Are you looking for an all-natural, environment-friendly alternative to your medication to control blood pressure, cholesterol, or blood sugar?  Or one that is relatively inexpensive with very few side effects?  An almost forgotten medicine, one that our pre-Industrial Revolution ancestors took in relatively large doses as they conquered life's hardships, will be finding its way onto your physician's prescription pad as the #1 "drug" of choice.  What is this wonder medication?  Exercise - nature's medicine.  Pure and simple.

     A nationwide initiative, "Exercise is Medicine," launched by the American College of Sports Medicine in conjunction with the American Medical Association, is underway.  This campaign is devoted to making it a standard practice that your physician review your current level of physical activity, provide counseling on exercise, and/or refer you to a certified health and fitness specialist for an appropriate exercise program meeting your needs.  

     The premise of this movement is that exercise really is medicine.  Scientific evidence has shown that increasing your physical activity level effectively treats and prevents many chronic health conditions such as heart disease, high blood pressure, obesity, diabetes, and certain forms of cancer (colon and breast).  For a list of exercise-related health benefits, view my March 5, 2009 posting "Why Exercise."  

     Implementing exercise as a first line treatment choice will not only improve public health in general, but has a potentially significant economic impact as it could result in dramatic decreases in long-term health care costs.  Below is a comparison of the cost of exercise versus the cost of physical inactivity.  

Cost of Exercise for One Year:*

• Pair of running/walking shoes - $90.00
• Exercise shorts - $36.00
• Exercise top - $30.00
• Exercise socks - $8.50
• Dirt road - free

Total cost of exercise for one year:  $164.50

Cost of Physical Inactivity for One Year:*

• Cholesterol medication (simvastatin) - $336.00/year ($28.00/month)
• Triglyceride-lowering medication (fenofibrate) - $780.00/year ($65.00/month)
• Blood pressure medication (lisinopril) - $156.00/year ($13.00/month)
• Blood sugar medication (metformin) - $228.00/year ($19.00/month)
• Co-pay for sick visit at doctor's office - $20.00/visit

*Values are estimates.  Actual values will vary based on type and brand of product and prescribed dosage.

To learn more about the "Exercise is Medicine" initiative and how you and/or your physician can get involved visit www.exerciseismedicine.org.

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions. 

Resources:

Epocrates (www.epocrates.com)

Road Runner Sports (www.roadrunnersports.com)

     With the onset of warm weather comes the increased risk of exercise-related dehydration.  Sweating, a protective mechanism of your body, regulates your body temperature.  As your sweat evaporates, heat is dissipated.  This prevents your core body temperature from rising to dangerously high levels.  The rate at which your body sweats is dependent upon the intensity and duration of the exercise, environmental conditions, acclimatization, type and amount of clothing worn, individual biological differences, and your hydration status before exercise.

     Dehydration can result if fluid consumed does not match fluid lost from exercise.  When you are dehydrated your risk for heat-related illnesses increases and your exercise performance becomes impaired.  Physiologic function of the body starts to be compromised when 1%-2% of body weight is lost as a result of fluid loss.  Your risk for heat-related illnesses increases when 3% or more of your body weight is lost as a result of fluid loss.  If you are well-hydrated before exercise, it could take only one hour of exercise for this to occur, sooner if you are dehydrated from the start.

     An understanding of the signs and symptoms of dehydration is important in order for you to take appropriate action when they occur.

Signs and Symptoms of Dehydration

• Thirst
• Headache
• Nausea
• Vomiting
• Dizziness
• Cramps
• Weakness
• Chills

     You can reduce or prevent the likelihood of becoming dehydrated by following certain guidelines.  These include adhering to a fluid replacement schedule and incorporating steps to optimize your fluid replacement.

Fluid Replacement Schedule

Pre-Exercise

• Drink 17-20 fluid ounces of water or sports drink 2-3 hours before beginning exercise
• Ingest 7-10 fluid ounces of water or sports drink 10-20 minutes before exercise

During Exercise

• Ingest 7-10 fluid ounces every 10-20 minutes

Post-Exercise

• Drink approximately 16-20 fluid ounces of water or sports drink for every pound of weight lost from the activity within 2 hours after completing your exercise session

     If you find it difficult to adequately rehydrate, there are some tactics you can follow to optimize fluid replacement.

Steps to Optimize Fluid Replacement

• Carry water bottle with you while you exercise
• Choose a water bottle with measurement markings to keep track of the amount of liquid consumed
• Choose drinks that are palatable, such as flavored water or sports drink

Characteristics of Fluid to be Consumed

• Palatable
• Cool.  The ideal temperature range of the drink is 50-59 degrees Fahrenheit (10-15 degrees Celsius)
• Post-exercise drink should include a carbohydrate source, especially if your session lasts more that 45 minutes, to replenish glycogen (energy) stores 
  
• Contains electrolytes, such as sodium chloride (0.3 - 0.7 g/L), to offset loss from sweat and to reduce your risk for conditions associated with electrolyte imbalance (muscle cramps) - this is particularly important if exercise lasts longer than 4 hours and during the initial days of warm weather when your body hasn't yet been acclimated.

Drinks to Avoid

• Caffeinated and alcoholic beverages which can increase fluid loss through increased urine output
• Carbonated beverages which may lead to a "full" sensation causing you to decrease your fluid intake
• Drinks with carbohydrate concentrations that are greater than 8% are not recommended to drink during exercise because they interfere with stomach emptying and intestinal absorption
  

Resources

Journal of Athletic Training, 2000:35(2):212-224; "National Athletic Trainers' Association Position Statement: Fluid Replacement for Athletes," Casa D.J. et al.

Track Shack - Sports Nutrition Developed by the Gatorade Sports Science Institute www.trackshack.com

     Can Vitamin D enhance exercise performance?  Vitamin D has been a topic of discussion lately as experts debate whether or not the current recommended daily intake is sufficient to meet the needs of the body.  Vitamin D is a fat-soluble vitamin (can be stored in body fat) and a hormone (conversion occurs in the skin to be sent to the liver and kidneys for further conversion to a useable form in other areas of the body).  Our primary source of Vitamin D comes from the sun.  Fortified foods, such as milk, are the next prominent source.

