Finding time to exercise is difficult, as is finding time to prepare and eat a nutritious meal.  Attempting both makes living a healthy lifestyle seem near impossible.  Buying commercial meal replacement bars, shakes, and trail mixes may be convenient, but can be expensive in the long-run.  You can help yourself make healthy choices at a relatively low cost, both financially and time-wise, by taking a little extra time on one day of the week to prepare and stock-up on homemade versions for the remaining days of the week.  These do-it-yourself delights can be portioned into single serving size containers for easy grab-and-go snacks/meals on days that you are pressed for time.  

     Basic recipes for a smoothie, energy bar, and trail mix are provided below.  Suggestions for add-ins and substitutes are also given for you to make a customized snack/meal.

Smoothie Power Basic Recipe

1 cup of skim/low-fat milk

6 oz. nonfat/low-fat vanilla yogurt

1/2 cup berries (such as blueberries, blackberries or raspberries)

1 large banana, sliced

1 Tbs. honey

4 ice cubes 

1 tsp. vanilla extract

pinch of cinnamon (optional)

pinch of nutmeg (optional)

pinch of salt (optional)

Place ice cubes in blender, cover and whirl to crush.  Add milk, yogurt, berries, banana, and honey.  Cover and blend about 30 seconds.  Add remaining ingredients, cover and blend about 10 seconds or until desired consistency.  Pour into travel mug and drink immediately or place in refrigerator the night before for an easy grab-on-the-go breakfast the next morning (smoothie may need to be stirred before drinking if prepared ahead of time).  Store remaining smoothie in refrigerator for up to two days.

Smoothie Power Substitutes

• Instead of cow's milk try 100% fruit juice (such as orange, cranberry, or pomegranate blends ) or try soy, almond, rice, or hemp milk
  
• Instead of yogurt try pureed sweet potato, pumpkin, butternut squash, or apple sauce (plain, flavored, or chunky)
• Use greek-style yogurt for added protein
• Instead of berries or banana try peach, mango, pineapple, or cantaloupe
• Instead of honey try maple syrup or agave nectar
• For added fiber, try blending in 2 Tbs. wheat germ or flaxseed meal
• For more protein add 1/4 cup peanut butter or 2 Tbs. whey protein

Trail Mix Delight Basic Recipe

1 cup nuts

1 cup dried fruit

1 cup cereal

1 cup seeds

1 cup chocolate chips

Combine ingredients in large bowl.  Scoop and store individual servings into sandwich bags or single serving size reusable containers for easy grab-and-go snacks.  Or, place in large airtight container and store in cool, dry place for up to one month.

Trail Mix Delight Ingredient Suggestions

• Nuts:  consider almonds, peanuts, walnuts, pecans, or a combination
  
• Dried Fruit:  consider blueberries, cranberries, dates, figs, raisins, apricots, cherries, or a combination
  
• Cereal:  consider granola, wheat bran flakes, corn flakes, Cheerios, uncooked rolled oats, bite-sized shredded wheat biscuits, or a combination
  
• Seeds:  consider flaxseed, pumpkin, sunflower, sesame seeds, or a combination
  
• Chocolate chips/Sweet & Salty Additions:  consider carob chips, dark chocolate chips, white chocolate chips, M&M's, coconut flakes, mini pretzels, sesame sticks, wasabi peas, dry roasted edamame (soy nuts), mini pita chips, gold fish crackers, popcorn, mini rice/corn cakes, or a combination
  
• Added Flavorings: for savory, consider mixing in 2 Tbs. of your favorite dry italian or barbecue seasonings with a little bit of sea salt; for sweet, consider mixing in 2 Tbs. cinnamon or vanilla sugar
  

"I Need Some Spunk" Energy Bars

3/4 cup whole-wheat flour

1/4 cup flaxseed meal

1 1/2 cups uncooked rolled oats cereal

1/4 cup chopped almonds

3/4 cup dried cherries

1 1/4 cups apricot preserves

1/2 cup packed brown sugar

1/4 cup granulated sugar

1/4 cup plus 1 Tbs. egg whites (or egg substitute)

6 oz. vanilla nonfat/low-fat yogurt

1/2 cup pureed sweet potato

1 tsp. vanilla

1/2 tsp. baking soda

1/4 tsp. salt

1/2 tsp. cinnamon

 

Preheat oven to 350 degrees Fahrenheit.  Grease 8"x8" baking pan with cooking spray.  In small bowl combine flour, flaxseed meal, baking soda, salt, and cinnamon. Set aside.  In medium bowl, beat egg and brown and granulated sugars.  Beat in yogurt and vanilla.  Beat in sweet potato until well-combined.  Slowly beat in flour mixture about 1/4 cup at a time.  Turn off mixer.  Stir in rolled oats.  Divide mixture in half.  Press half of mixture onto bottom of pan.  Spread apricot preserves over mixture.  Sprinkle dried cherries over apricot preserves.  Spread remaining batter over cherries.  Sprinkle with chopped almonds.  Bake for 35 minutes or until a toothpick comes out clean when inserted.  Cool on wire rack.  Cut into bars.  Wrap individual bars in plastic wrap and store in refrigerator.

