What is every 2 year old's favorite question?  "Why?"  Inquisitive toddlers have a lot to say and even more to ask.  Why do you eat that?  Why do you run?  Why this?  Why that?  They are like little scientists wanting to know why their world works the way it does.  They want to know the reason behind something and "just because" is not a good enough answer for them.  It is this kind of inquisitiveness that we should always nurture within ourselves allowing us to remain the scientists that we start out as.

The reason this comes to mind is the staggering amount of information (and misinformation) that is now accessible to so many people through the creation of the world wide web.  It is open to anyone (like myself) who wants to share knowledge, opinions, expertise, etc. to the masses.  Unfortunately, this is a double edged sword.  On the one hand, you have more access to excellent resources on any topic you can possibly think of.  On the other hand, you have the same access to questionable resources and information about those same topics which is very concerning.  Since this is the case, asking "why" like a two year old to make sure something makes sense will prove to be very beneficial instead of just accepting something at face value.

This is most definitely the case with the health, fitness, rehab and nutrition worlds.  There is no shortage of dubious information, outrageous claims and downright zealotry about health and the human body.  Perhaps I am becoming more critical of what I read on the internet as I continue to practice as a physical therapist and do my best to keep up with current evidence and literature but it seems as if the frequency of questionable (and just plain wrong) articles and headlines I come across on a daily basis is increasing.  This becomes incredibly dangerous with social media's capacity to disseminate information so you get all sorts of myths (and truths, thank goodness) spreading like wildfire.  Despite countless individuals and organizations doing their best to discount bad information, beliefs continue to persist and get in the way of facts.  There also continues to be this idea that "But I read something or I saw something online" equals truth.  It reminds me of this commercial:

Not everything on the internet is true.  Somehow it has become the media's job to sell stories and latch on to hot topics rather than report and publish legitimate information as objectively as possible.  Bloggers (like me), writers and "experts" among many others are trying to gain visibility within their respective fields in a very crowded health landscape and although the majority of intentions are good, it still does not make something true.  Just because everyone is posting on Facebook does not make something true.  And just because someone has some letters after their name also does not make something true.  With all of this in mind, I strongly encourage you to read and listen with caution and to question everything (including me) as a two year old would.  Why?  Does that make sense?  If I don't sit straight all of the time, I'll develop low back pain?!  Gluten is the devil?!  (I'll answer those last two for you: No and no.)  Take a few minutes to double check what you read and listen to, and seek out credible and reliable sources so that you can truly make healthy and informed decisions.

Like that old saying goes, if it's too good to be true, then it probably is.

Knowledge = Power; Share The Power:

A couple of weeks ago I came across two things that really hit home and gave me one of those "aha" moments.  One was an article on a blog I follow and the other was someone's "testimonial" for her current fitness choice.  The common theme between the article and testimonial is that movement rocks!  So often we take for granted the ability to move without any limitations and do whatever we need or like to do.  It usually takes an injury or physical limitation to remind us how awesome it is to move or a change/increase in activity level to remind ourselves what we've been missing.  Either way, the conclusion from both of these scenarios is the same with regard to movement.  As the old milk commercials used to say, it does the body (and mind) good.  On top of that, I would add that it is addicting (in a good way).

In the article, entitled "The Privilege of Movement", the author, Neghar Fonooni, reminds us that movement is a choice.  In it she says "It's not an obligation or a begrudging requirement - it’s something to be eternally grateful for.  Movement is a privilege, and one which we should honor daily...[by] making fitness enrich your life, not detract from it."  Now fitness means a lot of different things to a lot of people as it should.  That's the beauty of it since there is no one size fits all definition.  At its core, however, I would argue that a major component of fitness means being able to move independently and satisfy your physical goals without any limitations rather than some number or image you are supposed to adhere to.  Whether you accomplish that by going to a gym, heading to your local yoga studio or hiking with your dog, in some ways it does not really matter as long as it is something you like to do.  The choices are endless.  As long as it remains a positive element in your life and continues to enhance it then at some level you are probably addicted to movement without even knowing it.  Now it's still important to mix things up and keep your body and mind engaged so that you don't get stuck in a rut and lose interest in making that choice to move altogether.  We all know the outcomes when you choose not to keep moving and they are not pretty.