     Vitamin D is "inactive" and in order for it to become "active", and useable by the body, it has to go through hydroxylation.  This process starts in the liver where Vitamin D becomes 25-hydroxyvitamin D (25(OH)D).  Further conversion occurs in the kidneys where it becomes 1,25-dihydroxyvitamin D (1,25(OH)2D).  Adequate blood levels of Vitamin D, 40-100 nmol/L, are determined by measuring blood levels of 25(OH)D.  Modern day man's habits, such as sunscreen use and increased participation in indoor activities, have reduced our exposure to the sun's Vitamin D producing rays.  This, in turn, increases the risk for becoming deficient.  In order to achieve sufficient levels for body systems to function, dietary intake of Vitamin D needs to be increased to compensate for the decreased sun exposure.

     Adequate levels of Vitamin D are needed by the body to promote calcium absorption, bone health and muscle function, to maintain normal blood levels of calcium and phosphorus, for homeostasis of the nervous system, to regulate cell production, and for protein synthesis.  Vitamin D's role in enhancing exercise performance has been recently speculated.  An extensive review of the literature by Cannell et al., published in the May 2009 issue of Medicine & Science in Sports & Exercise, suggests that it can for individuals who are Vitamin D-deficient, especially for those who participate in indoor athletics (gymnastics) or who live at the northern latitudes.  The extra stress that exercise places on the metabolic pathways in which micronutrients, such as Vitamin D, play a role may indicate that there is a greater need for, and hence a greater intake required, of Vitamin D.  In addition, athletes are more likely to engage in dietary practices that limit Vitamin D intake, such as restricting total energy consumption and eliminating one or more of the food groups.

     Cannell et al.'s review of the literataure discovered that many studies have shown exercise performance to be seasonal.  That is, individuals perform at their best when 25(OH)D is at its peak in the late summer (when sun exposure has been greatest).  Exercise performance then starts to decline in early autumn as sun exposure decreases, and subsequently 25(OH)D levels decline.  In late winter, when sun exposure is very limited, and 25(OH)D levels are at their lowest, so is athletic performance.  This phenomenon suggests adequate levels of vitamin D are needed for optimum performance.  Cannell et al. also cited literature that indicated Vitamin D has been shown to increase the size and number of Type II (fast twitch) muscle fibers.

     Do these findings mean that everyone who wants to enhance their physical performance should start supplementing with Vitamin D?  No.  If you consume a nutritionally adequate, well-balanced diet, your Vitamin D levels should be sufficient to meet the demands of exercise.  There is no evidence that Vitamin D levels above normal will increase exercise performance.  In fact, taking mega-doses of Vitamin D can lead to toxicity.  Scientific findings only indicate that individuals who are Vitamin D-deficient can benefit from increased sun exposure and dietary intake or through Vitamin D supplements.

     If you think you may be Vitamin D deficient you should consult your physician to have your blood levels tested.  You may also want to consider having your diet reviewed by a registered dietician who has experience counseling active and athletic individuals.

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources:

Medicine & Science in Sports & Exercise, Vol. 41 No.5 May 2009, "Athletic Performance and Vitamin D,"pp. 1102-1109.  Cannell, JJ et al.

ACSM's Health & Fitness Journal Vol. 12, No. 5 September/October 2008, "Vitamin D and Health: Do We Need More Than the Current 

DRI?," pp. 34-36. Volpe, S.L.

The Encyclopedia of Healing Foods, Murray M., Pizzorno, J., and Pizzorno L.

American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada Joint Position Statement "Nutrition and Athletic Performance," Medicine & Science in Sports & Exercise, pp. 709-731.

     The rising numbers of overweight and obese children is of great concern.  Obesity threatens the child's quality of life both in the present and for the future.  Health problems that were once considered to occur only in adulthood, such as type II diabetes and high blood pressure, are showing up in overweight and obese children.  Furthermore, individuals who are obese in childhood tend to become obese adults.  

     Improving diet along with increasing levels of physical activity can lead to weight loss and better health for the overweight/obese child.  Aerobic exercise programs, however, may not be well-tolerated by this population, thereby interfering with compliance.  Factors that contribute to poor tolerance for the overweight/obese child include: increased thermal stress during the activity due to the excess body weight, increased risk of musculoskeletal injury, increased intensity of weight-bearing exercise as a result of having to "carry" the extra weight compared to their leaner peers, and a greater perceived level of difficulty of exercise due to the latter.

     Strength training has been suggested as an alternative to traditional aerobic exercise interventions for the overweight/obese child.  One reason is that these children tend to have greater strength due to their larger body mass than their leaner counterparts.  This ability can boost the overweight/obese child's self-confidence, enhancing compliance to the resistance training program. 

     To determine if resistance training is in fact an acceptable alternative to aerobic exercise interventions for the overweight/obese child, McGuigan et al. conducted a study which was published in the January 2009 issue of Journal of Strength and Conditioning Research that looked at the role resistance training played in altering body composition in this population.  Children who were between the ages of 7-12 years and classified as either being overweight or obese by means of Body Mass Index (BMI) values participated in an 8-week resistance training program.  Dietary and physical activity levels, body composition, strength, power, and muscular endurance were measured at baseline and at the end of the 8-week program.

     The researchers found that a significant decrease in absolute body fat percentage (2.6%) and a significant increase in lean body mass (5.3%) occurred as a result of the 8-week resistance training program.  The subjects also experienced significant improvements in their levels of strength and power.  No subjects complained of muscle soreness or injury as a result of participating in the strength training program, suggesting that the subjects tolerated the activity well. 

     The researchers concluded that participation in a resistance training regimen is an acceptable alternative to aerobic-based exercise programs for children who are overweight or obese.  Such a program not only improves body composition, strength, and power in this population, but may yield a greater compliance rate because it is tolerated well and can have a positive effect on self-esteem.