"I Need Some Spunk" Energy Bar Substitutes

• Apricot preserves can be replaced with your favorite preserves or jam
  
• Sweet potato puree can be replaced with applesauce or pumpkin or butternut squash puree
• Almonds can be replaced with chopped pecans or walnuts

Pair your smoothie, trail mix, or bar with a fresh piece of fruit/vegetable and/or a slice of cheese for extra easy grab-and-go nutrition.

     The American College of Sports Medicine, in conjunction with the American Heart Association, recently released their Position Stand on "Exercise and Physical Activity for Older Adults" in the July 2009 issue of Medicine & Science in Sports & Exercise.  This updated version has been expanded to include evidence compiled since 1998 (when the last Position Stand was published) supporting the role of exercise in older adults with chronic diseases and functional limitations, a population in which the safety of exercise was once questioned.  In addition, it addresses the positive impact exercise has on psychological health and well-being and cognitive functioning in older adults.

     These new guidelines were developed for adults 65 years and older.  However, the recommendations are relevant for those individuals between the ages of 50-64 years who have clinically apparent chronic health conditions or who have functional restrictions that limit physical activity, fitness, and mobility.  In general, these new recommendations are consistent with the recently released 2008 Physical Activity Guidelines for Americans by the Department of Health and Human Services.*

  Based on a growing body of knowledge, the ACSM and the AHA have made the following conclusions regarding the effects of exercise and physical activity on the older adult population:**

• Inactivity should be avoided.  Some exercise is better than none.  Health benefits are gained with any amount of physical activity; although, health gains are greater as the frequency, duration and/or intensity of exercise and physical activity increases.
• If chronic health conditions are present, physical activities should be performed as abilities and health status allow.
• Physical fitness can be improved through an accumulation of physical activity and participation in exercise.
• Advancing age is associated with an increased relative risk for developing and dying from cardiovascular disease, certain cancers, obesity, and type 2 diabetes.  It is also associated with a greater incidence of osteoporosis, muscle tissue loss (sarcopenia), and arthritis.  However, engaging in regular physical activity greatly reduces these risks.  In addition, exercise can be used to treat these diseases.
• Independent of cardiovascular fitness, muscular strength and power are indicators of all-cause and cardiovascular mortality.
• Average life expectancy is increased by participation in regular physical activity which maintains functional capacity and reduces risk of chronic diseases.
• Middle-aged and apparently healthy older adults can initiate aerobic and resistance training exercise and experience a qualitatively similar physiological response to that of younger adults.  In fact, the body's ability to adapt to such physical activities is well preserved into the 70's.  Therefore, age-related declines in functional capacity should not prevent an individual from participating in these exercises.
• Older adults may take longer to reach the same level of physiological improvements than their younger counterparts.
• Older adults do not tolerate exercise in temperature extremes as well as younger adults.
• Compared to their sedentary peers, athletic older adults who engage in vigorous-intensity aerobic exercise have a more desirable body composition (greater bone mineral density, larger relative muscle mass, and less abdominal and total body fat), lower blood pressure, better cholesterol profile, and can sustain exercise longer for a given workload (i.e. experience less cardiac stress and muscular fatigue).
• Compared to their sedentary peers, older adults who engage in regular resistance training activities are approximately 30-50% stronger, have a greater muscle mass, and tend to be leaner.  Furthermore, compared to older adults who engage in aerobic training alone, those who participate in resistance training exercises have greater bone mineral densities and increased muscular strength and power.
• Participation in moderate- to high-intensity resistance training increases lean body tissue and decreases fat mass.  In addition, high-intensity resistance training has been shown to be an effective treatment modality for clinical depression.
• Exercise programs that include aerobic, strength, flexibility, and balance activities reduce the risk of falls for older adults.
• Both fitness level and participation in aerobic exercise are associated with a lower incidence of clinical depression and anxiety and a reduced risk for cognitive decline and dementia.

The ACSM and the AHA recommend the following in their recent Position Stand:

• Engage in regular moderate-intensity physical activity for at least 150-300 minutes per week or 75-150 minutes per week of vigorous-intensity exercise.
• Participate in moderate- to vigorous-intensity strength training exercises at least 2-3 days per week.  A regimen of eight to ten exercises of 8- 12 repetitions each that involve the major muscle groups of the body should be followed.
• Incorporate flexibility exercises into the exercise program on a least 2 days of the week.
• Perform balance exercises, especially for individuals who frequently fall or who have mobility limitations.

* For a summary of the national guidelines read my February 17, 2009 post "Exercise Recommendations: An Overview."  For more detailed information, visit www.health.gov.paguidelines.

** For the purposes of the Position Stand, physical activity is defined as body movement that results from contracting muscles and requires an increase in energy expenditure.  Raking the yard is an example of physical activity.   Exercise is defined as planned and structured participation in physical activity with the purpose to improve health/fitness.  An aerobic dance class is an example of exercise.

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. 7, July 2009 "Position Stand; Exercise and Physical Activity for Older Adults," pp. 1510-1523; Wojtek J et al.

