Why I'm Still Stretching

Stretching has gone out of fashion in recent years.  Formerly touted as a way of improving your workout and preventing injuries, the practice, particularly static stretching, has been shown in some studies to decrease power in activities such as running and jumping and to have no benefit in preventing injuries.  The new thinking is that workouts should be preceded by a warm-up, such as jogging in place, and ballistic stretches like goose-stepping.  Some recommend avoiding static stretching altogether on the grounds that it tends to tighten muscles, while others would give it a role in a post-workout routine.  The current situation was discussed in a New York Times blog post by Gretchen Reynolds.

For a few months I tried ballistic stretching before working out on the elliptical and I was not impressed.  It did not raise my heart rate high enough to prepare me for the workout nor did it improve my flexibility by extending my range of motion.  These days I do a warm-up consisting of jumping jacks and jogging in place; I don’t do any stretching at before a workout.  In the evenings, especially on days when my muscles are sore from resistance training, I use a foam roller, then do a series of resistance stretches.  These exercises, which I learned from Anne Tierney and Steve Sierra, involve pulling against the stretch which is supposed to avoid tightening the muscle.  Stretching makes me more comfortable, more relaxed, and probably lets me sleep better.  

The stretches I learned in years of yoga classes helped me to recover full range of motion after having a frozen shoulder.  I am now applying the same type of technique to my hands, which have scar tissue at the knuckles because of arthritis.  I’ve been in enough yoga classes to believe that what happens to the body happens to the mind as well.  A calm, relaxed body is probably conducive to an open, percipient mind.  New research also shows that a flexible body can mean flexible arteries, lower blood pressure, and a reduced risk of cardiac problems, findings that are of great interest to me because of my family history of heart disease. 

When Emotion Trumps Science: the Latest on Hormone Therapy

Let’s imagine that there is a new medication available for post-menopausal women.  It is an effective remedy for hot flashes and osteoporosis and lowers the risk of diabetes and colon cancer.  In younger women, it may protect against heart disease.  One version of this drug can also diminish a woman’s risk of dying of breast cancer.  Potential downsides include a small increased risk of having a stroke (12 more per 10,000) or of dying of breast cancer (about 1 more death per 10,000 with the drug). 

This blog has a feature called “Should I Be Taking This?” in which the potential side effects of a particular medication are listed first, followed by ostensible benefits.  Often the first list is quite long and the second rather short and tentative.  Some of the medications have only been on the market for a short time so the full extent of the risks and benefits may not yet be apparent, a situation I discussed in “Statistics and the Twenty Year Rule.”  

Against this background hormone therapy seemed like a pretty good deal:  substantial and proven benefits associated with risks that amount to tenths or hundredths of a percent.  And some hormone medications had been around for decades.  I started taking Premarin, an estrogen-only version of hormone therapy, in 1979 after a complete hysterectomy at age 32.  The initial dosage of 1.25mg was too high and was later reduced by half.  I tried taking even less but started getting hot flashes.  Then in 2002 the Women’s Health Initiative study of estrogen-plus-progestin therapy was halted because of higher-than-expected rates of breast cancer and heart attack in women using the medication; the risks of the therapy were deemed to outweigh the benefits.  When this news was released, widespread panic ensued among women using hormone therapy.  Many abandoned it altogether.  WHI was taken as a blanket rejection of hormone therapy by the medical community, whether researchers intended it or not.

The women who discontinued taking these medications avoided risks but they also lost substantial benefits.  Many undoubtedly experienced hot flashes which disturbed their sleep and interfered with their ability to concentrate.  People tend to joke about hot flashes but insomnia is a big deal.  Sleep is right up there with air, water, and food among the essentials for survival.  That’s why sleep deprivation is used as a form of torture.  These women were also more likely to get osteoporosis.  Sometimes their doctors prescribed bisphosphonates to protect from bone loss but these have been related to a rare type of femur fracture and, in a few cases, with osteonecrosis of the jaw (disintegration of the jaw bone), although the nature of the association is not yet clear.   

