"Discoveries Of Scientific Balance Training - Part 1"

"Discoveries Of Scientific Balance Training - Part 1"



I’m not going to lie to you. This is a technical series of articles that will challenge many readers for a variety of reasons. Some may be challenged by the anatomy, some may be challenged by the concepts and others may find the realities of balance training and how it relates to fitness professionals a bit alarming. The goal was not just to write an article on balance training and show the reader a few of exercises they could do with their clients. Rather, we were interested in showing you the science behind balance training and to provide a structural approach.

Today’s population is more unhealthy than ever before in history, including a large number of people suffering from a variety of orthopaedic dysfunctions. How does this relate to you? Many of these people are your clients, and if you don’t have a solid grasp of what you are doing when prescribing exercises to them, you may be doing far more harm to them than good!

When reading this article, we recommend you spend some time going through it more than once. A good anatomy textbook and a highlighter may prove to be valuable in later parts of this article especially. More than anything, we want to show you that balance training is not as simple as some make it out to be and that there is much more to balance training than meets the eye. Our hope is that this article series will provide you with the tools necessary to start prescribing smart exercise programs and helping your clients far beyond their expectations!

Introduction

Balance training is needed today more than ever! It is projected that by the year 2045, there will be 77 million people older than the age of 65, and one out of every five people will be age 85 or older! Almost half the population over age 74 has difficulty with common functional activities, such as lifting, climbing stairs, walking, standing, bending, reaching and grasping, and it is well known that the most common orthopaedic injury among the elderly are hip fractures.

To address the growing numbers of elderly members joining gyms and health clubs, emphasis will need to be placed on exercises that improve key biomotor abilities such as strength, endurance, balance, agility, coordination and flexibility. Accomplishing these objectives requires greater emphasis on functional exercise programs, including Tai Chi, Yoga, Swiss ball training and free weight training, and a greater emphasis will need to be put on the skillful use of tools such as the Fitter, balance boards and BOSU balls. Notice I said skillful use of balance tools... that will be part of my focus in this article series.

Tai Chi has been shown to positively augment physical therapy programs aimed at improving balance, posture, coordination and integration of movement, endurance, strength, flexibility and relaxation. Swiss ball training has been shown to improve balance in a controlled study and has been used as a key modality in the treatment of neurologically impaired patients for over 30 years. Effective implementation of these functional exercise programs will require a more structured approach to balance training than is currently being used, and it will require that gyms provide the space for these types of exercise, particularly in the free weight area.

The topic of balance training is exceedingly complex. Though much more could be written on the subject than I am including here, it is my intention to give the reader a better understanding of the science behind balance training and to show you it’s not quite as easy as simply putting someone on a balance board or foam roller. That being said, here are the objectives for this series of balance training articles:

* Understand the relationships between segmental and gross stabilization and posture and the development of balance skills
* Learn to prescribe specific balance training exercises based on the individual needs of your client’s environmental demands - not the latest F.A.D. (Forthcoming Anatomical Dysfunction) training methods!
* Appreciate that balancing is a skill and that because someone can perform complex balancing acts does not assure they have intrinsic balance, segmental stability, nor does it correlate with a reduced incidence of musculoskeletal dysfunction.

We will be covering the first of these objectives in this part of the series.

HOW STABILITY AND POSTURE RELATE TO BALANCE

While the terms stability and posture may appear to be two distinct terms at first glance, they are intimately related to one another - especially with regard to balance and the related functional applications of such training.

SEGMENTAL STABILITY

The ability for any joint complex in the human body to function without internal derangement during normal human activities requires the maintenance of an Optimal Instantaneous Axis of Rotation (OIAR). While there a variety of joint types in the human body, joint movement can be broken down into the following: surface gliding, linear gliding, rocking or rolling motion, rocking combined with gliding motions and/or axial rotation. All joints in the human body are under the influence of segmental stabilizers (muscles crossing that joint only) and gross stabilizers (muscles crossing multiple joints). For example, the shoulder joint receives segmental stability from the rotator cuff musculature, while larger muscles like the pectoralis major and latissimus dorsi serve as gross stabilizers. Assisting with joint stabilization are ligaments, joint capsules and fascial structures such as the iliotibial band.