     There are some safety issues to consider before initiating a strength training program for the overweight/obese child.  First, it is imperative that the child receive proper instruction and supervision while performing strength training exercises, preferably from a qualified fitness professional.  Second, the child should use equipment that properly fits his/her body size to ensure proper form is maintained throughout the activity.  Third, it is recommended that the program include 8-15 repetitions of moderate-intensity for 1-3 sets of each exercise.  Following these safety precautions can reduce the risk of injury.

Note:  Before beginning an exercise program, your child should have a physician's approval, especially if your child is overweight/obese or has been diagnosed with a condition such as high blood pressure or diabetes.

Resources

Journal of Strength and Conditioning, vol. 23(1), January 2009, pp. 80-85, "Eight Weeks of Resistance Training Can Significantly Alter Body Composition in Children Who Are Overweight or Obese," McGuigan, M., Tatasciore, M., Newton, R., Pettigrew, S.

ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription, Sixth Edition

     Aerobic exercise has long been considered the "power house" when it comes to yielding health benefits, especially in terms of modifying risk factors for cardiovascular disease.  However, resistance (strength) training is quickly climbing the ranks, proving it has a role in a comprehensive exercise regimen to promote better health.  Its positive effects on muscle strength, endurance, and power in the general healthy population have been well established.

     In the past, its safety for those at risk for or who have established cardiovascular disease has been questioned.  This mindset has changed in recent years.  Resistance training is now accepted by health professionals to be part of a well-rounded exercise program for this population.  Benefits include: enhanced muscular endurance and strength, improved capability of performing daily activities, promotion of independence, and increased self-confidence.  

     The effects of resistance training on obesity and diabetes, two risk factors for cardiovascular disease, has been less well understood.  A study that reviewed this area of interest was published in the March/April 2009 issue of the Journal of Cardiopulmonary Rehabilitation and Prevention.  Researchers obtained literature that was published during 1950-2008 from the MEDLINE Plus/Ovid literature search system to determine the effects of resistance training on obesity and diabetes.  Findings of the review substantiate the positive role that resistance exericse plays in the management of blood sugar and obesity.

Effects of Resistance Exercise on Blood Sugar Control

• Enhances insulin sensitivity
• Improves glucose tolerance 
  
• Decreases levels of glycated hemoglobin concentrations (high levels of glycated hemoglobin are associated with high blood pressure, heart disease, and kidney failure in individuals with metabolic syndrome and diabetes)
• Effects of resistance exercise appear to be related to changes in the trained muscle as opposed to an increase in muscle size 

Effects of Resistance Exercise on Obesity

• Improves overall body composition in both men and women
• Increases resting metabolic rate
• Decreases body fat, including abdominal and visceral fat (excess levels of these in particular have been associated with an increased risk for developing the metabolic syndrome)
• Increases muscle size and strength which leads to a greater tolerance for longer durations of aerobic exercise, thereby increasing the caloric expenditure of the activity 

     The researchers of the review conclude that resistance training appears to aid in the management of diabetes and obesity and, therefore, should be part of a comprehensive exercise program.  Resistance exercises do not have to be limited to the use of machines and/or dumbbells but can include resistance bands/tubing, medicine balls, and even soup cans or milk jugs.  The federal government's 2008 Physical Activity Guidelines for Americans recommends that apparently healthy adults and older adults perform moderate- to high- intensity muscle strengthening exercises for the major muscle groups of the body at least twice a week. 

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources

Journal of Cardiopulmonary Rehabilitation, vol 29(2), March/April 2009, pp. 67-75; "Resistance Training in the Treatment of Diabetes and Obesity:  Mechanisms and Outcomes," Tresierras, M., Balady, G.

2008 Physical Activity Guidelines for Americans (www.health.gov/paguidelines)

ACSM's Guidelines for Exercise Testing and Prescription, Eighth Edition

     Proper nutrition and aerobic endurance are typically equated with the achievement of optimal health, often at the expense of other factors that can promote well-being.  We sometimes overlook that the body is made up of systems that are interdependent.  To improve and maintain your quality of life, and to promote independence as you age, the body needs to be treated as a unified whole.  Mental, emotional, and spiritual health are just as important, as are adequate levels of flexibility, balance, stability, and muscular coordination.  The discipline of mind/body exercise seeks to attain this union of systems.  Its foundation is to promote the alignment of mind, body and spirit. 

     There are many different disciplines of mind/body exercise.  However, most center on increasing self-awareness while performing a physical activity.  Mind/body exercise incorporates precise, controlled body movements while directing your attention inward.  The internal focus is on your breathing and body position in space (kinesthetic or proprioceptive awareness).  Pilates, Yoga, and Tai Chi are examples of mind/body exercise.  These disciplines have been around for hundreds (Tai Chi) and thousands (Yoga) of years and have numerous variations.  Pilates is the "newest" form of the three examples, originating in the early- to mid- 1900's.  

     The many variations and degrees of difficulty of these methods make mind/body exercise a versatile choice for individuals of all age groups and functional levels.  The multiple health benefits obtained from mind/body exercise have contributed to its continued popularity into modern times.

Health Benefits of Mind/Body Exercise

• Stress management/decreased anxiety
• Increased sense of well-being
• Improved balance/stability
• Increased flexibility/range of motion
• Improved motor coordination
• Increased muscular strength
• Improved body posture
• Enhanced quality of sleep
• Pain management (e.g. low-back pain)
• Decreased risk of falls in older adults
• Reduced risk of bone fractures in older adults
• Facilitates rehabilitation from injury (e.g. Pilates for dancers)

Mind/body exercise proves to be a good compliment to a traditional exercise program (e.g. walking).  It can be easily incorporated into your warm-up or cool-down session.  Mind/body exercise can also serve as a substitute or alternative form of exercise one or two days a week.  Classes can be found through fitness centers, community parks and recreation facilities, YMCA's, and senior centers.

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources:

Fitness for Dummies, 3rd Edition; Schlosberg, S., Neporent, L.

