if you have ever been involved in change management, you know the latter is a formidable challenge. Nevertheless, I believe if we compare the costs of implementing a meaningful health education program with the costs related to health illiteracy, we would find the return on investment well worth the effort.


This post was first published July 2, 2010. It has been reviewed by the author and updated with the latest SHPPS statistics on September 4, 2017.

Our knees are not built to take this pounding.” I can’t count the number of times I heard this refrain from doctors and other healthcare mavens—all well-meaning, none of them runners. And, I must say, it made a lot of sense to me. How could repetitive pounding over hundreds of miles and for many years not cause damage? Before we answer this question, let’s take a look at the anatomy of the knee.

The structure of the knee

The knee is the joint between the femur (thigh bone) and the tibia (shin bone). The ends of the femur, tibia, and the back of the patella (knee cap) are covered with a smooth, slippery articular cartilage. This allows the knee bones to glide past each other when the leg is bent or straightened. Another more fibrous type of cartilage, called meniscal cartilage, covers the surface of the tibia making up the medial and lateral menisci (not shown in the picture below). They act as shock absorbers for the knee. Collagen, a protein, is an important component of both types of cartilage. The joint is also encapsulated in a membrane called the synovium, and the synovial cells secrete a thick, mucous liquid that nourishes the cartilage cells and lubricates the surface of the meniscus.

knee joint anatomy 600 x 401

Any damage to the knee cartilage causes pain, the release of inflammatory factors, and eventual destruction of the cartilage. The end result is bone rubbing against bone. One of the hallmarks of a type of arthritis known as osteoarthritis (OA). Many experts tell you that OA, the most common form of the arthritic diseases, is the unfortunate result of the normal wear and tear that comes with aging. So, it is not surprising that running, what seems like the ultimate wear on the knee joint, has long been suspected as a cause of OA.

The facts are always right, it’s the interpretation that will trip you up

At one period of my research career, I was involved in the investigation of the biochemistry and immunology of connective tissue. I knew the process of damage to the cartilage and collagen down to the molecular level. That facilitated my falling into a common psychological trap: the bias of accessible information. When we are confronted with a problem for which we don’t have a ready answer, we tend to substitute that problem with another, for which we do have the answer. In behavioral psychology, this is called the availability heuristic.

In my case, the answer to the question of whether running caused OA was not readily available at the time. But I had a lot of related, if indirect information. Consider, for example, the presumption that OA is a wear and tear disease. In running, the force exerted on the foot (and traveling up to the knee and spine) by a 150 lbs person is an astounding 1,000 lbs! Cartilage treated in the laboratory with repeated pounding and macerating forces of 1,000 pounds results in the fraying of the hydrated bundles of collagen type II and proteoglycans, the molecular scaffold of cartilage. So no, we didn’t know specifically whether running caused OA, but the weight of the evidence seems compelling, doesn’t it? And yet…

Over the years, I kept on running long distances despite the pounding my knees took, joined by millions of other avid runners around the globe. Interestingly, when I looked around at the hundreds and thousands of fellow runners at the starting line of various races, I saw dozens of older people, some of them octogenarians, who had been running for many years—without any obvious signs of OA. But that, of course, is an anecdote and does not qualify as scientific evidence. So, what does science have to say?

Surprise, running may actually be good for you (and your knees)

There are many small studies, most of problematic design, that have looked at the question of a relationship between long-distance running and OA. In most of them, the results are equivocal. However, in a seminal series of studies by Dr. Nancy Lane and Dr. James Fries (now retired) of the Rheumatology Department at Stanford, they gave a definitive scientific answer to the question of whether recreational running over long periods of time eventually causes OA.

They followed 45 long-distance runners and 53 controls with a mean age of 58 (range 50–72) from 1984 through 2002 ( 18 years of follow-up!) with serial knee radiographs. Most of the subjects, both runners and non-runners, showed little initial radiographic changes. In fact, slightly more runners showed osteoarthritis in their initial radiographs than non-runners (6.7% vs. 0% for non-runners). However, by the end of the study, the runners did not have more prevalent OA (20% vs 32%, p=0.25) nor more cases of severe OA (2.2% vs 9.4%, p=0.21) compared to the non-runners. Note that if anything, runners showed less OA and severe OA than non-runners, but the differences were not statistically significant. Could a larger sample size make those differences statistically significant? Possibly. And, this is not just wishful musing; the biology of connective tissue suggests it.

Collagen and cartilage require weight-bearing activity in order to maintain their strength. In fact, with repeated exercise, they increase their tensile strength (defined as the resistance of a material to a force tending to tear it apart, measured as the maximum tension the material can withstand without tearing). The same is true for the tendons and ligaments that stabilize the knee joint. Furthermore, the synovium, the membrane that provides the lubricating fluid and nourishment to the joint requires weight bearing for its normal functioning. These observations suggest that, if anything, running should decrease, not increase, the prevalence of OA.

Related Content: What Really Works to Reduce Osteoarthritis Pain in the Knee?

Knee OA has doubled in prevalence since the mid-20th century

According to a paper in PNAS, knee OA has doubled in prevalence since the mid-20th century. The authors, Harvard anthropologists Ian Wallace and Daniel Lieberman, in a remarkable study, examined 2,576 American skeletons of ages >50 years old. They examined 116 native American hunter-gatherers, 60 early farmers from the prehistoric era (6,000-300 ago), 1581 skeletons from the early industrial era (1905-1940), and 819 skeletons from the modern post-industrial era (1976-2015). The radiographic marker of OA was the presence of eburnation (from burnish, to polish), the polished surface from bone-on-bone contact.

