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Exercise and endothelial function in Chronic Heart Failure

10 May

Chronic heart failure (CHF) is a disease most prevalent in the elderly. Additionally, symptoms are often aggravated in this population because of an overlap between the physiological age-related decline in exercise capacity and the disease-related functional decline. This study aimed to asses the effects of exercise training on endothelial progenator cells (EPCs) number and function in young and older CHF patients. It was found that 4 weeks of aerobic exercise training are effective in increasing EPCs number and function in young and older CHF patients.

60 with stable CHF and 60 healthy controls were divided into 2 age strata of 65 years old. Subjects were randomized until half of each strata (young healthy, young patients, older healthy, older patients) was in the intervention group, receiving 4 weeks of daily exercise training and the other half was in the control group, receiving usual care. EPCs number and function was measured at baseline and after 4 weeks.

This study found an age-related decline in EPCs number and function in healthy subjects, but not in CHF patients. After the short high-dose aerobic exercise training, a significant increase in function and number of EPCs was found in young and older CHF patients, and in older healthy subjects.

The beneficial effects of exercise training on endothelial function and EPCs were not diminished in older patients with CHF, emphasizing the potentials o

f exercise interventions in a patient group where CHF has a high prevalence.

Pendulum by night – Frozen Shoulder

12 Jan

Pendulum by night:

Many a time patients with frozen shoulder, complain of pain in the night. we as therapists, run out of ideas after a while when nothing works!!

The challenging part with adhesive capsulitis stage 1 and 2 (the inflammation & freezing stages ) the patients feels so uncomfortable in the night.,whatever the position they adopt is uncomfortable. They resort to painkillers, hot packs and end up sleeping in sitting the whole night.

I have advised them not to sleep on the affected shoulder and to lie flat.,but to no avail. So what helps??

If anyone says i can get frozen shoulder alright in two sittings please don’t believe it. I tell all my patients it will take time.,i give them atleast 3-4 months..I will discuss this in detail in another post.

Even when you sleep on the painfree shoulder, the weight of the top hand itself will increase the tension in the shoulder. I have found relief in my patients by asking them to support it on a pillow while sleeping on tummy up and on their pain free sides. kind of a distraction effect.

Recently i understood.,that the pain in the night could be because of the migration of the humeral head towards the acromion and reducing the subacromial space and causing compression of the inflammed tissues and thereby pain.

in the day , the gravity does a wonderful job of distracting the shoulder.,so i have started recommending pendulam exercise in the night.,roll on to the tummy leave your hand out of the cot, pick up the waterbottle next to you and swing 30 reps * 2 sets and trust me it helps. ( just make sure the bed is high enough to swing without hurting your hand, if not get next to the bed, take support, bend your knees slightly and swing)

It gives a traction effect and thereby relieves pain and the patients appreciate this simple tip. Managing pain is very important to get patient satisfaction and we have to do so using our physiotherapy skills , technique and most importantly common sense in most cases!!!

The Six pack secret!!!

29 Aug

Many a times, i have been countered with this question.,How do i get a six pack?? Yes its a sign of a healthy , super fit body.,with our without musculoskeletal injuries, a price you sometimes pay for pushing the limits.

Once one of my celebrity client said.,the 6 pack fad is so rampant that all the film stars want one.,even a cart puller or a farmer in the village or fisherman has one!! The truth is it looks great on some and not so great on few.,the reason you lose fat all over the body and not selectively over abdomen ( There is no spot reduction ). Every man and sometimes women (wash board abs) want it., why my 7 year old nephew was trying to show me one recently.

How do we achieve it?? For me its your lifestyle.,i have seen young tennis / cricket players have six pack without hitting the gym or doing any form of specific drills..its their lifestyle (sport) that gives them.

Well then what about you and me?? Yes of course its possible.,its all about how badly??

In my experience you need to have 3-5% body fat only to have a 6 pack for men. If you are someone looking at a six pack thats what you need to aim at. Give yourself time and work towards it.

Exercise:

You need to burn fat.,moderate intense cardiovascular exercise.,( cycling/swimming/jogging/walking) interspersed with high intensity bouts (cross fit / functional training / boot camp) amounting to not less than 700 calories a day.

Add to that your core training and good strength training (as you may lose your muscle in the process if you don’t train them). The predominant focus should be on cardio vascular activity.