ACSM Fit Society Page Fall 2008; "Mind/Body Exercise: What is it?", pp. 1-2. Schroeder, J.

ACSM's Health & Fitness Journal, September/October 2005,  Vol. 9/Issue 5, "Aligning Mind and Body: Exploring the Disciplines of Mindful Exercise", pp. 7-13. La Forge, R.

     Carbohydrate loading is a strategy used by endurance athletes to enhance performance during competitions.  The goal is to maximize the body's glycogen (energy) stores to delay the onset of fatigue during an event.  This concept was introduced in the late 1960's by scientist Bengt Saltin.  To understand the premise of carbohydrate loading, an explanation of how carbohydrates are used by the body to support exercise is warranted.  Your body can break down carbohydrates more readily and efficiently than either protein or fat and, therefore, are the main fuel source for your body during strenuous prolonged exercise.  

     Carbohydrates are stored in your muscles and liver as glycogen and circulate in your blood as glucose.  Muscle glycogen is a quick source of energy for the working muscles.  Glycogen stores in the liver are released into the blood stream as glucose to assist with meeting the energy requirements of the exercise.  Glycogen stores become depleted when exercise is intense and lasts 90 minutes or more.

     The amount of stored glycogen is an important factor for optimal performance during sustained endurance exercise.  If your stores are low at the beginning of the event, you will fatigue sooner.  Carbohydrate loading, in which glycogen stores are increased beyond normal levels, can prevent this.

Who Should Carbohydrate Load?

     Individuals whose competition requires intense exercise that lasts for 90 minutes or more (e.g. marathon runners and triathlon athletes).  In general, carbohydrate loading does not provide additional benefit to individuals who participate in events of shorter duration because the body's glycogen stores are sufficient to meet energy needs during this type of activity.

Methods of Carbohydrate Loading

     The original method involves a depletion phase followed by a loading phase.  This strategy is started several days before your competition.  The depletion phase requires you to train hard for 3-4 days while consuming a low-carbohydrate diet to deplete your glycogen stores. This phase serves to stimulate glycogen synthetase, an enzyme that forms glycogen.  The loading phase involves 3-4 days of rest while consuming a high-carbohydrate diet.  This "deplete then load" regimen maximizes glycogen stores because the extra carbohydrates consumed are converted to glycogen by the elevated levels of glycogen synthetase circulating in the blood.  Unfortunately, for some individuals, this method can have side effects such as abdominal distress and water weight gain.  As a result, an alternative carbohydrate loading method has been developed.

     The modified carbohydrate loading method eliminates the depletion phase.  It involves increasing your consumption of carbohydrates while decreasing the duration and intensity level of your workouts 3-4 days before your event.  The increased amount of carbohydrates consumed should account for 65-70% of your total daily calories and come from complex sources such as whole grain pasta. 

Points to Consider Regarding Carbohydrate Loading

• Although more research is needed, the results of the few studies that are available indicate that women are less responsive to the effects of carbohydrate loading than are men.  The menstrual cycle is thought to play a role.
  
• The results of carbohydrate loading are specific to the muscles in which the glycogen stores are depleted.
  
• Individuals respond differently to changes in their diet; therefore, you should experiment with carbohydrate loading during training or before a less important competition.
  
• If the event lasts longer than 1 hour you will still need to consume a carbohydrate source such as a sports bar, gel or drink during exercise to extend performance.
• For best results, seek the advice of a sports nutritionist who can develop an individualized protocol for you to follow.

Resources:

Department of Sports Nutrition, Australian Sports Commission Website (www.ausport.gov.au) "Carbohydrate Loading," Minehan, M.

Health & Fitness Journal March/April 2008, Vol. 12 No. 2; "Fitness Focus: Carbohydrate Loading", p. 5, Thompson, D.

Fitness & Health, Sixth Edition

Mayo Clinic Website (www.mayoclinic.com) "Carbohydrate Loading Diet"

     Life that is.  A recent study published in the May 2009 issue of Medicine & Science in Sports & Exercise found that there is a strong relationship between time spent sitting and mortality from cardiovascular disease and all causes, except cancer - despite participation in exercise at recommended levels.

     The researchers set out to investigate a different twist on the relationship between sedentary behaviors and mortality.  It is well documented that getting at least 30 minutes of physical activity a day reduces your risk for morbidity and mortality.  But, little is known about the effects of prolonged periods of sitting during the day independent of physical activity levels.

     Over a period of approximately 12 years, researchers followed 7,278 men and 9,735 women ages 18-90 years who were participants in the 1981 Canada Fitness Survey.  During household visits, participants were asked to rate the amount of time they spent sitting during the day on a scale from "almost none of the time" to "almost all of the time."  Leisure time physical activity levels were recorded, as well as Body Mass Index (BMI) profiles.

     During the time of the study there were 1,832 deaths - 759 from cardiovascular disease, 547 from cancer, and 526 from other causes such as respiratory disease, injuries, violence, mental disorders, nervous system disorders, and digestive system disorders.  The study found that those individuals who died during the study had a higher BMI, were less physically active, and were older compared to the survivors.  

     Furthermore, after controlling for factors such as age, gender, smoking status, alcohol consumption, and physical activity levels, a dose-response relationship between sitting time and mortality of all causes, except cancer, was observed.  That is, length of sitting time has an independent effect on mortality; and, the greater the period of time you spend sitting during daily activities (such as working at your desk or computer and watching television) the greater your mortality risk.

     These findings reveal that participation in physical activity, even if it exceeds recommended levels, cannot compensate for extended periods of sitting.  This does not mean, however, to discontinue participation in regular exercise; rather, you should limit time spent sitting throughout the day during sedentary tasks/pursuits.  Break-up long periods of sitting at work by hand delivering a memo instead of sending an email, perform calisthenics during commercials while watching television, and walk around the house instead of sitting while talking on the phone.