Women with a higher risk of breast cancer or stroke may not want any additional risk, however small.  My situation is different.  The Cleveland Clinic’s online calculator of stroke risk puts mine at 3.6% over 10 years, about half the average for women my age.  Taking estrogen may increase that risk to 3.60432%, an increment too tiny to worry about.  Decisions about medical treatment should be made on an individual basis: one size does not fit all.  The hormone therapy saga is a good illustration of this point.  

For those of us on hormone therapy, the medical discussion of this issue has been like an extended good news/bad news joke.  In a recent issue of the Wall Street Journal the invaluable Melinda Beck brings us up to date on the most recent findings.  The current notion is that for younger women the benefits may outweigh the risks.  Did doctors overseeing WHI anticipate the extreme reaction to their study? Did they consider what the consequences would be for women who stopped taking hormones?  Some of them, when quoted, sound a bit defensive.  In the WSJ article Rowan Chlebowski, a WHI investigator, asks:  “Why would anyone want to double their risk of dying from breast cancer?”  If the additional risk is tiny and the benefits include protection from hot flashes, osteoporosis, colon cancer,and diabetes, I’d say it was worth it.   

Women are still being advised to take these medications for the shortest time possible because of the risks, but how much is known about longer term use of these medications? I’ve met or read about many women like me who have taken them for decades and are doing fine.  When is someone going to study us?

Fat Gain Versus Weight Gain: All Calories Are Not Created Equal

In January of this year I read about a new study on how calories from different types of food affect fat gain and weight gain, but until I heard Dr. David Crabb’s discussion of the study on WFIU’s medical program “Sound Medicine” I didn’t appreciate how counter-intuitive and downright strange the results were.  Dr. George Bray of the Pennington Biomedical Research Center in Baton Rouge began by determining the daily caloric needs of 25 healthy men and women.  Then, over an eight-week period, he fed them 1000 calories more.  

The participants were divided into three groups according to the type of diet they were fed during the study.  Some received a diet low in protein - about 5% - and high in fat; others ate a normal protein diet of roughly 15%, an average of 139 grams per day; while the third group consumed a high protein diet of 26%, about 228 grams per day, and very little fat.  Carbohydrate levels for all three groups were the held constant.
   

At the end of the eight weeks all the groups had put on the same amount of fat but weight gains varied among the groups in an unexpected fashion.  The low protein/high fat group put on the least amount of weight and those on the high protein/low fat diet put on the most but the normal and high protein groups gained lean body mass in addition to fat and increased their energy output, while the low protein group actually lost lean body mass.  In his commentary Dr. Crabb notes that it is surprising that the protein in the diet alone produced an increase in lean body mass without any sort of physical training.  (The study did not involve any exercise for any of the participants.)  Presumably the loss of lean body mass would make it harder for the high fat group to lose the weight they had gained once they started to do this, though the study did not address that point.

Some commenters on the research see the study as further evidence of the unreliability of BMI as an index of good health.  At the end of the study the low protein group weighed less but were also less fit.  One aspect of the study seems to confirm a point made by nutrition researcher Douglas Paddon-Jones, that the body does not absorb more than a certain amount of protein, about 30 grams per meal maximum for most people.  Those on the high protein diet did not gain much more lean body mass than those on the normal protein diet.  

Related post:  “Get Older, Stay Strong:  Exciting New Research" 3/08/2012

Better Than BMI

In an earlier post, “What’s Wrong With BMI” (8/06/2011), I talked about why BMI (body mass index) can be misleading, classifying unusually muscular people as obese and thin but unfit individuals as healthy.  I’ve just read about a new and simpler index that is said to be a more accurate predictor of future health problems than BMI.  

