FAQ 12 (Scroll for all articles)
Can Exercise Help Overcome a Family History of Heart Disease?
A: Surely it can, although couch potatoes might argue that genes are destiny. I've often wondered about it. My father battled high cholesterol for years and died after suffering a silent heart attack and later a stroke.
An observational study published April 9, 2018, in the journal Circulation suggests that exercise may actually have a greater impact on those with the worst genes.
One of the largest studies of fitness and heart disease, it examined data collected from nearly a half-million people in the UK Biobank database. They found that people with high levels of fitness had reduced risks of heart attack and stroke--even if they had an elevated genetic susceptibility to these diseases.
Among those with an intermediate genetic risk, those with the strongest grips were 36% less likely to develop coronary heart disease and 46% less likely to develop atrial fibrillation (AF) than those with the same genetic risk and the weakest grips.
Among those with the highest genetic risk, the highest level of cardiorespiratory fitness was associated with a 49% lower risk for heart disease and a 60% lower risk for AF.
"People should not just give up on exercise because they have a high genetic risk for heart disease," explained senior researcher Erik Ingelsson, MD, PhD, professor of medicine at Stanford University School of Medicine. "And vice versa: Even if you have a low genetic risk, you should still get exercise. It all ties back to what we have known all along: It's a mix of genes and environment that influence health."
For more details--and there are many--you'll find the entire study online. 10.1161/CIRCULATIONAHA.117.032432
Another study, published October 31, 2017, in the American Journal of Epidemiology, investigated the unique benefits of strength exercise, aerobic exercise, and a combination of the two forms of exercise on all-cause mortality, cardiovascular disease, and cancer.
Researchers from the University of Sydney analyzed data from 80,306 adults over a span 14 years in health surveys in England and Scotland. They found strength training to be associated with a reduction in premature death from all causes, and may be even more beneficial than aerobic exercise when it comes to cancer.
Those doing strength training showed a 23% reduced risk of all-cause mortality, and a 31% reduction in cancer related death. Those doing both cardiovascular and strength training were shown to have a greater risk reduction than those doing cardio training only. Strength training alone, however, did not appear to reduce the risk of death from cardiovascular disease.
"In terms of mortality risk reduction, adherence to the strength promoting guideline on physical activity appears to be at least as important as adherence to the aerobic guideline," the researchers concluded. "Our results support the value of specifically promoting adherence to the strength exercise guideline over and above the generic physical activity targets."
Once again you'll find the entire study on line: https://academic.oup.com/aje/article-abstract/187/5/1102/4582884
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A well rounded exercise routine including both strength and aerobic exercise will help tremendously to overcome a family history of illness and early death. Find a balanced exercise routine that you enjoy and keep doing it as long as you can. Our friend Judge Dan Sawyer, now in his 90s and having outlived almost all of his peers, vows to stop off at the gym for a final workout on the way to the cemetery.
June 1, 2018
What's the Best Way to Avoid Back Pain?
A: Trinity College Dublin Associate Professor & Chartered Physiotherapist Fiona Wilson wrote April 5, 2018, in The Conversation that the best way to avoid back pain is to "lift heavy things." That would probably come as a surprise to most adults suffering from lower-back pain. Not me, however. With some qualifications, I'm inclined to agree. I've been managing a gimpy lower back for years by lifting and rowing hard. I no longer do squats or deadlifts, but I challenge the muscles of my lower back and body in many other ways. I warm-up thoroughly and avoid movements that hurt.
Wouldn't works for everyone, of course. Those with bad backs should talk with their doctor or physical therapist before making major changes.
The fact that so many people have back problems suggests that a different approach is needed. Avoiding heavy lifting whenever possible doesn't seem to be working.
Professor Wilson reminds us that human tissue needs to be exposed to loads to become strong. The spine is no exception. "Regular loading prepares the joints, muscle, and ligaments for normal tasks," she explains. "Nobody would expect to run a marathon without preparing the body for such loading, so it seems logical that to be able to lift a weight requires exposure to that activity."
Weight trainers are no doubt nodding in agreement. Weak backs are more likely to complain than strong backs.
Wilson references studies of astronauts showing that prolonged weightlessness in space caused back pain when they returned to earth. "Prolonged unloading caused an unstable or weak spine leading to back pain."
Research on elite rowers--who fully flex and load their lower backs hundreds of times every time they train--provides a model for building a strong and pain free back.
Wilson says there appears to be a loading sweet spot--progressive loading and adequate recovery--where the lower back is gradually trained to cope with the load. "Rapid increases in training load with poor recovery is associated with the onset of back pain in rowers," she warns.
