Article: Sitting is the New Smoking - so... Exercise!

 

Exercise that burns between 90 and 100 calories per day could reduce the risk of early death by 16% to 30%.

A sedentary lifestyle may be twice as deadly as obesity, results of a study published in the American Journal of Clinical Nutrition suggest. However, even a small amount of exercise is enough activity to reduce the risk of early death by as much as 30%.

“Studies that have examined the combined associations between physical activity,body mass index (BMI), and mortality suggest that physical activity protects against premature death but does not eliminate the increased risk associated with high BMI,” wrote Ulf Ekelund, PhD, of the Medical Research Council Epidemiology Unit at the University of Cambridge in the United Kingdom, and colleagues.

To examine if overall and abdominal adiposity modified the association between physical activity and all-cause mortality, the investigators conducted a cohort study with data culled from 334,161 European men and women. Over an average of 12 years of follow-up, the researchers measured height, weight, waist circumference, and self-reported levels of physical activity.

A moderate amount of physical activity, compared with no activity, was the key to lowering the chances of premature death, the study authors found. Exercise that burns between 90 and 100 calories per day could reduce the risk of early death by 16% to 30%. The effect of moderate exercise was greatest among normal-weight patients, but even overweight and obese patients saw a benefit.

Using the most recent data on deaths in Europe, the investigators found that 337,000 of the 9.2 million deaths of European men and women were linked to obesity. However, twice that number of deaths could be linked to a lack of exercise, the scientists added.

“Efforts to encourage even small increases in activity in inactive individuals may be beneficial to public health,” concluded the researchers.

References: Ekelund U et al. Am J Clin Nutr. 2015; doi: 10.3945/ajcn.114.100065

 

If Exercise is of benefit, HOW MUCH IS ENOUGH?

It's no secret that exercise is essential for a healthy heart. But scientists are questioning just how intensely people need to exercise to accrue cardiovascular benefits. For years, the dogma was that two or three intense exercise workouts several times a week were necessary for cardiovascular fitness. However, a panel of exercise scientists convened by the Centers for Disease Control and Prevention (CDC) and ACSM in 1993 found that belief to be unfounded. It reported that 30 minutes of moderate exercise, such as walking, gardening, or bicycling, spread out over the course of a day, provided the bulk of cardiovascular benefits.

One study used to back up the report was conducted by Steven Blair, director of research at the Cooper Institute for Aerobics Research in Dallas (S.N. Blair et al., JAMA-Journal of the American Medical Association, 262:2395-401, 1989; for a follow-up report, see S.N. Blair et al., JAMA, 276:205-10, 1996). Blair assigned one of three fitness categories-low fit, moderately fit, and high fit-to more than 13,000 men and women based on their performances on a treadmill test. The categories roughly corresponded to levels of physical activity. He observed that those in the least-fit category were the most likely to die over the eight-year course of the study, with the greatest difference in death rates between the low-fit and the moderately fit groups. "You get more bang for your buck, so to speak, by getting out of the low-fit category and into the moderate," says Blair. "If you go from low fit or completely sedentary to moderately fit and moderately active, you can cut your risk of dying by about 50 percent. If you go from moderate to high, I think you can drop your risk by another 10 [percent] to 15 percent."

I have a Bad Back...Is Walking the "Best" Exercise?

Exercise is such an important thing for all of us to be doing for a whole host of reasons. In the lower back in particular, doing the right kinds of exercises for the lower back as part of an overall exercise routine can be such an important thing. Something that I tell people when they come in with lower back pain from a variety of different causes and they are concerned it could now be a lifelong thing that they are dealing with is I say, "Look, typically we are going to get this better and there's a glass half-full/half-empty way of looking at this. The glass half-empty is after somebody goes through an episode of lower back pain and they do nothing about it and just take care of the symptoms, then they are going to be more likely in the future probably to develop a similar kind of episode somewhere down the line. The glass half-full way of looking at it is if they take this as a learning experience and they learn a set of exercises that are going to take the pressure off the spine, then in some way they are going to be less likely than their neighbor to have anything like this happen to them in the future."

Most of us at some point in our lives are going to experience some kind of lower back pain. Most of us can probably prevent a lot of it if we took the time to do a few simple exercises to help take the pressure off the back and keep the back nice and healthy. The trouble is getting people to do those exercises before the fact. If we all just took an ounce of prevention, it would go a long way to alleviate a lot of the problems of lower back pain.

Doing exercises for the spine doesn't have to be a massive life change or even a major commitment, but we do need to be consistent with it. We should plan to do at least ten to fifteen minutes of exercises on a relatively daily basis to retrain the muscles, then build to 30 minutes a day, 3 days minimum.

Are you walking correctly?

Walking is, of course, something that most people take for granted. There is walking, then there is EXERCISE WALKING.

