Diet and disease

[Jon Newman]

No need to read further if you don't believe in disease. For anyone else however the following is quite interesting.

http://www.nyas.org/snc/annals.asp?annalID=28

[Jon Newman]

A follow up thought. If eating less seems to prolong lives but exercise (especially vigorous or prolonged exercise) requires that we eat more, what do you suppose the optimal balance of exercise and diet restriction is? Perhaps eating less is not really the key. Rather, maintaining a body mass in a specific range (striking a near equilibrium in a matter of speaking), is more important.

What do you suppose the upper and lower limits are for the health benefits of exercise and calorie restriction?

[Nick]

Jon,

I think there is tremendous confusion around both exercise and nutrition. I think there are lots of examples where too much "exercise" leads to inflammation, injury, degenerative changes, etc. Exercise is physical medicine and, like any medicine, should be prescribed to produce the desired results without toxic side effects. As I am sure you know, exercise is catabolic and breaks the body down. If performed within safe parameters and given adequate time and resources for recovery, the body will adapt and produce the desired changes. It should not be how much exercise one can tolerate, but how little is required to produce the desired result.

Exercise has become one of those words that is used to describe almost any type of activity. Without clear definition, its usage has become almost meaningless in common language and in research.

Nick

[Jon Newman]

Hi Nick,

Thanks for the reply. I'm also interested in the minimally sufficient dose of exercise required to prevent early cardiovascular disease and what those recommendations might look like. Currently I believe the guidelines for cardiovascular health are for exercise on most days of the week (i.e. at least 4) at an intensity of about 80% of predicted max heart rate. It is also appearing that perhaps calorie restriction alone may be sufficient to decrease risk of early cardiovascular disease but I think that is yet to be verified in humans. And who wants to not eat?
Also, it would seem that increased calorie consumption may not be harmful in itself based on studies demonstrating increased life expectancy for pro/olymipic athletes whose calorie consumption is likely more than average (I think).

Anyone with other thoughts about this or any interesting literature regarding this topic? I and many of my patients would be interested.

[nari]

Nick,

Spot on!

This is my take on defining the difference: (OK, it's only my version)

Exercise - choreographed routines eg McKenzie, abs, TA, and all that repetitive stuff; gym regimes

Activity - walking, playing sport of some kind, housecleaning, running (I think) not necessarily a weightbearing, dynamic thing. Knitting is an activity.
So is cycling, except for the diehards.

Movement - David Butler advocated in 2003 that the word 'exercise' should be placed into disuse, and replaced with movement, to get away from the repetition and coercive nature of 'exercises'. I see movement as neuromodulatory stuff...martial arts, neurodynamics, dancing.

Work-out - for gym freaks who believe the only way to look and feel good is to have various bulges all over the anatomy. The public also see 'going to physiotherapy' as having a work-out.

Nutrition: Eat less, of whatever one wishes with a consistent balance of protein, vitamins and carbohydrates.

Yours with bias++

Nari

[Jon Newman]

Hi Nari,

I agree with what you've just stated, especially as it pertains to the management of painful conditions. But what about exercise when we're not in pain or when we discharge patients and want to give them general health guidelines?

[nari]

Hi jon

What's the difference?

Nari

[Jon Newman]

Hi Nari,

I'm not sure what you mean by your question. What's the difference between movement for pain relief and movement for cardiovascular health? I think they may, but not necessarily, look different.

I guess I'm focusing on what exercise for disease prevention looks like. In the end we can compare it with what we do for pain relief and see if there might be a difference between the two.

[Nick]

Barrett's work has helped me here as well. Jon, I think the difference lies in understanding the distinctions between creative, expressive movement and productive work. Creative, instinctive movement arising from the subconscious works best for pain relief. Productive work in exercise actually requires working against the instincts for the purpose of strengthening the body in various ways.

I'll tune in tomorrow with more.

Nick

[nari]

I think that what the average painfree person who is looking for cv health fits the above 'definitions'; and I also think the person with a history of pain and dysfunction does as well. Maybe I'm simplifying too much; but I think they cover the baseline of mutual selection according to the person's goals and desires.
...remembering that I am rather anti-exercise, especially the repetitive/stylised segmental ones...

Nari

[David W]

I would highly recommend checking out some of Paul Chek's work. He's a hollistic health practioner who deals with this subject matter extensively.

[Jon Newman]

Hi David,

Is there something in particular about Paul Chek that you like or endorse? I can't say I found much insight at his website but maybe there is something worth considering that I didn't take the time to find.

[nari]

I am not sure about his hypotheses but he is one heck of a salesman.....
Not sure about the kinesiology part of him either ...isn't that a bit of a fringe "-ology"? Could be wrong.

Nari

[Nick]

Many pathologies or processes that characterize the aging process have been directly linked to sarcopenia, the natural loss of muscle tissue that occurs with aging. This begins at about age 25 and continues at a rate of about 1% decline in muscle strength per year beyond age 40. Working the muscles through exercise accesses all the other body tissues and can counteract this process and stop or slow the loss of functional ability.

