Monday, December 16, 2013

Motivation, Finding Your Inner Coach

My junior high school math teacher Mr. Lyons decorated his classroom with an assortment of inspirational messages; “Well Begun Is Half Done” is one I remember. We, sophisticated eighth graders, thought it was pretty silly. These days, in my mid-sixties, I can see that he was onto something. When I first attempt a task that is difficult, uncomfortable, or boring, a voice in my brain tries to talk me out of it. “This workout is too hard – let’s read a book instead.” “Cardio makes my quads hurt – let’s skip it this time.” I think of this voice as my Inner Five-Year-Old and I deal with it in much the same way that parents negotiate with little children, encouraging, prodding, sometimes even bribing, as a last resort.  I do DVD workouts featuring Tony Horton, Erik Owings, and Bob Harper, all of them excellent trainers. I’ve tried to analyze what they do and use the same strategies to encourage myself to do challenging workouts. Here are some examples:

  • I start from where I am. Maybe I’ve put on a couple of pounds in the past month but I don’t agonize about that. I focus on what I can do right now.
  • I observe what I can do easily and what gives me trouble. It’s fun to do the easy moves but the hard stuff is where the money is, as Tony would say. Endurance exercises like chair pose are not that hard for me, but plyo is tough. When I started P90X a few years ago I could hardly do five jumping jacks, much less the seventy or so in the warm-ups, but I kept doing a few more and a few more and now I can keep up with the DVD.
  • I concentrate on maintaining good form. With weight lifting, correct form is essential for safety. With other exercises, it can help you avoid wasting your time because you’re not really getting into the muscle.
  • I don’t worry about what or how well anyone else is doing. Everybody’s different.
  • When I see progress, I pat myself on the back (sometimes literally) but I don’t beat myself up about things I still can’t do.

The two thirty-three minutes cardio intervals I do each week are tough. I get through them by keeping up a running line of encouraging chat. The first fifteen minutes are the hardest because I have to get my heart rate up from the fifty-something beats per minute, where it normally is, to about 125, which is the lowest worthwhile starting place if I’m going to get the results I want. I say, “This part is hard, but I can do it. Fifteen minutes isn’t that long.” After a three-minute fast interval I say, “More than halfway through, almost done.” After a four-minute, slower interval I say, “Only two more fast ones, hang in there!” At thirty minutes I’m really tired but I say, “Only three more minutes – anybody could do three minutes.” After that I’m done.

Some people who don’t exercise a lot believe that those of us who do have some special magic that enables us to do what they can’t, or don’t want to, do. Speaking only for myself, when I get done with a hard workout, I don’t experience any rush of endorphins or runner’s high; I feel only relief that I won’t have to do this again for another few days. It’s not easy, but the practical rewards are enormous. I have the energy to pursue my interests during the day; I sleep well at night; I don’t worry about injuring myself; and I feel completely comfortable in my body.

Monday, December 2, 2013

What I’ve Been Reading

- Anyone wanting to sample the full range of opinion (and emotion) about health care in this country need look no further than Jerome Groopman’s review of Paul A. Offit’s book, The Quackish Cult of Alternative Medicine, and the comments, 81 in all, that appeared in a recent New Republic: http://on.tnr.com/1bKyvz2. Dr. Groopman, who is Chair of Medicine at Harvard Medical School and author of many articles and books, seems to be generally in agreement with Offit in dismissing most forms of alternative medicine, though he also points out the need for greater transparency in the medical profession, especially with respect to conflicts of interest.

      - Noreena Hertz’s frightening ordeal with a mystery illness led her to ponder the decision-making process in “Why We Make Bad Decisions,” http://nyti.ms/1b2EvSP. Here are a couple of salient quotes:

“If we are to control our own destinies, we have to switch our brains back on and come to our medical consultations with plenty of research done, able to use the relevant jargon.”

“One study of radiologists, for example, reveals that those who perform poorly on diagnostic tests are also those most confident in their diagnostic prowess.”