Take your time building back strength and allow time for recovery--and growth--between training sessions.
Another lesson from rowers is that engaging the hips and thighs along with the back makes you less likely to develop back pain. "The emphasis should be on strengthening these muscles," Wilson writes.
"Rather than advise people to avoid lifting, they should be taught to make regular lifting part of their everyday routine," Professor Wilson concludes. "Emphasis should be on creating a fit workforce rather than providing them with lifting equipment. After all our spines can handle it."
Elite rowers row five or more days a week--and I row once every two weeks. For most people, one is probably too much and the other too little. Rowers mainly row, while I add many other forms of exercise for my back and the surrounding muscles. The photos below show me using the Glute-Ham Developer to strengthen my lower back, hips, and leg biceps--without compressing my spine. The only muscles aiding the back it doesn't work are the quads on the front of the thighs. I do the leg press to work my thighs, lower back, and hips. My rowing, of course, works my legs, lower back, traps, arms, and rear deltoids.
I tells you this to illustrate a way to strengthen your lower back and the surrounding muscles, without doing more harm than good. Few people want to row every day or do exactly what I do. If you can squat and deadlift, by all means includes these proven movements in your routine. I prefer the Trap-Bar deadlift, because it allows a more upright position. It's up to you to find what you enjoy and works for you--and then keep doing it.
Listen to Professor Wilson. Avoid the crowd with low-back pain. Make back training part of your lifestyle. Better yet, make total-body fitness your goal.
Once again, avoid movements that hurt. If it hurts don't do it!
Photos by Laszlo
June 1, 2018
Steps to Avoid Dementia?
Q: You've written about steps to cope with aging and keep arteries flexible. Are there similar steps to lower the risk of dementia?
A: Interestingly, there are two avenues (one long and the other short and focused) to combat the gradual decline of the brain and its abilities--a growing and costly problem worldwide. Both are telling and instructive.
Conferences in London and elsewhere have brought together experts to review existing dementia research and recommend ways to lower the risk of this devastating condition. A recent report published in The Lancet identified nine modifiable risk factors:
1: Low levels of education
2: Midlife hearing loss
3: Physical inactivity
4: High blood pressure
5: Type 2 diabetes
9: Social isolation
About 35 percent of dementia cases are attributable to these factors, according the report. The majority of them are the same as those for slowing aging and preventing arterial stiffening. Like the others, the four new ones can be modified for dementia prevention.
The first one can be modified by increasing education in early life, which the report estimates could reduce the total number of dementia cases by 8 percent. Continued education and other mentally stimulating tasks are believed to help the brain strengthen its networks so it can continue to function at a higher level even if it starts to decline later in life.
Never stop learning and challenging your mind.
For the first time, the researchers identified hearing loss as a major risk factor for dementia. They estimated that treating hearing loss in mid-life could reduce the number of dementia cases by 9 percent.
Hearing loss contributes to the other new risk factors, social isolation and depression. "They may work in similar ways as they reduce the chance of interactions and conversations, which are like exercise for the brain and enrich it and predispose to depression," commission member Lon Schneider, MD, a professor of psychiatry and behavioral sciences at the Keck School of Medicine of USC, said in a statement.
While it is not clear whether depression is a cause or a symptom of dementia, it was found to be responsible for 4% of the risk of developing dementia.
Social isolation is increasingly thought to be a risk factor for dementia as it also increases the risk of hypertension, heart conditions and depression. However, like depression, it remains unclear whether social isolation is a result of the development of dementia. It was found to be responsible for 2.3% of dementia.
Noting that modifying all nine risk factors could reduce risk by 35 percent, Professor Schneider observed that lifestyle modification is inexpensive and that a 35 percent reduction of risk is "far larger than anything you can ever expect for drugs." (Lifestyle trumps drugs once again.)
Another report, by the National Academies of Sciences, Engineering and Medicine, using different methodologies than The Lancet report, found that just three types of intervention offered "encouraging but inconclusive" evidence: cognitive training, blood pressure management for hypertension, and increased physical exercise.
According to The Washington Post, similar studies are underway in this country, in Singapore, and in Australia.
While the war against dementia will be with us for a very long time, lifestyle modification can stem the tide.
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Once again, we find that we can do more for ourselves than any drug can do for us. Lifestyle is the most powerful tool we have. Whether--and how--to use it is up to each one of us.
December 1, 2017
Heavy Weights Build Stronger Nerves?
Q: You've written before that light weights and heavy weights lifted to failure are equally effective for building muscle mass, but that heavy weights have the edge for building strength; to lift heavy weights you must lift heavy weights. Anything new on how this works?