Exercise is a specific stimulus applied to the body to produce a specific change. Increased muscle strength ought to be its main purpose. In order to achieve this, the stimulus must be of adequate intensity, the person must have sufficient resources (rest, nutrition, etc.), and appropriate recovery must be allowed. Overload and progression are essential principles.

No, this is not the best way to treat pain. Pain (at least of mechanical origin) is primarily a mobility issue and the best movement, in my opinion and experience, is nonconscious in origin. Strengthening helps improve functional ability and prevent the decline associated with aging or injury. In one sense, though they can support one another and the person's goals if properly applied, the two types of movement are at cross-purposes. If you look at mechanical loading as an exacerbating factor for mechanical pain, that would include sustained positions, repetitive movements, and forceful movements. High intensity strenght training involves low reps, low force, and no sustained positions. The muscular system is maximally loaded, without mechanically overloading the nervous system. The person must have enough adaptive potential to tolerate this or pain can be aggravated.

Some advantages for types of pain:
Mechanical - build strength to support functional tolerance and avoid exacerbating pain through normal activity; apply full range exercise to incorporate mobility into strength training. Creative movement is more important for pain relief.
Chemical pain - avoids wear and tear from high volume and high force exercise; increased strength supports and stabilizes joints
Central sensitivity - graded exposure and increased self efficacy - safely demonstrated increased functional ability without exposing to increased risk of injury.

For those with other health problems or conditions, the benefits of strength training are immense. The primary objective is to increase functional ability. And yes, most people do want to improve their appearance as well. Increased lean muscle tissue will improve bone density, support better cardiovascular health, improve cholesterol profile and glucose tolerance, improve metabolism, support joints, and reduce fatigue.

In my opinion, physiotherapists ought to be combining their knowledge of special conditions with an advanced understanding of exercise to deal with these huge public health issues. As fascinated as I am by the mechanisms of pain, there are lots of other issues we need to help people with. Personal trainers may know lots about exercise (few actually do), but most know very little about what is actually going on with a person's body and how to safely improve someone's physical health.

Nick

[Jon Newman]

Hi Nick

Thanks for the reply. Do you advocate high intensity, short duration type exercise for both CV and strengthening (assuming there is a difference)?

[Nick]

Yes, but not without qualification. The heart only ever works harder with activity to deliver blood to the working muscle. Increased muscular effort increases the cardiovascular adaptations and more in line with the type of physical demands normally placed on the heart.

Strength conditioning and skill conditioning need to be distinguished to ensure that someone is able to meet the demands of their lifestyle. Strength is a general attribute, but skill is specific. A cyclist obviously needs to cycle to create the metabolic changes that enable them to perform well. It won't help them much for running, though. Strength will help both a runner and cyclist because they'll have more horsepower and endurance and they'll have more resistance to wear and tear.

Check out Dr. Doug McGuff's www.ultimate-exercise.com. There is a great article on cardiovascular demands of high intensity strength training.

Nick

[EricM]

Thanks for the interesting link Nick. Its making me think about the old 3 sets of 10 meme...

Eric

[Jon Newman]

Hi Nick,

Thanks for the link. I'm curious if this 20 min or less work out refers to a single extremity muscle group or the whole body. Certainly it would seem possible (probably not enjoyable exactly) to exercise to failure the major muscle groups within 20 minutes.

I like your distinction between skill and strength. This makes sense.

[nari]

Just as an aside, because I have never been involved with, or been even vaguely interested in cv training and that stuff.....does anyone today still do the 3 sets of 10? I understood they were 'old hat' for strengthening or skill training.
Probably wrong...

Nari

[bernard]

BMC Complement Altern Med. 2005 Dec 22;5(1):22 [Epub ahead of print] Related Articles, Links
Mediterranean diet and extended fasting's influence on changing the intestinal microflora, immunoglobulin A secretion and clinical outcome in patients with rheumatoid arthritis and fibromyalgia: an observational study.

Michalsen A, Riegert M, Ludtke R, Backer M, Langhorst J, Schwickert M, Dobos GJ.

ABSTRACT: BACKGROUND: Alterations in the intestinal bacterial flora are believed to be contributing factors to many chronic inflammatory and degenerative diseases including rheumatic diseases. While microbiological fecal culture analysis is now increasingly used, little is known about the relationship of changes in intestinal flora, dietary patterns and clinical outcome in specific diseases. To clarify the role of microbiological culture analysis we aimed to evaluate whether in patients with rheumatoid arthritis (RA) or fibromyalgia (FM) a Mediterranean diet or an 8-day fasting period are associated with changes in fecal flora and whether changes in fecal flora are associated with clinical outcome. METHODS: During a two-months-period 51 consecutive patients from an Integrative Medicine hospital department with an established diagnosis of RA (n=16) or FM (n=35) were included in the study. According to predefined clinical criteria and the subjects' choice the patients received a mostly vegetarian Mediterranean diet (n=21; mean age 50.9 +/-13.3 y) or participated in an intermittent modified 8-day fasting therapy (n=30; mean age 53.7 +/- 9.4 y). Quantitative aerob and anaerob bacterial flora, stool pH and concentrations of secretory immunoglobulin A (sIgA) were analysed from stool samples at the beginning, at the end of the 2-week hospital stay and at a 3-months follow-up. Clinical outcome was assessed with the DAS 28 for RA patients and with a disease severity rating scale in FM patients. RESULTS: We found no significant changes in the fecal bacterial counts following the two dietary interventions within and between groups, nor were significant differences found in the analysis of sIgA and stool ph. Clinical improvement at the end of the hospital stay tended to be greater in fasting vs. non-fasting patients with RA (p=0.09). Clinical outcome was not related to alterations in the intestinal flora. CONCLUSIONS: Neither Mediterranean diet nor fasting treatments affect the microbiologically assessed intestinal flora and sIgA levels in patients with RA and FM. The impact of dietary interventions on the human intestinal flora and the role of the fecal flora in rheumatic diseases have to be clarified with newer molecular analysis techniques. The potential benefit of fasting treatment in RA and FM should be further tested in randomised trials.

