MOVE: October 2012

Ask our Staff - I know what my numbers are......but I am not sure how they stack up, where I should be, and how exercise helps?

Great question, and thanks for queuing this one up!  Let’s start with a little story....

I know a guy...let’s call him “Bob”....and “Bob” just got back from his annual physical with his doctor and was told, “Your numbers are borderline.  It’s really time to start exercising!”  But unfortunately the message that didn’t quite come clear was....why?... where should my numbers be?... how exactly do I get them there?... how much exercise should I do?....what types?....for how long?.....and, are you sure it will work? Maybe “Bob’s” story sounds pretty familiar?

It probably should.....we tend to talk to a lot of “Bobs”!...and rightfully so...exercise after all IS one of life’s great panaceas (woah...check out that vocab word)!  And while exercise has benefits that touch nearly all of the areas of health that we so often refer to: "physical health" (both body & brain function that we refer to as "physiological health"), "mental health" (self esteem, confidence, anti-depression, mindset, etc that we refer to as "psychological health"), "social health" (connectedness among friends, that we refer to as "sociological health") and even "spiritual health" (connectedness to a purpose or being bigger than self). For the purposes of this article, and to most directly answer your question - we’ll focus on the most concrete ways that exercise has been shown to impact “your numbers”.  For an overview on the “numbers” we choose to measure and why - check out this month’s ENDURE article.

Vitals

• Resting Heart Rate - it’s simple really, the body needs a certain amount of nutrients and oxygen, carried by the blood, and pumped by the heart.  The amount of blood the heart can pump is known as “stroke volume”.  If the heart, being a muscle, is strong, it can “pump” hard enough to produce enough stroke volume and supply the body the nutrients it needs with fewer pumps than if it is weak (and therefore needs to be run "faster").  Want to get the heart stronger....make it pump more frequently through frequent exercise bouts that (preferably at least 30 minutes each) total of at least 150-180 minutes weekly intensely enough to "break a sweat". As the heart gets stronger, the heart rate will often slow.

• Blood Pressure - the systolic (top number) is the amount of pressure on the artery walls while the heart contracts, while the diastolic (bottom number) is the amount of pressure when the heart relaxes, or in between contractions (think "re-filling").  There are almost too many benefits of exercise on BP to discuss, but similar to it’s effect on resting heart rate, when the heart is stronger it doesn't have to work as hard during each beat, thereby decreasing the amount of pressure required to push blood through the arteries.  In addition, as exercise lowers cholesterol and triglycerides, the likelihood of arterial narrowing decreases, logically leading to a larger “pipe” to push blood through, thereby decreasing the pressure in the “pipes”. Finally, as you exercise the demand from the working muscles increases and the body responds by relaxing the arteries allowing for a larger, more flexible pipe for blood to pass through......the more you "ask" the body to give you this temporary change, the more permanent it becomes.

Cholesterol

• HDL (High Density Lipoprotein) “The Good” - Research published by the American Heart Association suggests HDL cholesterol, produced in the liver, helps to form a protective oil like wall on the interior of the arteries, preventing blockages, and  “scrubbing” the interior walls of the arteries. It also cleans out excess LDL (bad) cholesterol, and transports it back to the liver where it is converted into bile and digested, or excreted from the body.  Most research links exercise as an effective method to cause the liver to produce more HDL cholesterol.  And while there are some studies that suggest all exercise forms can help in reducing bad cholesterol, most recent studies conducted and published by Duke University in 2002 suggest that longer duration and more intense aerobic-based exercise such as jogging, swimming, and cycling for at least 30-60 minutes on most (5-6) days per week have the greatest effect on raising HDL.