Nutrition / Diet :

Diet plays a major role.,its not about how much you eat.,its about what you eat. what does a farmer get to eat / drink?? The ragi / rice kanji, the buttermilk, milk, vegetables, fish, eggs may be. Cutting of oil, sugar, anything that tastes sweet, be it even fruits.,and switching to millets/cereals, low calorie, low fat, low sugar natural foods is the key,

Plenty of fluids and spaced out mini meals, i recently learnt about eating every hours and handful amount of right kind of food and thats what your body needs. The bottom line you don’t need to starve.

Do not stock high calorie stuffs at home.,or your temptation foods.,that are high in sugar and fat. Do not eat when stressed or when you have nothing to do.,if you have to, snack on fresh vegetables and fruits.

Do not resort to supplements, fat burners or steroids.,may give you short term, quick results in a short time.,but are potentially harmful, most of them, if not all.

Life style:

Its not those two hours you spend in the gym.,its about the rest of 22 hours that matter..if you are a software guy, sitting in front of the computer for 10 hours a day.,its gonna be difficult. if you are a sportsmen, trainer, physio you have a much better opportunity to get one and maintain it.

Stay active is the key!!

Genetics:

If you are blessed with a good gene, with a good resting / basal metabolic rate you are lucky.

Now go get it guys, its simple.,all it takes is only a lot of determination!!

What are we missing!!!

25 Feb

The other day, when i was in Manipal, i was little reluctant to use the shower in the guest house and i used the bucket with mug, to bathe. To my surprise, i ended up doing 25 squats at least in the process!!There used to be days, where we used to sit on the floor cross legged and do the Indian squats.,which till recently our allopathy medicine discourages to do it..We need a foreigner to research and to tell us the Indian squat position is great for bowel movement .

Then we have this thoppukaranam., our teachers used to make us do as punishment if we come late to school..again we need a outsider to tell is its brain yoga.We used to run and play barefoot, when we were kids.,now the newly born baby has socks and mitts!! Thanks to western influence. Now the whole world says, walk / run barefoot!!

Well water pulley and rope, Carrying pots on the head and waist, pounding rice (ulakkai), the ammi kal (Hand Grinder stone), Chakki and kulavi & aatukal (stone grinder ), mortar and pestle have been traditionally great functional work., solagu or muram and pan grinder are great relaxing exercises, Now they are all near oblivion since everyone has moved towards electrical grinders. Incidentally my physio saranya, accounted how all these were greatly useful during the power cut in the flooding days in Chennai. I also see all of them taking place in fitness in the form of functional exercise in recent times.,which were part of our day today life till about 20 years back!!

Cycling / walking to school great cardio exercise.,we used to do doubles and triples on the cycle.,playing on the streets in the hot sun (talk about vitamin D). My 8 year old nephew was recently jumping on the stair case from 4-5 steps.,didn’t feel like stopping him.,as i recently read jumping and plyometrics are great for fascial fitness!!

Growing up, we were less protected.,allowed to fall and rise, get hurt.,today i feel children are too protected within the confines of the wall. The whole world is realizing what we as india has offered to the world.,yoga, varma, ayurveda…its time we realized what we have in store!!

Growing up, we were less protected.,allowed to fall and rise, get hurt.,today i feel children are too protected within the confines of the wall. The whole world is realizing what we as india has offered to the world.,yoga, varma, ayurveda…its time we realized what we have in store!!

Exercise for the Health of It. Is TABATA TRAINING for you?

29 Jan

There are all kinds of exercise routines from which active people can choose, and the choice depends on what you want to accomplish. For example, some exercise routines are specifically designed to help you lose body fat by improving aerobic energy systems, and yet another may help you to gain muscle mass or power output by improving anaerobic systems. But for those of you who have no health problems or physical limitations that would limit exercise performance, and who want to improve both aerobic and anaerobic energy systems, the Tabata exercise routine may be for you.