PMID: 16372904 [PubMed - as supplied by publisher]

[Nick]

Jon,

Whole body. One set to failure than move on. Preferably compund movements that address more than one muscle group at a time.


Nari,

High volume training remains quite popular. There are many variations on the DeLorme method of 3 sets of 10, but many consider that the gold standard. In the PT world, most "therapeutic" exercise focusses mostly on neurofacilitation.


My primary interest in PT is pain management and, as I've said, strength training is not the answer for people in pain. It can be a useful adjunct for those with functional limitations. It is, however, absolutely essential for those with degenerative conditions and functional loss. It is never too early to begin proper exercise. I think the distinction between creative movement and productive work is very important.

Nick

[Nick]

Nari,

I do like your distinction between exercise, movement, and activity. Many people think that when I am trying to get them to move correctively that I am telling them to be more active. Activity, as a mechanical load, can, of course, exacerbate pain. Pain is mostly a problem of mobility (if related to mechanical sensitivity). I agree that choreographed regimes are unlikely to achieve much in terms of pain relief, although it can help people achieve other goals. I'm not sure about Oz, but in North America, there is a huge boom in our population between 40 and 60. The first baby boomers turn 60 this year. Combined with an increased life expectancy, this group already faces and increasingly will face issues for which neuromodulation is not enough.

Nick

[nari]

Nick,

In Oz we face the same problem with the post-WWll boomers living longer and getting into trouble with aged structures. Our major baby boom started in 1944-45; school classes increased 100% in numbers.
Mechanical loading can certainly increase pain; and light unloaded work may not be enough for those not in significant pain.
What interests me is that routine gym-type exercise is unappealing to many because the drive to fend off boredom must be high. Someone I know who is a PT goes three times a week for an hour in the gym; she is 68 and looks dreadful, extremely underweight and tired. Yet she has so-called supervision and guidance with the program. This is of some concern, and I wonder if there is enough evidence available to query the need for rather 'violent' exercise for the over 60s.....with medical OK. of course.

Nari

[Nick]

Nari,

I was formerly emphatically anti-exercise as well, but the evidence is actually quite compelling and done properly it is challenging, but far from violent. Your acquaintance is almost certainly over-training if she is feeling the things you mentioned. That is why dosage is such an important consideration and more is definitely not better. It should be the minimum dose necessary to produce the desired changes. Efficiency also helps with boredom, since anyone should be able to put up with a little hard work for 20 minutes a week. High intensity, low force exercise allows one to maximally load the muscular system while minimizing mechanical load on the nervous system and joints. Therefore, there is less chance of exacerbating pain. Having said that, the intervention is directed more toward individuals with other conditions for which strengthening is appropriate or for those wishing to increase or fend off the decline of functional ability.

Nick

[nari]

Thanks, Nick; that all makes sense. Especially the minimum requirement bit.

I have actually tried to convonce this woman to slow down, and so have other PTs, but she is hell-bent on preventing further osteoporosis - even though her BMD is only slightly out of whack. Sounds a bit addicted.
Interestingly (though off the topic somewhat) she fractured her NOF in a heavy fall two years ago, and her orthopod remarked to her that regardless of the BMD score, he had a bad time fitting the prosthesis "as the bone was so strong and dense".

Makes one wonder....

Nari

[Nick]

I think addiction to activity and the psychological gratification of the supposed benefits of exercise are very big problems. Many people undoubtedly drive themselves into our offices through a misguided approach to exercise. And there is a certain smugness present in those who think they are on a different plane in terms of wellness. Health is something you either have or do not have. It is either adequate or inadequate. If inadequate, it is known as "disease" (despite what John Barnes thinks!). There is no such thing as super health - it is an impossibility.

The connection between health and exercise has never been "proven" and is actually quite tenuous. Most studies do not define exercise or control its parameters. Also there is always selection bias - ie. healthy people tend to exercise and unhealthy people tend not to exercise. Therefore, exercise seems to be responsible for health, but health may well be responsible for exercise. It is not clear cause and effect. Many people who never exercise are very healthy. Many who exercise religiously are not. When accounting for injuries and overuse syndromes, most people would improve their health status if they gave up their activity program!!