• LDL (Low Density Lipoprotein) “The Bad” - While we’ve covered some of the basics to lowering LDL through increased exercise above, new research is also indicating that exercise can actually increase the size of the protein particles that carry cholesterol through the blood (when the protein particles bind with cholesterol they form a “lipoprotein”).  And in this case, the bigger the better!  Small lipoproteins have proven much more dangerous as they can infiltrate the interior linings of the heart and blood vessels, while larger particles tend to remain on their “best behavior”

Triglycerides - are simply a three chain fatty acid, and the most common form of fat found in the body and food.  High triglycerides are most often a result of a lifestyle where one consumes more calories than one burns.  Energy not burned is then stored as fatty acids in adipose (fat) tissue, or in the blood.  The risk associated is that high triglycerides can lead to artherosclerosis (hardening) or narrowing of the arteries, causing less than adequate blood flow, and potential heart attack or stroke.  The American Heart Associations suggests that exercise, the most common and effective way to “increase” the burn of calories, for at least 150 minutes weekly can reduce blood triglycerides by 20-30%.

Blood Sugar (Glucose) - sugar (glucose / glycogen) is the primary fuel for the body’s muscle, however it relies on insulin to transport the glucose from the blood to the muscle.  Individuals with high blood sugar are most often referred to as “insulin resistant” meaning the insulin is unable to effectively transport glucose into the body’s muscle.  Research indicates that exercise increases the rate of glucose uptake by the contracting skeletal muscle.  Makes sense, right?  We use our muscles and burn up their fuel...they go to the body for more fuel.  Interestingly, resistance training of the larger muscle groups (legs, back / trunk, chest, shoulders) have shown increased benefit on maintaining a healthy blood sugar.

Weight / Body Composition / Body Fat - although there are some complexities, this one starts as simple math!  If we know that exercise helps us “burn” more energy in the form of calories, and we know that what we consume (with the exception of water) has a caloric value, if we burn more than we consume, our body must tap into it’s energy storage, aka fat.  Key points to keep in mind - although not an "exact" value at all times because of things like hormonal fluctuations and levels of insulin sensitivity (as listed above), 1 lb. of body fat stores the equivalent of 3,500 calories worth of energy, and the average person burns approximately 100 calories per 10-15 minutes of moderate to vigorous activity.  Or for you walkers / runners, approximately 100 calories per mile, it's just a question of how much "stored energy" you're looking to burn. One caution here though......people who attempt to exercise their way to a lean body (i.e. don't look closely at their nutrition) are OFTEN frustrated in this pursuit. To this end, we OFTEN (if not always) recommend taking a close look at your nutrition before you try to use exercise as your primary fat-loss strategy.

Are you “Normal”?
http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/Hyperlipidemia_UCM_434965_Article.jsp
http://www.mayoclinic.com/health/reduce-cholesterol/CL00012
http://www.webmd.com/cholesterol-management/features/exercise-to-lower-cholesterol
http://www.theheart.org/article/1214279.do
http://www.ncbi.nlm.nih.gov/pubmed/9509261
http://www.nlm.nih.gov/medlineplus/triglycerides.html
http://www.aanp.org/images/documents/education/ManagingYourTriglycerides.pdf

Written by Eric Eisenhart, CPT, PES.  Eric is a Partner and Director of Health & Fitness services with Pro-Activity.

FUEL: October 2012

 FOUND IN (SOCIAL MEDIA) SPACE

The "found in (social media) space" article is a new feature in 2012. We ask a member of the geekdom to pay attention to the social-space and stringing together, in some fashion, some of the themes being bantered-about "out there in space" as they relate to the elements. Sometimes these will just be lists of interesting posts, sometimes there'll be some original content.....follow along and find out for yourself.

This month Lindsay Eisenhart, reports on FUEL. 

What's trending in the media regarding using fuel as today's medicine?