As WebMD reported, “Researchers reviewed 31 studies of more than 300,000 men and women. They found that waist-to-height ratio was more accurate than BMI and than waist circumference alone at predicting certain health risks associated with being overweight or obese, such as high blood pressure, diabetes, and heart disease.”  The goal is to keep your waist size less than 50% of your height, a ratio of less than .5.  With a ratio of .7 (six feet tall, 50 inch waist), a non-smoking 30-year-old man could decrease his life expectancy by as much as 14%; at .8 (six feet, 58 inch waist), by as much as one-third.  Let’s hope this easy and inexpensive tool will be widely used from now on.

Scales

Kyra Sedgwick says she threw her scale away because it never showed her the right number.  I know how she feels.  Since I was eleven or twelve I’ve had a love/hate relationship with scales.  Even if your diet and exercise habits stay the same, there are all kinds of circumstances that can cause your weight to go up or down:  getting a cold (up) or stomach flu (down), taking a long plane trip (up) or eating a naturally diuretic vegetable like spinach (down).  Most restaurants use a lot of salt in the food they prepare.  Oddly, places that serve spicy foods, like Indian or Mexican, tend to be especially bad about this.  If I eat at one of those I can put on five pounds overnight.

The Tanita Ironman Scale

About ten years ago I started to get serious about losing body fat.  At the time a test with calipers showed mine to be 38%, well into the “Excess Fat” category.  I bought a Tanita body fat scale and worked the number down into the mid-20’s.  Four years ago I decided to do even more and invested in a Tanita Ironman.  The Ironman won’t mow your lawn or do your taxes but it has a lot of cool features, as well as one major drawback.  In addition to your weight, muscle mass, and percentage of body fat, it will give you a separate read-out for the muscle mass and body fat in each of five areas:  right and left arm, right and left leg, and torso.  This can clue you in to asymmetries in your body that might interfere with athletic performance.  It shows visceral fat (the nasty stuff around your internal organs), bone mass (not very precise), basal metabolism rate (ditto), and body water percentage.  There are also a couple of vanity features: metabolic age and physique rating.  There are separate settings for men and women and for male and female athletes.  Anyone with a resting heart rate of less than 60 beats per minute is considered an athlete and that includes me.

Now for the bad news.  Even when I use the “female athlete” setting I don’t get sensible results for muscle mass and body fat; apparently I fall too far outside the Tanita algorithm for women.  If I pretend to be a male athlete, the numbers are closer to accurate; even if they’re not precisely right, they give me an indication of whether my condition is improving or getting worse.  The Ironman has a memory and can display previous results by day (for the past year only), week, and month.  

Like all body fat scales, the Ironman works by sending a harmless electrical current through your body and evaluating the data it produces (bioelectrical impedance analysis).  In the case of muscle mass, body fat, and water, the calculation process can cause the results to interact in unexpected ways.  For example, on days when I am dehydrated, muscle mass will go down and body fat will go up.  This may be simply an artifact of the measuring process.  Muscle is about 75% water so less water will be “read” as less muscle.  At the same weight, less muscle means more fat.

In spite of these limitations, I feel a real sense of accomplishment when I look at my numbers in 1/2008 and today:  weight 162/148, body fat 23%/13%, muscle mass 118/121.

Arthritis 4: What I'm Going to Do

After sorting through the information I have gathered from doctors, tests, and online, I’ve decided on an approach to dealing with the osteoarthritis that I now have. 

1. I will ease off a little (but not much) on my cardio workout.  I’ve been doing intervals on the cross trainer averaging 138 bpm, almost 90% of maximum heart rate for 33 minutes three times a week.  I’m dropping down to 133 bpm or 85% for 35 minutes.  This probably won’t make much difference in terms of calories burned and my heart will still get a good workout.  Less intensity may mean less oxidative stress which will probably be easier on my hands.
2. I will be cautious about repetitive motion activities and about gripping anything for an extended period of time.  On the cross trainer, instead of clutching the handles for thirty-plus minutes straight, I will alternate with pumping my arms and not holding on, better for my balance anyhow.
3. I will start using a higher quality calcium supplement.  I have been buying a calcium caplets from Target, along with a separate vitamin D gel cap, plus vitamin K₂ from an online supplier.  I’ve now ordered New Chapter Bone Strength Take Care, which has all three of these, plus other ingredients that are supposed to preserve bone health.  New Chapter supplements are expensive but their products are tested for potency and safety and recommended by some physicians.
4. I will try hot water soaks, paraffin dips, and the Voltaren gel prescribed by MHO.
5. I will exercise my hands in order to try to increase range of motion – or at least hold on to what I have now.  In the following picture you can see that my right hand is stiffer than the left.  On the left side I can pull my fingertips all the way back to the base of the fingers.  On the right side I can only get to within about ¼”, especially the index finger, because of swelling and adhesions.