There are, however, some clear measures of physical conditioning that have been demonstrated to improve with strength training. Throughout almost all of human history people did not live much beyond age 40. Our bodies are not designed (just using the term loosely - not trying to spark an intelligent design debate) to live 40+ years beyond this. In addition, one of the reasons people died at younger ages in the past was because life was physcially demanding (in other words, physical demanding activity is not good for us - it will wear us out). If dosed appropriately though (just enough to stimulate change) what exercise will do is preserve strength to maintain functional abilitiy and offset the degeneration of the aging process.

Nick

[Diane]

Lots of food for thought here, Nick. As an aging baby boomer who dislikes exercise and does as little as she can get away with and still feel "healthy" (walking to work and back, a total of maybe 45-50 minutes a day total), I was greatly impressed by a study that was done right here at the Bonser rec. center several years ago, with elders between 70 and 90, in all stages of disuse atrophy, some in wheel chairs, some on walkers and canes. They did weight training for 3 months, 3X week, to tolerance. Results were excellent. All of them improved functionally, the ones on walkers went to canes, the ones on canes came off canes, the ones in wheelchairs went to walkers.. (Musical walking aids )
Scans showed in some cases doubling of muscle mass/reduction of fat.

I decided to take up weight training for some far off day in the future when I would begin to feel feeble.

[nari]

Diane, I agree - when I start feeling feeble I will look at some weighted movements......maybe.

I am fortunate to have a slender build; and patients often said: "You must work out so hard!"..to which I replied: "I hate sport and have never been to a gym in my life". I just blame the genes and low calorie intake...mostly.
So, I agree strongly that the relationship between health and exercise is rather like that of posture and pain - highly doubtful.

In fact, the latest Scientific American issue Dec 2005 (actually the latest in Oz; we are well behind the USA's 'latest') has an interesting article on stress and poverty by Robert Sapolsky.

People in poverty generally have poor health, which can hardly be argued if we are talking metropolitan-type poverty. This has been attributed to lack of access to health care; unhealthy lifestyles (smoking;drinking; living in violent ghettos; obesity; fast food;lack of exercise; poor education, etc etc).
A massive study called the Whitehall Study (in the UK) has shown these assumed reasons for poor health as inaccurate. By far the greatest cause of poor or indifferent health has been shown to be psychosocial in nature.

Reasons cited (for cardiovascular conditions, cancer, and any condition of an immunological nature, etc):

a) minimal control over stress factors (hence the higher incidence of cv events amongst the lower echelons of an organisation).

b) having no predictive information about duration and intensity of stressors.

c) having few outlets for frustration.

d) identifying the stressor as evidence of circumstances worsening.

e) lack of social support (isolation) for the duress caused by the stressors.

Also there was identified the subjective state of "poorness"; the state of feeling poor, rather than being objectively poor. This was noted in those folk who were upset and distressed by the 'haves' of society.

Interestingly, the huge gap between the 'haves' and the 'have-nots' has been increasing in most countries, particularly the USA, where 40% of the wealth is owned by 1% of the population. (Though I could argue, perhaps tenuously, that there are quite a few other countries, no names mentioned, where it would be just as bad or worse???)

It's quite a long article and anything by Sapolsky is worth reading. He is the author of Why Zebras Don't Get Ulcers.....


Nari

[Diane]

Sapolsky is worth reading. He is the author of Why Zebras Don't Get Ulcers.....

And also A Primate's Memoire, a really good read, his own memoire of his thirty years studying baboons in Africa. About the poverty factor, perhaps we can say that as primates ourselves, we are subject to all the same stresses/stressors as those that plagued the baboons Sapolsky studied (took blood samples from to measure indicators like cortisol) who were at the bottom of the ranking system with small hope for advance.

What would exercise do for a chronic physiological state of high cortisol? Maybe lower it somewhat? Maybe raise it more?

[Nick]

Diane and Nari,

Interesting long-term commitments or perhaps concessions...I would merely suggest that a little effort up front could go a long way to prevent you from becoming feeble in the first place . The two of you, however, obviously use many other means to "exercise" your capacities. Your involvement in self awareness, learning, and mental sparring is admirable and, no doubt, healthy .

With regard to cortisol, I'll have to look for some research, but it is very likely a good measure of over-training. Someone who is depleting themseleves and getting diminishing returns will almost certainly have elevated cortisol due to excessive physical stress. There is lots of room for individuality here, though. Some people are simply built to withstand more than others.

Interesting comments on socioeconomic status and health - certainly worth more discussion.

Nick

[Jon Newman]

An ounce of prevention...

When I look at the last years and last months of someone's life it would seem the ability to have meaningful communication is the biggest contributor to quality of life. Come to think of it, it plays an important aspect throughout life.

What physical performance measures seem to impart quality in the autumn of life? Sufficient strength and endurance for independent toileting and hygiene seem to be big players.

I think the contribution Nari made regarding poverty is extremely important. Clearly genes have little role to play when they are expressed in a destitute environment.

[Nick]

Jon,

In reviewing the thread, I realized we got a little sidetracked and never discussed much from the perspective of diet. Diet is probably the most important modifiable factor in determining health. The easy availability of poor quality food makes it very difficult for many people to avoid over-indulgence. Being omnivores means that humans can eat anything, but it doesn't mean they should eat everything.

The poverty issue fits here as well since healthy food is typically more expensive.