We’ve all heard the term, “you are what you eat”.  I’ve enjoyed one tv commercial’s interpretation showing a woman with cinnamon buns as her backside - not the most flattering of imagery, but DEFINITELY drives the point!  That said, there’s most certainly a link between one’s diet and all aspects of performance; whether it’s on the field, on the job, or just an overall feeling of well being.  We took a look at what’s out in the news and social media regarding not only food and mood, but how food might be used as a medical "cure" (that is, having the power to PREVENT AND REVERSE disease) and this is what we came up with:

Somer M. blogs about her experience with Ulcerative Colitis and how eating a plant-based whole-food diet has her in remission and feeling strong and healthy:
http://www.forksoverknives.com/articles/

On that note, check out the movie trailer for Forks Over Knives a film which “examines the profound claim that most, if not all, of the degenerative diseases that afflict us can be controlled, or even reversed, by rejecting animal-based and processed foods”.  
http://www.forksoverknives.com/about/synopsis/

One study shows that an apple a day may actually keep the doctor away by preventing the hardening of arteries: http://producenews.com/index.php/news-dep-menu/test-featured/8939-an-apple-a-day-may-prevent-hardening-of-the-arteries

Dr. Joel Fuhrman, MD (a Flemington, NJ physician who is well known on the topic of food and disease prevention) recommends eating a daily dose of G-BOMBS  (Greens, Beans, Onions, Mushrooms, Berries and Seeds) to ward off cancer and other diseases: 
http://www.diseaseproof.com/archives/breast-cancer-fight-breast-cancer-with-gbombs.html




AMAZING VIDEO: One of our personal favorites, Dr. Caldwell Esselstyn, MD (a retired physician associated with the renowned Cleveland Clinic) shows evidence of how heart disease can be prevented and REVERSED through our diet choices. Essylstyn, in this 14 minute video argues that "heart attacks, the leading cause of death for men and women worldwide are a ‘foodborne illness’ and explains why diet is the most powerful medicine” in this Tedx video: 

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It is important to note that the members of the Fuel Good Cafe' and Pro-Activity DO NOT attempt to diagnose or treat disease, however we DO believe that what you eat DIRECTLY relates; and although not everyone is ready to take healthy eating as a way to change their life.....we're ready to talk about it when you are.

RECOVER: October 2012

"Take a deep breath" 
The Relaxation Response and 
its effect on Blood Pressure

There is no question about it, this is a time of exceptionally high stress levels in America.  Just ask the person next to you and they will likely agree that stress levels are high and have been for several years.  A 2010 study completed by the American Psychological Association reported that 75% of those surveyed said their stress levels are high enough to feel unhealthy.

Stress management is critical to maximizing health and quality of life.  Although it has been connected with many physiological responses, we see and hear it most related to blood pressure.  Stress causes the activation of our primitive “fight or flight” response as cascade of hormones and chemical reactions, including vasoconstriction (narrowing of the vessels) that if not "used-up" in some physically exerting way, they pile up vastly increasing the likelihood of chronic health issues.  Best bet? Daily physical exercise to use it up which acts like a "reset button" on the stress response.

But what if you "can't" exercise?

Well, if you've ever read any of our other posts you probably know we don't take the word "can't" lightly, but if, for example, a traffic jam on the way to work sets off your stress response and it will be a while before you can execute the "reset" sequence, there is still hope......try some exercises that induce the relaxation response.  The relaxation response, a term coined by Herbert Benson, MD (of the Harvard Medical School), in 1971 and later in a 1975 classic titled "The Relaxation Response", is an effect on the body that, opposite the "fight-flight" response, CAUSES relaxation.

Think mediTation not mediCation

Relaxation helps the body to release nitric oxide which helps open (vasodilation) the blood vessels.  It also allows for a state of being where muscle tension eases, breathing slows and the heart rate reduces.  There are many ways to achieve the relaxation response, however one of the important things (to increase the likelihood of a more permanent effect) is to do it consistently.  Try the exercise below:

Close your eyes.  This alone may help.  Focus on a single word or image that you enjoy.  Say or replay this thought many times in your mind while you relax.  You may feel your shoulders lower, your neck muscles relax.  You may want to lean back in your chair.  Some people even fall asleep.  If your blood pressure were taken now, the systolic (top) number could be as much as 10 mm Hg lower than prior to the exercise as a NEW-cascade of chemicals and hormones floods the system.  What's even better?  That few minute investment and new state of calm is linked with greater focus, productivity and effectiveness in nearly every domain, work and play.