Twice a day I work each hand, pushing against the straight part (phalanx), never the joint itself, moving it forward and down as far as it will go and holding for a few seconds, three areas on each finger, two on each thumb.  For most of the joints there is little or no pain but with my right index finger, especially the middle joint, there is a sore, raw sensation that I recognize from when I used to work on my shoulder.  My hope is to loosen up the adhesions and at least maintain the space I’ve currently got at each of the joints.  It may be months or years before I know whether this will do any good but I’d rather try than do nothing.

Arthritis 3: More Insights

In order to get a clearer picture of what was going on, I made an appointment with my husband’s orthopedist (MHO), whom I had met five years ago.  I gathered up the DVD and all the test results and made a list of questions.  When MHO came into the room I almost didn’t recognize him; he seemed to have lost at least fifty pounds and looked tan and fit.  I told him my story and he gave me his version of the situation.  Like my PCP, he thought that the pain and inflammation were caused by a flare-up of pre-existing osteoarthritis.  He thought the arthritis, especially in my right hand, was more serious than the radiologist did.  He was intrigued by what I said about the workouts and the gliSODin, which he hadn’t heard of either.

The bottom line, as I already suspected, was that this condition was not going to go away.  The bone spurs were there to stay and so was the swelling in my index finger.  To help the inflammation I could do warm water soaks and paraffin dips (the same treatment beauty salons use to soften hands).  There was also a more expensive therapy involving corn husks (?), which I probably didn’t need.  I could try glucosamine/chondroitin supplements or a capzasin-based cream or a prescription gel called Voltaren.  Years before I had tried glucosamine/chondroitin to see if it would help my knees.  It made them swell up; when I was doing Sleeping Child pose I felt as though I was kneeling on balloons.  I had also tried capzasin and found it too irritating to my skin – it’s based on hot pepper.  I decided to try the Voltaren gel.  

I also asked MHO about exercising my hands – the  parts of my body that get lots of exercise don’t seem to have bad arthritis, though they probably have some – and he had a couple of helpful comments.  He said, “If you’re going to work with exercise, work on stretching.” He also told me that in arthritic fingers bands of tissue build up around the joints limiting range of motion.  Since he does surgery on people’s joints, he has seen this firsthand.  Since I can only look at my hands from the outside (and in the x-ray), I would not have known about this.

Over the next few days I thought about this conversation, especially the part about the bands of tissue, and was reminded of when I had dealt with frozen shoulder many years ago (see my post “Frozen Shoulder:  What Worked For Me.” 8/25/2011).  I had torn something in the back of my shoulder.  In order to avoid the requisite surgery, which takes a long time to heal, I went to an acupuncturist.  Her treatments healed the tear but left me with frozen shoulder, otherwise known as adhesive capsulitis.  When the body experiences injury or inflammation it sometimes constructs protective bands (adhesions) around the affected area.  In the case of the shoulder, this can make it difficult to do put on a coat or fasten your seat belt in a car.  In the case of my hands, it was starting to prevent me from bending my fingers, which I need to do in order to hold a pen or a pair of scissors.   

The way you deal with adhesions, as I discovered with my shoulder, is to work into them a little at a time.  Over a period of six months, I used yoga and other stretches to work into the affected area and get back the range of motion in my shoulder.  I still have a bone spur where the injury was but the muscle slides right over it when I do rotator cuff exercises.  Perhaps I could apply the same approach to the present situation.