Nick

[nari]

Healthy food not only costs more, but doesn't necessarily taste as good, either. Extra fat, salt and sugar does improve the flavour of all sorts of food; which attracts people to takeaways. Someone on the poverty line is going to avoid meat and fish; salads are not too costly but don't fill one up unless it is coated with mayonnaise; bread is cheap but what does one put on it?
Hamburgers are instant fodder, and reasonably nutritious compared with a bag of chips and fizzy drink; if someone has $5 spare for a meal -what do they buy? High fat, high carbohydrate, high sugar....

It is especially confusing when minds change about what is good nutrition - once it was pasta, now it's protein...again. Raw veges were considered much better than cooked, until someone worked out that raw veges don't release nutrients until they are lightly boiled.

I think the essence of eating is not to eat much, but anything goes, in moderation.

I find nutrition a bit of a no man's land for me as I have never been involved with it in the workplace - I don't see it as relevant to physiotherapy, but that is my funny idea. I'm likely to change if someone can convince me.

Nari

[bernard]

Originally Posted by Ian Stevens

Hi couldn't post this -not sure why


http://books.guardian.co.uk/reviews/...538844,00.html

http://news.bbc.co.uk/1/hi/health/459932.stm


Nick thanks for all the well thought out posts .
For anyone looking for reasons to embark on strengthening in the elderly
look at the work of professor Marion McMurdo.There is a link to her work on
the bbc link above.
For the realities of psychosocial issues and 'health' look at Professor
Wilkinsons work (top link is to his work on differentials of
wealth).Socially it seems Scandavian countries have a better balance .

Nari, your colleague seems to be a classic case of punishment for the
greater good --this always ends in disaster or at least a short burst of
activity which never lasts . Many insidious sports injuries end up through
this mechanism and the treatment of further strengthening makes things
worse.......
Nicks points are valued especially prescribing exercise . For fit healthy
people prescribing 'movement' is often the best bet .Depending on
inclination and personality body awareness eg Alexander technique and
running helped a friend of mine .
For many I think tai chi is a perfectly effective form of strengthening as
'sarcopenia' is very common in the functionally important quads . Tai chi or
modified simplified forms of it have the benefit of proprioception
enhancement which machines cannot replicate .
Nick you might be interested in Perspectives on Health and Exercise by
McKenna and Riddoch (get the dept to buy it ?) There are v good chapters on
epidemiology / measurement / barriers /environmental influences /mental
health and exercise and a very interesting chapter on anthropology and
physical activity.

[bernard]

Originally Posted by Ian Stevens

http://www.studentbmj.com/issues/04/...orials/266.php

Am J Med. 1988 Apr;84(4):739-49.
Related Articles, Links

Stone agers in the fast lane: chronic degenerative diseases in evolutionary
perspective.

Eaton SB, Konner M, Shostak M.

Department of Anthropology, School of Medicine, Emory University, Atlanta,
Georgia 30322.

>From a genetic standpoint, humans living today are Stone Age
hunter-gatherers displaced through time to a world that differs from that
for which our genetic constitution was selected. Unlike evolutionary
maladaptation, our current discordance has little effect on reproductive
success; rather it acts as a potent promoter of chronic illnesses:
atherosclerosis, essential hypertension, many cancers, diabetes mellitus,
and obesity among others. These diseases are the results of interaction
between genetically controlled biochemical processes and a myriad of
biocultural influences--lifestyle factors--that include nutrition, exercise,
and exposure to noxious substances. Although our genes have hardly changed,
our culture has been transformed almost beyond recognition during the past
10,000 years, especially since the Industrial Revolution. There is
increasing evidence that the resulting mismatch fosters "diseases of
civilization" that together cause 75 percent of all deaths in Western
nations, but that are rare among persons whose lifeways reflect those of our preagricultural ancestors.

[JaneS]

Originally Posted by nari

Nick,

Spot on!

This is my take on defining the difference: (OK, it's only my version)

Exercise - choreographed routines eg McKenzie, abs, TA, and all that repetitive stuff; gym regimes

Activity - walking, playing sport of some kind, housecleaning, running (I think) not necessarily a weightbearing, dynamic thing. Knitting is an activity.
So is cycling, except for the diehards.

Movement - David Butler advocated in 2003 that the word 'exercise' should be placed into disuse, and replaced with movement, to get away from the repetition and coercive nature of 'exercises'. I see movement as neuromodulatory stuff...martial arts, neurodynamics, dancing.

Work-out - for gym freaks who believe the only way to look and feel good is to have various bulges all over the anatomy. The public also see 'going to physiotherapy' as having a work-out.

Nutrition: Eat less, of whatever one wishes with a consistent balance of protein, vitamins and carbohydrates.

Yours with bias++

Nari

Nari,
I really like your definitions here - bias or no bias. May I go the step further and relate them functionally.

Most of us live in a goal-directed manner, whether it be work, leisure, ADLs etc etc. To achieve these goals we need to embark on physical (and/or cognitive) activity. Physical activity involves movement and difficulty with that component will limit one's ability to perform the activity successfully.