     Is your best walking/running companion your dog?  If so, there are some safety precautions to consider concerning your canine exercise partner before the two of you head out into the heat this summer.  First, it is important to realize that your dog cannot cool its body as efficiently as can you.  Its fur interferes with heat conduction to the environment.  Your dog also cannot rely on sweating as a means by which to remove heat because it has a limited number of sweat glands (located on the pads of its paws).  Your dog removes body heat through panting.  As your dog fatigues from the exercise, this mechanism of regulating its body temperature becomes more difficult, putting it at risk for developing heat exhaustion.

     According to Dr. Douglas Brooks of Gasow Veterinary Hospital in Birmingham, Michigan, there are certain breeds of dogs who are most susceptible to developing heat exhaustion.  Short-muzzled breeds such as boxers, bull dogs, and pugs will have the greatest trouble dissipating heat as will canines with heavy coats.  Dogs that are overweight, de-conditioned, or old may have difficulty as well. 

     To reduce your dog's risk for developing heat exhaustion, Dr. Brooks recommends taking your dog for walks/runs in the early morning or evening hours when temperatures are cooler (this will also reduce your risk for developing a heat illness).  Make sure to bring water with you for both you and your dog.  Allowing your dog to take frequent water/rest breaks, preferably in the shade, will also lower its risk of overheating.  

     Dr. Brooks suggests that you take your dog for fewer and shorter walks when the temperature is above 80 degrees Fahrenheit (following this recommendation for your dog will benefit and protect you from the heat as well).  To protect your dog, you should also have an understanding that there is a heat gradient between the ground and the air.  The average sized dog falls right in middle of this gradient, about 18 inches above the ground.  This gradient is a result of surfaces, such as asphalt, retaining heat from the sun.  Therefore, air temperature for the dog is hotter than it is for you, putting it at a greater risk for overheating.

     While exercising with your dog, you will want to pay close attention to how it is acting.  Dr. Brooks states that if your dog starts to pant heavily, appears lethargic, or is having difficulty standing up, these could be an indication that it is developing heat exhaustion.  Other signs to look for in your dog include excessive salivating followed by a dry mouth, pale/gray gums, rapid heartbeat, vomiting, diarrhea, and/or seizures.  If you suspect heat exhaustion, Dr. Brooks recommends placing your dog in a tub of water to facilitate lowering its core body temperature.  In severe cases, a trip to your vet may be warranted.

     Another concern to be aware of is the temperature of the surface on which you and your dog will be walking or running.  Your shoes protect your feet from the heat of the cement; but, your dog's paw pads will have direct contact with the hot pavement, putting them at risk for getting burned.  Feel the pavement before you start your run.  If it is too hot, consider running on the grass or wait until temperatures have cooled.

     A run in the sun with your favorite canine companion this summer should be enjoyable.  Make sure it doesn't lead to a heat illness in either one of you by following the tips above.  For more information on how to protect yourself while exercising in the summer heat, refer to my earlier posts "Keeping Water on Board: An Exerciser's Guide to Staying Hydrated During the Summer Months" and "Tips to Prevent Your Child from Overheating at Summer Camp."

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:

June 23, 2009 Phone Interview: Dr. Douglas Brooks of the Gasow Veterinary Hosptial (www.gasowvet.com).

ACSM Fit Society Page Summer 2005, "Dog Safety During Hot Summer Runs," p.4. Angle, C.

www.dogrundog.com

 

     

     

     Osteoporosis, which is defined as "porous bone," is a chronic condition that affects approximately 10 million Americans.  Another 34 million Americans are thought to have a condition called osteopenia (low bone mass) which puts them at risk for developing osteoporosis.  Osteoporosis is a disease in which the bones have become less dense, thin, and weak making them susceptible to fractures.  Under a microscope, healthy bone resembles a honeycomb.  With osteoporosis, structural changes have occurred in the bone that make the holes and spaces of the honeycomb structure much larger.  As a result, the bone becomes less dense, weaker and more susceptible to fracture.

     Bone is living tissue that constantly breaks down and rebuilds throughout life.  This process involves calcium to be withdrawn from and deposited into your bones daily.  The strength of your bones depends upon the amount of calcium stored in them.  In children and teenagers, new bone is formed faster than it is broken down.  Thus, the bones continue to become more dense until peak bone mass (the greatest amount of bone that you will have in your lifetime) is achieved.  

     Your body is efficient at depositing calcium into your bones until you are about the age of 30.  At this point, the rate of bone loss is greater than the rate of new bone formation.  This is why it is important to concentrate on optimizing calcium stores and building up bone tissue at a young age.  If you can optimize your peak bone mass as a youth, your bones will be stronger and less susceptible to osteoporosis when your body starts to lose bone faster than it can make it.

     Osteoporosis is a major public health problem.  It is estimated that in adults 50 years and older, one in two women and one in four men will suffer an osteoporosis-related fracture in their lifetime.  Each year it leads to fractures in 1.5 million people.  Fractures typically occur in the hip, spine, and wrist.

     Fractures of the hip are of particular concern.  Approximately 24% of adults over the age of 50 who have suffered a hip fracture will die within a year of the incident.  For those who survive a hip fracture, quality of life can be greatly reduced by functional limitations.  One in five sufferers will need long-term aid (nursing home care) afterward.  And, only 15% of hip fracture sufferers can walk unaided across the room six months post-incident. 