So take a breath, relax, let the blood travel through the system with less resistance.  Spend five minutes a day, everyday to effectively add this technique to your routine.  By teaching your body to find its "calm" you can surprise yourself as to how much control you really have over your stress levels, your state of mind, your biochemistry and even disorders with blood pressure.

Written by Amy Weller, PT, DPT, GCS.  Amy is a Partner at Pro-Activity and the Director of Clinical Services.  

ENDURE: October 2012

Pro-Activity Prevention Screenings...

Your "Not So Routine" Medical Care - The Proof Is In The Pudding!

With a large bulk of prevention screenings and assessments happening this time of year, our team has been fielding questions related to our annual Prevention Screenings almost every day.  Most specifically, we find ourselves responding to questions/statements like: “Do I really need to do the screening I just got blood work done at my doctors office” or “I didn’t fast so my results will be all wrong...right?”

Unfortunately, there are times when giving a complete answer (in the midst of a prevention screening event for example) to questions like these proves difficult.  But, in truth, we couldn’t be answering a more important question, the implications are tremendous.

The central theme in many of these questions revolves around the idea that the “Prevention Screening” offered by Pro-Activity and lab tests as part of “Routine Medical Care” one receives at their doctor’s office (i.e. “I just got blood work done at my doctor’s office”) is the same thing.  The fact is...they couldn’t be more different! This is where it can get confusing.

Diving in: It often starts with where our "head is at", i.e. our personal definition about what it means to be “healthy” or “well”!  We hope your definition of wellness is not some version of the “well I’m not sick, therefore I must be healthy” delusion, which we call the coin-flip definition, and rather is one that equates health and wellness as "optimal function and performance", the very peak of our personal potential, which we call the spectrum definition.

So how is it different?

It is important to understand that the Prevention Screening is NOT designed to diagnose disease, which is what “routine medical care” is typically for.  The “Prevention Screening” on the other hand is designed to look at a few of the ELEMENTS that matter most in our goal of maintaining the very highest quality of life.  This means it not only needs to identify the risk factors associated with preventable chronic disease, but also needs to identify key factors closely tied to (and perhaps predictive of) high quality of life and longevity.  This is achieved by blending prevention oriented tests (3-minute step, waist-to-hip ratio, sit & reach and grip strength to name a few) with non-fasting values on blood tests into a single screening tool which makes the vantage very different than what is often delivered as part of routine medical care.

Let’s explore the differences a little further...

Why is having non-fasting blood work important?  To many this seems counterintuitive because consumption of anything will have an effect on your numbers......but as we learn more about what the early indicators of risk are (indicators that can be detected much earlier than the "disease markers" most traditional medical groups are looking for) we know that this information - i.e. how your body is handling/processing the food you consume is critically important.  For example, an inappropriate spike in triglycerides or glucose after eating is more important at the early stages than what your blood values look like fasting.  Without getting too deep into it you can think of fasting values as a view of what your blood looks like AFTER many hours of relative rest (sleeping usually) to battle back the damage and "empty the bucket".  In that sense it's telling you if you have the capability to battle back the damage inflicted on the body each day (by our diet, activity, recovery or lack thereof and other lifestyle factors)......and if you don't?  Well that signifies a problem further down the line than we like to be.....more reaction to damage done than prevention per se.  On the prevention side of the spectrum, we want to know as early as we possibly can if that bucket is likely to overflow - the adjustments are easier to make, more effective and the likelihood of damage being done before we recognize it is much lower.  In essence, we want to know IF damage is being done (at all) rather than if you can successfully battle it back each night and non-fasting blood values allow us to get a much better picture of this process underway.  In addition we find that many people in essence "study" for their fasting tests - becoming more mindful of their diet the week leading up to the test - which can give an artificially low value......we'd much rather see the "real" values and work from there.

How about those other tests that I’ve typically never seen performed at my doctor’s office?