      - When it comes to staying healthy, which is more important, diet or exercise? This question is addressed in a short but useful article: http://bit.ly/1eANTjEBriefly, it depends on your goal: if you want to drop a dress size or increase your energy, diet is the way to go; if you’d like to reduce your risk of heart disease, keep your mind sharp, or increase your libido, exercise is the better choice. The article includes specific recommendations in connection with each objective.

- These days there are a lot of doctor/bloggers. The stories they tell are often poignant and eloquently expressed. One that I just started reading is “In My Humble Opinion” by Dr. Jordan Grumet, an internist who practices in the Chicago area: 
http://jordan-inmyhumbleopinion.blogspot.com/

Saturday, November 16, 2013

Searching for Healing 2000 Years Ago

On a recent trip my husband and I went to Bath, a lovely small city in the south of England. The place is name for the hot spring that has been an attraction for millennia. Bath was founded in 860. Legend tells that Prince Bladud became afflicted with leprosy. He was banished from court and made to look after pigs. The pigs too had a skin condition; Bladud noticed that, when they rolled in the hot mud, they were healed. He tried it himself and was cured of his disease. He went on to found Bath and become the father of King Lear. 

Centuries earlier, the Romans had been interested in the healing properties of the spring. In 50 AD they built a temple to Minerva, the Roman goddess of healing, and the Celtic god Sul. They also constructed a bath complex, with water supplied by the hot spring. Around these a settlement grew up known as Aquae Sulis, the waters of Sul. Today the remains of the temple and the baths are displayed in a wonderful museum, which includes sculpture, inscriptions, items lost when they were dropped in the water, and a skeleton of an ancient Roman with a reconstruction to show how he looked in life.

Some of the inscriptions are gravestones, a couple of them of Roman soldiers. These were young men by today’s standards, men in their twenties to mid-forties who died far from home. Roman soldiers formed cooperative associations that would pay for gravestones when one of them died so we now know their names, sometimes their ages, and places of birth. Did they come here hoping to find a remedy for war injuries or illnesses? I came away with a sense of how difficult life must have been for these people.

Today leprosy, also known as Hansen’s disease, is treated with antibiotics, anti-inflammatory drugs, and immunosuppressants.

Tuesday, October 1, 2013

Good News 2 – But Are Doctors Following the Recommended Protocols for Tests?

My doctor was concerned about the high BUN/creatinine ratio that showed up on my annual blood work. After looking back at a couple of years’ previous blood work results, she concluded that the number was going up. I looked back eight years in my own records and found that it had actually bounced around, although it was generally higher starting in 2008, when I amped up my exercise routines with interval work on the cross trainer. The original reading, taken on 7/19/13 was 36; a second reading, on 8/21/13 was lower but still high, 32. 

After the second high reading, I wanted to know what factors other than kidney disease could affect the test. My doctor’s office always tells me to fast before checking my cholesterol or blood glucose but does not give me any particular instructions relating to the BUN test. Yet it turns out that both exercise and diet the day before can affect its results. One website suggests not doing either cardio or weightlifting the day before. WebMD recommends not eating a lot of protein for 24 hours before the test. The day before the third test I heeded this advice; I did no exercise and ate virtually no protein. The third test showed a BUN/creatinine ratio of 19, within the normal range. Within the space of two weeks the number had dropped by one-third. If the BUN is so sensitive to extraneous factors, should it really be considered a reliable indicator of kidney health?

I’ve read that cholesterol tests too can be affected by what you eat the day before but no doctor’s office has ever cautioned me about this. Speaking of not following recommended protocols, both WebMD and Medline Plus say that, before your blood pressure is taken, you should sit quietly for at least five minutes. The medical staff I have dealt with recently never do this. Instead they take it while I am in the middle of a conversation with them. Then they tell me I have high blood pressure, which I know is not true because I take it myself at home; it’s about 105 over 60. I wonder how many people receive unnecessary treatment because medical tests are being improperly administered.