The "testimonial" was a bit of a different flavor in that it perfectly exposed the importance of movement on the brain.  I am not the first person to make the connection of fitness/movement with changes in the brain and I will certainly not be the last either.  There are plenty of researchers who have beaten me to the punch but after reading the next two quotes, it is quite obvious and you won't have to bore yourself with dry scientific publications.  It began with, "I looked in the mirror and didn't know who that was. I was tired, weak, sad, embarrassed of my body and just felt plain old ugly."  After a recent change in her activity level and choosing to make movement and fitness a priority, this same person now says, "I feel strong! I have tons of energy! I feel positive about myself and what I can do, in and out of the gym. My kids think of their mom as strong! I am happy."  There has been a total transformation in her brain and mindset thanks to the power of movement and fitness.  It is quite clear from this example that physical fitness and mental health go hand in hand.  And those last three words are awesome!  Happiness is pretty easy to get addicted to!

I could keep adding more anecdotes, articles and research studies reiterating the same ideas but that would be very boring.  Why not be an experiment of one and make the choice to find the right kind of addiction to enrich your life?

You can also check out Ben Bruno for the article that inspired this post as well as find great information on training and programming for your movement, fitness (and brain) goals.

Knowledge = Power; Share The Power:

Perhaps.  At least it is for mice as of a 2011 study. (1)  It is not a perfect connection to make to humans but the conclusions from this particular study are not farfetched either.  To this day, it remains a favorite study of mine because the implications of it involve one of my favorite things: Dark Chocolate.

At this point, it is no secret that dark chocolate can provide a number of health benefits.  Some of these include being an excellent source of antioxidants and several minerals like iron, magnesium and copper as well as being linked to lowering the risk of heart disease, improving HDL and LDL values, and improving blood flow. (2)  Flavonoids (or flavonols), chemical compounds found in plants, the cocoa plant in this case, have been implicated in a number of studies as being critical to many aspects of human physiology including the aforementioned examples.  A particular flavonol called (-)-epicatechin (known as 'minus' epicatechin), which is present in dark chocolate, has garnered attention over the last several years and was the target of interest in the 2011 study involving mice.

Twenty-five mice were randomly split into four groups: 1) water only, 2) water and daily exercise, 3) (-)-epicatechin only, and 4) (-)-epicatechin and daily exercise.  All of the mice performed a treadmill test on day 0, underwent their assigned intervention over the course of 15 days and were tested again on the treadmill.  The group that received (-)-epicatechin and daily exercise showed significant improvements in all outcomes but boasted an almost 50% increase in distance compared to their initial treadmill test.  In comparison, neither of the water groups showed improvements on the treadmill test and actually performed worse overall compared to their initial test.  A surprising outcome was the group that received (-)-epicatechin only also performed extremely well.  Their treadmill test was nearly as good as the group who exercised.

Upon further examination of the two (-)-epicatechin groups, it was discovered that there was a significant increase in capillarity (blood vessels) in skeletal muscle as well as an increase in number and size of mitochondria (the energy factories of cells) in skeletal and cardiac muscle.  As with the treadmill test, the group that received (-)-epicatechin and exercised showed the most change but again, even (-)-epicatechin only showed significant changes as well compared to the water groups.  In short, this means the mice were able to deliver more blood (read: oxygen) to their muscles and produce more usable energy than their counterparts who only received water.  It is no wonder then that they were able to run longer and farther, and fatigue at a slower rate.

So what conclusions can we draw from this?  Considering the similarities of skeletal and cardiac muscle among mammals, it is entirely plausible that (-)-epicatechin found in dark chocolate could have the same effect on humans as it does on mice.  Clearly the greatest benefit was coupled with exercise but even that wasn't necessary to gain results.  Since both groups showed significant improvements, there doesn't appear to be a major advantage of timing your dark chocolate intake.  As long as you eat it daily, you will have consistent levels of (-)-epicatechin in your system. 