Every joint complex in the body is richly innervated with mechanoreceptors or nerve endings highly sensitive to motion that provide information regarding joint position, pressure, tension and pain (Table 1). When the active and passive systems of the body effectively stabilize a given joint and maintain an OIAR, normal neuromechanical relationships allow pain free function.

Figure 1. Segmental Stability

A. Maintenance of an optimal instantaneous axis of rotation (OIAR) results in physiological mechanoreceptor response and joint health.

B. Loss of an OIAR results in capsule and ligament stress, strain and/or injury. Due to mechanoreceptor influences on tonic and phasic musculature, locally and globally, faulty recruitment patterns may disrupt recruitment of gross stabilizers and balance!

However, in the presence of a muscle imbalance or faulty recruitment of stabilizer muscles, the chances of maintaining segmental stability and an OIAR are significantly diminished. This will likely result in aberrant strain in the capsular and ligamentous structures of the joint complex and may cause faulty proprioceptive information to be sent to the spinal cord and brain (Figure 1-B). Additionally, there will be compensatory facilitation of key muscles around the involved joint complex and possibly other areas of the body.

Because the Type I mechanoreceptors are located in the most superficial portions of a joint capsule, they are the first to be damaged any time there is of a loss of an OIAR that induces non-physiological loading of the joint capsule and ligaments. If the joint structure is damaged enough to traumatize the deeper fibers of the capsule, there will also be destruction of Type II mechanoreceptors.

JOINT RECEPTORS


FUNCTION

Type I


Low threshold, slowly adapting static and dynamic mechanoreceptors. Tonic reflexogenic effects on neck, limb, jaw and eye muscles. Postural and kinesthetic sensation. Pain suppression. Facilitate the tonic muscle system.

Type II


Fast adapting, low threshold dynamic mechanoreceptors. Phasic reflexogenic effects on the neck, limb, jaw, and eye muscles as well as pain suppression. Facilitate the phasic muscle system.

Type III


High threshold, very slow adapting receptors. Have the same characteristics as a golgi tendon organ.

Type IV


High threshold, non-adapting pain provoking nerve fibers. These fibers have tonic reflexogenic effects on the neck, limb, jaw and eye muscles. They also induce cardiovascular reflexogenic effects. Facilitation can cause guarding in the tonic muscle system.

TABLE 1. Joint Mechanoreceptors

Another important aspect to understand is that the Type I mechanoreceptors communicate directly with the tonic muscles of the body and the Type II mechanoreceptors communicate with the phasic muscles of the body. For a better understanding of tonic and phasic muscles, please refer to Table 2.

Predominantly Tonic Muscles


Predominantly Phasic Muscles

Prone to Hyperactivity


Prone to Inhibition

Function

Posture


Movement

Susceptibility to Fatigue

Late


Early

Reaction to Faulty Loading

Shortening


Weakening

Shoulder Girdle - Arm

Pectoralis Major & Minor
Levator Scapulae
Trapezius (upper)
Biceps Brachii
Scalenes
Subscapularis
Sternocleidomastoids
Masticatory
Forearm Flexors


Rhomboids
Trapezius (middle)
Trapezius (lower)
Triceps Brachii
Deep Neck Flexors
Forearm Extensors
Supraspinatus
Infraspinatus
Serratus lateralis
Deltoid

Trunk

Lumbar and Cervical Erectors
Quadratus Lumborum


Thoracic Erectors
Rectus Abdominis

Pelvis – Thigh

Hamstrings

Iliopsoas

Rectus Femoris

Thigh Adductors

Piriformis

Tensor Fasciae Latae


Vastus Lateralis

Vastus Medialis

Gluteal Muscles

Lower Leg - Foot

Gastrocnemius
Soleus


Anterior Tibialis
Peroneals
Extensors of the toes
Table 2. Properties of Tonic and Phasic Musculature

Modified from (7) and (8).

When capsule and ligament structures become overloaded and damaged, the resulting tonic muscle facilitation commonly leads to characteristic holding patterns and faulty movement sequences. A classic example of this is seen in a postural holding pattern demonstrated by an elevated, forward-rounded shoulder with increased tone in the biceps, or increased postural elbow flexion. When someone has this holding pattern and they perform movements such as lat pull downs, chin ups, rows and shoulder abductions, the movement is usually initiated from the upper trapezius, evidenced by a shoulder-hiking action. During shoulder abduction, there is often increased effort from the upper trapezius at the beginning of the motion to carry the arm through mid and upper ranges of abduction; there may also be an associated pain with this movement.