Wednesday, September 18, 2013

Capoeira

In the warm-up sequence in the Rushfit workouts there is one exercise based on capoeira, a Brazilian style of dance and martial arts. According to the wikipedia article, capoeira was invented starting in the sixteenth century, mainly by escaped slaves and their descendants. Here is a marvelous video clip of two master capoeiristas. There was a somewhat similar situation with yoga in colonial India; for some practitioners it was a martial arts program disguised as a self-improvement regimen.

Good News Part 1: DXA

One of the unnecessary scares at the time of a physical exam took place in 2003, the first year I had a DXA scan to measure bone density. I went to a testing center where an MRI was administered and later interpreted by a doctor. The results revealed significant bone loss in the lumbar spine and left femur. I was horrified. My PCP wanted me to take Fosamax; I decided to get a second opinion.

I went to the radiologist who did (and still does) my mammograms. The results on his machine were significantly better than on the first test. The radiologist explained that readings can differ from one machine to another. There is also a margin of error for any machine so that small differences are not considered significant. (Since 2003 I’ve had five DXAs since then and none has ever given results as low as the first one.)  The overall picture was not too bad. The reading for the spine was definitely in osteopenia territory, those for the femurs were normal.

In the succeeding years the picture has stayed about the same: osteopenia in the spine but no worse than before, some additional bone loss in the hips but just barely out of the normal range. Last year the spine was somewhat better, the femur readings a bit worse. This year the spine was back down but the right hip (the side with the shorter leg) had increased 3.7%. So the overall picture is that the numbers bounce around a bit but not much changes. After ten years, is it really worthwhile for me to continue with these tests?

Clearly, my body can still rebuild bone. To help the process along I’ve decided to increase my calcium supplement intake by 25%. I also take vitamin D and magnesium along with the calcium. There has been a lot of talk lately about people taking too much calcium. The theory is that the excess mineral can harden the walls of the arteries and contribute to heart disease. But how can we know whether a particular person is getting more than enough without a blood test? We’re all different. In my own case, I take well over the recommended amount yet my serum level is at the low end of normal. My blood pressure is low normal and my cholesterol readings are just fine. Instead of making sweeping generalizations, I wish the experts would recommend that people get themselves tested. That is the scientific way, after all.

Thursday, September 12, 2013

A Blast from my Dental Past plus Coping with Medical Procedures

I emerged unscathed from my annual physical (more about that in future posts) but a few weeks ago I started getting worrisome messages from my mouth. Nothing hurt, but whenever I aimed the water pick at my upper right molars, there was blood. When it comes to problems with teeth, I am super-vigilant because my dental past is checkered, to say the least. 

From my early teens to my mid-thirties there was one crisis after another: large cavities requiring extensive excavation, abscessed molars, root canals, and extractions. Heredity and stress probably contributed to this and I probably could have taken better care of my teeth, plus the fact that I was a smoker then. When I moved to Bloomington somebody put me in touch with The SuperDentist. He got right to work fixing up the damage done by neglect and less-than-successful remedies by previous dentists. The SuperDentist (now retired, alas) is a master craftsman; when his patients would move to other parts of the country their new dentists would ask, “Where did you get that wonderful dental work?” After a few years, during which I also quit smoking and my stressful job, my teeth stabilized. Apart from replacing the occasional old filling, there was not much to be done. 

(Side Note: There has been a lot of talk about whether silver amalgam fillings can cause high levels of mercury in the blood. For decades of my life I had a mouth full of those fillings, most of them replaced now. I also worked for a dentist one summer and mixed up the silver amalgam for him. This year I had my mercury level tested and it was very low. If anyone would have been harmed by silver amalgam, you would think it would have been dental workers. In the years before they wore masks all the time, clouds of dust from silver amalgam would be in their faces for much of their work day. Has anyone surveyed them?)

Anyway, I went to my regular dentist and he cleaned out a little something under the gum. Two days later, the bleeding started again so I went to my husband’s periodontist. MHP surveyed the situation. The bad news was that this was the beginning of periodontal disease. The good news was that it was early enough that he could do a laser procedure – no cutting, no sutures – that should take care of it. Since I’m always in favor of getting out in front of impending problems, I said “Let’s do it.”