     Fractures of the vertebrae (spine) are also of special concern.  They can lead to death as well.  In addition, they are associated with physical deformity and a decrease in height.  These physical changes can affect self-esteem and lead to anxiety and depression.

     There are certain lifestyle habits and traits that can increase your risk for developing osteoporosis.  They are listed below.

Risk Factors for Osteoporosis:

• Female gender - 80% of those affected are women
• Small/thin body frame
• Low body weight
• Ethnicity - Caucasian and Asian races are at a greater risk
• Older age
• Family history of osteoporosis and broken bones
• Personal history of broken bones
• Physical inactivity
• Smoking
• Low levels of sex hormones - Estrogen protects bones.  Women who have low levels, such as from menopause, are at a greater risk.  The risk is also greater for those women who have amenorrhea (absence of periods).  Testosterone protects bone in men, therefore, low levels can lead to bone loss.
• Poor diet - Low intake of calcium and vitamin D as well as excessive consumption of caffeine, alcohol, protein, and sodium can increase risk.
• History of steroid and anticonvulsant medication use 
• History of anorexia nervosa, rheumatoid arthritis, and gastrointestinal disease

     Osteoporosis is known as a "silent" disease.  You cannot feel your bones becoming less dense and weak.  Many times, the first sign that osteoporosis is present is a bone fracture.  Kyphosis (a stooped posture) or a loss of height also can be an indication of the presence of osteoporosis. 

     Fortunately, osteoporosis is preventable and can be treated.  You can take action to promote bone health by following the healthy lifestyle habits listed below.

Tips to Promote Bone Health:

• Engage in regular exercise that is weight-bearing and uses the major muscle groups of the body. 
• Participate in resistance training activities at least 2-3 days/week.
• Perform balance exercises at least 1 day/week.
• Consume adequate levels of calcium and vitamin D.  Foods that are high in calcium include dairy products, fortified oatmeal, soybeans, canned salmon with edible bones, and broccoli.  The best way to get vitamin D is by sun exposure, about 15 minutes per day.  Vitamin D-fortified cow's milk and soy milk are other sources of the vitamin.
• Avoid smoking and excessive alcohol consumption.
• Discuss your bone health and risk for developing osteoporosis with your physician.  He/She may suggest a bone density test, supplementation, and/or medication.

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:

The 2004 Surgeon General's Report on Bone Health and Osteoporosis

The National Osteoporosis Foundation (www.nof.org)

     Muscle soreness can be a normal response to exercise, especially if you have just started a program, have dramatically increased the intensity or duration of a routine, or attempted a new mode of physical activity to which your body is unaccustomed.  Muscle discomfort that starts about 12-24 hours after an exercise session and lasts for about 3-4 days is referred to as delayed-onset muscle soreness (DOMS).  Symptoms of DOMS are listed below.

• Muscle stiffness
• Mild pain/discomfort 
• Minor swelling
• Decreased strength
• Decreased power
• Decreased range of motion

     The discomfort associated with DOMS is specific to the muscles exercised.  Its severity is related to the intensity and volume of the physical activity.  Eccentric exercise, such as down hill running and the weight lowering phase of resistance training, is associated with the greatest amount of exercise-induced muscle soreness, especially in older individuals.  DOMS appears to be correlated with the following factors:

• Microscopic tears in the muscle tissue
• Damage to the contractile components of the muscle tissue
• Inflammation/Edema - a build-up of fluid in surrounding tissues
• Muscle spasms 

     DOMS is part of an adaptive process that results in a stronger, more resistant muscle.  It has been found that a single bout of exercise has a protective effect, up to 6 weeks, against the development of muscle soreness from subsequent exercise.  Thus, it is suggested that you can minimize muscle soreness by starting with light exercise and slowly progressing the intensity level.  Although the most effective form of treatment is still questionable in alleviating DOMS, the following tactics may provide some relief:

• Selenium and Vitamins E & C supplements (they are thought to protect against disruption of the cellular membrane)
• Protein supplements (for those involved in extremely intense exercise)
• Stretching
• Massage
• Non-steroidal anti-inflammatory medication

     DOMS symptoms should resolve within 10 days.  Stop any physical activity that exacerbates the discomfort and seek medical attention if pain persists longer than expected or if you experience excessive swelling, redness and/or pain. 

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:

Exercise Physiology Energy, Nutrition, & Human Performance, Sixth Edition. pp. 549-552, McArdle, WD., Katch, FI., and Katch, VL.

About.com "Muscle Pain and Soreness After Exercise - What is Delayed Onset Muscle Soreness," Quinn, E. (www.sportsmedicine.about.com/cs/injuries/a/doms.htm)

   
     

     This Father's Day, June 21, 2009, the Michigan Institute of Urology is sponsoring the first annual "Run for the Ribbon 5K Walk/Run" to be held at the Detroit Zoo starting at 8:00 AM.  The "Run for the Ribbon" race was created to promote prostate cancer awareness.  Proceeds from the race will be used for prostate cancer research and treatment in southeastern Michigan.

     The most common form of cancer affecting American men, other than skin cancer, is prostate cancer.  One out of 6 men will get this form of cancer and one out of 35 men will die from it.  The American Cancer Society (ACS) estimates that there will be 192,280 new cases diagnosed and 27,360 deaths from prostate cancer this year.  