Comparing the two modern groups, the early industrial and the post-industrial, the rate of knee OA has more than doubled since 1940, from 6% to 16%. The researchers also had information about body habitus of the individuals that revealed even more depressing numbers. Of the early industrial group only 1% were obese (BMI >30) and 6% were overweight (BMI 25 -30). The post-industrial group (that’s us!) was quite different: 25% were obese and 24% overweight. Also, the post-industrial group was, on average, 6 years older.

So, there you have it. We live longer and we are more obese in the post-industrial group that suffers from more osteoarthritis. You might interpret these findings as proving that those are the reasons that we suffer more from knee OA. Not so fast. Using statistical analysis the researchers teased out the effect of BMI and age, and lo and behold, they found that the prevalence of knee OA is still more than double that of the pre-industrial group.

What might explain this unexpected observation? We don’t know yet. But if I may offer a tentative explanation, it comes back to running and weight-bearing exercise in general. We know that the more you do it, the more you inhibit the destructive influence of aging and inactivity. Perhaps a more sedentary lifestyle in the post-industrial compared to the pre-industrial group could be the explanation. But before we firmly place the blame on inactivity, as all researchers are wont to say: more studies must be done.

Even though exercise is recognized as one of the healthiest activities you can do, for some people, it seems like a chore. When you are going through recovery, just thinking about adding exercise to your daily activities may feel overwhelming. However, small adjustments to your life, in the form of regular short workouts, can carry you miles when it comes to maintaining sobriety.

When a person embarks on the path to recovery, their body and mind may still crave the feeling of euphoria produced by drugs, particularly narcotics. Exercise stimulates the body’s production of endorphins, chemical messengers produced by the brain, that reduce your perception of pain. These substances also trigger a sense of euphoria that some refer to as the “runners high.” The feeling has been likened to the sensation produced by morphine. It is admittedly less strong, but it is also without the addictive potential. Research suggests that adding exercise to your addiction treatment may boost the effects of the therapy.

Beyond euphoria

In addition to stimulating endorphins, here are 6 more reasons why exercise can help you through the process of recovery from addiction:

1. Exercise keeps you busy

When you start giving priority to physical activity, it can eventually end up taking a good chunk of your daily schedule. This is a good thing. Scheduling regular workouts mean that you have to be on time, committed, and focused on the task, without any distractions or any bad habits to pick up.

Aside from this, it also keeps boredom out of the way (not to mention the troubling thoughts and daily stress that may lead a person to use again). Even if these activities don’t seem or feel like the best things to do at first, try to keep in mind the overall benefits that come post-workout: You’ll notice an increment in your energy, a better mood overall, considerably less stress, and a clearer mind.

2. Better sleep

One of the worst effects of addiction is the way it disrupts several body processes, such as the circadian rhythms. This causes the person to struggle for good sleep unless they consume a dose of whatever it is they are on. After starting therapy and recovery, the body will slowly and gradually begin to restore to a healthier state. And with exercise, this process will speed up; it will also help restore the normal sleep cycle faster. As a result, your body will heal faster when you are well rested.

3. You’ll heal your body and mind

It is no secret that a person who regularly exercises has a lower chance of suffering from a variety of diseases such as heart conditions, type 2 diabetes, as well as several types of cancer and overall greater immunity. In addition, recent research has shown that exercise stimulates neurogenesis (growth of new nerves) in the area of the brain responsible for cognition. This may make it easier to concentrate, meditate, and focus on everything you try, including your recovery tasks. Many say they feel more motivated and have more energy overall when they incorporate exercise into their lives.

4. Exercising provides an outlet for your anger

Two of the most common elements of people going through recovery are anger issues and deep frustration. And, in many cases, those feelings were part of the initial reason that person went into substance abuse. As a result, they do not know how to deal or express these emotions in a healthy way. Exercise provides a wonderful release for all the emotions you might have built up inside. You can try going for a run or go to the gym and take it out on the punching bag or lift some weights, or even a combination of the three! All the while healing yourself and getting in great shape.

5. Less stress

Stress is something you have to deal with every day, whether it is your job, personal relations, or other uncomfortable situations. They all add up to the regular tension you need to handle as a recovering addict. Exercise can be key here, as it can become your default stress-reducing tool. It will help you compose yourself and start being more proactive in regards to your recovery. It can help in times of crisis, too. It doesn’t matter if it is a major or minor one, having a workout regimen planned out can be great to carry you through tough times. It is important to make the distinction that this is by no means an escape; it merely is a tool to help keep you focused and balanced.

6. Exercise helps build self-confidence

It does not matter if you have never felt like the athletic type; there is a start for everyone. Taking it slow is the way to go. Try simple power walks for 10-15 minutes and progress from there. You can slowly increase the duration up to 45 and even 60 minutes. And you can advance from doing it a couple of times a week to doing it daily. You can even try a gym routine or get into muscle building and strength gaining; you can try Crossfit or hard endurance practices (like martial arts) if you want to get a bit deeper into exercise.

As time goes by, you will want to increase your regimen because exercise will push you to be better and increase your practices. Because, just like with recovery, each step forward will make you feel like you can accomplish even more. However, it is important to keep in mind that exercise is just another tool of the many you have available in your recovery process. What is your favorite exercise to implement in your daily routine? Have you used exercise as a tool for managing stress or addiction recovery? Share your story and let us know in the comments below.

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