I’ve had so many medical and dental procedures over the years that I’ve developed a routine that helps to reduce stress and anxiety. First, I try to get a good night’s sleep the night before. The next day I don’t do any strenuous exercise but I do a stretching routine, like the ones in RushFit and P90X. This gets my circulation going, which helps me relax and will promote healing. I wear layers of comfortable clothes, including a light sweater in case the office is over-air conditioned. I bring along something small to read, like a cell phone or paperback book, that can stay in my lap. When I’m waiting for the appointment or sitting by myself in the treatment room I don’t want to be staring off into space worrying about what comes next. Finally, following a tip from my grandmother, I focus on what I’m going to do afterwards.

Compared with many of my past dental adventures, the laser treatment was a piece of cake. There will be follow-up after a couple of weeks and then at longer intervals after that. I’m actually glad to get established with MHP because he will keep an eye on things so that I can avoid periodontal problems in the future.

Wednesday, August 14, 2013

Why I Always Get and Keep Copies of Medical Test Results

Yesterday was my annual physical, a day I always anticipate with dread because it represents my annual battle with The Way Things Are in the health care business today. Inevitably this battle involves my doctor, a kind and intelligent person who has only my best interests at heart. She is the one I would want beside me in a medical crisis. But there is no crisis – I am perfectly healthy – and this year, like most years, I will have to prove it, by achieving normal results on various medical tests or by justifying any result that is out of line.

I might give up having an annual physical at all, except that I need refills of the two medications I take regularly: Synthroid for my hypothyroidism (no generics, please, we’ve tried that already) and Premarin, which I’ve taken since 1980 because I had a complete hysterectomy and want to stave off bone loss. So I go for my physical, get my blood work, mammogram, and DEXA scan, and deal with the consequences. 

An individual test result, looked at in isolation, can be misleading. In health care, as in most of life, context is everything. Unfortunately, because of the way medicine is practiced today, context is very limited or absent altogether. Most doctors don’t know their patients well; many don’t know them at all. Record-keeping systems are constantly changing which can lead to the loss, misfiling, or intentional destruction of older documents. One topic of conversation with my doctor yesterday was my high BUN/creatinine ratio. This is an item to be taken seriously because it is an indicator of kidney function. In my case, creatinine is a perfectly respectable .9 (normal range .5 to 1.3) but BUN or blood urea nitrogen is a whopping 32 (normal 7 to 20), resulting in a ratio of 36 (normal 6 to 25). On a more positive note, my GFR, another measure of kidney function, is 66, perfectly fine.

My doctor was concerned but I pointed out that the ratio, for me, has been high for years, maybe even decades. In the past doctors have attributed the high BUN to dehydration associated with fasting before blood work. “Still,” the doctor said, “it’s higher than last year and the year before. It seems to be going up.” We talked about whether I’m dehydrated  (no), whether the protein supplement I take could be affecting it, and she wants me to repeat the test on a day when I’m not fasting. I agreed.
My doctor only has test results for me going back a couple of years but I started getting and keeping copies in 2000 when my doctor at the time wanted me to take statins. After my appointment I went back through the file and found that the BUN/creatinine ratio has bounced around a lot; in 2005 it was 36! Protein in the diet can have an impact on BUN; cardiosmart.org, the website of the American College of Cardiology says, "Do not eat a lot of meat or other protein in the 24 hours before having a blood urea nitrogen (BUN) test." Exercise can affect it too. One website for weight lifters recommends not lifting weights or doing cardio the day before the test. (I had probably done both the day before this year’s.)
I haven’t had the mammogram or DEXA yet but so far this year’s flap has been relatively minor compared with the breast cancer non-event a few years back and the heart disease false alarm last year. Doctors devote their lives to helping others. In order to help as many people as possible they rely on test results and on generalizations based on large research studies. Since their time with individual patients is very limited, they sometimes interpret idiosyncratic variations as disease. In addition to a very real concern for patients, the prevalence of malpractice litigation inclines doctors to err on the side of caution.
I believe that having health coaches in doctors’ offices would do a great deal to reduce unnecessary testing and anxiety on the part of both doctors and patients. A health coach would have the time to review my medical records and know that my white blood cell count is sometimes low and that my BUN is always high. Instead of making assumptions about my physical condition based on my age and sex, a health coach could actually find out how many pushups I can do and what I eat for breakfast. The main reason to respect Western medical care is that it is based on science and science depends on accurate information about specific situations. A health coach who knows me could be a valued ally in my annual fight to prove that I am healthy.