Walking correctly is essentially the act of falling forward and catching yourself, repeated. As the body is propelled through space, the brain will tell the back leg to step forward to prevent us from face planting. This forward leaning posture is correct for exercise walking.

But, for whatever reason, many people tend to lean backwards slightly with legs that move forward before the trunk so that the rest of the body has to be pulled along to catch up.

Walking this way is a recipe for sciatic trouble. Sciatica occurs because something, either bone, disc or muscle, is impinging the sciatic nerve. If we learn to walk and stand correctly, we align ourselves in a more effective way, creating a much better pathway for the flow of the sciatic nerve.

Our walking and standing posture greatly determines the route of the sciatic nerve. Poor walking patterns basically cause interference along the path by allowing for a misalignment of the skeleton and misuse of muscles.

If the sciatic nerve is irritated by any of these interferences, such as bulging discs, or a piriformis muscle in spasm, or overtightening of any of the posterior leg muscles...sciatic pain is the likely result. Doesn't matter how much treatment you have, if you are walking incorrectly, the problem will return!

People with ongoing or recurrent episodes of lower back pain should consider the benefits of Exercise Walking as a low-impact form of exercise. For some back conditions, walking will aggravate or cause too much pain to be bearable. For these patients, other low-impact exercise may be advisable, especially water therapy (pool therapy such as aqua-jogging or deep water aerobics). The body's buoyancy reduces compression on the lower back, allowing for more pain free movement.

Benefits of Exercise Walking

It has long been known that there are many inherent health benefits from a regular routine of exercise walking, such as

Strengthens muscles in the feet, legs, hips, and torso - walking increases the stability of the spine and conditions the muscles that keep the body in the upright position.

Nourishes the spinal structures - walking for exercise facilitates strong circulation, pumping nutrients into soft tissues and draining toxins.

Improves flexibility and posture - exercise walking along with regular stretching allows greater range of motion; helps prevent awkward movements, and susceptibility of future injury.

Strengthens bones and reduces bone density loss - regular walking for exercise helps prevent osteoporosis and can aid in reducing osteoarthritis pain.

Helps with controlling weight - any regular exercise routine helps maintain a healthy weight, especially as one ages and metabolism slows.

For people with ongoing back pain, balanced and stable walking maintains and enhances one's ability to continue doing everyday activities, while reducing the likelihood and/or severity of additional episodes of back pain.

To realize the full benefits of exercise walking, certain guidelines need to be followed as outlined below.

If the legs move forward first, the pelvis is pulled into a tucked position which shortens or compresses the piriformis muscle and flattens the lumbar spine. Both of these factors increase the likelihood of the sciatic nerve being impinged by muscle, bone or disc.

Stretching before Walking

There are several stretches and techniques that will improve the benefits of exercise walking, as well as help prevent injury.

Prior to exercise walking, gentle stretching should be done to prepare the joints and muscles for the increased range of motion needed. It is important to take an easy five minute walk to warm up the muscles before stretching so they're not completely cold when stretching.

Discuss with a healthcare practitioner the best way to do stretches, and be sure to include the neck, arms, hips, upper and lower leg muscles (including the hamstring muscles in the back of the thigh), and ankles. We give our patients a chart of stretches.

Techniques for Exercise Walking

Using the following techniques will help improve the benefits of walking:

1. Walk briskly, but as a general rule maintain enough breath to be able to carry on a conversation.

2. Start out with a 5 minute walk and work up to walking for at least 30 minutes (roughly 2 miles), 3 to 4 times a week.

3. Maintain good form while walking to get the optimum aerobic benefit with each step and help protect the back and avoid injury. These elements of form should be followed:

Head and shoulders: Keep the head up and centered between the shoulders, with eyes focused straight ahead at the horizon. Keep the shoulders relaxed but straight - avoid slouching forward.

Abdominal muscles: It is important to actively use the abdominal muscles to help support the trunk of the body and the spine. To do this, keep the stomach pulled in slightly and stand fully upright. Avoid leaning forward as you walk.

Hips: The majority of the forward motion should start with the hips. Each stride should feel natural - not too long or too short. Most people make the mistake of trying to take too long of stride.

Arms and hands: Arms should stay close to the body, with elbows bent at a 90 degree angle. While walking, the arms should keep in motion, swinging front to back in pace with the stride of the opposite leg. Remember to keep hands relaxed, lightly cupped with the palms inward and thumbs on top. Avoid clenching the hands or making tight fists.

Feet: With each step, land gently on the heel and midfoot, rolling smoothly to push off with the toes. Be mindful about using the balls of the feet and toes to push forward with each step.

Exercise walking, as with other forms of exercise, requires the right equipment for a safe and effective routine. Good walking shoes are an important investment, and choosing the appropriate walking shoes is an important step in maximizing the benefits of exercise walking.

Finding the proper walking shoe may take some time and a bit of money, but it is essential for achieving long and short term benefits. Shoes are the most important piece of equipment in walking.