     

     For years exercise enthusiasts have touted the phrases "Go for the Burn" and "No Pain, No Gain" in hopes to motivate individuals to get active.  With a large percentage of our population still not acquiring the recommended amount of exercise to gain health benefits, the origin of these slogans can be understood.  However, exercise does not have to be performed at an intensity and/or volume level that unduly stresses the body in order to improve overall health and well-being.  In fact, too much exercise can be counterproductive, leading to conditions known as overreaching and overtraining.  Overreaching and overtraining conditions are not limited to the elite athlete, but can occur in individuals whose exercise goal is to improve overall health.

     Overreaching is excessive training that occurs on a short-term basis.  The body is overworked resulting in decreased exercise performance.  The decrements in performance, however, can be easily reversed with a decrease in exercise workload for several days.  When carefully prescribed by a qualified health fitness or sports medicine professional, overreaching can actually have a positive impact on exercise performance.  Substantial gains in strength and power can occur when the muscles are overworked for a period of time followed by a tapering down phase in which the training stimulus is reduced.  However, if not monitored properly and allowed to continue for an extended period of time, overreaching can lead to overtraining.

     Overtraining occurs when the intensity and/or volume of exercise is excessive over a prolonged period of time without a sufficient recovery period.  Overtraining not only impairs exercise performance, but alters the mood of the overtrained athlete.  It can lead to marked decrements in exercise performance, injury, and/or illness.  Unlike overreaching, overtraining can require months, if not years, for a full recovery to occur.  

     Overtraining is not fully understood and more research is needed in the area.  However, there are certain physiological and psychological symptoms, known as the Overtraining Syndrome (OTS), that are suggestive of overtraining.

Physiological Symptoms Suggestive of OTS

• Decreased and/or plateaued exercise performance despite continued exercise training
• Time to recover from exercise is prolonged
• Poor/reduced coordination of body movements
• Chronic fatigue (both during exercise and daily life activities)
• Insomnia
• Sore/tender muscles 
• Painful joints
• Increased thirst
• Altered breathing, heart rate, and blood pressure at rest
• Disruption of menstrual cycle

Psychological Symptoms Suggestive of OTS

• Altered personality
• Lack of motivation to exercise
• Poor concentration
• Depression
• Poor self-esteem
• Irritability
• Apathy

     If you are experiencing one or more of these symptoms, you should schedule an appointment with your health care professional to determine the cause.  If it is determined that you are suffering from overtraining, your exercise regimen will have to be altered to allow for adequate recovery and rest.  If the thought of taking a break from exercise for a while is anxiety producing, discuss with your health care professional the possibility of alternative forms of activity such as light-intensity walking, calisthenics, stretching, or balance and stability exercises.

     If you want to avoid the pitfalls of overtraining, there are some preventative steps you can take.

Steps to Avoid OTS

• Vary your workouts, alternating days of low-, moderate-, and high-intensity exercise levels
• Cross-train to work different muscle groups (e.g. bike one day, run the next)
• Schedule at least one or two days of rest throughout the week, especially after an intense workout
• Consume a healthy, well-balanced diet that will allow for adequate repletion of glycogen stores depleted from exercise (see my nutrition postings during the week of May 4, 2009)
• Drink plenty of fluids to avoid dehydration

     It is important to listen to your body during your workout.  If you notice that your workouts are harder despite continued training, that you have lost the desire to exercise, and/or your mood and personality have become altered, then you need to reevaluate your exercise program.  The volume and/or intensity level of your activity may need to be reduced and extra recovery days added to your routine. 

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources:

ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription, Sixth Edition

ACSM's Health & Fitness Journal, July/August 2007 vol. 11, Issue 4; "Overtraining: Undermining Success?", pp. 8-12. Kinucan, P. and Kravitz, L.

     

     A nation-wide initiative devoted to empowering women to take control of their health starts today.  May 10-16 marks the 10th Annual National Women's Health Week, a health observance created by the U.S. Department of Health and Human Services Office on Women's Health (OWH).  This year's theme is "Its Your Time."  The goal is to educate women about simple steps you can take to improve your health both physically and mentally.

OWH Recommended Steps to Better Health

• Engage in 2 1/2 hours of moderate-intensity exercise per week, or 1 hour and 15 minutes of vigorous-intensity exercise per week, or a combination of moderate- and vigorous-intensity exercise per week.
• Consume a nutrient-dense diet.
• Get regular physical exams and health screenings by a qualified health care professional.
• Avoid harmful behaviors such as smoking, not wearing a helmet while bike riding, and/or not fastening your seat belt while in the car.
• Promote your mental health by managing your stress and getting sufficient sleep.

     You can start taking these steps today, with thousands of other women throughout the country, by enrolling in the OWH sponsored program, Woman Challenge.  The Woman Challenge is an 8 week long online exercise program that takes place May 10-July 4, 2009.

How Can You Participate in the Woman Challenge?

• Register online at www.womenshealth.gov/women/for the Woman Activity Tracker.
• Take the Woman Challenge Pledge.
• Set your weekly goals.
• Record your physical activity.
• Receive a virtual Woman Challenge Trophy each week you meet your exercise goal.  If you meet your goal each of the 8 weeks, you receive a Certificate of Completion.

     Another initiative sponsored by the OWH that you can participate in is National Women's Check-up Day which will be held Monday, May 11.  On this day, you are encouraged to make a commitment to start receiving regular physical exams and health screenings by a qualified health care professional.  Why?  Your health care professional can determine if you are at risk for or have certain health conditions such as heart disease, cancer, sexually transmitted infections, mental health issues, and/or other health problems.  During your visit you can discuss with him or her the preventative measures and treatment options available to you for better health.

How do You Participate in National Women's Check-up Day?

• Go to www.womenshealth.gov and use their Interactive Health Screening Tool to learn more about health screens and vaccines available to you.
• Contact your health care professional to schedule an appointment for a physical exam and to discuss your current health.

     Happy Mother's Day to all of you that are moms and Happy National Women's Health Week to all women.  Remember, "Its Your Time."  Take control of your life and make it happy and healthy for a better you.

Resource:

U.S. Department of Health and Human Services, The National Women's Health Information Center - The Federal Government Source for Women's Health Information www.womenshealth.gov/.