How does this pertain to balance training? When practicing any balance exercise or drill, such compensatory recruitment patterns are commonly accompanied with posture that is not conducive to optimal skills development or maintenance of one’s center of gravity over their own base of support. For instance, many protective patterns resulting from joint instabilities in the body result in gradual pronation of one’s entire body. From a postural perspective, this constitutes forward head posture, increased pronation of the extremities and a reduced ability to support the body against gravity and kinetic loading.

Poor posture is detrimental to learning or maintaining a balance skill because any environment requiring maintenance of balance also requires three-dimentional freedom of motion in the spine in order to right oneself. Because extremity motions required to right oneself are generally acyclical, the ability to rotate the spine efficiently and effectively is essential to preventing unwanted falls. As you can see from Figure 2, anytime someone’s thoracic kyphosis is increased and/or they have forward migration of the head, rotational capacity and rotational efficiency will be reduced, thus reducing one’s ability to right themselves or balance!

The problem of muscle imbalance and faulty joint motion is not just localized to a “dysfunctional joint complex.” Clinical experience demonstrates that such clients not only have an increased risk of injury while learning new and unfamiliar balance skills, but they may also complain of “abnormal nagging pains” of an unknown origin while learning or practicing such exercises. This is likely to result from faulty motor recruitment of muscles at distant locations.

In support of this contention, Dvorak and Dvorak have demonstrated something they refer to as a spondylogenic reflex syndrome. While under cervical traction, the researchers electrically stimulated mechanoreceptors at the C3-4 level and were able to record significant EMG (electrical activity) responses in muscles certain muscles including the sternocleidomastoid, trapezius, digastric, scalenes, triceps, rectus femoris and biceps femoris! These findings strongly suggest that the electrical messages sent to the brain may make it respond as if a corresponding preprogrammed pattern of motion were taking place. Dvorak and Dvorak identified this phenomenon as a distant recruitment pattern.

This relates to the fitness professional because any individual suffering from a muscle imbalance and an inability to maintain OIAR during a challenging balance skill may develop an idiopathic hamstring strain, groin strain, muscle tear or spasm in a seemingly unrelated region relative to the problematic joint. In other words, you could injure a client that has a muscle imbalance if you give them an ill-prescribed balance exercise!

Additionally, balance training drills in the presence of intrinsic imbalance are likely to predispose your client to injury outside the gym, secondary to facilitation of faulty motor sequencing.

GROSS STABILITY, MUSCLE CHAINS AND BALANCE

The body knows nothing of muscles, only of movement. During the continual changes that take place to preserve our equilibrium while moving, the body is constantly activating an array of muscles in patterns of coordination that causes muscles to lose their identity. When we train people using balance exercises, we are training hundreds of muscles at once.

Current research by Serge Gracovetsky and Andre Vleeming et.al. expands on previous knowledge of muscle chains presented by such anatomy experts as Raymond A. Dart. In Figures 3-6, specific chains of muscle are now referred to as outer unit muscle systems by these and other researchers. The outer unit muscle chains work synergistically with inner unit muscle systems to carry out motor commands from the CNS. (For more detailed information, please read my articles on The Inner Unit and The Outer Unit.)

An understanding of outer unit systems and their working relationship with inner unit systems is necessary to understand how an individual or an athlete, such as a gymnast, can display impressive feats of balance (above) yet suffer from chronic musculoskeletal pain. In many cases they are predisposing themselves to injury by performing various balance acts while their body is out of balance at a segmental or gross level. Just because they can perform acrobatic feats of balance doesn’t mean they have inner structural balance, nor does it mean that repetitive exposure to further balance training is optimal for long term progress!

To appreciate how this works a little better, first consider that the small segmental stabilizer muscles have a profound influence on the recruitment of the larger outer unit muscles. For example, spindle cell counts of small muscles such as the suboccipital muscles in the anterior and posterior cervical region, and the intertransvarii and interspinales of the cervical and lumbar spine, have as many as 200-500 spindle cells per gram of muscle tissue! Using this information it becomes evident that one of their primary roles is to inform the CNS of joint position. As these position sensitive muscles discharge through the gamma nervous system they, along with local mechanoreceptors, have a profound influence on the alpha motor neurons of the larger muscles, which have the capacity to alleviate compression, torsion and sheer forces acting on any joint experiencing threshold limits of motion.