A: Yes, we have an interesting new study from the University of Nebraska-Lincoln examine how lifting 30 and 80 percent of one-rep maximum to failure influence neuromuscular adaptation--signals from the brain to the muscles. The unique contribution of the study is measuring the difference in neural adaptation. Let's look at what they found and then discuss the practical application.
Readers might want to begin by reviewing our earlier piece on the effect of low- and high-loads on building muscle and strength: http://www.cbass.com/LightWeights2.htm Specificity comes more into play in building strength. As you say, to lift heavy weights you must lift heavy weights. You have to challenge your nervous system to lift heavier and heavier weights.
Muscles contract when they receive electrical signals from the brain. The signals speed through the spinal column to the motor neurons that trigger the muscle fibers involved.
Nathaniel Jenkins, now an assistant professor of exercise physiology at Oklahoma State University, conducted the research for his dissertation at Nebraska-Lincoln. His team randomly assigned 26 men to train for six weeks on a leg-extension machine loaded with either 30 or 80 percent of their one-rep maximum. Three times a week they lifted until they couldn't complete another repetition. As in earlier studies, the groups saw similar growth in muscle mass but a larger strength gain (about 10 pounds) in the high-load group.
To understand the role nerves play in building strength, the researchers supplied an electrical current to the nerves that stimulate the quadriceps muscle. This allowed participants to work at 100 percent of capacity, which cannot be achieved voluntarily. They then compared maximum force production with and without help from an electrical current.
By doing this, they were able to determine how close each participant's nerve cells were to achieving 100 percent activation, a measure known as voluntary activation.
After repeating this test at baseline, 3 and 6 weeks, they found that the low-load group increased their nerve capacity from 90.07% to 90.22%, or 0.15%. Low-load training barely moved the dial.
The high-load group on the other hand saw their voluntary activation jump from 90.94 to 93.29 percent, a rise of 2.35 percent. Almost 16 times more than the low-load group.
Jenkins acknowledged that low-load training remains a viable option for those looking to simply build muscle mass or avoid putting too much stress on joints. Still, he said, when it comes to building strength--heavier is better.
"I don't think anybody would argue (with the idea) that high-load training is more efficient," Professor Jenkins said. "It's more time-efficient. We're seeing greater adaptation. And now we're seeing greater neural [nerve cell] adaptation."
"The unique contributions of this study were robust measurements...used to elucidate any potential underlying neural factors," the researchers wrote in concluding their report.
Reported July 10, 2017, in the journal Frontiers in Physiology, you can read the entire study online. http://www.readcube.com/articles/10.3389/fphys.2017.00331
I beg to differ with Professor Jenkins. While he is correct that heavier is better for building nerve force and strength, that doesn't mean training heavy all the time is a good idea. It seems to me that a practical take away would be to train in the middle of the two extremes, using 50 or 60 percent of maximum, getting the best of both worlds in a more user friendly manner. Both low- and high-load training can be oppressive.
Another approach would be to cycle between the two extremes. Topping out at 40%, 60% and 80% (high reps to low reps) and then starting over would be more interesting--and keep you progressing.
Competitive lifters would, of course, want to spend most of their time in the high-load area. Still, Tommy Kono America's greatest weightlifter did low-load training from time to time. He also won four international bodybuilding titles.
Professor Jenkins' efficient might very well be another person's agony.
The key for long term success is to lift in ways that keeps you interested and motivated.
Understand the principle illustrated in the Jenkins study and put it to use in a manner that suits you.
Get Ripped on Whole Milk & Yogurt?
Q: Will full-fat dairy foods make you fat? Are they good for you?
A: The latest findings challenge the current dietary guidelines, which recommend limiting saturated fat and and skim over whole milk: http://www.cbass.com/dietaryguidelines.htm
A new study from Ireland found that full-fat dairy foods were associated with lower body fat and blood pressure, while reduced-fat milk and yogurt were associated with higher triglyceride levels and LDL-cholesterol.
The researchers confirmed that people who regularly consume low-fat milk and yogurt tended to have a higher intake of carbohydrate, which can elevate blood sugar.
Cheese was found to be neutral, not associated, negatively or positively, with cholesterol, body fat, or various markers of metabolic health.
Here's how Dr. Emma Feeney and her team of researchers from the University of Dublin arrived at those conclusions.
Using results from the National Adult Nutrition Survey, they divided 1,500 healthy Irish adults aged 18-90 years into patterns of dairy consumption, including whole milk, and reduced fat milks and yogurt. They also considered the overall diet in which the dairy foods were consumed. Finally, they then collected blood samples and measured body composition, blood pressure, and other markers of metabolic health.