It is important to note that all dark chocolate is not created equal.  If you plan on adding this to your diet, dark chocolate with higher percentages of cocoa (cacao) will have more (-)-epicatechin so you may want to look for 70-75% or higher depending on your tastes.  The only downside that I foresee is that this does not mean you can eat dark chocolate until your heart is content, which is a true shame.  The levels administered to the mice would equate to rather small portions, on the order of a half to a full square per day for humans, in order to have the same desired effect.  Unfortunately, more is not better in this case.  This type of self control and will power may be difficult for some but the potential benefits could really prove to be performance enhancing.

What is not known is whether these types of physiological changes plateau after a certain amount of time or if it would even have an effect on those who are already at a higher level of fitness.  Either way I'll take my chances since dark chocolate is absolutely delicious to begin with and at the very least I can take advantage of the other health benefits it has to offer anyway.  It sounds like a win-win to me.

References:

1. L. Nogueira, I. Ramirez-Sanchez, G. A. Perkins, A. Murphy, P.R. Taub, G. Ceballos, F.J. Villarreal, M.C. Hogan, M.H. Malek. (-)-Epicatechin enhances fatigue resistance and oxidative capacity in mouse muscle. The Journal of Physiology. 589.18. 2011 pp 4615-4631.

2. Gunnars, Kris. "7 Proven Benefits of Dark Chocolate." Authority Nutrition. 13 June 2013. Web. 11 June 2014.

Knowledge = Power; Share the Power:

After graduating from my physical therapy program I took it for granted that the general public truly knows what physical therapy is.  I assumed (first mistake!) most people knew the basics since it is a common and relatively mainstream intervention for injuries...or so I thought.  It also seems like most people have sought care from a physical therapist or know someone that has and yet there still seems to be a lot of misinformation out there.  Now that I've worked with hundreds of clients and have been talking to many people within my community as I build my practice I have found that there is a huge spectrum of knowledge about what physical therapy is and who it can help as it relates to an outpatient style clinic.

Here are some of my favorite thoughts I've heard over the past several years about physical therapy:
    You only work with people after they've had surgery.
    It's just a bunch of exercises.
    Chiropractors take care of the spine, you do everything else.
    You use cool gadgets like ultrasound and electrical stimulation.
    I thought physical therapy is hot/cold packs, massage and a couple of exercises.
    It's kind of like personal training, right?
    This is PT?  This is a lot different than I expected!

While there is some truth to a few of these statements, they are pretty amusing if you ask me because there is so much more to physical therapy than these ideas.  I especially like the last one.

The most common definition(s) you will see for physical therapists is something along the lines of someone who is licensed to evaluate, treat and/or prevent pain, disability, injury, movement dysfunction, disease and functional limitations using physical, mechanical or chemical means including but not limited to therapeutic exercises, mobilizations and/or manipulations, and modalities (cold/hot packs, ultrasound, electrical stimulation, etc.).  The definition I prefer to use is physical therapists are neuromusculoskeletal experts (not to be mistaken with gurus), movement educators and performance enhancers (the legal kind).  This means we are specialists in the human body, how it moves and how to address issues like pain, injury, strength deficits, dysfunction, disease progression and performance optimization among many others.  No matter what exact definition you use for physical therapy they are very open ended which is great because it means we can work with virtually anyone.

Through our training we have the knowledge to analyze and understand each component of the neuromusculoskeletal system including the brain, spinal cord, nerves, muscles, bones, joints, tendons, ligaments and connective tissues.  More importantly, we understand how each of these components interacts with each other to influence and allow the human body to function.  In order to address any and all of these components and their impact on the whole system, we have an extremely diverse skill set at our disposal.

To begin with, we perform a thorough physical examination and assessment as it relates to a client's specific situation and complaints.  We have a wide variety of tests and measures that reveal valuable information which is interpreted to develop a diagnosis, a treatment plan and a prognosis.  As far as treatment is concerned there are several interventions we can choose from in our skill set.  The specific mix of interventions will vary from clinician to clinician and from client to client depending on each individual case.  They include:

Education: This is quite possibly the most important part of treatment.  First and foremost, it is our job to listen so that we know what to teach and explain.  It is our job to teach anatomy and physiology, pain science, biomechanics, relaxation techniques...whatever is necessary to help our clients understand their bodies better.  It is our job to dispel myths and fears so that the brain and body isn't in a constant state of stress and exacerbating any issues.  It is our job to develop a plan and strategies for our clients so that they are able to help themselves and reach their goals.