Wednesday, July 17, 2013

Working Out With Bob, Erik, and (of course) Tony

Anyone who reads this blog knows that I am a huge fan of P90X.  I first learned about the program from a Sunday morning infomercial on TV, bought the DVDs in September of 2009, and wasn’t sure I would ever be able to do the whole thing. I started interspersing some of the workouts with ones I was currently doing.  Eventually I did P90X Lean, the slightly scaled back version, all the way through. Last year I advanced to Classic, the main version, and did that all the way through twice. 

This year, when I started on my third round of P90X it occurred to me that I wasn’t getting as much out of some of the workouts as I had previously. One of the ideas behind the program is that muscle confusion prevents you from getting to a plateau so you keep making progress indefinitely. A survey of the reviews of P90X on Amazon l tells me that this is wishful thinking. With any resistance workout, no matter how intense and varied, sooner or later you reach a point of diminishing returns. (Cardio workouts are different: the body doesn’t seem to care whether you’re running, swimming, or on a machine. As long as you keep your heart rate up high enough, long enough, at the right intervals, you’ll keep your condition.)

I would like to have done P90X2, but it requires more space for exercising and for storing additional equipment than I have in my house. I looked at Insanity, another Beachbody program, but the amount of high impact activity seemed like a bad idea for my 67-year-old knees. I finally settled on two workouts by Bob Harper, who is one of the coaches on “The Biggest Loser,” and Rushfit, a six-DVD series featuring Canadian martial arts champion Georges St. Pierre and led by trainer Erik Owings, who created the program.  All of these are great workouts and each has its advantages and drawbacks.

So I’m now doing a combination of all three programs, trying to keep a variety of different types of exercise (as in P90X), while increasing the intensity. Each new workout you try uncovers unsuspected weak areas in your body that can be made stronger. Each one changes different parts of the body.  From P90X I’ve kept the four upper body routines plus Ab Ripper X. Upper body is really Tony Horton’s strongest area and you can tell that by looking at him. I also do Yoga X and Plyo X, which I alternate with the corresponding workouts in Rushfit.  “Balance & Agility” and “Stretching for Flexibility” are two bonus workouts in Rushfit that cover some of the same territory as Yoga X. “Explosive Power Training” is shorter than Plyo X but some of the moves are harder.

In the P90X workouts you are working out with Tony and a group of his friends. The mood ranges from serious to playful with Tony’s background in mime and standup comedy on full display. Tony seems genuinely interested in how each person in the class is doing and he introduces them all by name. He also does most of the workouts himself. In Rushfit you are being invited to share a workout that Georges St. Pierre is doing with trainer Erik Owings. The workouts all use the same warm-up and cool-down and all are based on a five-round cycle with short breaks in between, like a championship fight. As in P90X, the instructions are clear and there is a lot of attention given to correct form. I especially like Rushfit’s emphasis on fluid range of movement; "functional training" is the term Erik Owings uses to describe this approach. At one point he sits cross-legged on the ground, lifts himself onto his hands, and swings his legs back into a plank - very impressive! Since I started these workouts I have seen improvement in my flexibility and my mid-section is looking better too.