     Fortunately, the death rate from this disease is declining and its presence is being detected earlier according to the ACS.  You can help these trends continue by joining the fight against prostate cancer.  Decrease the negative impact that this disease can have on your life or that of a loved one by increasing your knowledge about its signs and symptoms, risk factors, and suggested ways to prevent it (see below). 

Risk Factors*:

• Age - most cases occur in men over the age of 65, but can occur at any age
  
• Race - African-American men are more likely to develop and die from prostate cancer than caucasian-American men
• Family History - men whose close family members (father or brother) who have had this disease are at a greater risk
• High-fat diet - research is suggestive of a possible link between a high-fat diet and prostate cancer

*Note:  The actual cause of prostate cancer is unknown, however, these factors are related to a higher incidence of the disease.

Signs and Symptoms*:

• Impotence
• Urinary or fecal incontinence
• Presence of blood in urine
• Weakness/numbness in legs and/or feet
• Pain in back, hips or ribs

*Note:  Signs and symptoms of prostate cancer usually do not occur until the later stages of cancer.  It is not uncommon for the man in the early stages of this disease to be asymptomatic.

Prevention:

• Although more research is needed, it is suggested that following a low-fat diet that limits fats from red meat and dairy products and is composed of a variety of fruits and vegetables may prove to be beneficial.  Diets that contain tomatoes and soybeans may be linked to a lower incidence of prostate cancer as well.

The Best Defense Against Prostate Cancer:

• Early detection - this can be done through a routine blood test called a PSA (prostate-specific antigen, a protein produced by the prostate cells) or by a rectal exam.  High levels of PSA may indicate the presence of cancer.  If high levels are detected then further tests, such as a biopsy, will be done.  A tumor on the prostate may be detected during the rectal exam.  As with a finding of high PSA levels, if an abnormality is detected during the rectal exam, further tests will be conducted.

     Give a father the gift of life this Father's Day by participating in "The Run for the Ribbon 5K Walk/Run" at the Detroit Zoo.  For more information on the race and how to register, visit www.MIURunForTheRibbon.com.

Resources:

American Cancer Society "Facts on Prostate Cancer and Prostate Cancer Testing" brochure

American Cancer Society "After Diagnosis: Prostate Cancer Understanding Your Treatment Options" brochure

     My husband and I always get a laugh when we get stuck behind a sports car that is going 15 mph below the speed limit.  Its not that we want the driver to go beyond the speed limit, but it seems odd that (s)he owns this beautifully engineered "muscle" car designed for high speeds, yet s(he) chooses to go below what is an acceptable speed.  It is a paradox of sorts.  The potential is there, but the minimum isn't even attempted.

     Where am I going with this?  The human body has evolved to possess specific features that provide us with the potential to be exceptional long distance runners, an ability which is unique to humans when compared to other primates and is a rarity among mammals.  According to Daniel E. Lieberman and Dennis M. Bramble in their article "The Evolution of Marathon Running Capabilities in Humans," this ability emerged about 2 million years ago when food had to be hunted and scavenged by our ancestors for survival.  

     What are these features that our bodies possess to achieve such a feat?  In an earlier article by Dennis Bramble and Daniel Lieberman "Endurance Running and the Evolution of Homo," they describe 4 categories of these specialized features which are outlined below:

Energetics (the metabolic or energy cost of moving the body):

• The tendons (most important of which is the Achilles tendon) in the legs store elastic energy that is used to propel the body into the aerial phase (both feet off the ground) of running, thereby reducing approximately 50% of the energy cost of running.
• The arch and ligaments of the foot function as a spring during the stance phase, reducing approximately 17% of the energy cost of running.
• A smaller lower leg (calf) mass compared to that of the upper leg (thigh) reduces muscular effort to move the lower leg.
• Stride length is increased and stride rate is decreased during endurance running due to the spring-mechanisms of tendons and ligaments and relatively long legs compared to animals.  The decreased stride rate reduces the force that has to be used to move the legs, which account for 30% of total body mass.
• Human forearms are smaller in muscle mass compared to chimpanzees.  The smaller muscle mass reduces the effort needed to keep the elbow flexed during running.

Skeletal Strength:

• The larger joint surfaces found at the femoral head, knee, sacroililac, and lumbar centra joints allow the resultant impact forces from the ground during heel strike to be spread and dissipated over a larger surface area reducing stress placed on the body.

Stabilization:

• The neck and trunk shift slightly forward during running to aid with balance.
• Trunk stabilization is enhanced due to broader surfaces on the sacrum and posterior iliac spine to which the erector spinae muscles are attached.
• An enlarged gluteus maximus aids in stability while running.  This muscle is not active during walking, but is greatly recruited during running.
• The torso is very mobile.  It allows for counter rotation within itself and of the arms to counteract the opposing forces created by the legs when they are swung forward in running.  In walking these forces are counteracted by ground reaction forces (during running there is the aerial phase in which there is no contact with the ground to make use of this form of stabilization).
• The elongated, narrow waist of the body allows the trunk to rotate independently from the hips to a greater degree compared to apes.  This allows for a counter balance of torques generated by the legs while running.
• Humans possess relatively wide shoulders which function to counteract the motion of arm-swinging during running. 