Interestingly, the reduced-fat and yogurt group had the highest score on the Healthy Eating Index (fruit, vegetables, nuts, whole grain, vegetable fat, less red meat, and no trans fat), but higher triglycerides levels and total cholesterol. Those eating full-fat dairy rated lower on the Healthy Eating Index, but had less body fat and lower blood pressure.
“We have to consider not just the nutrients themselves but also the matrix in which we are eating them in and what the overall dietary pattern is, so not just about the food then, but the pattern of other foods we eat with them as well," Dr. Feeney told University College Dublin News and Opinion: http://www.ucd.ie/newsandopinion/news/2017/mar/13/eatinglotsofcheesedoesnotraisecholesterol/
Whole milk and yogurt in an overall healthy diet pattern would seem to be best. Unfortunately, few if any of the participants fit that pattern. It appears that skim milk drinkers were paying more attention to the dietary guidelines than those drinking whole milk. Time for a change in both groups?
The researchers summarized their conclusions:
This study applies
the concept of dietary pattern analysis to understanding dairy food
intakes and allows for the exploration of patterns of dairy food intakes
with differing fat contents. Here we show that clear and robust patterns
of dairy food intake exist in the Irish population. The results of the
tertile analysis suggest that dairy foods overall may offer potential
for weight management, particularly milk and yogurt. Dairy foods,
principally milk, may also have a role in the control of blood pressure,
and potentially in the management of blood glucose. Cheese consumption
was not associated with adverse lipid profiles, measures of body fatness
or other markers of metabolic health in this cohort. Although greater
overall dairy food consumption, driven mainly by milk and yogurt, was
associated with more favourable body weight status, no single pattern of
dairy food consumption stood out as having an overall healthier profile
in this reportedly healthy population sample, when actual patterns of
intake were examined. In fact, a ‘Reduced fat milks and yogurt’ pattern
was associated with higher triglycerides. As this cluster consumed a
lower percentage energy from fat, and a higher percentage energy from
grains, this suggests that the food intake pattern associated with low
fat high carbohydrate may be less healthy than other patterns. More
research is needed to better understand this result.
The study was published February 20, 2017, in the journal Nutrition & Diabetes and can be read online: http://www.nature.com/nutd/journal/v7/n2/full/nutd201654a.html?foxtrotcallback=true
Time to Decide
The weaknesses of the Irish study are that association does not prove causation and that food diaries leave no way to tell if foods were missed or excluded. Be that as it may, the evidence presented is likely to be the best we are going to get. There is no practical way to control what people eat over an extended period of time.
For what it's worth, I am an example of the benefits of consuming organic whole milk in the matrix of a balanced whole food diet. Except for the whole milk, I would score high on the Healthy Eating Index used in the study. I rarely eat junk food.
Switching to whole milk after decades of skimmed milk consumption had little or effect on my body fat level--but did push my HDL "good" cholesterol level off the chart, into the 80s for the first time. My other blood lipids and triglycerides remained low. My overall numbers were and are ideal.
For more details, see the results of my first visit to the Cooper Clinic after switching to whole milk: http://www.cbass.com/ClarenceBassCooperClinic14.htm and More HDL is Better: http://www.cbass.com/HDLCholesterolMax.htm
Finally, see Milk in the Middle: http://www.cbass.com/milk.htm (Note that butter, red and processed meats fall into the "harm" category. The green light on whole milk and yogurt does not extend to fatty and cured meats.)
If we wait for the experts to agree on the dairy fat issue, we are likely to be waiting a very long time. Many are heavy invested in low fat eating and are not likely to change their mind.
It's time to decide what's best for you.
October 1, 2017
Fat But Fit?
Q: Where do we stand on those who are fat but fit? Is there a price to be paid for being overweight if you are otherwise fit and healthy?
A: A new study from the University of Birmingham in the UK, followed 3.5 million people for 20 years, and found "fat but fit" to be a pipe dream for most people.
This dispute dates back to 1999, when Dr. Steven Blair, director of research at the Cooper Institute in Dallas, opined that being fat appears to be okay if you are also fit. "In the men who are overweight or obese, but also moderately or high-fit, we don't see much increase in the risk of dying," he told everyone willing to listen. I believe it would be fair to say that this became his signature issue.
Continuing to explore this controversial topic, Professor Blair appears to have refined his position. “Our data support the idea that interventions might be more urgently needed in metabolically unhealthy and unfit obese people, since they are at a higher risk," he reported from his perch at the University of South Carolina. "This research highlights once again the important role of physical fitness as a health marker,” he continued. http://www.sc.edu/news/newsarticle.php?nid=4574#.WTrm-NE2ycw
While the UK researchers would probably agree on the importance of physical fitness, they provide strong evidence that ignoring obesity is a bad bet.