     May is National Bike Month!  If the cold and snowy winter had you relying on your car to get you places, now is the perfect time to "switch gears" and start biking.  The League of American Bicyclists is celebrating this month by designating next week, May 11-15, as Bike-to-Work Week and Friday, May 15, as Bike-to-Work Day.  There are numerous environmental, economic, transportation, and health reasons to exchange your gas pedal for a pair of bike pedals, even if it is just for one outing.

Pedal Versus Pedal Facts (taken from the Pedestrian and Bicycle Information Center (PBIC) website, www.bicyclinginfo.org/index.cfm) 

• Riding your bike, instead of driving your car, on a four-mile round trip reduces air pollutants by approximately 15  pounds. 
• 60% of pollutants from automobile emissions are released during the first few minutes after starting the car.
• "Cold starts" result in high levels of automobile emissions, therefore shorter car trips cause greater pollution per mile than longer trips.
• 40% of all car trips are shorter than 2 miles - the equivalent to a 10 minute bike ride.  
• The cost to operate a sedan for one year is $7,800 while the cost to operate a bike is only $120 for one year.

Health Benefits

• Bicycling is a low-impact sport that is easy on your joints.
• Bicycling on a regular basis can improve aerobic fitness which has been associated with prevention of chronic health conditions such as heart disease, stroke, diabetes, and high blood pressure.

Celebrating National Bike Month

• Participate in one of two rides on May 15, 2009 that are part of the 4th Annual Bike to Work Day, Detroit Bikes! sponsored by the Detroit Synergy Project (for more information on the rides visit www.detroitsynergy.org/projects/biketoworkday).
• Bike to work.
• Bike with your child to school.
• Choose at least one destination that you can ride your bike to rather than driving your car.

Celebration Safety Tips

• Service your bike (either yourself or at a bike shop) to ensure tires, gears, and brakes are in working order.
• Wear a helmet.
• Follow the traffic rules.
• Map out your route before you begin.
• Bring portable first aid kit, cell phone, water, and healthy snacks.

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources:

Pedestrian and Bicycle Information Center website, www.bicyclinginfo.org. 

     Are you one of those individuals who waits until your car's gas gauge needle is just barely on "E" before you fill the tank?  I am not, but I know many people who do.  I have heard them discuss the "thrill" of pushing the limit until they are almost "riding on fumes" to their destination.  I suppose they figure running out of gas is not a big problem - just a minor inconvenience until the gas can be brought to the car, then they are on the road again.

     On the contrary, having your body "run on fumes" is not very thrilling.  It needs to have its stores replenished in a timely fashion for optimal performance.  This time occurs post-exercise, during the recovery phase. 

     Adequate recovery from exercise involves refueling the body to replenish carbohydrate stores (glycogen) in the muscles and liver, replacing fluids lost from sweating, and reestablishing electrolyte balance (e.g. sodium and potassium levels).  The optimal time to consume the post-exercise meal is dependent upon the number of workouts in a given day, the exercise mode, and the intensity and duration of the physical activity.  In general, to maximize your body's ability to replenish glycogen stores and repair muscle tissue, the meal should be consumed within the first 30 minutes, and preferably before 2 hours, post-exercise.  This is because the glycogen forming enzyme, glycogen synthetase, circulates at high levels during this time frame (refer to my posting "Milking Endurance").  Eating within this period is especially important if you will be participating in more than one exercise session in a day (e.g. triathlon competition, softball tournament, etc.)

     The meal chosen should be a mixture of the macronutrients carbohydrate, protein, and fat, with carbohydrate assuming the greatest percentage.  It is recommended that your meal contain a ratio of 4 grams of carbohydrate to 1 gram of protein in order to maximize the processes of glycogen repletion and rebuilding of muscle tissue.  Approximately 1.0-1.5 grams of carbohydrate per kilogram of body weight should be consumed at 2 hour intervals over the next 6 hours post-exercise, particularly if you have engaged in vigorous exercise or will be exercising on consecutive days.

     The type of carbohydrate ingested post-exercise may impact the rebuilding of glycogen stores.  Food sources that contain glucose and sucrose appear to be more effective than those that contain fructose alone.  The glycemic index of the food source may play a role as well.  The glycemic index measures how fast and how much the type of carbohydrate (simple versus complex) found in a food raises blood sugar levels after ingestion.  Carbohydrate foods with a high glycemic index tend to result in greater levels of muscle glycogen stores.  However, this can be affected by your overall diet.

     If you are an individual who prefers not to eat a meal right after exercise, drinking a high-carbohydrate liquid supplement is adequate.  Consuming such an energy source will aid in fluid replacement as well.  After exercise you should aim to ingest at least 16-24 ounces of fluid per pound of body weight lost through sweat.  Choosing fluids that contain sodium (0.5 -0.7 grams per liter) and potassium (0.8-2.0 grams per liter) are important to reestablish electrolyte balance, especially if you have participated in endurance exercise lasting more than 2 hours.

Post-Exercise Meal Ideas

• Cereal with low-fat milk
  
• Bagel with peanut butter or low-fat cream cheese
  
• Pancakes with slices of banana
  
• Low-fat yogurt and fruit juice
  
• Energy bar and an apple
  
• Carbohydrate liquid supplement and a handful of nuts/seeds
  

Resources:

ACSM Fitness Book: a proven step-by-step program from the experts, 3rd edition.

McKinley Health Center Website (www.mckinley.uiuc.edu/) "Nutrition for Optimal Exercise Recovery"

Montana State University-Bozeman Website  (btc.montana.edu/olympics/nutrition/default.htm) "Sports Nutrition: What Can Foods and Fluids Do For You?"

American College of Sports Medicine, American Dietetic Association, and Dietetians of Canada Joint Position Statement "Nutrition and Athletic Performance", Medicine & Science in Sports & Exercise, pp. 709-731.