When one has difficulty or is unable to achieve their desired physical activities, exercise may provide a useful upgrading and maintenance of the strength/endurance required to perform the activities. In my view, exercise is a vehicle to the successful performance of activity. A work-out on the other hand, appears to be the end product of the effort. The satisfaction in being able to perform progressively more strenuous or challenging activities is functional chiefly in achieving psychological satisfaction.

In case you think I'm spouting rot (and I may well be), here are a couple of examples;

When I started on medication for SLE at the end of 2004, my aim was to get back to golf and Scottish country dancing. At that stage, I had the physical stamina for neither and not enough upper arm strength for 18 holes of golf.
I turned up at Fit For Work (an Aussie provider of exercise programmes for people with injuries (usually on the Workers' comp or CTP systems). They'd never had a private self-referral before but, as I'd referred a lot of people to them, we came to an arrangement. Within a couple of months I was back to both my goal activities and others.

My partner, on the other hand, goes for a 'work-out' at least every day, sometimes twice in a day. He derives satisfaction from having the strength, suppleness & stamina to attempt any physical task to which he turns his mind. When he has had injuries, he tries to persist or miss minimal sessions. His goal is simply to be able to return to those activities. As he works purely with his head (ie an I.T. person) perhaps he needs this activity more to satisfy his psyche than maintain his physique - not bad either

Can we tie all these terms in with functional reference to each other?

Jane

[Gil Haight]

Hi all,
I can’t help but comment on Nari’s reference to Sapolsky and the point about haves and have nots. In Michael Moore’s Fahrenheit 911, George W is quoted at a fund raising dinner “ it is nice to be surrounded by the haves’ and the haves’ more”. Gee that’s funny.
Anyway the real reason I’m joining in here is to add something to the exercise discussion. There seems to be a consensus that certain people do in fact find aerobic exercise beneficial (in terms of relieving pain) and others find this type of exercise provocative for their pain sxs. I agree wholeheartedly with Nick who says that in the second group a creative, instinctual or unconscious movement is much more effective. The question I have pondered for years however is how did the former become the latter? Every chronic pain was at some point acute and not every acute sxs became chronic. Why is it so common for those dx with fibromyalgia to state: I used to be able to do almost anything and now I can’t even walk a mile.
An aspect of neuromodulation which has not been given much play here or previously on RE is the mechanisms described by Randich and Maximer . These gentlemen have written extensively on the baroceptor reflex arc. These receptors located in the heart, lungs and carotids are activated during periods of increased exertion by these organs. This also includes the state of hypertension. It has been my experience that very, very few pts with chronic pain have high blood pressure and those that do are on beta-blockers or other hypertensive meds. The receptors in question have a direct link with the centers of the brain stem long known to produce endogenous analgesia. The purpose of the arc is obvious. The relevant question is why did this mechanism begin to fail and can it be reactivated?
In other words, do those who enjoy aerobic exercise simply possess a more effective or robust baroceptor reflex than those who don’t?
Gil

[Diane]

That is a very interesting angle Gil, thanks for bringing it up. Do you have any handy links?

[Gil Haight]

Diane,
I don't have access here, but will provide the references tomorrow.
Gil

[nari]

ian

Others (Dawkins, Shermer) have made similar comments:we are Out of Africa beings, designed for moderate activity and simple living, caught up in the maelstrom of our own making. (My words)

Jane

You're right, the 'kick' of endorphins with strong exercise is powerful enough to be associated with feeling good and thus addictive.

Can we tie all these terms in with functional reference to each other?

Probably, but I'd have to think about it for a long time...people are individuals and this makes it difficult. Might have to search around..

Gil

Baroceptor reflex arcs....good point! Another search for correlative info ahead.
Look forward to your links. Particularly a link between chronic pain, meds and analgesic effects....


Nari

[Diane]

Diane,
I don't have access here, but will provide the references tomorrow.
Gil

Gil, it's ok, I found quite a bit out there. I will try to attach a huge pdf (120 pages long) I found (hope it doesn't break the board!).
Some links:
1. http://hyper.ahajournals.org/cgi/content/full/31/5/1146
2. http://hyper.ahajournals.org/cgi/content/full/28/3/494
3. pubmed
4. http://myprofile.cos.com/maixnerw
5. http://www.blackwell-synergy.com/doi...6.2005.00273.x

[Jon Newman]

A quick read relevant to the thread.

Low-Fat Diet Does Not Cut Health Risks, Study Finds

[Nick]

One important point here that jumped out at me: genetics. Hugely important component of all measures of health. I'm not a determinist by any means, but understanding genetics is a big reality check for most people. Some are simply luckier in others.

Diet and exercise remain the most modifiable factors influencing health (along with avoidance of things such as smoking). The commentators in this article recommend controlling weight and getting regular exercise, but that is a loaded statement and there is much that flies in the face of common wisdom. First off, exercise is not good for you! It is a negative physiological event that, if performed within safe parameters, produces a desirable physiological response. Many studies have shown that, while it may contirbute to preventing weight gain, the role of physical activity in burning calories is quite minimal. Diet is by far the more important factor as it is impossible for physical activity to compete with the mouth.