3-minute step test:  This version of an "exercise tolerance test" (distant cousin of a cardiac stress test) is a great way of assessing how fit your heart is which is an independent risk factor for heart and metabolic disease.  For example, your blood test numbers may appear to be “fair”, but if you find yourself struggling with this test it may be an early sign that your cardiovascular system is struggling to keep up.  Having a healthy pump is just as important as what you're pushing through it.....if not addressed, over time poor cardiorespiratory fitness can greatly impact your health.

Waist-to-hip ratio:  This simple test has big implications.  We know carrying excess weight in the form of adipose tissue (body fat) is bad for our health, but where we carry that tissue is even more important.  Visceral body fat, the fat carried around the midsection and belly is metabolically active.  Being metabolic active in this case means it increases our body’s production of cortisol, a stress hormone, that when increased has big impacts on elevating blood pressure, blood sugar and triglycerides just to mention a few.Sit & Reach:  A lot of individuals taking part in the Prevention Screening aren’t really sure why a flexibility test they last performed in the 6th grade has a place in this screening.  The reality is this: having good flexibility of the hips, lower extremities and low back has been shown to reduce the risk of low back pain.  In addition, there is evidence to suggest that maintaining adequate flexibility can reduce the risk of developing osteoarthritis in the long term.  Soft tissue that is short and tight place more stress (compression) on the skeleton and in effect accelerates the degenerative process and if you're tight across the hips, you're likely tight across multiple joints.

Grip Strength:  Ensuring you have adequate grip strength is important for many reasons.  Two of the most important: First, the greater the grip strength you have means less compensation is required by other muscles and joints while performing common tasks.  Have you ever strained your neck while opening that stubborn jelly jar?  A little more grip strength can help reduce that risk by allowing you to recruit ONLY upper extremity muscles rather than invoking all of those "body english" maneuvers.  Furthermore, (believe it or not) studies demonstrate a strong correlation between grip strength and longevity.  Simply put- individuals who have or maintain strong grips typically live longer than their counterparts with weaker grips.  The simple fact of the matter is that a strong grip generally means an individual has more muscle and bone mass...both good predictors of longevity.


So why do we push so many people to participate in a PREVENTION screening each year? Well, we feel that “The proof is in the pudding”... the quality, effectiveness or truth of something is easier to judge by putting it into action!  We believe that if you put the Prevention Screening into action you, like the MANY MANY individuals before you, will find honest and effective information that can truly impact the quality of your life!


Written by Justin Bagley, PT, DPT  who practices in the areas of general orthopedics and neuromuscular rehabilitation, injury/disease prevention, wellness and human performance.   

CONNECT: October 2012

More Than Just a Numbers-Game, 
Leading Your Lifestyle Change

Written By: 
Nick Pfaff, NASM-CPT
Prevention Consultant & Health Coach

During a recent event, an employee at one of our corporate clients, Brian McAlpine, caught me by surprise when he mentioned his recent struggles with his blood work numbers.  Having known Brian for a couple of years, I would have never guessed. I have watched him set personal best times in local 5K races in his mid 50’s, have heard of him completing multiple marathon distance runs (3 of them to be exact), and we often talk about his children and home that keep him moving.  So, yes, I was surprised when Brian mentioned to me that his blood work numbers including his cholesterol, triglycerides, and glucose were better this year then when he got his prevention screening at his workplace last year.  As someone who went from having cholesterol numbers in the 300 range and triglycerides in the 400 to 500 range to now having those numbers in the normal ranges (Cholesterol < 200 & Triglycerides < 150), I had a real interest in learning more about his story.

NP: So when did you find out you had high cholesterol and triglycerides?

Brian:  In 2008, my screening revealed that I had a cholesterol of around 300 and tri’s between 400 to 500, but I was never lead to believe that it was anything I should be concerned about.  The next year I was going in for a surgery, and the numbers almost prevented me from going through with it.  The doctor basically told me I had to do something about my numbers, or I’d have to go on medication.  And that’s the last thing I wanted to do, so I decided to make some changes.

NP: Had you done screenings prior to 2008?

Brian: Yes, off and on, but I don’t recall any of the results in particular.  I don’t think any of them were all that bad, they must have slowly gotten worse over time.