Problems arise in these systems when athletes become more experienced at exerting themselves and therefore become progressively more able to ignore warning signals coming from within. Examples of this are Golgi inhibition override by experienced Power Lifters, and the fact that many gymnasts and martial artists are capable of performing amazing feats in the presence of intrinsic pain and dysfunction.

It must be remembered that pain is the most powerful and effective re-programming agent of the CNS and anytime you are learning a balance skill at the expense of segmental stability or in the presence of muscle imbalance syndromes, you are retarding the ability to effectively utilize the segmental and gross stabilizers of the body. More importantly, you are teaching the body to move in an environment in which pain avoidance is the primary goal, not optimal motor learning!

As a clinician, I have had to treat scores of elite athletes in sports requiring exquisite balance skills, including motocross, skate boarding, ice skating, gymnastics, equestrian, hockey, skiing, surfing and martial arts. All of the athletes in these sports could perform amazing balance acts, yet they all came to me because they were in pain! To restore an athlete or individual’s ability to train for and participate in these sports, muscle balance and segmental stability training must precede balance skills development if long-term performance and injury prevention are the goals!

POSTURE AND BALANCE SKILLS DEVELOPMENT

The topic of posture is a complex one, but my goal here is to merely show you the intimate relationship between posture and balance training. To begin, I would like to point out that in nature, where animals function naturally, poor posture and poor balance are virtually unheard of (below).

Simply stated, posture is the sum total, or static and dynamic expression, of segmental and gross stability. At the segmental level, each joint complex maintains it’s own balance as expressed by the maintenance of an OIAR and must maintain a balanced working relationship with one another.

In an individual with poor posture (above, B), attempting to learn balance skills will only reinforce poor posture if they are unable to achieve optimal alignment and stability during the exercise! Ultimately, balance training in the absence of postural training and segmental stability perpetuates postural, joint and soft tissue dysfunction - the tonic muscles become progressively more facilitated while the phasic antagonists become progressively more inhibited, further degenerating length/force relationships. This is very important to remember because the body always moves toward its position of strength. Therefore, anytime you learn a new skill from a position of poor posture (balance skill or otherwise), you are merely reinforcing faulty biomechanical relationships and faulty motor skills development! In this case, the brain now seeks to generate an equilibrium reaction or to generate force from a position of poor posture (below).



Your client with poor static posture will demonstrate poor dynamic posture if therapeutic intervention and postural training are not implemented prior to structural adaptation taking place. For example, notice the kypholordotic posture presented by this roofer carrying a sheet of plywood across a rooftop, a situation that naturally requires axial extension or lengthening of the spine for optimal performance and injury prevention! It is important to have an appreciation for static vs. dynamic posture when attempting to improve balance in your client.
Part 2 of this article series takes a look at the basic reflexes of Righting and Equilibrium that we use during balance activities, and it will give us practical tools for building the right type of balance in our clients, from sedentary to elite level athletes.

References: Paul Chek

Forwarded By, Natalie Pyles

Fitness & Nutritional Expert, Author, Speaker

Call Me For Your FREE Consultation Today! 1-800-681-9894 or e-mail fitnesselementsassociates@yahoo.com

"Tips On How To Apply The Mind-Body Medicine: A Balanced Approach"

Inner IDEA: Dr. Herbert Benson and colleagues talk about the Relaxation Response and the current role of mind-body techniques in wellness and medical care.

“My goal has always been to promote a healthy balance between self-care approaches and more traditional approaches—medical and surgical inter­ventions that can be magnificent and lifesaving when appropriate. However, self-care is immensely powerful in its own right. The elicitation of the Relaxation Response, stress management, regular exercise, good nutrition, and the power of belief all have a tremendous role to play in our healing.”

—Herbert Benson, MD
The Relaxation Response

Herbert Benson, the doctor who defined the Relaxation Response, is hailed as a visionary, a pioneer, a dedicated cardiologist who has devoted much of his nearly 40-year career to the fields of behavioral medicine and mind-body studies. Director emeritus of the Benson-Henry Institute for Mind Body Medicine (BHI) at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School’s Mind/Body Medical Institute, he continues to teach and lead cutting-edge research on ways to counteract the harmful effects of stress. Dr. Benson recently agreed to an interview with IDEA Fitness Journal.