Thermoregulation and Breathing:  

• Running can generate up to 10 times more heat than walking.  Most mammals are not as efficient at dissipating heat as are humans.  Therefore, they have to stop after short distances to avoid hyperthermia.
  
• Humans are proficient sweaters due to an increased number and density of sweat glands.  This allows for heat to be dissipated through evaporation.
• Humans have reduced body hair (fur) compared to animals allowing an increase in convection rates to dissipate heat.
• Although humans mouth breath while running, they do not pant like animals.  Panting is how mammals cool their bodies.  However, it interferes with respiration, decreasing endurance capabilities.  The mouth breathing of humans helps to release excess body heat during expiration.

     According to Lieberman and Bramble, humans have this amazing capability to outrun most other mammals, even horses at times, when it is hot.  In their articles, they hypothesize that these specialized features evolved in humans to give them a hunting and scavenging advantage over other animals.  It is believed that early humans used "persistence hunting" to obtain food.  This tactic involved the human runner to follow an animal for a prolonged period of time until it was driven into hyperthermia, allowing the runner to safely get close to it to kill it.

     Isn't it interesting, and a bit unfortunate, that the years of "fine tuning" our specialized features have been met with modern man's physical inactivity and complacency?  Many of us are like the slow driving owner of a sports car, we are not even attempting what we have been designed to do - run.  Don't you think it is time that we at least try?

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: 

Sports Med 2007: 37 (4-5): 288-290. "The Evolution of Marathon Running Capabilities in Humans," Lieberman, DE. and Bramble, DM.

Nature 432, 345-352 (18 November 2004). "Endurance Running and the Evolution of Homo," Bramble, DM., Lieberman, DE.

Symposium - What was Normal Human Physical Activity and What is the Biological Basis for Current Daily Exercise? American College of Sports Medicine 2009 Annual Meeting, Seattle Washington. "Endurance Exercise and the Emergence of the Human Body: A Two Million Year Record," Bramble, DM. 

     If you are looking to put a little "spritz" into your exercise routine this summer, water exercise is an excellent alternative.  Its level of difficulty can be easily adjusted to accommodate your fitness and skill level.  Exercising in the water, whether it be through swimming or water aerobics, reduces the load placed on your joints, thereby reducing your risk for musculoskeletal injury and discomfort.  Therefore, it is a great option if you are an older adult, an individual who is trying to lose weight, someone who suffers from arthritis, or one who is recovering from an injury from which traditional weight bearing exercise should be temporarily avoided.  

     If you are interested in a form of water activity that is a little more adventurous (and which may require greater skill) consider canoeing, kayaking, paddle boating, water volleyball, and/or water polo.  Below is a list of estimated caloric expenditure for some common water activities and swim strokes.

Calories Burned During Water Activities*: (estimates for a person weighing 150 lbs. performing activity for 30 minutes)

• Swimming/treading water at a moderate effort:  143 kcal
• Swimming - backstroke, crawl (slow), sidestroke:  286 kcal
• Swimming - breaststroke:  358 kcal
• Water aerobics:  143 kcal
• Paddle boating:  143 kcal
• Canoeing - light to vigorous effort:  107-430 kcal
• Kayaking:  179 kcal
• Water volleyball:  107 kcal

*Older adults, overweight individuals, those suffering from arthritis or injury may need to perform these activities at a lower intensity level based on current fitness and health condition.  Therefore, kcal expended may be less than estimated above.  Also, you should consult your physician to ensure underlying health conditions will not be aggravated by participation in these activities.

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:

The Compendium of Physical Activities Tracking Guide. www.prevention.sph.sc.edu/tools/docs/documents_compendium.pdf

     It is not uncommon to hear grumbles and whining from my three children at the mention of a family walk.  Although the proposition gets greeted with less than desirable enthusiasm, it has never been challenged outright.  That is, until a few months ago when my 11 year-old son, who has always been an intense and passionate child but never defiant, stood with arms crossed and feet firmly planted on the driveway as he sharply stated "No, I am NOT going on a family walk!" in response to my husband's announcement that it was time.  At that moment, I realized that we were starting down a whole new path with my oldest - the "tween" years, a stage of development when a child seeks independence but still needs boundaries.  

     To coax our son into the walk we appealed to his new-found tween identity, but in a way that did not compromise our authority as parents.  We made it clear that participation in the walk was nonnegotiable.  However, we gave him the freedom to choose how he participated in the walk.  That is, he could listen to his ipod instead of joining in on the conversation during the walk; and, he didn't have to keep stride with us, but could stay a comfortable distance either behind or in front.  On recent walks he has chosen to take his soccer ball, practicing his dribbling skills on the way. 

     Another tween-appealing tactic that has worked to promote physical activity for our son is to enlist the company of a friend.  He dreaded his summer practice runs for this fall's cross-country season until his friend agreed to join him.  Now, they have a standing date to go for a run every afternoon, to which my son looks forward.  Not only does this option provide a social outlet for my son (a tween must), but it helps to foster a positive self-identity as the boys accomplish their running goals for the day.  This boost in self-esteem is especially important for the tween who is entering a stage plagued with feelings of self-consciousness and awkwardness.