NP: Perhaps if you had noticed the trend sooner, you could have made changes before it became a big problem.  What do you think caused the elevated numbers?

Brian: I was busy with work and family and on the road all the time.  I didn’t spend any time exercising even though I had been a runner in high school and college, and I basically went 30 years without being active.  Also, I would just stop and get something to eat for lunch at whatever was convenient...a deli, fast food, and places like that.

NP: How did you get things turned around?

Brian: The first step was to totally change my diet.  Over the years I’d gathered information about what I needed to do and just started putting them to practice.  A couple things I did was I cut out fried & fast foods, stopped eating cold cuts, cut out soda completely (both regular and diet), deferred mayonnaise and chips with lunch, started eating less red meat, and more chicken, fruit, vegetables, and whole grains.  I still eat bread, I love bread, but I just make sure it’s good bread, made from 100% whole grains.  In addition, my doctor recommended I start taking fish oil and flaxseed oil, which I started doing at that point.

NP: And when did you start exercising?

Brian: After I got my nutrition in check, I started running again and have been doing so for 3 years.  It was really my daughter who got me into it as I joined her for some runs, and my wife was always active, which helped too.  It was important that my family was so supportive of the changes I was trying to make, and since then I’ve completed 3 half marathons, 3 full marathons, and my 5k times keep getting faster even though I’m getting older.  I figure that’s a good sign of progress.

NP: It sure is!  I figure even if you stay the same speed as you age, then you’d be making progress...so that’s great!  Tell me about how hard it was to make the change.

Brian:  Well, I have a 45 minute commute to and from work every day.  I work a full time job, have a wife and 2 kids with a granddaughter on the way, and a home to take care of, so it was pretty tough.  As far as running goes, I made up my mind to MAKE time to run and wake-up at 4:30 in the morning to do it, because I knew I was never going to just FIND some extra time...I’ve got a long honey-do list.  Sometimes it gets tough to not spend as much time with my family because I’m exercising, but choose to invest a little time now in order to reap the rewards of more, high quality time with them the rest of my life.

NP: Tell me a little more about your nutrition changes.

Brian:  I started cooking.  I watched the food network, got a subscription to Bon Apetit magazine and away I went looking for healthy recipes.  I also do all the shopping and stop on my way home from work.  I’ll buy the staples on the weekend, and then stop to pick up the things I need for dinner 2 or 3 other times throughout the week.  I use the grill a lot and am not afraid of a good roast beef every once and awhile.  The stuff you can buy from the butcher and cook up at home is much different than cold cuts.

NP: How hard was it to change your eating?  Most believe eating healthy means eating foods with no taste.

Brian:  I’ve probably been eating more flavorful foods since I started eating healthy than I ever did before.  I use a lot more herbs and spices now, so it wasn’t hard at all.

NP: So do you have any advice for someone if they find out they have high numbers?

Brian:  I would definitely recommend talking to the consultants (in the case of the screenings at my place of employment) or the doctor who give you the results first to see what they have to say.  In my case though, I started with nutrition before exercise.  I thought about what I could exchange in my daily food to eat better, and went for walks around the block.  There are some pretty simple places to start.

NP: What would you say to someone that doesn’t think knowing your blood numbers is important?

Brian: Do It!  Just to know where you’re at.  You can’t see inside yourself, and you may feel fine and think everything is fine, but there may be something seriously wrong and this is the only way to find out.

NP: What would you say to people who are afraid to know their numbers?

Brian: For me, it was what I needed, a slap in the face, something that scared me into getting motivated.  I would just recommend to disassociate yourself from the situation and ask, “who else does this affect other than myself such as my wife and children.”  I’d rather know and be able to address the situation, no matter how hard the truth may be.  It’s just that important, especially if you have other people to think about other than just yourself.  

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Brian, we couldn't agree more......thank you for your willingness to share this part of your story and taking the time to tell it.  I hope this story of "one man’s" journey which started with knowing "numbers" and resulted in a life-change can help others in the future.