Seeds of Change

Benson’s own journey establishing the mind-body connection began, as he recalls, “in the middle 1960s, when I noticed that people’s blood pressures were higher during visits to my office than at other times and wondered whether stress wasn’t causing that rise. Stress wasn’t on the radar then, so I began investigating a connection between stress and hypertension.” To this end, he returned to physiology research at Harvard to develop a model for stress-induced hypertension using biofeedback technology with monkeys.

On hearing of Dr. Benson’s work on stress and hypertension with animals, a group of Transcendental Meditation (TM) practitioners met with him, stating that they could lower their blood pressure simply by meditating. After what he terms “considerable hesitation,” he agreed to study them. “I collaborated with Robert Keith Wallace of the University of California, Irvine, who was performing similar experiments.” After compiling the data, he and Wallace found that “with meditation alone, the TM practitioners brought about striking physiologic changes—a drop in heart rate, metabolic rate and breathing rate—that I would subsequently label ‘the Relaxation Response.’” [Drs. Wallace and Archie F. Wilson simultaneously conducted similar studies with TM practitioners in California. Later, Wallace joined Dr. Benson at Harvard, where they continued their collaboration.]

Coincidentally, it was in the very room where Benson studied the TM adherents that 60 years earlier Harvard physiologist Walter B. Cannon discovered the “fight-or-flight” response, also known as the stress response. Human beings developed this primitive physiologic response as a mechanism for surviving stressful situations. As Benson explains, “Our bodies release hormones—adrenaline and noradrenaline, or epinephrine and norepinephrine—to increase heart rate, breathing rate, blood pressure, metabolic rate and blood flow to the muscles, gearing our bodies either to do battle with an opponent or to flee.” Benson’s own research showed that the polar opposite was also true: “The body is imbued with what I termed the Relaxation Response, an inducible, physiologic state of quietude.” Teaching people why that quietude is important and how to induce it has been a major focus of Dr. Benson’s work ever since.

“The world is so fast-paced, and it is excitatory,” says Benson. “People think they need more and more excitement to shut their minds off. But, in truth, it is just the opposite. They have to find periods of quietude to rejuvenate, to rebuild their resiliency. People are undergoing changes in the way they think, . . . cognitive restructuring, because they are always looking for [something] new and exciting.” What they really need is to find a balance in their lives, he says, and one of the most effective means of doing that is by incorporating the Relaxation Response into their daily activities.

It has to be something they do daily, he explains, to have “its long-term effects, to have the physical changes in the body—such as brain thickening, such as changes in metabolism. . . . It is what people used to do. Think of our parents or grandparents—they used to pray regularly or they used to do routine exercise. This has left our modern world.”

For instructions on Dr. Benson’s method of relaxation, see the sidebar “How to Elicit the Relaxation Response.”

Integrative Health Care: The Three-Legged Stool

When Dr. Benson founded the Mind/Body Medical Institute in 1988 at Beth Israel Deaconess Medical Center in Boston, his goal was to enhance traditional medical approaches, such as pharmaceuticals and surgery, by cultivating people’s natural capacity to heal. The BHI (at Massachusetts General) opened on December 1, 2006, an important next step that Benson’s colleagues say provides huge growth potential, especially for cutting-edge research in behavioral medicine. The institute’s current literature describes it as a nonprofit scientific and educational organization dedicated to research, teaching and the clinical application of mind-body medicine and its integration into all areas of health. The “Henry” in the name is John Henry, principal owner of the Boston Red Sox and a member of the BHI’s board of trustees.

Benson likens his ideal model for optimal health care to a “three-legged stool.” This model provides a means of achieving better, more balanced care for the patient, he believes. One leg of the stool represents pharmaceuticals; a second represents surgery and procedures; and the third is self-care, the strategies the patient uses to enhance his or her natural capacity to heal.

“Health and well-being is an end-point,” he says, “and to achieve that, most people believe that drugs and surgeries are necessary steps, but there has to be a third leg to that stool, and that is self-care. Self-care is so important because 60%–90% of visits to doctors are related to stress and [are] poorly treated, if treated at all, by drugs or surgeries. So you need that self-care leg, and within self-care you obviously have the Relaxation Response, nutrition, exercise and socialization, and we also have belief and spirituality. What we have to do is learn to respect [self-care’s] importance and then integrate pharmaceuticals, surgery and self-care together.” Benson firmly believes that self-care “is a vital next step” in our current medical environment.