     It is our job as parents to instill proper exercise habits in our children now so that they are more likely to continue this healthy lifestyle choice into adulthood.  This practice becomes more challenging to parents as the tween attempts to exert independence by questioning the "rules of the house."  Below are some tips to get your tween to exercise.

Tips to Inspire Your Tween to Exercise:

• Give your child an opportunity to feel in control.  Let him/her choose the physical activity in which (s)he will participate.  
• Make it social.  Enlist friends or encourage participation in group exercise programs offered through your community parks & recreation department, church, synagogue, or YMCA.
• Build confidence.  Provide exercise opportunities that involve attainable goals (e.g. walking around the block two times or training for a fun run race) which will result in personal mastery and enhanced self-esteem.
• Provide positive reinforcement when your child meets set goals (e.g. give a "congratulations" card or certificate).
• Be a positive role model.  Exercise yourself and discuss strategies with your child on how to overcome barriers to exercise.

For additional information on how to get your child physically active visit the We Can! website (www.nhlbi.nih.gov/health/heart/obesity/wecan/).  We Can! (Ways to Enhance Children's Activity & Nutrition) is a national program sponsored by the National Institutes of Health to help families adopt a healthy lifestyle.

     

     I have witnessed two individuals experience the early phases of exertional heat illness - a spectrum of conditions that, if left unchecked, can be potentially life-threatening.  Both episodes were in children.  Both occurred during summer camp, one a general day camp and the other a sport camp.  

     As you exercise, your body produces sweat in order to regulate body temperature.  As the sweat evaporates it cools your body.  Exercising during hot and humid weather inhibits the effectiveness of this process which can result in your body temperature reaching above normal levels.  When the heat stress exceeds your body's ability to dissipate the heat, and therefore maintain a normal core temperature, heat illness can result.  

     You are most susceptible to developing heat illness during the first few days of warm/hot weather when your body has not yet acclimated to the higher temperatures.  In addition to the excessive demands placed on your body's thermoregulatory system by the hot and humid environment, dehydration can compound the situation either directly or indirectly.  Heat illnesses can be minor and easily reversible, such as with muscle cramps, or they can be life threatening, such as with heat stroke.  

     Children are especially susceptible to developing heat illnesses because they have immature thermoregulatory systems.  It takes longer for children to start sweating compared to adults; and, the rate at which they produce sweat is not as fast.  Furthermore, children have a greater surface area to body mass ratio in comparison so when they are exposed to a hot environment, they gain heat more quickly.  Below is a list of heat related illnesses and their associated symptoms.

Heat Cramps:  These commonly occur following intense exercise of a prolonged duration.

• Painful involuntary muscle spasm/contraction
• Occur in muscles of the abdomen, legs, and arms
• Caused by dehydration and electrolyte imbalance
• Relieved by rest, prolonged stretching, and fluid and electrolyte replacement

Heat Exhaustion:  The most common form of heat illness.  It can occur during or after exercise.  It is characterized as the inability to continue physical activity.  Individuals experiencing heat exhaustion have core body temperatures that range from 97 degrees to 104 degrees Fahrenheit (36 degrees to 40 degrees Celsius).

• Pale, sweaty skin
• Dizziness
• Weakness
• Decreased muscle coordination
• Nausea
• Vomiting
• Diarrhea
• Headache
• Irritability
• Chills
• Treatment involves moving affected individual to a shaded or air conditioned area.  Feet should be elevated while in the supine (on the back) position.  Excess clothes should be removed and fluids given.  Medical attention should be sought if symptoms do not resolve.

Heat Stroke:  A medical emergency that can result in death.  It requires immediate treatment.  Associated with body core temperatures exceeding 104 degrees Fahrenheit (40 degress Celsius).

• Disoriented
• Irrational behavior
• Loss of muscle coordination and balance
• Fast breathing (hyperventilation)
• Rapid heart rate (tachycardia)
• Low blood pressure (hypotension)
• Vomiting
• Diarrhea
• Seizures
• Collapse/coma
• Treatment involves whole body cooling in the form of cold water and ice water immersion therapy.

Tips to Reduce your Child's Risk at Camp:

• Make sure your child is adequately hydrated before going to camp.  Serve a breakfast that includes a beverage and foods with a high water content such as fruit (watermelon, oranges, etc.).
• Send a water bottle/sports drink for consumption during the day.
• Pack an extra beverage and foods with a high water content for lunch.
• Have your child dress in loose-fitting, light-colored and light-weight (e.g. mesh) clothing.
• Talk to the camp counselor/coach to ensure adequate water and rest breaks will be taken throughout the day.
• Confirm that camp counselors/coaches are familiar with the signs and symptoms of heat illnesses and that they are prepared and equipped to take the necessary action if a situation arises.
• Inquire about the camp's protocol for high-risk days (Wet Bulb Globe Temperature greater than 82 degrees Fahrenheit [28 degrees Celsius]).  For example, will they decrease the intensity and/or length of events involving physical activity?  Will they move sessions to indoors where there is air conditioning?
• If possible, choose a sport camp that offers sessions in the early morning before temperatures get too high.

     Summer day and sport camps should be an enjoyable and rewarding experience for your child.  Increasing your awareness of the signs and symptoms of heat illnesses, as well as how to avoid these conditions from occurring, will help to prevent a negative experience for both you and your child this summer.  