     

     

     Meat and Potatoes or Pasta for dinner?  What is the best meal to eat before the big game or road race?  It depends.  There isn't a "one-meal-fits-all" solution.  Individual needs vary based on body size and type.  The mode of exercise, as well as the intensity and duration of the activity, will also dictate your food choices.

     It is important to note that the pre-competition meal is only one part of a complete training program.  For optimal performance, you need a solid foundation of nutritional practices that cover your daily energy needs throughout the training period (see my earlier postings "Fueling Your Exercise" and "Nutrition for the Physically Active Vegetarian").  Because individual requirements vary, you need to discover and understand what works best for you.  To determine your ideal pre-event meal, you should experiment with different foods and drinks during your practice/training season, not the day before or of the competition.

     To start, you need to understand the purpose that a pre-event meal serves.  According to the Joint Position Statement by the American College of Sports Medicine, the American Dietetic Association and the Dietetics of Canada, the pre-competition meal "should prepare athletes for the upcoming activity [by ensuring adequate blood sugar and glycogen stores] and leave the individual neither hungry nor with undigested food in the stomach."  A pre-competition meal should prevent premature fatigue and loss of strength during the event.

General Rules to Consider Regarding the Pre-Event Meal:

1. Consume foods low in fat and fiber.  This will reduce gastrointestinal discomfort and promote gastric emptying.  
2. Choose foods high in carbohydrate.  Studies have shown that performance is enhanced when 200-300 grams of carbohydrate are ingested 3-4 hours before the event.  Liquid carbohydrate meals, such as sports drinks and low-fat shakes, are acceptable choices.
3. Eat foods with a moderate protein content.
   
4. Avoid gas-producing foods such as beans, bran, cabbage, cauliflower and legumes to prevent gastric distress.
   
5. Consume 5-7 ml/kg of body weight of fluids about 4 hours prior to the event to maintain a hydrated state.
   
6. Avoid carbonated beverages.  They can cause abdominal distress.
   
7. Know the effects of caffeinated beverages on your body.  For some, caffeine can improve performance - for others, it can promote feelings of nervousness and cause stomach upset.  It can also lead to dehydration if taken in excess.
   
8. Choose foods to which you are familiar and that you can tolerate well.
   

General Rules for Timing of Pre-event Meal:

1. Rule-of-Thumb:  The larger the meal, the longer it takes to digest; and, the more time that will be needed to elapse between ingestion and the start of the competition.
   
2. Small meals (400-500 calories) can be ingested 2-3 hours before the event.
   
3. Large meals, if eaten, should be consumed 5-6 hours before the event, especially if they contain substantial amounts of fat, fiber, and/or protein.
   

Meal-Timing and Content in Regards to Time of Day of the Event:

1. Morning Event:  The day of the event consume a light snack such as fruit, low-fat yogurt, or a liquid sports drink.  The night before, eat a substantially high carbohydrate meal such as spaghetti with marinara sauce.  This meal is of particular importance (especially if you do not have time to eat breakfast the morning of the competition) due to the relatively long period of time that will elapse while sleeping between ingestion and competition.  This length of time could leave glycogen stores at levels lower than desired for optimal performance.
   
2. Afternoon Event:  The day of the event consume a high carbohydrate breakfast such as pancakes, waffles, or bagels.  Lunch should be small (e.g. a salad with low-fat dressing).  The night before the competition, consume a high carbohydrate meal.
   
3. Evening Event:  The day of the competition both your breakfast and lunch should consist of high carbohydrate foods.  A small snack later in the day, such as a baked potato or soup and crackers, can be consumed.
   

     Remember, there is not one food choice that is recommended for everyone.  You need to discover what works best for you.  Do your experimenting during your practice season instead of near the big game or road race.  Following a proper diet throughout your exercise program as well as consuming an appropriate pre-competition meal will help you to perform at your best.

Resources:  

American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada Joint Position Statement "Nutrition and Athletic Performance", Medicine & Science in Sports & Exercise, pp. 709-731.

American College of Sports Medicine, Current Comments "Report on Pre-Event Meals", DeMarco, H.

If you consume a vegetarian diet and are physically active, there are nutritional guidelines to follow to ensure optimal health and exercise performance. As is with the non-vegetarian, energy requirements for the active vegetarian are dependent upon gender, age, body size, nutritional status, amount of activity involved in daily tasks, exercise mode, and intensity level, duration, and frequency of exercise. Due to the lower caloric density typically associated with the vegetarian diet, vegetarians, and particularly vegans, are at a greater risk for falling short of meeting daily energy needs. Taking in an insufficient amount of calories can result in loss of body weight below healthy levels and a loss of muscle mass resulting in decreased exercise performance. To meet your recommended daily caloric intake, you may need to include extra meals or snacks throughout the day.

The potential for consuming poor quality and inadequate amounts of protein are other concerns with the vegetarian diet. If all animal-based foods are avoided (e.g. milk), such as with the vegan, then there is the risk of consuming insufficient amounts of the amino acids lysine, methionine, threonine, and tryptophan. The physically active vegetarian should make it a point to consume a variety of plant-based protein foods to ensure a diet that is of sufficient protein quality. Such foods include whole grains, nuts, seeds, legumes, and soy products.

Plant-based proteins are not digested as well by the body as are animal-based proteins. As a result, the active vegetarian needs to increase the amount of protein consumed daily by about 10% beyond what is recommended for the non-vegetarian. This equates to an intake of about 1.2-1.8 grams/kilogram of body weight.

Physically active vegetarians are also at risk for consuming inadequate amounts of iron. In addition, your body is less efficient at extracting iron from plant sources than it is from animal sources. This increases the likelihood of developing iron deficiency or anemia, particularly for the physically active female. In general, iron stores of vegetarians are lower than those of non-vegetarians. Good sources of iron include soy beans (1/2 cup cooked provides 4.4 mg), tofu (firm, 1/2 cup provides 6.6 mg), lentils (1/2 cup cooked provides 3.3 mg), pumpkin seeds (1/4 cup provides 5.2 mg), and fortified cereal (1 oz. provides 5.1 mg). Since Vitamin C can enhance absorption of iron, it is recommended that you consume it at the same time as you do the iron source.