Nutrition is more important for overall health as well. You are what you eat, after all. There are likely implications for genetic expression here as well. Low fat recommendations came from the fact that fat contains more calories; however, all calories are not created equally in terms of the response of the body.

Nick

[Diane]

This newspiece, There's something fishy about human brain evolution, brings in an idea about brain evolution having been if not driven by, at least supported by, a diet rich in shoreline sources of iodine and fatty acids of the right kind; "our initial brain boost didn't happen by adaptation, but by exaptation, or chance." It talks about how human babies are born much fatter than other babies, although it doesn't eliminate ordinary neotony as a factor in that.. we are also born more motorically helpless as well.

Catchy title though. I thought it might be about the fish part of the brain, but no luck. Oh well.

[nari]

Interesting...and sort of relevant to the fact that in this country, over 50% of kids are at risk of underdevelopment (brain-wise) because the consumption of iodised salt is not mandatory. I think we are heading for trouble. Other Western and Eastern countries are cognisant of this and some have returned to cleaning the milk vats with iodine in the factory, as they did years ago.
They have also removed non-iodised salt from shelves.
And the bottled water craze adds to the problem, for many areas have natural iodine in the water table....


Nari

[Tim]

This has been a topic of keen interest to me the past couple of years. I do not have articles on hand for reference, but I will try to get some together for you. I have two areas of comment:
1. As a member of the Section on Geriatrics, APTA the past 2 years, and receiving their journal: GERINOTES, I have read many very good articles on exercise as applied to the elderly, which I'm guessing I fit into since senior citizenship has been reduced to 55. In their articles, as well as others in the more recent literature (and not just for geriatrics), I am finding that the recommendations of 30-60 minutes of aerobic exercise 3-5x/wk seen in much of the literature is being lowered more and more, with some studies now recommending certain levels of "activity" rather than specific exercise programs, in order to maintain optimal musculoskeletal health.

2. Hopefully you are keeping-up with the rapidly developing understanding of general inflammation in the body as the unifying cause of numerous disease processes, including cardiovascular disease, diabetes, possibly Alzheimer's disease, and even so-called age related loss of muscle mass that I think Diane was talking about. To prevent these diseases we must prevent the oxidative processes that cause the inflammation that cause them. This means not just having nutritional intake with the optimal amounts of protein, fat, carbohydrate, vitamins, minerals and essential omega-3 fatty acids. It also means making sure you are eliminating foods with high levels of oxidants which produce the free radicals that cause inflamation and tissue damage. Recent studies have shown that exercise/activity is one of the best "anti-oxidants". There is a one-day seminar called: Inflammation: The Silent Killer that is being constantly updated with the most current research. I found it one of the most informative and helpful seminars I have been to in a long time. If anyone is interested, I can look-up the information. I also gave an inservice on it to our rehab department. I could post my 4-page outline here if it is not too long to do that. I don't know how to do attachments.

Just some things to think about and do some personal research.

[Diane]

Sure Tim, post it here. We can always turn it into a new pdf if it is too long, and reattach it here. No worries. Bernard can do forum magic, and I'm learning (slowly... after all I'm a senior too, by the sound of it.)

[Tim]

I thought I had copied my inservice from my computer at work to a CD, but obviously it didn't work. I'll try again later.
Inflamation: The Silent Killer seminar is through MED2000, Inc
info@med2000.com
There is a seminar coming up 4/24/06 in White Plains, NY
1-800-856-0371
Lori Kanter presented the seminar I went to. It was excellent.

[Tim]

Here is the inservice on:


INFLAMMATION: THE SILENT KILLER



Inflammation:

Local response to cellular injury

Includes marked capillary dilation, infiltration by leukocytes, redness, heat, pain , swelling.

Serves as a mechanism to rid the body of noxious agents and damaged tissue.



Inflammatory Response:

Normal part of the immune response

Occurs when tissues are injured, whether by bacteria, trauma, toxins, heat, etc





Normal Artery



Functions of the Healthy Artery Endothelium:

1. Inhibits platelet adhesion and aggregation

2. Inhibits leukocyte adhesion and migration

3. Secretes anticoagulant

4. Inhibits vascular smooth muscle cell proliferation and migration

5. SECRETES VASODILATORS, the most important of which is

Nitric Oxide (NO) xxx THIS IS THE KEY TO VASODILATION xxx



Functions of Nitric Oxide:

1. Mediates vasodilation

2. Inhibits platelet adherence and aggregation

3. Inhibits leukocyte adhesion

4. Inhibits proliferation of smooth muscle cells

5. Prevents oxidative modification of LDL cholesterol

INSUFFICIENT NITRIC OXIDE PROMOTES ATHEROSCLEROSIS



HYPERCHOLESTEROLEMIA, HYPERTENSION, DIABETES and SMOKING

All cause the production of REACTIVE OXYGEN SPECIES (FREE RADICALS).

FREE RADICALS inhibit the availability of NITRIC OXIDE.



C-Reactive Protein (CRP) is the best MEASURE OF INFLAMMATION in the vessel wall, and therefore, the best measure of coronary artery disease RISK. (fasting level of hsCRP is recommended).



CRP :

1. Causes the formation of FREE RADICALS.

2. Regulates adhesion molecule expression

3. Inhibits endothelial NO



1.