Resources:

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

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

ACSM's 2007 Position Stand: "Exertional Heat Illness during Training and Competition," Medicine & Science in Sports & Exercise.

     As the days get longer and warmer you may find yourself engaging in more physical activity, whether it is through yard work or a "pick-up" game of softball.  This increase in activity creates more opportunities for stress and strain to be placed on your back, and resultant discomfort if you are not careful.  Back pain is a common ailment that sends individuals to visit their doctor or to miss work.  Knowledge of who is at risk for developing back pain, what conditions cause back discomfort, and steps that you can take to minimize your risk for developing back problems can help prevent this from happening to you.

     Your back is composed of bone (vertebrae), muscles, connective tissue (ligaments and tendons), discs (round "pads" found between the vertebrae that have a gel-like center that act as cushions/shock absorbers), and nerves (spinal cord).  Any of these structures could be involved in causing your back pain.  Back pain can be acute or chronic.  Acute back pain comes on suddenly and resolves in a few days to a few weeks.  Chronic back pain lasts longer than 2-4 weeks.  

     You are at a greater risk for developing back pain if you are overweight or obese, a smoker, are of the female gender, are older in age, or have anxiety or depression.  Job positions that are stressful, require strenuous manual labor, involve repetitive motion, or require sitting for prolonged periods of time (desk work) increase your risk as well.   Implementing proper body mechanics throughout the day can promote back health.  Often times back pain results from improper lifting mechanics.  Common mistakes made while lifting are listed below.

Lifting Mistakes:

• Lifting an item that is too heavy for one person.
• Lifting an awkward object.
• Lifting a heavy item above your shoulders (e.g. placing a heavy box on the top shelf).
• Bending at the waist while lifting an object.
• Holding/carrying an overweight item away from your body.
• Twisting your body while lifting a heavy load.

The Proper Lifting Technique Involves:

• Think before you lift.  Develop a plan.  What is the best way to approach picking-up the object?  Does it require more than one person to lift it?
• Position yourself close to the object to be lifted.
• Create a wide base of support by separating your feet shoulder-width apart.
• Squat down, bending at the knees and hips.  Do not curve your back forward.
• Tighten your stomach muscles while slowly lifting the object with your leg muscles (not your back) as you assume the standing position.  Make sure to keep your back straight and avoid twisting movements while you lift the item.  Do not "jerk" the object up toward you.
• Carry the object as close to you as possible while moving to a new location.
• To set down the object, squat down by bending at the knees and hips.  Do not curve your back forward.  Slowly lower the item to the ground.

     Improper posture can lead to back pain as well.  To maintain a healthy back while sitting, provide support at the curve of your back with a lumbar roll, small pillow, or a rolled towel.  Adjust the height of your chair so that your knees are even with or slightly higher than your hips.  You may need to use a foot rest to achieve this.  While working at a desk, your shoulders should be relaxed with your elbows resting on either the desk or the arms of the chair.  In order to avoid the habit of slouching forward, organize your work station so that your work can be tilted up toward you.

     Back pain can arise from poor sleeping habits.  Avoid sleeping on your stomach.  To support and maintain the natural curve of your back, consider using a pillow under your lower back or your knees.  When getting out of bed in the morning, roll onto your side, bend your knees and swing your legs slowly to the side of the bed as you push your torso up with your hands to the seated position.

     In addition to implementing proper body posture and body mechanics, improving your overall fitness level will promote back health.  Exercises should focus on strengthening your stomach, as well as your back, muscles to stabilize the vertebrae.  Strengthening your hip and leg muscles are essential for proper lifting mechanics.  Exercises that increase flexibility will help reduce risk of injury if sudden unexpected movements are required.  Some toning and stretching exercises to consider include the following:

Wall Squats:

• Stand with your back against the wall
• Move your feet approximately 12 inches away from wall
• Slowly bend your knees to a 45 degree angle while keeping your back straight and stomach muscles tight - hold for 5-10 seconds
• Slowly return to upright position
• Repeat 5- 10 times

Pelvic Tilt:

• Lie on your back on the floor with your knees bent
• Tighten your stomach muscles until the curve of your back lies flat against the floor - hold for 10 seconds
• Relax stomach muscles
• Repeat 5- 10 times

Knees-to-Chest:

• Lie on your back on the floor with your legs straight
• Bend one knee
• With your arms "hugging" your knee, bring it up to your chest, hold for 10 seconds
• Release your arms and straighten your knee while lowering your leg back to the floor
• Perform with your opposite leg
• Repeat 5-10 times for each leg

     Implementing the above guidelines, when performed appropriately and consistently by most apparently healthy individuals, should help to promote back health and reduce your risk for developing back problems.  However, if at anytime while attempting these tactics, you experience pain, you should discontinue the activity.  Seek medical attention if the symptoms do not subside.

Note:  A physician's approval should be obtained prior to beginning an exercise program, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources:

The Cleveland Clinic website (my.clevelandclinic.org)

The Mayo Clinic website (www.mayoclinic.com)

American Academy of Orthopaedic Surgeons (www.aaos.org)

WebMD (www.webmd.com)