If you follow a diet that eliminates all animal protein or one that is very low in fat (<15% of total energy intake) you are at risk for developing a deficiency of essential fatty acids. Fatty acids are an important fuel source for moderate-intensity aerobic exercise. In addition, as you become more aerobically fit, your body uses a greater percentage of fat to perform the activity while decreasing the use of carbohydrate sources.

Other nutrients that physically active vegetarians may consume insufficient amounts of include Vitamins D, B12, and riboflavin and minerals zinc and calcium. To ensure that you are consuming an adequate amount of calories as well as required nutrients you may want to consider consulting a sports dietitian. This is of particular importance if you are a novice vegetarian or have been a previously sedentary vegetarian engaging in exercise for the first time.

Note: Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources:

American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada Joint Position Statement "Nutrition and Athletic Performance", Medicine & Science in Sports & Exercise, pp. 709-731.

President's Council on Physical Fitness and Sports Research Digest Series 5, No. 1; March 2004 (www.fitness.gov)

Journal of the American Dietetic Association, June 2003, Vol. 103, No. 6; pp. 748-765, "ADA Reports: Position of the American Dietetic Association and Dietetics of Canada: Vegetarian Diets." (www.eatright.org)

Vegetarian Nutrition: A Dietetic Practice Group of the American Dietetic Association, "Vegetarian Diet for Exercise and Athletic Training and Performing: An Update", Larson, D.E.

     Your body requires optimal nutrition to meet the demands placed on it by regular exercise.  Adequate amounts of carbohydrate, protein and fat are needed not only to fuel the activity but to repair and rebuild muscle tissue that has been broken down from exercising.  If energy and nutrient intake are insufficient, your exercise performance can be hindered, injury and illness could result and the health benefits of the exercise can be minimized.  

     Many active individuals wonder how many calories they need daily to "drive" their exercise.  Regular exercisers need more calories per day than their less active counterparts in order to maintain energy balance.  Energy balance occurs when the amount of calories consumed equals the amount of calories burned throughout the day.  Energy requirements are based on gender, age, body size, nutritional status, amount of activity involved in daily tasks, exercise mode, and intensity level, duration, and frequency of exercise.  Sports nutritionists use predictive equations to determine total energy expenditure and thus calories needed on a daily basis.  To determine your caloric needs refer to the United State's Department of Agriculture's (USDA) Nutrition and Your Health: Dietary Guidelines for Americans section of their website at www.health.gov/dietaryguidelines/dga2005/report/HTML/D3_Disccalories.htm and go to the subheading "Calculating the Estimated Energy Requirements".

     In addition to knowing the total number of calories needed daily, active individuals want to know what is the best energy source to fuel their exercise.  The contribution of fuel sources is dependent upon the intensity and duration of the exercise as well as your fitness and nutritional status.  According to the President's Council on Physical Fitness and Sports Research Digest March 2004, the amount of carbohydrate needed for moderate intensity exercise is 5-7 grams/kilogram of body weight and 7-12 grams/kilogram of body weight for high intensity endurance exercise.  Protein requirements for the active individual (including those involved in resistance training) range from 1.2-1.7 grams/kilogram of body weight or 15% of total daily calories consumed.  Fat intake should range from 20-35% of total daily caloric intake (or 1 gram/kilogram of body weight according to recommendations outlined in the ACSM Fit Society Page Winter 2007) with carbohydrate and protein needs taking precedence over fat consumption.  In the American College of Sports Medicine Position Stand on Nutrition and Athletic Performance they advise against following diets that severely restrict calories or ones that exclude/eliminate certain macronutrients (e.g. carbohydrates) because of the negative effects on health and performance.  

     Carbohydrates are needed by your body because they are its primary energy source.  They maintain blood sugar levels during the activity as well as replenish sugar stores (glycogen) that have been depleted from the exercise.  According to the ACSM Position Stand, 50-60% of the energy needed to sustain 1-4 hours of continuous exercise at 70% of maximal capacity comes from carbohydrates.  Adequate amounts of carbohydrates are also needed to spare amino acids for protein synthesis (muscle tissue repair/building).  Insufficient amounts could lead to amino acids being used to meet the energy demands of the exercise instead of muscle repair, resulting in decreased muscle mass.  Good sources of carbohydrates include whole grain pasta, bread and cereals (oatmeal), brown rice, potatoes, and fruit.

     Protein is needed by your body to repair and build muscle and connective tissue.  Although active individuals need more protein than their sedentary counterparts, the difference is not enough to warrant protein supplements according to recommendations outlined in the ACSM Fit Society Page Winter 2007.  Eating too much protein can lead to the body converting and storing the excess into fat.  Good sources of protein include lean meats, low- or non-fat dairy products, fish, eggs, soy products, beans, and legumes.

     Fat is a valuable energy source for activities lasting longer than 3 hours.  Saturated fat sources, such as from animal products, should be limited because of their role in the development of heart disease.  Good sources of "healthy" fats (unsaturated fats) include fish, nuts, avocados, olive oil, and soy products.

     Acquiring proper nutrition and meeting your body's energy requirements is a balancing act.  Adjustments may be needed as your fitness level and exercise routine changes.  Age will also impact your energy requirements, with a decrease in total caloric needs occurring as you get older.  Monitoring the amount and type of calories that you consume will enhance your exercise performance as well as your overall health.

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources:

United States Department of Agriculture Food and Nutrition Information Center "Nutrition and Your Health: Dietary Guidelines for Americans" (www.usda.gov)

President's Council on Physical Fitness and Sports Research Digest. Series 5, No. 1; March 2004 (www.fitness.gov)

American College of Sports Medicine ACSM Fit Society Page Winter 2007. "Nutrition: Who needs it?  If you're and athlete... you do!" pp.5-6, LeBlond, J., Beals, K.

American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada Joint Position Statement "Nutrition and Athletic Performance" Medicine & Science in Sports & Exercise, pp. 709-731,