The hardest workout I do is Bob Harper’s Total Body Transformation, a full hour of non-stop action.  There isn’t much of a warm-up but the first quarter of the workout is not too hard.  This part features a lot of work for shoulders – great for the often-weak rotator cuff areas.  The rest of the workout is more about legs and core, including a fair number of isometric moves using planks and squats.  It’s a good workout but a bit unrealistic; toward the end, even the people in the class are starting to lose their form. I alternate this with Bob Harper’s Totally Ripped Core, which is supposed to be mainly for abs.  With these two workouts the main change I have seen has been in the backs and sides of my legs. My quads are naturally strong but these workouts have helped my hamstrings and abductors especially.  I can now lift my top leg while doing a side plank, which I couldn’t do before.

I do at least one of these workouts six days a week.  Twice a week I also have to do 30+ minutes of cardio because none of these workouts gets my heart rate much above 120 bpm and I need to get into the low 130’s to maintain condition.

Saturday, July 6, 2013

Do You Take Supplements? Use Generic Drugs? Check Out ConsumerLab.

There is so much information out there about supplements – which ones we should take and how much of each, whether we should take them at all – that it can be different to sort out the facts from the rhetoric and self-promotion. If you want to know what the science says, check out ConsumerLab. Founded in 1999, this organization tests supplements to determine whether they actually contain what the label says and not too much or too little of it, that they aren’t contaminated by toxins such as heavy metals (found in some calcium supplements), and that they can be absorbed by the body. Tod Cooperman, MD, president of ConsumerLab, appeared on Dr. Oz on 4/9/2013 discussing the mission of ConsumerLab and some recent findings. A follow-up article by Dr. Cooperman appears on the Dr. Oz web site.

The same program included a discussion of generic drugs, an area where I’ve had some personal experience. Dr. Cooperman pointed out that the FDA does not test generics for efficacy and safety; in fact it doesn’t test them at all. Manufacturers of generic drugs themselves test their products to ensure that they include approximately the same amount of active ingredient as the original drug.  "Approximately" in this case is defined as 80%-125%. Different manufacturers of generics may contain different percentages of the active ingredient so if you got generics from one place one month and another the next your dosage could vary by as much as 45%! This gets you into trouble with medications where it is important to stay within the same narrow range. Dr. Cooperman listed the following groups of drugs:
1.       Blood pressure
2.       Thyroid
3.       Anti-seizure
4.       Asthma
5.       Blood thinners
6.       Immunosuppressants
7.       Anti-depressants
In these cases generics should be used with caution. The same is true for extended release medications because the pills may differ in technology.  
Dr. Cooperman also recommended identifying the manufacturer of your generic by checking the label and trying to get the same kind each time. He also suggested asking whether there is an authorized generic for your medication. Authorized generics are made by the same company that originally produced the drug but after it has gone off patent. If you switch from a medication to a generic, he said, you should monitor yourself for a month to be sure that nothing has changed.

In my own case, it took years to get my thyroid level stabilized.  A couple of times I was put on generics instead of Synthroid and the results were bad.  These days I have a note in my doctor’s folder for me saying “Do Not Substitute.”

Friday, June 21, 2013

From Sharon Begley on Twitter

I follow science writer Sharon Begley on twitter and picked up references to a couple of recent articles on health care.  

Tuesday’s USA Today carried a long article:  “DoctorsPerform Thousands of Unnecessary Surgeries” by Peter Eisler and Barbara Hansen.  One man had his dreams of a career in professional baseball and the military shattered after he had a pacemaker installed.  It turned out that all he really needed was blood pressure medication.

On the website ModernHealthcare.com Jason Shafrin interviews author and economics professor  Douglas Hough about his recent book on irrational behavior of patients, providers, and stakeholders.

Tuesday, May 14, 2013

Better Feet, Stronger Bones

“I’m starting to get a nasty twinge across my kneecap.”  I wrote this in a note to my podiatrist Dr. Hoffman and taped it to my left-side orthotic.  These days I rarely see Dr. Hoffman in person; most of the time I write a note describing the pain I’m having, attach it to the orthotic, and leave it with the receptionist.  A few hours to a day later she calls me and I come and pick it up.  Usually he gets it right the first time and there’s no pain for several months.  Sometimes I have to bring it back to have it tweaked.  The average person doesn’t need to get their orthotics adjusted that often but I exercise eight or nine hours a week and that means that my body is constantly changing.