An important key to adequate health and well-being, Benson emphasizes, is integration. “There is no substitute for good surgery, there is no substitute for appropriate drugs, and there is no substitute for helping yourself help yourself. They work together. This is a vital point because it would be inappropriate and inaccurate to believe there is a one-legged stool, where self-care was all you needed.”

Could the self-care approach save the patient and the medical system money? “Oh, without question,” Benson says. “Why should you be spending for drugs that you don’t need or surgeries that you don’t need? But you need a doctor making that decision. I mean it would be tragic if one believed only in self-care and gave up, for example, penicillin that could save your life.”

For patients’ views on how BHI programs are applying the principles of integration, see the sidebar “A Sustainable ‘Whole-Life’ Approach.”

Stress and Resilience

In Benson’s view, understanding stress is a critical element in self-care and mind-body medicine—and a necessary step in learning to appreciate the healing capacities of the Relaxation Response. He defines stress as “any situation that requires behavioral adjustment, whether it is good or bad. A marriage is stressful; so is a divorce. In other words, [stress] is anything to which you have to adjust, and sometimes those changes to which you have to adjust are life-threatening: to avoid an accident, to avoid an attack by another; sometimes they’re worries about your health, your family’s health, worries about your financial situation, which means an adjustment. They all require behavioral adjustment.”

Nurse practitioner Peg Baim, MS, is the clinical director of the Center for Training in Mind/Body Medicine and a researcher at the BHI. As part of Harvard Medical School’s department of continuing education, she teaches classes and seminars with Dr. Benson on the science of stress and how self-care strategies work. Baim says, “If you think about the stress system, it’s the physiology within the body that gets recruited to bring it back into balance whenever it has been challenged. So, if we are too cold, or hungry, or if we are experiencing anxiety or sadness, all of that is going to change the body in such a way as to activate the stress system, which then works harder to get the body back into the narrow parameters of health.”

Baim explains that we have an intricate network of communications “within our hormones, our neuropeptides, and within ourselves.” (Neuropeptides—some of which are endorphins—influence neural activity or functioning.) She describes the communication network as a delicate system of checks and balances that, if taxed too much, depending on our biology, our inherited features and our environmental vulnerabilities, “becomes ‘disregulated,’ and we lose those extremely delicate feedback loops and start expressing illnesses or symptoms.” Allostatic systems allow our bodies to remain healthy by their capacity for change and adaptation; they include parts of the nervous system that control heartbeat, blood pressure and similar functions, as well as glands that collaborate to produce hormonal responses. The wear and tear that results from chronic overactivity or underactivity of allostatic systems, says Baim, is called our allostatic load.

On the other hand, she notes that allostasis is the equivalent of resilience. Resilience, Baim clarifies, “is adaptation through change. That’s really what our body is doing; our body is constantly adapting. We’re adapting to our signals of hunger, low blood sugar, inactivity, or to an individual’s anger, or to being cut off in traffic. When we adapt successfully and we can still stay within the narrow parameters of health, that’s referred to as allostasis or resilience.”

To support resilience, Baim says, people need recuperative sleep, stress man­agement in terms of cognitive re­struc­turing, stress management in terms of methods that elicit the Relaxation Response, a healthy diet, physical activity and social support. She says the Relaxation Response fits into the health equation because “you can’t be psychologically activating the stress system when you are in the Relaxation Response. So it is as if you can’t be hot and cold at the same time.”

When you practice the Relaxation Response, according to Baim, you are actually activating the areas of the brain that have been positively conditioned, rather than those that have been negatively conditioned. “You tend to feel compassion, forgiveness and oneness as opposed to the stress response, where you feel hatred, resentment and [separation]. It is as if we have two different brains.” She says people can elicit the Relaxation Response, using a variety of serviceable techniques, including contemplation, imagery and mindfulness (see the sidebar “How to Elicit the Relaxation Response”).