Named after the Japanese researcher who published his findings in 1996[1], Tabata is a type of interval training comprised of a combination of high-intensity bouts of exercise and alternating rest periods. Its benefits were demonstrated by Tabata’s research team who compared the training results of two groups of individuals put on two different exercise regimens. One group was placed on a typical endurance exercise program that comprised of submaximal intensity cycling on a leg ergometer for 30 minutes per day, five days per week. The other group was placed on an intermittent high intensity exercise routine that comprised of eight sets of maximal intensity cycling for 20 seconds with 10 seconds rest, five days per week. Each group underwent pre- and post- VO2 max and anaerobic capacity tests. Results of the study indicated the endurance training group improved their aerobic capacity (e.g., VO2max) as expected, but not their anaerobic capacity, and the high-intensity training group demonstrated improvements in both aerobic capacity and anaerobic capacity.

The Tabata research protocol used a leg cycle ergometer, but you can use any form or mode of exercise in your Tabata routine. Simply use the Tabata protocol of 20 seconds maximal intensity exercise followed by 10 seconds of rest (totaling 240 seconds or four minutes) , repeating seven more times with no lapse between sets. Because timing is so important, you will need a stopwatch or a clock with a second-hand. The number of reps in each set is not stipulated, but be sure to do them in good form, slowing down if you start to get sloppy. Never sacrifice form for speed or number of reps.

Each four-minute cycle is called a Tabata, and beginners may want to start out with one Tabata per exercise session. For the more adventurous, highly trained, and athletically inclined, you may add Tabatas to your exercise routine. For example, a Tabata session may include one Tabata of leg cycling plus a Tabata of jumping jacks with no lapse between Tabatas. A Tabata circuit can be created by adding other modes of exercise.

Here is a sample Tabata circuit that could be used:


Exercise at maximal intensity 20 seconds Rest 10 seconds >>Repeat 7 times for a total of 8 sets >>Go directly to next exercise mode.

Exercise #2 Stair Climbing

Exercise at maximal intensity 20 seconds Rest 10 seconds >>Repeat 7 times for a total of 8 sets >> Go directly to next exercise mode.

Exercise #3 Jumping Jacks

Exercise at maximal intensity 20 seconds Rest 10 seconds >> Repeat 7 times for a total of 8 sets  >> Go directly to next exercise mode.

Exercise #4 Stationary Cycling

Exercise at maximal intensity 20 seconds Rest 10 seconds >> Repeat 7 times for a total of 8 sets >> Go directly to next exercise mode.

Exercise #5 Pull-ups

Exercise at maximal intensity 20 seconds Rest 10 seconds >> Repeat 7 times for a total of 8 sets >> Go directly to next exercise mode.

Exercise #6 Abdominal Crunches

Exercise at maximal intensity 20 seconds Rest 10 seconds >> Repeat 7 times for a total of 8 sets >> Go directly to next exercise mode.

Exercise #7 Rowing

Exercise at maximal intensity 20 seconds Rest 10 seconds >>Repeat 7 times for a total of 8 sets >> Go directly to next exercise mode.

Exercise #8 Push-ups

Exercise at maximal intensity 20 seconds Rest 10 seconds >> Repeat 7 times for a total of 8 sets >> Go directly to next exercise mode.

Benefits of Tabata: These short, intense workouts have not only been shown to improve aerobic and anaerobic conditioning, but also provide improved glucose metabolism and increased fat burning

 

CARDIAC YOGA

9 Jan

1. Yoga is very friendly to your heart whether its in great shape or its in need of help.

2. Yoga exercises hardly increases the Workload on the Heart especially once you are a bit more seasoned in combining breathing with your Poses or Suryanamaskars.

3. Yogic Suryanamaskars combines the benefit of Cardiac Strengthening with Cardio vascular Endurance.

4. Yoga is very calming on the nerves that connect the heart and the Brain as well the Blood vessels and the other Spinal nerves. Because of this with regular practice of Yoga the Blood

pressure is regulated.

5. Yogic forward bends ie the poses that brings the head close to foot are observed to act on the Para sympathetic nervous system and bring about Para symnpathetic dominance. This helps a

person to Stay calm even during adverse situations.

6. Yogic pranayama techniques can improve the blood oxygen levels as well as the Prana content in your blood.

7. Yoga works the heart at a comfortable rate as against other Aerobic activities hence it is suitable for even people with some Heart conditions.

8. The topsy turvy poses in Yoga upon holding for a specific duration, directly reduces the gravitational effects on the heart and hence it actually eases the Heart muscles.