In “Respect the Feet,” 10/1/2011, I recounted the history of my dealings with Dr. Hoffman.  I got orthotics when I was in my late 40’s or early 50’s and started exercising more.  Dr. Hoffman would adjust my orthotics by adding pieces of cork to the bottoms.  If I started feeling pain, I would tape pieces of cardboard on to see whether it would go away.  Sometimes I would get such huge wads of cardboard that he would say, “I don’t see how you can walk on those things.”  Keeping the pain away, protecting my ankles, knees, hips, and lower back from inflammation, has allowed me to do harder and harder workouts and to get into the best shape of my life, at the age of 66.

Sometime in 2009 I bought an agility ladder and started doing plyo or jump training. Later that year I started working my way into P90X, which includes jumping jacks and more plyo.  In April of 2012 I went to have my orthotics adjusted and instead of adding to them, Dr. Hoffman started filing them down.  Somehow my muscles and bones were rebuilding themselves in the direction of greater stability so that I no longer needed as much support from the orthotics.  In “My Feet Are Changing!” 4/14/2012, I speculated about possible causes for this improvement – the P90X Legs and Back routine? more protein in my diet? This process has continued, the orthotics are getting thinner and thinner, but I now think that it may be the plyo that is helping.

In the sports medicine community plyo is attracting more attention.  A number of studies have shown that sprinting, hopping, and jumping routines can improve bone density in younger people.  Even more intriguing is a Danish study in which women ages 20-47 and men ages 20-40 played soccer two or three times per week over a period of several months.  These individuals saw improvement not only in bone density but also in muscle strength and balance.  It would be interesting to see research on even older adults.   

I have to confess that I don’t love doing plyo.  Vigorous, explosive movement takes a lot of energy, especially for someone like me who is better at endurance exercise.  Plyo isn’t for everyone.  People who already have knee, hip, or back injuries should consult a doctor before trying jump training­­ – but for those who can use it, this seems to be a promising, low cost way to maintain bone strength in old age.

4/2013
 
10/2011







 

Tuesday, April 30, 2013

Important Article on Breast Cancer

In the cover article for the Sunday New York Times Magazine Peggy Orenstein surveys past and present thinking about breast cancer in light of her own experience.  In "Our Feel-Good War on Breast Cancer" she shows that women are  pressured into being treated for a DCIS, a condition that might not harm them until years later - or at all.  Women treated unnecessarily vastly outnumber those whose lives are actually saved by treatment.  The Komen Foundation lionizes cancer survivors while marginalizing women with untreatable cancer as though they had somehow failed.

In a recent blog post Orenstein adds other important material that did not make it into the article, notably the brave but unsung deeds of Rose Kushner.

My own experience with non-cancer was described in this blog post.


Saturday, April 20, 2013

Michael Mosley's Exercise, My Exercise

After watching “The Truth About Exercise” I wanted to find out more about Michael Mosley.  He is a writer, doctor, and producer and presenter of TV programs and he has been interested in getting into better shape for several years.  About five years ago, after turning fifty and assessing his situation, he tried a restricted calorie diet and human growth hormone shots.  Neither approach was a success.  “The Truth About Exercise” chronicled more recent efforts and this year there is a book, The Fast Diet, that recommends eating your typical diet five days per week and one-quarter that number of calories (about 500 or 600) two days per week.  Apparently this worked for Mosley, as we will be able to see on an upcoming three part series on PBS.

In “The Truth About Exercise” Mosley applied new ideas about exercise to his own situation.  While watching the show, I mentally compared his experience with what has happened to me as I have tried to lose weight and improve my fitness over the years.  Michael Mosley and I have some things in common: we both like wine, chocolate, and good food.  Neither of us is especially fond of exercise.  In other ways, though, we are opposites.  Mosley is a toffee.  He looks lean but he has visceral fat around his internal organs.  I have never looked lean (and probably never will because I’m so muscular) but my visceral fat is not high, 9 or 10 on the Tanita Ironman’s scale of 1-60.  