Reduced CRP Levels are associated with:

1. Exercise/physical activity

2. Weight loss

3. Medications (statins, niacin, fibrates)

4. Moderate consumption of alcohol

(eg one glass of wine a day)



Risk Factors for Atherosclerosis (CAD):

1. High-normal blood pressure (>130/85)

2. Diabetes mellitus

3. Increased waist circumference: Men>40”; Women>35”

4. High total cholesterol

5. Hypertension

6. Smoking

7. Obesity



Factors Associated with High CRP Levels:

1. Elevated blood pressure

2. High Body Mass Index (BMI)

3. Cigarette smoking

4. Metabolic syndrome

5. hyperglycemia

6. Dyslipidemia – high TG/low HDL-C

7. Estrogen/Progesterone use

8. Chronic infection

9. Rheumatoid arthritis



Cardiovascular Disease (CVD) Statistics:

61.8 millian Americans have CVD
Claimed 1 of every 2.5 deaths in US in 2000
Claims more lives than the next 5 leading causes of death combined


Atherothrombosis:

The underlying cause of 80% of all sudden deaths
Inflammation plays a key role in all stages of atherothrombosis


Oxidized LDL:

High levels noted in patients with coronary heart disease



HDL:

Protective effect due, in part, to its anti-inflammatory and antioxidant properties





2.





Treating Inflammation:

1. Aspirin may be best choice at this time

Physicians’ Health Study showed 44% risk reduction in first CV events.

75mg aspirin daily

Enteric coated is questionably helpful

Aspirin is not recommended for age 21 and under

2. Plavix is 2nd choice

3. COX-2 inhibitors have been used, but may add to atherosclerotic process by inducing

Metalloprotienases

4. Thiazolidinediones

Reduces microalbuninuria

Reduces arterial wall inflammation

Lowers BP

Increases cardiac output

Aids in relaxation of coronary walls

5. Statins

Reduce vascular inflammation

Reduces plasma LDL-C

Reduces cardiovascular events 20-60%

Reduces atherosclerosis

May reduce risk of Alzheimer’s disease

Reduces CRP

Safe, with minimal side effects

Although has increased risk for myopathies



Type 2 Diabetes Mellitus

By 2025 9% of US population with have DM

Risk factors:

Over age 45

Overweight (BMI>25

Family history of DM

Inactivity

Htn

HDL-C<35mg/dl

Polycystic ovary syndrome

History of vascular disease

Prevention:

Moderate wt loss thru diet & ex decreases incidence by 40-60% in 3-4 yrs

Use of metformin reduces incidence by 31%

Use of ramipril reduces incidence by 34%

Inflammation and Diabetes:

Chronic subclinical inflammation

High CRP levels

Insulin has potent anti-inflammatory properties



3.

Metabolic Syndrome (Resistant to Insulin):

Abdominal obesity

Men >40”

Women >35”

Triglycerides > 150 mg/dl

HDL cholesterol

Men < 40 mg/dl

Women <50 mg/dl

BP >130/85

Fasting Glucose >110

24% of population have metabolic syndrome

Including 30% of obese children

High levels of intra-abdominal fat

Is obesity the casue of this inflammatory syndrome? Probably.

CHRONIC SYSTEMIC INFLAMMATION IS STRONGLY CORRELATED WITH THE DEGREE OF OBESITY AND INSULIN RESISTANCE



Adipose Tissue:

There are at least 12 known proteins in adipose tissue that contribute to inflammation

and to the production of FREE RADICALS (reactive oxidative species), interfering

with the anti-inflammatory effect of insulin. This OXIDATIVE STRESS produced by

free radicals impairs insulin secretion by pancreatic beta-cells and impairs glucose

transport by muscle and adipose tissue.

Orlistat (TID 120mg 30 minutes prior to each meal):

Lowers lipid count, decreases body fat, reduces BMI and waist circumference,

reduces risk of diabetes and reduces markers for chronic inflammation.



Is Hypertension an Inflammatory Disease?:

Lowering BP reduces inflammatory markers

CRP is elevated in pregnancy-induced Htn



Many of the inflammatory markers are also found in patients with osteoporosis, RA, gout, ankylosing spondylitis, Crohn’s disease



Alzheimer’s Disease:

May also be an inflammatory disease

NSAIDS and statin drugs seem to help

Oxidative stress seems to play a role in etiology

Anti-oxidants (free radical scavengers) seem to help: vit E, C, ginkgo biloba



New research suggests inflammation may be a cause of muscle loss in old age.







4.



DIET:

Increased fiber intake reduces CRP levels

Saturated fat consumption mildly increases CRP levels

Trans fatty acids increase systemic inflammation

Omega 3 fatty acids:

Fish oil supplementation suppresses inflammatory markers

Flaxseed

Walnuts

Soybeans



EXERCISE:

Exercise by itself has not yet been shown to decrease CRP levels

Exercise does reduce other inflammatory markers in the obese patient

We do know that exercise improves serum lipids, blood pressure, glucose tolerance,

platelet function, insulin sensitivity and endothelial function.

[rajulvasa]

Thanks Tim your information on Diet & disease is very informative & eye opening.
thanks