9. Anahatha Chakra located on the Physical Heart upon blossoming transcends a Human mind to Godly qualities and opens up the conduit for Universal love.

10. Yoga is the best for your Heart! Sincerely practice it everyday.

THE SKINNY ON ABDOMINAL FAT

6 Jan

It is well known that body composition is a major component of fitness and that excess body fat is not healthy. However, the distribution of body fat, e.g., where fat is located, is also an important health factor. Overall excess body fat can give someone a “pear” shape –where fat is deposited on the hips and buttocks, or an “apple” shape—where fat is deposited around the middle of the body. Research has shown that these two shapes have very different health implications.

Clinically known as central obesity, this location of excess fat has been associated with the incidence of a wide variety of cardiovascular and metabolic diseases, in particular, hypertension, dyslipidemia, insulin insensitivity and diabetes, as well as the presence of knee pain and osteoarthritis and asthma. Most recently, central adiposity hasalso been linked with Alzheimer’s disease.

A percent body fat measurement will not distinguish between the two body shapes. It is more useful to determine the waist-to-hip ratio (WHR) which takes a person’s body structure into account (see WHR measurement protocol below). According the World Health Organization, abdominal obesity is defined as a WHR above 0.90 for males and above 0.85 for females.

Other ways of determining abdominal obesity includes:

  •  Absolute waist circumference (>102 cm in men and >88 cm in women)
  •  Index of Central Obesity
  •  Sagittal Abdominal Diameter

It is important to note here that a differential diagnosis includes distinguishing central obesity from ascites and intestinal bloating, either of which could influence the WHR measurement.

There are two types of central abdominal fat, visceral and subcutaneous. Subcutaneous fat is located underneath the skin and can easily be measured in millimeters by skinfold calipers. A common

abdominal measurement is a vertical skinfold taken just to the right of the umbilicus. Visceral fat, also known as organ fat, is located inside the peritoneal cavity, packed in between internal organs

within the torso. A skinfold measurement on the abdomen of a person with a pot belly would not take the visceral fat into consideration. But visceral fat can be seen with powerful imaging techniques

such as magneticresonance imagining (MRI). It is this type of fat that makes the abdomen protrude excessively and is jokingly known as a beer gut or pot belly.

Of the two types of centrally located fat, it is believed that intra-abdominal fat conveys the bigger health risk. Research has shown that

  • Surgical removal of visceral fat, but not subcutaneous fat, has been shown to extend the mean and maximum lifespan of rodents.
  • Visceral fat, unlike subcutaneous fat, is implicated in many aging-associated diseases, for example, abdominal fat is a major source of increased inflammatory Interleukin associated with aging.                as well as other inflammatory responses;
  • Higher volumes of visceral fat, regardless of overall weight, has been associated with smaller brain volumes and increased risk of dementia
  • There is a relationship between abdominal obesity and lung function.

Though there are medical treatments which have proven to be successful in reducing fat weight, a lifestyle change of increasing caloric expenditure through a permanent exercise routine and moderately reducing caloric intake is still necessary in order to maintain a target weight and percentage body mass when it is achieved. A combination of aerobic/cardio exercises and resistance training has been shown    to be more effective than either mode alone. Your trainer should be able to prescribe an exercise program that will help you reach your weight goals.

WHR Measurement Protocol: Proper placement of a stretch-resistant measuring tape is important: for the hips, place the tape at the widest portion of the buttocks (usually at mid-point of buttocks from the side view), and for the waist, place the tape at the narrowest point (from the front view). If the waist is not apparent, place the tape at the midpoint between the bottom of the rib cage and the top of the iliac crest. For both measurements, the individual should be standing with feet close together, arms at the side, body weight evenly distributed, and wearing little clothing. The person should be relaxed, and the measurements should be taken at the end of a normal expiration, with tape measure placement parallel to the floor.

Eat Mindfully…

28 Dec

Eat Mindfully

When you are mindful you are fully present, in-the-moment without judgment. When it comes to eating, mindfulness helps increase the volume of your body’s cues so you can hear loud and clear when you are hungry and full. Many social and environmental factors can stand in the way of being able to accurately decode your body’s feedback. Mindfulness helps you break free from routine eating habits by examining the thoughts ,  feelings and internal pressures that affect how and why you eat (or don’t eat).