Baim thinks that many people have lost the positive behaviors that promote resilience, leaving them vulnerable to their negatively conditioned habits and beliefs. The result is chronic activation of the stress response: “It is amazing to me how easily people get angry, how quickly people become impatient; you see, people are really living off their last nerve. The more you live in this stress response, the more you are depleting your serotonin, your dopamine. There is less activation of the cells that secrete serotonin, dopamine and your endogenous opiates, and so it doesn’t feel good to be alive. I think it is very telling that we have an epidemic of depression in school-age children in the United States, for example; that’s a scandal.”

At the BHI, therapeutic cognitive restructuring techniques [changing the way we think and perceive a given event] are taught to assist people in beginning to think positively again. Therapists suggest that the best way to do this is first to identify thoughts and beliefs that are irrational and self-defeating; next to learn about new ways of thinking; and finally to practice them until they become second nature.

The Role of Exercise in Allostasis

Exercise, Baim says, has always played a major role in bolstering the resilience we need to keep stress in check. “Exercise is in and of itself an antioxidant, and stress is an oxidant. Stress is wearing and tearing the body down with more inflammatory molecules, and exercise is actually allowing the body to release molecules that will deactivate that inflammation.”

Jim Huddleston, MS, physical therapist, exercise physiologist and researcher at the BHI, says the idea is for people to find their own balance in the realms of exercise, diet, relaxation and dealing with life stresses. “It is about trying to develop a good homeostasis and balance. That’s why I like yoga, tai chi and Pilates so much; they really help you physically, emotionally and spiritually get better balance. Applying the Relaxation Response to exercise also brings you to that better balance. There is always some new inherent learning experience in a mindful exercise practice.

“The Eastern traditions have that inherent mindfulness built in,” he says, “but you can do it with aerobic exercise, with resistance training; as long as you have the mindset, you can do it with any type of exercise. I like adding that other mindfulness element because [it makes exercise] about total health rather than just fitness, because you are involving the whole body in the process.”

Huddleston notes that there are two criteria for eliciting the Relaxation Response during exercise: focus and an open attitude. These can be accomplished by paying attention to either the breath or the cadence of the activity. “If walking, [people] can focus on the cadence, and if they need to make that more concrete and objective, they can count their steps,” says Huddleston. “People can develop a mantra that they say over and over to themselves in the rhythm of the breath and the rhythm of their walk. This can be accomplished with a standard four-beat count or, if their mind tends to wander, a three-beat count, which puts them off a bit—as long as they have something on which to focus their awareness, so they are not caught up in the extra thinking that we always do, either in the past or in the future. That tends to get us into problems.

“The other criterion, open attitude,” he adds, “is about the experience they are having—not being judgmental or critical or setting certain expectations for themselves about the experience. It is observing what happens with the experience.”

Partnering for Prevention

An integral member of the BHI’s Cardiac Wellness and Lighten Up: Weight Management programs, Huddleston reiterates Dr. Benson’s belief in integration as the foundation for their philosophy. “It is really about helping the [patients] become more responsible for themselves,” he says.

He believes that the healthcare habits people develop can help them maximize their potential. Raising their awareness of what’s healthy and what’s not is a theme that underlies all the BHI programs. “When [people] are more aware, they have more control, and when they have more control, they can make better choices,” he says. Huddleston adds that the medical system needs to “move more into a preventative mode and out of the reactive mode. It is not a healthcare system; it is a sick-care system. We need to concentrate more on being a healthcare system and encourage people to be more responsible for taking care of themselves.”

Asked whether mind-body medicine is presently an equal, fully respected partner in Western medicine, Dr. Benson responds: “No, but it is on the table, and many people are accepting it as an important feature within the medical profession. We are now part of Mas­sachusetts General [the oldest and largest teaching hospital of Harvard Medical School], and that shows where [the BHI] should be based—within a medical establishment. Mass General is world-class with respect to its surgery and with respect to its pharmaceuticals. This institution has now recognized that they want to be experts in self-care.”

For four decades Dr. Benson has stayed true to his goal of changing our concept of health and well-being, using evidence-based medicine. “I’m emeritus director, but I am still working,” he says. “It’s a title. I still put in a full day, and I am delighted with the way things are evolving.” Harvard Medical School has honored his many contributions with the establishment of the Herbert Benson Professorship in Medicine, which will be activated upon his retirement.