Refining "fat but fit" to mean "metabolically healthy obese," the researchers classed any one who did not have coronary heart disease, diabetes, high blood pressure, or high cholesterol at the beginning of the study as "metabolically healthy obese." Taken from a large UK general practice database, the data did not include level of exercise or physical fitness. It stands to reason, however, that physically fit subjects are more likely to be among the metabolically healthy obese.
The UK researchers found that "metabolically healthy obese" individuals are 50% more likely to suffer heart disease than those of normal weight.
There are, of course, exceptions. There will always be people who remain healthy in spite of being obese. Being physically fit probably ups the odds.
Susannah Brown, senior scientist at the World Cancer Research Fund, told the European Congress on Obesity in Porto, Portugal, where the new study was reported, that being overweight or obese can increase the risk of 11 common cancers, including prostate and liver.
Dr. Rishi Caleyachetty, who led the new study, said that "the priority of health professionals should be to promote and facilitate weight loss among obese persons, regardless of the presence or absence of metabolic abnormalities."
The British Heart Foundation, the UK's biggest funder of cardiovascular research, said that the research helps to dispel an "age-old myth."
"The big bottom line is that you can't be fat and healthy forever - it's a ticking time bomb, and sooner or later it will lead to a disease or medical condition that is almost entirely preventable," Jacqueline Hooton wrote in The Independent on May 17, 2017. http://www.independent.co.uk/voices/fat-but-fit-myth-diet-fitness-obesity-complications-inclusive-a7741126.html
For many more details, read the coverage of the new study in The Guardian: https://www.theguardian.com/society/2017/may/17/obesity-health-no-such-thing-as-fat-but-fit-major-study
July 1, 2017
Step Up Exercise in Mid-Life?
Q: What’s the basis for your claim that exercise becomes more important with each passing year?
A: Until now, the basis was primarily my own experience. I see people younger than me who can barely pick up their feet and struggle to get out of a chair. Makes me thankful that I started exercising in my teens and never stopped trying to improve. A recent study in the Journal of Gerontology: Medical Sciences backs up my experience with hard evidence.
Researchers from Duke University gave 775 people, ages 30 to 100, simple tests of strength, endurance, and balance. They found that physical performance was worse with each decade. The decrement was about the same for men and women. Worsening physical performance was observed as early as the fifties for chair stands and balance and in the sixties for gait speed and aerobic endurance.
The association between performance and physical activity increased with age. As I've said many times, exercise became more important with each passing year.
“More physical activity was associated with better physical function.” Use it and you won’t lose it.
A good test is to see if you can stand on one leg for a minute. The researchers found that the average person in their 30s or 40s came close to the minute mark. People in their 50s made it just 45 seconds. For people in their 60s, it was 40 seconds; for those in their 70s, it was 27 seconds, and for over 80, it was 12 seconds.
“Typically, functional tests are conducted on people in their 70s and 80s, and by then you’ve missed 40 years of opportunities to remedy problems,” senior author Miriam C. Morey, PhD, told Duke Health.
“Our research reinforces a life-span approach to maintaining physical ability—don’t wait until you are 80 years old and can’t get out of a chair,” lead author Katherine S. Hall, PhD, added. “The good news is, with proper attention and effort, the ability to function independently can be preserved with regular exercise.”
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If you aren’t exercising regularly, you might begin by putting movement into your day. Simply get up and move around every hour or so; you'll be surprised how much better you'll feel and perform. See my article Get Up and Move: http://www.cbass.com/getupandmove.htm
In that article I refer to my “Morning Motion” routine. You might want to give that a try. I start my day by moving every part of my body, beginning by opening and closing my hands, and moving on to my wrists, elbows, shoulders, and then my torso and lower body. Nothing complicated; I make changes regularly as new moves occur to me. I pay particular attention to my lower back and knees, starting out by moving without resistance and moving on free squats, and then rapidly thrusting upward on my toes. I always include a series of balancing movements on one leg and then the other.
The whole routine takes about 10 minutes. Use your imagination and move your body in ways you enjoys. See my article on balance http://cbass.com/Balance.htm
For tips on gradually introducing exercise into your life, see my FAQ on New Year’s resolutions: http://www.cbass.com/Faq(8).htm (scroll down)
The key is to find forms of exercise you would enjoy doing regularly. The possibilities are practically endless. See my book Take Charge http://www.cbass.com/PROD08.htm
Stay active and thrive.
June 1, 2017
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