Shift out of Routine Eating  :

What did you have for breakfast? Be honest. Many people eat the same thing day in and day out. Notice whether you are stuck in any kind of rut or routine.

Take Mindful Bites :

Did you ever eat an entire plate of food and not taste one single bite? Bring all of your senses to the dinner table. Breathe in the aroma of a dish . Notice the texture on your tongue. Truly taste your meal. Experience each bite from start to finish.

Attentive Eating:

Sure, you’re busy and have a lot “on your plate.” It’s hard to make eating a priority rather than an option or side task. If you get the urge for a snack while doing your homework or studying, stop and take a break so that you can give eating 100% of your attention. Try to avoid multitasking while you eat. When you eat, just eat.

 

Gauge your hunger :

How hungry am I on a scale of one to ten? Gauging your hunger level is a little like taking your temperature. Each time you eat, ask yourself, “Am I physically hungry?” Aim to eat until you are satisfied, leaving yourself neither stuffed nor starving.

Emotional eating  :

Just because you think, doesn’t mean you have to act on them or let them sway your emotions. Negative thoughts can trigger overeating or stop you from adequately feeding your hunger. Remember: A thought is just a thought, not a fact.

Mindful Eating Support :

Friends provide an enormous amount of support, but often it’s helpful to obtain assistance or a second opinion from a trained professional. 

Walk Jog Run Sprint!!!

16 Oct

Increasing interest with running marathons, whether full, half 5k or 3k has opened a serious of discussions on technique, training, shoes, injuries etc. There are so many doubts in an avid runner on how to go about it. Most runners are recreational runners / joggers whose objective is to keep fit, healthy and stress free.

Health Fitness & Medical Screening:

This should be the first step any novice runner should embark on before starting the physical activity. If you are a male and above 40 and not used to vigorous form of exercise or activity, it’s

a wise option to undergo the medical screen & clearance with a physician’s consultation.The next step is to meet a Health & Fitness Specialist or a Sports Physiotherapist and get

evaluated on your Cardio vascular fitness, muscle strength and endurance, flexibility and body composition. A good posture evaluation to find out if you have any bio mechanical faults (like,

flat foot, knock knees, etc) soft tissue tightness, preexisting injuries, if any  and based on the findings she/he may advice you on a corrective exercise program, which can help you to enhance

performance and prevent injuries. Get your running mechanics evaluated.

Shoes & Terrain:

Investing on a good pair of shoes is of paramount importance. Shoes with good cushioning, toe room and arch support are things to look for in a shoe. It’s also important to pick up the shoe in

the evening when the toes are little expanded. Remember to change your shoes roughly after every 500kms of use.

Hard surfaces give you a push or bounce to run, with more impact, softer surfaces like the lawns, beach sand might offer less impact, but increases the muscle force or activity. So choose

a firm running surface like the running tracks, level grounds or good treadmills to train. Running up hill and downhill , cross country will enhance your fitness, but also will cause

injuries. If you are running out doors, be aware of the environment.

The FIT principle of training:

How often, how long and how intense should you train? It is the frequency, Intensity and the duration principle. If you are doing a less duration (less than 60mins) and low intensity (walk-

jog speed) you need lesser recover time and hence can train 5-6 days a week. If you are training at a high intensity (say running or sprinting) or longer duration (70 minutes

or more) you need longer recovery time and hence 2-3 times a week, not on subsequent days is advisable. You can however cross train those days with swimming, cycling or yoga.

Always start slowly and build gradually, giving time for the tissues to adapt. When you can walk or jog without going out of breath, you can progress to running!

Always warm up before the training, if you are planning to jog, a brisk walk for 5-10minutes would be a good option, followed by stretches of the muscle groups that are going to be in

action, obviously your calf, thighs back and shoulders. Do the same for a cool down.

Types of Training:

There are different types of training, the common ones are continuous training (steady speed through out), interval training ( 3 minutes run and 2 minute walk ), cross country (different

terrains) and fartlek training, which blends the continuous and interval training. If you are someone beginning to jog use the interval training and progress to continuous mode after

gradually increasing your percentage of jog.

Strength & Flexibility:

A 2 to 3 days a week of strength training on non-subsequent days to strengthen the core amd legs with moderate intensity with 8 to 12 repetitions, 2 sets for each major muscle groups

will be ideal.