Walking Shoes Interact with the Back

Walking shoes provide a basic protection and mechanical support for the foundation structures of the body - the feet - which in turn help keep the entire body balanced and aligned. When there is a minute imbalance in the feet, the compensatory domino effect causes changes throughout the body.

Specifically, when the body's natural gait motion is off balance, the body counterbalances the problem by redistributing weight. This ultimately changes the natural posture and alignment of the spine, leading to muscle strain and back pain over time. Though the imbalance may seem minor, in the long run, the stresses added to the body can add up and cause unnecessary wear and tear.

Finding the Correct Walking Shoes

The right walking shoes can help foster excellent balance and posture during exercise walking, while poorly fitted walking shoes can cause pain or increase susceptibility to injury. It is best to find a technical running shoe store that will watch the individual's walk and will provide a shoe that fits based on the individual's specific biomechanics (this service is not typically found in large chain store).

Walking shoes should allow the feet to naturally roll slightly inward (pronation) and outward (supination) to help absorb the different forces acting on the body. For many people, either one or both feet under pronate (roll outward) or over pronate (roll inward), altering the balance and length of the leg during stance, as well as gait. Some shoes are designed to control over pronation, whereas others are designed to encourage pronation. Therefore it is important to make sure that walking shoes match each individual's specific biomechanical pattern.

or both feet excessively roll inward, causing the arch to flatten - also known as "flat-feet". This will create excess motion in the leg as it internally rotates. The pelvis tilts to compensate for the rotation of the leg, tightening muscles in the lower back, fatiguing, and stressing the components of the spine.

• Under pronation - one or both feet fail to pronate and excessively roll outward, impairing the bodies ability to absorb shock. This added force is absorbed through the joint and muscles of the lower back and lower extremities, which over time may cause injury.

There are three essential factors that should be taken into consideration before purchasing a new pair of walking shoes.

• Stability - the shoes should have a balanced and secure feel throughout range of motion.
• Flexibility - the shoes should allow for a good degree of give at the base of the toes, providing smooth motion.
• Comfort - walking shoes should comprise contours and padding conformed closely to the feet, providing a snug fit at the heel and midfoot, with ample room in the forefoot.

When trying on shoes for exercise walking, it is advisable to examine the following four particular areas of walking shoes:

• Heelcounter - the area of the shoe that holds the back of the heel, just underneath the Achilles tendon. This area should be snug but not tight, comfortably cupping the back of the heel. A good heel counter will help prevent the feet from over pronation or supination.
• Midsole - the area between the tread and the cloth upper of the shoe. This is the most important component of any footwear. Midsoles are made of a variety of materials that give the shoe greater or lesser degrees of cushioning, support, and flexibility.
• Insole - the area inside the shoe, on the bottom, where the sole of the foot is in contact with the shoe. It should contour comfortably to the foot. It is designed to reduce shear forces between the foot and the shoe and provide some shock absorption.
• Toe box - the entire area that surrounds the toes. The toe box should provide adequate room for the toes to move freely. Wiggling and bending the toes at the knuckles should be unrestricted. Conversely, too much space will cause shifting and discomfort. There should be approximately one half to a full thumb's width between the end of the longest toe to the end of the toe box.

Fitting Guidelines for Walking Shoes

Here are some general guidelines to consider when getting fitted for a new pair of walking shoes:

• Have the salesperson take dimensions of both feet since there may be differences. Take measurements while standing, as feet expand when bearing weight. Base new shoe size on these measurements, not on previous shoe size.
• Take foot measurements at the end of the day, since feet tend to swell throughout the course of the day.
• Try on and lace up both walking shoes (left and right) while wearing regular socks. Stand up and walk around to make sure the fit is correct.
• Never buy walking shoes that immediately feel too tight. Though they will go through a break-in period, if walking shoes initially feel very tight, they are too small.

Finally, keep in mind that arch supports or orthotics can supplement the original shoe to help attain the best fit.

Walking Shoe Inserts

Walking shoes alone may not provide the needed comfort or support needed for exercise walking. Because of discrepancies in leg length or foot shape, each shoe may need certain adjustments in order for the feet to feel or perform balanced within the walking shoes.

Orthotics are removable shoe inserts that are placed within the walking shoes to remedy these discrepancies. They should enhance shock absorption, weight distribution, and alignment of the feet and body while walking. Some inserts may provide support for a flat arch, while others provide padding for a sore heel. Store bought orthotics can be relatively inexpensive compared to custom-made orthotics, but are nonspecific for discrepancies between the left and right foot.

In our practise we custom mold orthotics after assessment of foot posture and lowerlimb biomechanics. We don't advocate the "off the shelf" inserts because they simply don't provide adequate benefit.

Having the appropriate walking shoes is an important element in exercise walking. The combination of proper footwear and sound exercise walking technique will impart the maximum benefits of an exercise walking routine.

Article by Dr Peter Richard Pedersen