Manual Therapy: More often than not, physical therapists will be using their hands at some point.  It is here that you will see many different philosophies and schools of thought.  It is impossible to list all of the manual therapy variations but some of the general categories they would fall under are soft tissue mobilization like trigger point therapy, various styles of massage, active release technique and instrument assisted soft tissue mobilization to name a few, nerve mobilizations, joint mobilizations including chiropractic/thrust manipulations (depending on the state; legal in NY), stretching, and facilitation of movement to retrain motor control and movement quality.  How each of these is performed and accomplished will differ from clinician to clinician.

Exercise: This can be broken up into two subgroups even though they overlap quite a bit.  The first being neuromuscular re-education which is a fancy way of saying movement retraining.  Think balance, control, reaction and technique.  Single leg balance is a perfect example of an exercise that would be considered neuromuscular re-education.  The second group is therapeutic exercises and functional activities.  Traditionally you can think of strength training, flexibility and range of motion exercises fitting into this category as well as activities of daily living like walking, stair climbing and carrying objects.  You would obviously need good technique and control in order to accomplish these more traditional types of tasks.  With any of these exercises, what sets physical therapy apart is they are prescribed and progressed very specifically to achieve certain goals that can be tested and measured.  It is much different than a general fitness plan.

Modalities: This is where the gadgets can be listed like electrical stimulation (my favorite), ultrasound and mechanical traction.  It would also include things like heat and cold therapy.  In many cases, these passive modalities are used for pain control which is very helpful and a good adjunct to treatment but they will rarely ever resolve the underlying issues.  That is what the education, manual therapy and exercise is for.  There are other times when modalities are used therapeutically like electrical stimulation to improve activation (and strength) of the quadriceps after knee surgery or cold therapy to reduce swelling and inflammation.

Long story short, physical therapy is an extremely versatile and comprehensive solution to issues related to the neuromusculoskeletal system.  You might even consider physical therapists to be jacks of all trades as we have a wide array of skills to choose from in order to help our clients reach their goals.

So if you have neck or back pain, we can take care of you.  If you just had surgery, come on in.  If you feel like you have balance issues, we've got that covered.  If you can't play your favorite sport, we would love to fix that.  If you have pain/chronic pain and you can't figure out why, we'll figure out why.  I could keep going.  As you can see, physical therapy is an excellent first option if you have pain, suffered an injury, have functional limitations, etc. and you want to resolve these issues so that you can move better, feel better and live better.

Knowledge = Power; Share the Power:

If you read Parts I, II, and III, this topic got into some heavy material which is important to be aware of but there is also some good news out there which was touched upon in each post.  That good news can really be summarized in one word: MOVE.  Something I find myself sharing with my clients is a very simple analogy I wish I could take credit for but Sir Isaac Newton beat me to it with his first law of motion: A body at rest stays at rest and a body in motion stays in motion.  Granted he was talking about physical objects but it is amazing how much this relates to the dynamic organisms human beings are and their overall health, well being and mobility.  And based on the current body of research, if you move more, you tend to live longer.  That is pretty darn good news!

Avoiding sitting for prolonged periods of time and/or adding movement into your daily routine can be accomplished in any number of ways.  You are truly only limited by your imagination.  It could be simple things like taking 1-2 minute walking breaks each hour at work, taking the stairs instead of the elevator/escalator, parking farther from your destination, etc.  Each of these ideas often seems trivial in isolation but it is amazing what happens cumulatively over weeks, months and years, and they can become normal routines you don't even have to actively think to do.  (Your car will probably have less dings in it too from car doors and grocery carts...you're welcome.)