Flexibility exercises like yoga or sports stretches can be done for 20-30minutes for the major muscle groups with 15 seconds hold for each, without breath holding, 2 sets each will be good.

Add to that the foam roller for glutes, hamstrings, IT band and calf muscles and foot.

Running Injuries & How to handle them!

Injuries happen, if you try and progress too quickly, if your frequency, intensity and duration are high, if you have poor strength and flexibility, improper foot wear, poor running mechanics

and bio mechanics, and other external factors, like fall etc.

Remember RICE; Rest from activities that cause pain, Ice for 15-20mins 3-4 times a day (if not more often), Compression in case of swelling with elastic bandage and elevation above heart

level, in case of swelling.

The common running injuries are mostly because of overuse. Stress fractures of the metatarsals, plantar fasciitis, runners knee, muscle strain,, Achilles tendinitis, groin pulls, low

back ache etc.,

Hydration & Nutrition:

Remember to hydrate well, with water or isotonic solution. There are various ORS drinks available in the market, to prevent cramps and to fuel. Carbs are the fuel for any endurance

activity, so make sure your carbs are not depleted, by vigorous training the previous days. On the day of the run have enough carbs and depending on the distance have a moderate or

low glycemic index fruit or snack 30 minute before the run.

Happy running!!

Sweat!!!

13 Oct

Sweating is the production of a clear, salty fluid secreted by millions of eccrine or sweat

glands in the skin which are located all over the body. Sweat is comprised mostly of

water, but also contains a tiny amount of electrolytes (e.g., sodium, chloride, potassium,

magnesium) and urea, a colourless nitrogen-containing substance also found in the urine.

Even though people have about the same number of sweat glands, the amount of sweat

differs among individuals. How much sweat released by each gland is determined

by several factors, including age, gender, environmental conditions and a person’s

acclimatization to them, and, pertinent to this discussion, fitness level. Of all the official

rules and guidelines set for prescribing exercise and ensuring a training response, the

principle of perspiration or “sweat” response is hardly ever mentioned. So, it is not

surprising that many exercisers and exercise professionals ignore, take for granted, or

do not recognize the importance of breaking a sweat during exercise sessions. On the

contrary, sweat response should be considered as one of the major training responses to

watch for. Why? The major function of sweating is to keep the body’s core temperature

at a safe level. Exercising turns up your body’s internal heating system. While you pump

your arms and legs, your body temperature rises and millions of those tiny sweat glands

are activated and sweat is released. As your sweat evaporates, it cools you off. Sweating

is your body’s built-in cooling system–it is your body’s way of getting rid of that extra

heat. In general, as a person’s aerobic fitness level increases, so does his/her ability to

sweat. That means, as a person’s exercise capacity improves, sweating begins earlier in

the exercise session and increases in the overall volume of sweat. The body is simply

becoming acclimatized and more efficient at cooling.

During moderate intensity exercise, sweat losses can average up to 2 L of water per hour.

You need to stay hydrated during exercise for this very reason. Without an adequate

supply of water, your body cannot sweat and your internal temperature will be too high

for you to workout normally, putting you at risk of heat exhaustion or worse. Remember

to drink more water when humidity is high—sweat evaporates more slowly on humid

days when the air is already saturated with moisture.

Side note: Usually, sweat from exercise has no odor, but increased nitrogen in sweat can

have a “sour” smell. An increase in nitrogen can be due to

1) ingesting more protein thanis being utilized for building muscle tissue and maintaining important body functions

(usually seen in high-protein diets),

2) fasting or very low calorie diets–the body breaks down its own muscle to supply needed nitrogen to maintain important functions, and

3) muscle-wasting diseases.

 

 

 

So, next time you exercise, make a mental note of when you begin to sweat. If you are

not sweating at all, you need to increase your intensity. Talk to your trainer to work out a

plan to start sweating.

 

Dr. Sheri Melton, PhD is Professor, Assistant Chair &

Coordinator of Graduate Studies, Exercise Science Division.

Department of Kinesiology, West Chester University,

West Chester, Pennsylvania, USA. She is also an American College of Sports

Medicine (ACSM). Certified Exercise Specialist and a Fulbright-Nehru Scholor.

She is a renowned researcher and scholar in the field of exercise science.