SIDEBAR: How to Elicit the Relaxation Response

Two basic components are involved in eliciting the relaxation response:

1. repeating a word, sound, phrase, prayer or muscular activity
2. passively disregarding everyday thoughts that inevitably come to mind and returning to your repetition

The actual steps necessary to evoke the response are as follows:

1. Pick a focus word, sound, short phrase or prayer that is firmly rooted in your belief system.
2. Sit quietly in a comfortable position.
3. Close your eyes.
4. Relax your muscles, progressing from your feet to your calves, thighs, abdomen, shoulders, head and neck.
5. Breathe slowly and naturally, and as you do, say your focus word, sound, phrase or prayer silently to yourself as you exhale.
6. Assume a passive attitude. Don’t worry about how well you are doing. When other thoughts come to mind, simply say to yourself, “Oh well,” and gently return to your repetition.
7. Continue for 10–20 minutes.
8. Do not stand immediately. Continue sitting quietly for a minute or so, allowing other thoughts to return. Then open your eyes and sit for another minute before rising.
9. Practice the technique once or twice daily. Good times to do so are before breakfast and before dinner.

Techniques to Elicit the Relaxation Response

diaphragmatic breathing

meditation

body scan

mindfulness

repetitive exercise

repetitive prayer

progressive muscle relaxation

imagery

Permission to reprint these instructions was granted by Dr. Herbert Benson.

SIDEBAR: A Sustainable “Whole-Life” Approach

A graduate of the BHI’s Lighten Up: Weight Management program, Mary Hardy weighed more than 200 pounds and suffered from some major life stresses when she started at the institute. She believes the program provided her with a sustainable “whole-life” approach. “There was no ‘cookie cutter’ prescription. They didn’t have answers. Instead they modeled the process of personal exploration and seated it in the most up-to-date research in nutrition, exercise and stress reduction,” she says.

Now in her mid-50s and perimenopausal, Hardy says she feels better than she did in her 30s. Her blood pressure and cholesterol are now normal. She is well rested, has lost 60 pounds and says, “I am doing things I haven’t done in years—like hiking, snow shoeing, distance swimming and biking. [BHI] helped me tap into what had personal meaning and frame it in a healthy way of living.”

Mary Hadley, a 50-year-old who completed the BHI’s 13-week Cardiac Wellness program as an outpatient and still attends bimonthly sessions, is also definitive in her praise of the institute’s methods: “That program is lifesaving. It completely changed my quality of life, absolutely 100%. It taught me a new way to think.”

Hadley—who suffers from heart disease, has had two surgeries for chronic back pain and has two children with medical problems—was bedridden when she found the BHI with the assistance of her physician. She says the institute not only helped her manage her pain but got her moving again: “I started on the treadmill for only 3 seconds with my cane and kept working my way up. Now I can go on the treadmill for 30 minutes without help and without my cane. Believe me, it was a painfully slow process.”

Reflecting on her experience, Hadley affirms, “It is an integrative program, a holistic approach; the chronic pain, the cardiac problems and the anxiety are all considered just as important. You’re a person with all kinds of issues, and they are there to help you with each one.”

SIDEBAR: Resources

• Benson, H. 1979. The Mind/Body Effect. New York: Simon and Schuster.
• Benson, H., with Klipper, M.Z. 2000. The Relaxation Response. Updated and expanded edition. New York, HarperCollins.
• Benson, H., & Proctor, W. 2003. The Breakout Principle: How to Activate the Natural Trigger That Maximizes Creativity, Athletic Performance, Productivity, and Personal Well-Being. New York: Scribner.
• Benson, H., with Proctor, W. 1984. Beyond the Relaxation Response. New York: Times Books.
• Benson, H., with Stark, M. 1996. Timeless Healing: The Power and Biology of Belief. New York: Scribner.
• Benson, H., & Stuart, E.M. (with the staff of the Mind/Body Medical Institute). 1992. The Wellness Book: The Comprehensive Guide to Main­taining Health and Treating Stress-Related Illness. New York: Citadel.
• Casey, A., & Benson, H. 2005. The Harvard Medical School Guide to Lowering Your Blood Pressure. New York: McGraw-Hill.
• Casey, A., & Benson, H., with MacDonald, A. 2004. Mind Your Heart: A Mind/Body Approach to Stress Management, Exercise, and Nutrition for Heart Health. New York: Free Press.

Reference: Rosalind Gray Davis

By, Natalie Pyles

Fitness Expert, Nutritionist, Wellness Coach, Lifestyle Consultant, Author, Speaker