The more challenging change is actually engaging in more sustained activities instead of sitting because that involves time and we all know time is precious.  However, if you take an honest look at your schedule you can probably find at least 30 minutes during the day to engage in some type of activity.  You may have to tweak your schedule and routines a bit at first but again, sticking with good habits becomes a new routine.  Instead of passively watching television, actively watch your favorite shows by incorporating some simple bodyweight exercises (pushups, squats, lunges, etc.), stretching or matwork style routines (Pilates), or if you really want to get your heart rate up, shadowboxing (one of my favorites).  Or better yet, trade an hour of television altogether for an activity you like to do.

The easiest thing you can do and a great starting point is highlighted in this short video which addresses a few different things but relates very well to this topic.

The moral of this story is not to cause a panic or to suggest strict rules to live by because that would be unnecessarily extreme.  Instead it is meant to be food for thought so that you can take advantage of this information and incorporate it into your life as you see fit.  You know your schedule, you know your life and how you want to live it.  Hopefully this information can help you optimize the ways in which you live your life so that you can be a happy, healthy and mobile person for a long time coming.

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In this latest installment, I will summarize a couple of studies that address sitting time and associated health risks.  You can catch up on Parts I & II if you missed those the first time around here and here.

At this point there is a growing body of literature studying different outcomes, disease progressions and chronic conditions as they relate to sitting and they all have the same conclusions.  Prolonged sitting essentially has a dose response outcome: the more sitting you do, the more likely you are to suffer from chronic health issues and a shortened life span.  In many studies, these results are independent of other factors like diet and activity level which is even more concerning.  Even if you get your 5 mile run in everyday but you sit for 8 hours, it turns out there is still an increased risk for chronic health issues.  That being said, things like diet, exercise and sleep have profoundly positive effects in other ways so be sure to keep those good habits in your life.

Wilmot et al performed an analysis and summary of 18 moderate to high quality studies in 2012 all related to sedentary lifestyle and risk of diabetes, cardiovascular disease, and cardiovascular and all-cause mortality. (1)  In order to avoid discrepancies in analysis because of differing methods in each study, they compared highest sedentary times to lowest.  It is possible that this could skew their results by using the extremes but even taking that into consideration their results are striking:
112% increased risk of type II diabetes
147% increased risk of cardiovascular disease
90% increased risk of death by cardiovascular disease
49% increased risk of all-cause mortality

In 2010, Alpa et al looked at leisure time spent sitting and all-cause mortality rate. (2)  They compared sitting more than 6 hours vs. sitting less than 3 hours during leisure time and did not include occupational sitting time over the course of 14 years for over 120,000 people participating in the study.  Independent of physical activity women who sat for more than 6 hours had a 40% higher death rate than those who sat for less than 3 hours and men had an almost 20% higher death rate.  When combining sitting time with low physical activity, those numbers jump to 94% and 48% respectively!  Now you can imagine what happens if you add sitting time at work to these leisure numbers.  Conversely, those that sat less than 3 hours for leisure and were physically active had lower death rates.

I could continue to highlight other studies like the amount of time watching television and cardiovascular disease or the risk of obesity and prolonged sitting but I think it is quite clear already what the overall conclusion is.  Whether someone has to sit for work or chooses to sit for many hours during his/her leisure time (or both), that alone is a risk factor for his/her health and well being.

By pure coincidence, I came across an infographic basically addressing the same issues.  It is a bit sensationalized but even so it sheds some light on this important issue.  You can check it out here.

Wishing you many more healthy years before Mr. Reaper knocks on your door!  Then again, you may have some knocking on your door with much more reasonable requests of tricks or treats in the near future!

References:

1. E. G. Wilmot, C. L. Edwardson, F. A. Achana, M. J. Davies, T. Gorely, L. J. Gray, K. Khunti, T. Yates, S. J. H. Biddle. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. November 2012, Volume 55, Issue 11, pp 2895-2905.

2. Alpa V. Patel, Leslie Bernstein, Anusila Deka, Heather Spencer Feigelson, Peter T. Campbell, Susan M. Gapstur, Graham A. Colditz, Michael J. Thun. Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults. American Journal of Epidemiology. Volume 172, Issue 4, pp. 419-429.

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