When Mosley visits Dr. Emma Ross he learns that his brain is actually keeping him from exercising as much as he is physically capable of doing.  Something like this happened to me about four years ago.  I had been doing interval training and working up to faster speeds on the cross trainer but I was starting to feel that it was too much, getting a little tired and light-headed, especially on hot days during the summer.  What got me past this obstacle was the metabolic training program I did with Greg and Susan Simmons. 

I exercised with a mask over my face that allowed Greg and Susan to monitor how my body was burning carbs and fat.  Based on my (very slow) metabolism, they designed an exercise program that would increase my aerobic base so that my body would become better at burning fat.  After that, we worked to increase my anaerobic threshold so that I could exercise at a higher intensity.  The workouts for this program were long and boring at first but I ended up being able to do a shorter, harder workout without feeling overstressed.  These days the aerobic part of my workout consists of a 33-minute series of intervals with heart rate averaging in the low 130’s, about 85% of maximum heart rate for me.  I do this routine twice a week. As part of the program Greg and Susan tested my VO2max, a measure of cardiovascular fitness.  It was a not-bad 39 and got up to 42.9 the last time they tested it.  Mosley’s was a not-bad 37 but didn’t change at all as a result of the HIT training he did.

Michael Mosley seems especially interested in reaching the 80% of people who never go to the gym.  The segment with Dr. James Levine emphasizes the importance of non-exercise activity thermogenesis (NEAT) and encourages people to walk, ride a bike, and take the stairs in order to burn more calories during the day.  For people who rarely get up and move around during the day this approach may really help, but for people who are already somewhat active it may not make enough of a difference.  At our house we doing our own cooking, cleaning, laundry, and most of the yard work but we still have to watch what we eat and go to the Y in order to keep from putting on weight!

Interval training has been the subject of a lot of research lately.  It seems to be pretty well established that interval workouts are more efficient and effective that long, steady cardio sessions.  What is less clear is exactly how the intervals should be done and whether this is the same for everyone.  HIT, per Professor Jamie Timmons, involves very short intervals of 20-30 seconds.  I tried short-interval workouts for a while and saw no improvement at all; I didn’t lose weight and my fitness didn’t improve.  I was in decent shape so my resting heart rate was low (50 bpm or so).  To raise my heart rate to the point where I was actually working (at least 120) took more than 20 seconds – the interval was over before it had even started.  When I did the resting part my heart rate would go right back down to 70 or so and still not get much above 120 on the next round.  For my present regimen, I warm up for five minutes to get my heart rate to the mid-120’s, which is a good starting point.  I then alternate intervals of four and three minutes at 125-130 bpm and 135-140 bpm, respectively, for an overall average of about 132 bpm.  The 33-minute workout I do burns 300 calories or less, according to my Polar heart rate monitor.  For my body, a 12-minute workout would probably have no effect at all.  

It’s great that HIT improved Mosley’s insulin sensitivity but I sometimes felt that both he and Timmons verged on saying that the 12-minute routine might be all the exercise a person needs.  Leaving aside the issue of what cardio is right for each person, there are many types of exercise that can improve the body in many different areas, including strength, agility, quickness, flexibility, and balance.  While encouraging non-exercisers to exercise is a thoroughly admirable goal, it is also important to encourage those who do a little to try to expand the range of what they can do and improve their condition even more.  

I wish the segments about HIT had included information about Mosley’s resting heart rate and whether that changed as a result of the HIT training.  Resting heart rate is an important index of fitness.  I try to keep mine in the 45-50 bpm range and I do the cardio intervals mostly for that purpose.  If I go on a trip and don’t work out for a couple of weeks it tends to creep back up but after a few workouts it comes right back down.  A recent Danish study showing that healthy men with a resting heart rate of 51-80 bpm had a 40-50% greater risk of death than those at or below 50 bpm.  At 81-90 bpm the risk was doubled and above 90 bpm it was tripled!